autism therapy

Lumiere Children’s Therapy: Autism and Physical Therapy

Happy Autism Spectrum Disorder (ASD) awareness month! Many recognize speech therapy as an important component of the overall treatment plan for ASD due to difficulty with spoken language, eye contact, facial expressions, and emotional recognition. Although language deficits are a core symptom of autism, children may also demonstrate difficulty with coordination, motor planning, and hand-eye coordination. Therefore, physical therapy can help facilitate gross motor development to increase participation in everyday activities and social activities such as gym class, sports, playing, etc.

Lecates - Flickr

Lecates - Flickr

What are the signs and symptoms of Autism Spectrum Disorder?


  • Social communication challenges

    • Difficulty with social interaction including initiating and maintaining topics during conversation

  • Pragmatic difficulties

    • Children with ASD may present with poor eye contact, difficulty gauging personal space, and decreased facial expressions

  • Difficulty identifying emotions

    • Difficulties may include recognizing one’s own emotions as well as the feelings of others. They experience trouble expressing their emotions during a variety of situations. Also, children may lack knowledge of when to seek emotional support or provide emotional comfort to others.

  • Repetitive behaviors

    • Repetitive behaviors present differently for each individual but some examples may include repetitive body movements (arm flapping, spinning), motions with objects (spinning wheels), staring at lights, and/or ritualistic behaviors (lining up toys in order)

What physical difficulties may a child with autism experience?

Children with ASD may present with the following physical challenges:


  • Developmental Delay:

    A developmental delay is when a child is lacking the age-appropriate skills in one or more of the developmental areas: cognitive, social-emotional, speech and language, fine and gross motor. If a child demonstrates a physical developmental delay, they may have difficulty rolling over, holding up their head, sitting up, crawling, and eventually walking and jumping.


  • Low muscle tone:

    Muscle tone is the amount of tension in muscles used to hold up our bodies while sitting or standing. Low muscle tone is when the muscles require more effort to move properly while doing an activity. They may have difficulty maintaining good posture when standing and sitting, and often affects their overall gross motor development.


  • Difficulty with motor planning.

    Motor planning is the ability to conceive, plan, and then execute the physical skill in the correct sequence. Motor planning assists children in attempting new tasks without the need to consciously learn the steps to each new task. Motor planning arises from organizing sensory input from the body, and having adequate body awareness and environmental perception. Children who have trouble with motor planning may experience difficulty carrying out new tasks, following physical commands when given verbal instructions, and appearing clumsy while executing new tasks.


  • Decreased body awareness.

    Children with ASD may lack awareness of where their bodies are in relation to their environment, causing children to become accident-prone or present clumsy.

Who is a Physical Therapist?

Physical therapists, often referred to as PTs, are professionals that help people gain strength, mobility and gross motor skills. They are experts in motor development, body function, strength, and movement. Pediatric physical therapists can help children with a variety of disorders gain functional physical skills so they can participate in everyday activities.

What does physical therapy target?

  • Basic skills. Physical therapists can help children develop the primary gross motor skills of sitting, rolling, standing and running if they are experiencing a developmental delay.

  • Coordination. Physical therapists focus on the necessary muscles and skills to improve balance and coordination in everyday activities.

  • Improve reciprocal-play skills. Help children use motor planning to coordination throwing and catching a ball, and other activities that involves interacting and reacting to another person.

  • Development of motor imitation skills. In order to learn new skills, a child must be efficient in imitation and following physical directions. PTs can offer strategies and practice of imitating movements.

  • Increasing stamina and fitness. For older children, physical therapy may focus on skills required to participate in play and sports such as kicking, throwing, catching, and running.

  • Parent education. PTs create home exercise programs so that family members can help facilitate building on strength, coordination, and development of specific goals into their natural environments and routines.


Why is physical activity important for children with ASD?

Physical therapy increases a child’s ability to participate in physical activities by improving strength and coordination. Once a child is able to functionally participate in physical activities, they are able to reap the many benefits of daily exercise.


  • Social skills. Gym class, playgrounds, and organized sports teams offer opportunities for children to develop friendships and social skills. For children with ASD, physical activity programs provide a fun, safe environment to develop and practice social interaction skills.

  • Improvement in behaviors. Physical activity may help decrease maladaptive behaviors and aggression. Children with ASD have difficulty expressing and understanding their feelings. Physical activity can aid in reducing stress and frustration in children, often helping them adjust in different activities without aggression.

  • Overall health improvements. Staying active and participating in daily physical activities can decrease the risk of general health problems in individuals with ASD, including obesity.

  • Increase quality of life. Daily activities such as climbing stairs, walking on the sidewalk, and going grocery shopping require the use of gross motor skills. Improving one’s strength and stamina can positively affect their participation in everyday chores and activities.


If your child has Autism Spectrum Disorder, and is experiencing difficulty with coordination, strength, and motor planning, physical therapy might be right for you. Our physical therapists at Lumiere Children’s Therapy can offer evaluations, customized treatment plans, and home exercise programs for carryover into the home.





References:

“Does Physical Activity Have Special Benefits for People with Autism?” Autism Speaks, www.autismspeaks.org/expert-opinion/does-physical-activity-have-special-benefits-people-autism.

