Autism Spectrum Disorder - Annikka J & Emily B

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Classifications

Prognosis

Medical Diagnosis & Treatment

Exercise/PT Considerations

Evidence Based PT Interventions

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PT Impairments/Activity Limitations & Tests and Measures

By Annikka Johnson & Emily Baynes

Autism Spectrum Disorder (ASD)

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Fatigue and Motivation

Motor Planning

Sensory Processing

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Fine Motor Skills

Postural Control

Gross Motor Skills

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Drag the following outcome measures to match the correct impairment and activity limitation. When complete, click the icon below to reveal each correct answer.

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Test of gross motor development (TGMD-3) OR Gross Motor Function Measure (GMFM)

Test of gross motor development (TGMD-3) OR Gross Motor Function Measure (GMFM)

Pediatric Berg Balance ScaleORDynamic Gait Index (DGI)

Pediatric Berg Balance ScaleORDynamic Gait Index (DGI)

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) OR Peabody Developmental Motor System (PDMS-2)

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) OR Peabody Developmental Motor System (PDMS-2)

Sensory Integration and Praxis Tests (SIPT)

Sensory Integration and Praxis Tests (SIPT)

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) OR Test of Gross Motor Development (TGMD-2)

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) OR Test of Gross Motor Development (TGMD-2)

Strengths and Difficulties Questionnaire

Strengths and Difficulties Questionnaire

1. Autism spectrum disorder. National Institute of Mental Health. Accessed September 30, 2024. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd.
2. Kerem Gürkan R, Kocak F. Perceived constraints and facilitators of participation in physical activity by individuals with autism spectrum disorders. Physical Activity Review. 2020;8(1):51-63. doi:10.16926/par.2020.08.07
3. Syles M, Alsharshani M, Samara M, et al. Risk factors, diagnosis, prognosis and treatment of autism. Accessed October 18, 2024. https://eprints.kingston.ac.uk/id/eprint/45385/1/Samara-M-45385-AAM.pdf.
4. Yin CLC, Yin TK. A review on the efficacy of physical therapy intervention on motor skills of children with autism spectrum disorder. Atlantis Press. December 1, 2019. Accessed October 18, 2024. https://www.atlantis-press.com/proceedings/icse-19/125928886.
5. Srinivasan, S. M., Kaur, M., Park, I. K., Gifford, T. D., Marsh, K. L., & Bhat, A. N. (2015). The Effects of Rhythm and Robotic Interventions on the Imitation/Praxis, Interpersonal Synchrony, and Motor Performance of Children with Autism Spectrum Disorder (ASD): A Pilot Randomized Controlled Trial. Autism research and treatment, 2015, 736516. https://doi.org/10.1155/2015/736516
6. Djordjević, M., Memisevic, H., Potić, S., & Djuric, U. (2021). Exercise-Based Interventions Aimed at Improving Balance in Children with Autism Spectrum Disorder: A Meta-Analysis. Perceptual and Motor Skills, 129, 90 - 119.
7. ASD levels of severity. Autism Speaks. Accessed October 18, 2024. https://www.autismspeaks.org/levels-of-autism#:~:text=The%20DSM%2D5%20introduced%20three,requiring%20very%20substantial%20support%E2%80%9D).
8. Mohd Nordin A, Ismail J, Kamal Nor N. Motor Development in Children With Autism Spectrum Disorder. Front Pediatr. 2021;9:598276. Published 2021 Sep 15. doi:10.3389/fped.2021.598276
9. Ming X, Brimacombe M, Wagner GC. Prevalence of motor impairment in autism spectrum disorders. Brain and Development. 2007;29(9):565-570. doi:10.1016/j.braindev.2007.03.002
10. The challenge of Physical Fitness for people with autism. Kennedy Krieger Institute. Accessed October 18, 2024. https://www.kennedykrieger.org/stories/interactive-autism-network-ian/autism-physical-fitness.
11. Children's Hospital of Philadelphia. Vaccines and Autism. Chop.edu. Published 2019. https://www.chop.edu/vaccine-education-center/vaccine-safety/vaccines-and-other-conditions/autism

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Autism is a life-long condition that will affect a person for the duration of their life. However, treatment, education, and support are factors that can positively impact the outlook of the individual. The aspects of ASD that a person may struggle with early in their diagnosis may not be a struggle later in life.Individuals on the milder end of the spectrum often successfully engage in mainstream education and transition into the workforce, aided by therapeutic support while enhancing their social communication skills. In contrast, those with a severe diagnosis face a much more challenging outlook. Severe cases may struggle to develop communication abilities and could remain isolated from peers and family.

Prognosis3

"The prognosis for an individual with ASD is as heterogeneous as the diagnosis."

Research suggests that ASD can be caused by a combination of genetics and environmental factors. Click on each of the child's blocks to explore possible risk factors.

ASD Overview1,7,11

According to Autism Speaks, "Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication."ASD can present differently in every individual, however, is estimated that 1 in 36 children and 1 in 45 adults are affected in the United States today.

