Autism spectrum disorder (ASD) is a developmental disorder that emerges in early childhood and typically involves delays and impairment in social skills, communication and behaviour. Autism is a ‘spectrum’ disorder, meaning that it affects different children in different ways and can range from very mild to severe.
In recent years it has become clear that many children with Autism Spectrum Disorder have difficulty with gross motor skills, coordination and balance, all factors that affect walking gait.
What causes Autism Spectrum Disorder?
There is no clear explanation about what causes Autism Spectrum Disorder. Most research indicates that ASD is due to a combination of genetic and environmental factors and further work is being done to identify the risk factors for the development of ASD.
The prevalence of autism spectrum disorder has shown a dramatic increase in the past 20 years with recent research estimating that 1 in 68 children have been identified with ASD. It is 4 times more common in boys than girls.
How is Autism Spectrum Disorder diagnosed?
The diagnosis of ASD can be difficult, because there are no standard medical tests (like a blood test or scan) that can diagnose the condition. Your family doctor will look at your child’s behaviour and development and will refer you to a paediatrician for a diagnosis.
ASD can be diagnosed as early as 2 years old. There is currently no cure, however, research is clear that access to early intervention treatment services can improve a child’s development. Treatment services include therapy to help children talk, walk and play, and interact with others. The earlier treatment services are started the better the outcome for the child.
How does Autism Spectrum Disorder affect my child’s ability to walk, play and participate in sporting activities?
Some children with ASD can appear awkward or clumsy in their motor skills, play and walking or running activities. Recent research findings suggest that many children with ASD demonstrate delayed or atypical motor achievements.
Some children have marked difficulties with gross (large) motor skills and they may show obvious problems with static or dynamic balance, coordinated walking, running, hopping, skipping, jumping or climbing. The most common difficulties podiatrists observe in children with ASD include:
- Low muscle tone (hypotonia) – a recent study found that 30% of children with ASD have a moderate to severe reduction in muscle tone. Low muscle tone can result in a floppy child with poor physical endurance and difficulties standing or walking for prolonged periods
- Poor balance, coordination and joint proprioception or an ‘awkward’ gait, most noticeable in running activities
- Gait changes – recent research has highlighted that children with ASD try to augment their walking stability by taking shorter steps and increasing their step width, therefore providing for a wider base of support
- Toe-walking – children with ASD are more prone to walking on their tip-toes which may lead to leg muscle imbalance and significant restrictions in ankle and knee joint flexibility
- Sensory sensitivities – many autistic children have unusual sensitivities to sounds, touch or taste. They may find certain ground surfaces (eg. sand, grass) or footwear and socks intolerable
What is involved in a podiatry assessment for my child with Autism Spectrum Disorder?
Your podiatrist will take a comprehensive medical history and complete a physical examination and visual gait analysis. The assessment will include:
- Foot posture assessment
- Joint flexibility tests (or range of motion
- Foot and leg muscle strength testing
- Gait analysis and biomechanical assessment – to look for any abnormalities in the way the feet and legs move during gait
- Balance, coordination and pelvic stability screening
- Footwear assessment
What podiatry treatment options are available for my child with Autism Spectrum Disorder?
Podiatry treatment for children with ASD will depend upon the individual child, presence of symptoms and the results of the physical examination and gait analysis. Treatment may involve some of the following:
- Custom foot orthotics – to address any abnormal foot posture problems and provide a stable base of support to help with balance and dynamic stability
- Home exercise program – to address any foot or leg muscle imbalance, weakness or tightness. If your child requires a pelvic stability or core strengthening program a physiotherapy referral may be recommended
- Balance and proprioception exercises and activities
- Footwear advice – for school and sport
What should I do if my child has Autism Spectrum Disorder?
If your child has been diagnosed with Autism Spectrum Disorder and you are concerned about their gait or foot posture, don’t hesitate to consult with our experienced paediatric podiatrists for a comprehensive walking assessment and professional advice.