Morin, Amanda. “What You Need to Know About Developmental Delays.” Understood.org, www.understood.org/en/learning-attention-issues/treatments-approaches/early-intervention/what-you-need-to-know-about-developmental-delays.

“Motor Planning.” North Shore Pediatric Therapy, nspt4kids.com/healthtopics-and-conditions-database/motor-planning/.

“Physical Deficits.” Mental Help Physical Deficits Comments, www.mentalhelp.net/articles/physical-deficits/.

Rudy, Lisa Jo. “What Can a Physical Therapist Do for a Your Autistic Child?” Verywell Health, 24 July 2018, www.verywellhealth.com/physical-therapy-as-a-treatment-for-autism-260052.

Ries, Eric. “Physical Therapy for People With Autism.” Physical Therapy for People With Autism, www.apta.org/PTinMotion/2018/7/Feature/Autism/.

“What Are the Symptoms of Autism?” Autism Speaks, www.autismspeaks.org/what-are-symptoms-autism.






Autism: Recognizing & Managing Challenging Behaviors

Did you know that a big part of your child’s behavior, positive or challenging, is a reaction to something that is happening in their immediate environment?


Sometimes we inadvertently reinforce challenging behaviors but knowing the ABCs can help prevent inadvertent reinforcement. By recognizing the ABCs of behavior, you may be able to help prevent and better de-escalate challenging behaviors with your child. 

 A) Antecedent- This is what happens just before the behavior to provoke it.  

B)  Behavior-This is what you can see your child doing. 

C) Consequence-This is how you react the behavior.  The consequence will determine whether or not that behavior will reoccur. 

When thinking about how to intervene your child’s behavior, it is important to look at why the behavior is occurring, also known as identifying thefunction.  This is much more important than what the behavior looks like.  By recognizing which function the challenging behavior serves, you can begin to understand how to intervene.  The four main functions of behavior are:

 

Sensory - These behaviors are occurring because they feel good.  Stereotypy, or self-stimulatory behavior, is a common sensory behavior that children with autism often engage in. 

 

Escape - These are behaviors occur when your child wants to get out of doing something they don’t want to do.  This is often the root cause of difficulty with transitions, with which many children with autism have difficulty.

 

Attention - These behaviors occur to gain attention from somebody.  Attention-based behaviors can be easily inadvertently reinforced, so it is important to remember that negative attention is still attention!

 

Tangible - These are behaviors that your child engages in when they are told they can’t have something they want or if something they like is taken from them. By identifying common things that provoke behavior, we can arrange the environment to prevent behaviors in the first place.  By knowing why your child is engaging in a challenging behavior, you can begin to understand how to respond to your child. 

 

General Preventative Strategies

  • Give your child choices throughout the day.  This gives them a sense of control in their environment.  You can give them a “choice” when there may not actually be one.  An example of this is, “Which shoe do you want to put on first?” or “Do you want to go potty in 2 minutes or 4 minutes?”

  • If you would like for your child to do something, present it as a choice via instruction.  It is important that instructions are followed through. An example of this is, “Are you ready to put on your shoes?” vs. “It’s time to put your shoes on.” 

  • Prepare your child for transitions.  Instead of abruptly telling them that it is time to transition away from a preferred task, give them a visual or verbal countdown

  • Reward the positives!  Point out when you see your child making good choices.  Throw a party if they engage in a difficult and desirable behavior.  Some children with autism may not be motivated by social praise.  If this is the case, allow your child time with a favorite toy or sensory input (tickles, hugs, squeezes etc.)

  • Encourage flexibility!  Many children with autism can be rigid, so encouraging your child to play with different toys, try different foods, and pointing out when unexpected changes occur, can help prevent challenging behavior related to rigidity

  • Make sure your child has meaningful breaks throughout the day to engage in preferred activities

  • Teach appropriate behaviors when your child is calm and not engaging in challenging behavior 

 

General Consequence Strategies

 

 Sensory

  • Give your child something similar to do/have instead of the inappropriate behavior.  An example of this may be to offer your child a chewy snack instead of putting toys in their mouth

Escape

  • Be sure to follow through when an instruction is given

  • Validate your child’s frustration and let them know that you understand that they are upset, but they do need to complete whatever task is at hand

  • Try not to force your child to comply.  Have them complete the task at hand when they are calm and ready

  • Remember what the original instruction was and stick with it

  • Reward your child as soon as they complete the non-preferred task

Attention

  • Ignore attention-seeking behavior as much as possible.  Sometimes this is not 100% doable.  If you must provide your child with attention, minimize verbal attention and remain neutral

  • Do not show frustration or anger.  Children with autism sometimes think this is “funny” and may not have the social awareness to truly understand your frustration.  Emotions should be taught when your child is calm and regulated

 

Tangible

  • Not allowing the child to have access until they ask calmly or show that they are calm (if they do not have the language to ask)

  • If you are unable to provide your child access to the preferred item, acknowledge their emotion and their feelings

  • Do not go back on your word.  If you told your child that they cannot have an item, do not give your child that item, especially if they engage in challenging behavior

 

 

Tips provided by Lumiere therapist, Jacqueline M., M.A., BCBA, (Lead Board Certified Behavior Analyst)

 

 

Does My Child Have Autism?

