Physiotherapy for children with autism

Daniel Smit | APA Titled Paediatric Physiotherapist

Children with autism have individual strengths, interests, preferences and support needs. Some children also experience differences in balance, coordination, motor planning, strength, stamina or movement skills. These differences do not look the same for every child, and autism itself does not mean a child needs physiotherapy.

When movement differences make everyday activities, play, sport, school routines or community participation harder, paediatric physiotherapy can help identify practical goals and build skills in ways that fit the child and family.

How movement can affect everyday life

Movement skills support many parts of a child’s day: getting up and down from the floor, managing steps, running and jumping, joining playground games, learning to ride a scooter or bike, swimming, dressing and keeping up with peers. A child may have difficulty with one movement area and be confident in others.

Research suggests motor differences are common among children with autism, but prevalence estimates vary. Recent studies also report that structured exercise and sport programmes can improve some measured motor skills. The results are encouraging, although the studies are generally small and use different programmes and outcome measures. More research is needed to understand which approaches work best for which children and whether measured gains carry over into everyday participation. [1,2]

What paediatric physiotherapy may support

A physiotherapist can assess how movement is working for your child and what matters most to them and your family. Depending on the child’s goals, support may focus on:

• balance, coordination and motor planning
• strength, mobility and stamina for daily activities
• walking, running, jumping, stairs and getting up from the floor
• gross motor skills for playground activities, swimming, cycling or sport
• confidence and access to movement that the child enjoys
• adapting activities, equipment or the environment to make participation easier.

Goals are chosen with the child and family. Progress can be measured in a way that is meaningful in real life – for example, stepping onto a kerb more independently, joining a preferred game, or feeling more confident at the pool.

What an assessment may involve

An initial appointment usually includes a conversation about your child’s interests, strengths, daily routines, movement concerns and priorities. The physiotherapist may observe or assess selected activities such as walking, balance, coordination, strength or functional movement. Assessment should be paced to suit the child, with clear explanations, breaks and adjustments where helpful.

A plan is developed together and reviewed over time. It may include play-based practice, activity ideas for home or community settings, advice for school or sport, and communication with other members of the child’s support team when the family wants this.

Making movement activities work for your child

Enjoyment, choice and a sense of success can help children stay involved in physical activity. Research with autistic young people also highlights the importance of feeling capable and the impact that sensory features of an activity setting can have on participation. [3] A physiotherapist can help families and activity providers consider options such as:

• starting with the child’s interests and offering meaningful choices
• using a predictable routine, visual cues or a clear demonstration when useful
• adjusting noise, lighting, clothing, temperature, waiting time or group size to the child’s preferences
• breaking a new movement into manageable steps and building practice gradually
• choosing a quieter time or a familiar place to try an activity
• valuing enjoyment, comfort and participation alongside skill development.

There is no single activity that suits every child. Swimming, dancing, playground play, walking, martial arts, cycling and ball games may all be options, depending on the child’s preferences, access and goals. Recent reviews report potential motor benefits from structured programmes, including organised sport, but do not establish one best programme for every child. [1,2]

A note about W-sitting

W-sitting is not automatically harmful and does not need to be corrected simply because a child uses it. It can be one of several comfortable sitting positions. Consider assessment if it is the child’s only comfortable position, or if it occurs alongside pain, stiffness, marked asymmetry, frequent falls, unusual walking or concerns about motor development. The goal is to support comfort and a range of movement options, not to police one posture.

When to seek a physiotherapy assessment

You may wish to speak with a paediatric physiotherapist if movement differences:

• make everyday tasks or moving around less independent
• lead to repeated falls or difficulty keeping up with activities
• limit access to play, sport, school or community activities the child wants to join
• are associated with pain or a noticeable change in walking or movement.

Sudden weakness, loss of previously acquired skills, persistent or night pain, swelling, or an acute change in walking should be discussed promptly with a medical practitioner.

Working with your child and family

Support should respect the child’s communication, preferences and sensory needs. Language preferences vary: some people prefer identity-first language (“autistic child”), while others prefer person-first language (“child with autism”). We use “children with autism” here and are happy to follow the language each child and family prefers.

The Australian National Guideline for supporting autistic children and their families emphasises supports that are safe, effective and desirable to children and families, with attention to goals, planning, delivery and review. [4] Physiotherapy is one part of a broader support network and can be coordinated with other professionals when appropriate.

Download the handout

For a quick overview of how physiotherapy can support movement, play and participation, download our one-page handout:

Download the physiotherapy for children with autism handout (PDF)

References and further reading

Related resources and physiotherapy support

Explore Little Strides physiotherapy in Narre Warren. Selected appointments are available in Nunawading. View appointment and booking information or ask us about your needs.

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