Prenatal Pesticide exposure

Prenatal Oxygen Deprivation

Advanced Parental Age

Very Low Birth Weight

Maternal Immune System Disorders

Extreme Prematurity

Maternal Diabetes

Fragile X Syndrome

Rett Syndrome

Prenatal air pollution exposure

Males > Females

Family History

Maternal Obesity

NOT VACCINES

Level 1: Difficulty initiating interactions and may have decreased interest in social interaction. Inflexibility of behavior causes interference in functioning. Difficulty switching between activities and problems with organization and planning hamper independence.Level 2: Marked deficits in verbal/nonverbal social communication skills. Social impairments even with supports in place. Inflexibility of behavior and difficulty coping with change enough to be obvious to casual observer. Level 3: Severe deficits in verbal/nonverbal social communication causing heavy impairments in functioning. Very limited initiation of social interactions. Extreme difficulty coping with change and great distress with change of focus or action.

DSM-5 diagnostic tool introduced 3 ASD levels of severity

Classifications/Levels of ASD7:

For more info on the DSM-5 Diagnostic Tool for ASD

Teachers and caregivers are often the first to notice ASD symptoms in older children and adolescents.

• ASD can be reliability diagnosed at age 2.

Diagnosis in young children includes:

• General development screening during check ups
• Additional diagnostic evaluation such as the DSM-5 that provides standardized criteria to help diagnose ASD

ASD can also be diagnosed in older children, adolescents, and adults but often is more difficult as an adult due to ASD symptom overlapping with mental health disorders such as anxiety or ADHD.

Evaluation of behavior & development1

ASD deficits are primarily treated with a multifaceted team approach including physical, occupational, behavioral, speech, and play therapies.Healthcare providers may prescribe medications to treat specific symptoms such as irritability, aggression, repetitive behavior, hyperactivity, attention problems, anxiety, and depression, along with comorbidities such as seizures. But, there are no pharmacological treatments for specifically for ASD. Individuals may also be referred to a psychological, educational, or skill-building healthcare professional to participate in a program to learn life skills for increasing independence. Studies show that children with ASD that participate in an exercise program "reduces interpersonal factors such as loneliness and social inadaptability.2"While available treatment options will not cure ASD, they can help improve the individual's quality of life.

Treatment Options1,2,3

American children with ASD have a higher risk of being overweight or obese than other children. This is primarily attributed to a variety of possibilities including: picky with food selection, antipsychotic medications causing weight gain, and developmental delays.

There are no established contraindications to PT or exercise for children, however there are considerations to keep in mind.

• Sensory sensitivities and overstimulation
• Communication barrier
• Behavioral issues
• Medical issues
• Seizure disorders and epilepsy are frequently reported medical comorbidities
• Fatigue, muscle cramps, dizziness

Ensure to start any exercise program at a low intensity when working with a child with ASD then progress as appropriate.

PT/Exercise Considerations1,10

5. Motor Planning: Difficulty with planning and executing movements can make it hard for children to learn new physical skills or participate in sports and games.6. Fatigue and Motivation: Increased fatigue during physical activity can lead to decreased motivation to participate in therapy or recreational activities.

1. Gross Motor Skills: Difficulties with balance, coordination, and strength can impact activities like running, jumping, and climbing
2. Postural Control: Many children with ASD may struggle with maintaining stable postures due to hypotonia, which can affect their ability to sit or stand for extended periods.
3. Fine Motor Skills: Challenges with tasks requiring hand-eye coordination, such as writing, cutting, or manipulating small objects, can affect their ability to engage in daily activities.
4. Sensory Processing: Sensory sensitivities or aversions can affect how children with ASD interact with their environment, leading to challenges in physical activities.

PT Impairments/Activity Limitations & Tests and Measures 8,9

Gross Motor Skills

Test of gross motor development (TGMD-3)GMFM

Postural Control

Pediatric Berg Balance ScaleDynamic Gait Index (DGI)

Fine Motor Skills

BOT-2PDMS-2

Sensory Processing

Sensory Integration and Praxis Tests (SIPT)

Motor Planning

BOT-2Test of Gross Motor Development (TGMD-2)

Fatigue and Motivation

Strengths and Difficulties Questionnaire

Click on each icon to reveal possible tests and measures for each PT impairment and Activity Limitation!

Click on each icon to reveal possible tests and measures for each PT impairment and Activity Limitation!

Note that the severity and classification of ASD may impact how a child performs on each test and measure.

Note that the severity and classification of ASD may impact how a child performs on each test and measure.

Common noted impairments are very similar to others without ASD. However, the delivery of the interventions and adaptability of the session is the key to success in treating an individual with ASD.

Physical therapy has been shown as a helpful tool for children with ASD provided that interventions are based on the impairments of the child. There is not one impairment that is specific to ASD, however, it has been determined that greater than 50% of individuals with ASD have a movement impairment as identified by the Movement ABC-2.Individuals with ASD have a predisposition to negative emotions or responses from environments that have many stimuli at once which could include increased physical contact, verbal cueing, or additional noises within the treatment area.Ensure you can adapt to these needs if they are to arise.

Evidence Based Interventions2,4,5,6