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is characterized by deficits in three keys areas: social interaction, communication with others, and repetitive or rigid behaviors.  These impairments can present themselves in a variety of ways.  

Lumiere Children’s Therapy Instagram Page

Lumiere Children’s Therapy Instagram Page

What are signs of autism in my child?  

Social Deficits 

Some social deficits that may be noticed with your little one, include:

·      Lack of smiling or joyful response to a parent by 6 months of age

·      Not responding to their name by looking or orienting their body in the direction their name was called, by 1 year

·      Not waving “bye-bye” by 1 year

·      No pretend or “make believe” play by 18-24 months

·      Preference to play by themselves/no desire to interact with peers by 2 ½ years

 

Communication Deficits

Some communication deficits that may be noticed with your little one, include:

·     Not making or sharing sounds with others by 9 months of age

·      Lack of pointing to items of interest by 14-16 months

·      No regularly used words by 16-18 months

·      Lack of use of 2-word utterances by age 2

 

Repetitive or Rigid Behavior

The occurrence of repetitive or rigid behavior at any time during development can be cause for concern.  Some of these behaviors include:

·     Stereotypy - the persistent repetition of movement of the body or of an object, is a big indicator of autism.  Examples of stereotypy include, but are not limited to, repetitive movement of the hands in front of the face, hand-flapping, following objects or body parts with a repetitive eye gaze, lining up toys (and becoming very upset if the line is broken in any way), and/or pulling at the hair or hair twirling

·     Echolalia - repeating back what was said to them in a non-functional way or repeating lines from movies, commercials or other outlets that have been heard previously in a non-functional context 

·     Extreme duress expressed to a change in routine or schedule; a need for “sameness” in daily routines

·     Difficulties with transitions

 

It is important to note that any of these deficits in isolation does not mean that a little one may have autism.  Typically, a combination of these deficits will be present and when combined, there may be cause for concern.  Also, loss of any skills at any point in development is a red flag and indicator.  Examples of this include, a child who used to wave “bye-bye” but no longer does, used to babble but stopped, used to respond to their name or used to speak a few words but no longer uses them.  

What do I do if I think my child may have autism? 

If your little one is displaying a combination of these behaviors or has lost any skills, please consult your pediatrician. The pediatrician should then refer to a specialist, including a developmental pediatrician, developmental psychologist, or developmental neurologist who is qualified to perform a full diagnostic evaluation.   

My child has been diagnosed with autism (ASD). What are the next steps? 

First of all, breathe. You’ve got this! There is a lot of information to take in when a diagnosis of autism is determined.  Often times, recommendations are given for up to 30 hours per week for intensive ABA therapy which leaves parents thinking, “Where can I fit 30 hours of therapy into my child’s schedule?!”  

What is ABA therapy and how can it fit into my schedule?

Applied Behavior Analysis (ABA) is the scientific approach to teaching socially significant behavior by the use of behavior principles and understanding the variables responsible for lasting change. For young learners, quality ABA therapy programs focus on family-centered programming that targets pre-academic, social, communication, and self-help skills.  ABA also focuses on decreasing challenging behavior while increasing positive behaviors.  One goal of ABA is to give your child the tools they will need to feel comfortable in the community and surroundings.  This is done in a variety of ways.  

Research shows that ABA therapy is one of the most effective treatments for teaching those with Autism Spectrum Disorder. Although ABA is a critical therapy for your child, it often is just one component of a multidisciplinary treatment plan.  ABA targets a wide array of skills, however, remains behavioral in nature so other therapies including physical, speech, occupational therapies may also be beneficial to your child.  Using a collaborative and multidisciplinary approach is just one effective method to treatment.

ABA therapy can be conducted across environments. Often, therapy will occur at a center, at your child’s daycare, and/or in the home.  An ABA therapist may be present during family outings to the grocery store, park, or other activity to teach appropriate behaviors in these settings. Scheduling can be flexible and can even occur on the weekends.    

Lumiere Children’s Therapy focuses on naturalistic instruction, or play-based learning for young children and offers a multidisciplinary approach to therapy, with a customized treatment plan created just for your child. If you need help with your child’s ASD diagnosis, contact us today so we can help.


 

References

Cooper, John O., Heron, Timothy E.Heward, William L.. (2007) Applied behavior analysis /Upper 

Saddle River, N.J. : Pearson/Merrill-Prentice Hall,

Green, G.  Mansfield, R. Geckeler, E.  Gardenier, N.   Anderson, J. Holcomb, W. &  Sanchez, J. 

(2007)Stereotypy in young children with autism and typically developing children, Research in Developmental Disabilities. 28 (2007) 266–277. 

Leaf, J.  Leaf, R. McEachin, J.  Taubman, M. Rosales, S. Ross, R. Smith, T. & Weiss, M. J. (2015). 

Applied Behavior Analysis is a Science and, Therefore, Progressive.  Journal of Autism 

Dev Disorders.   (46)720–731.

Ozonof, S. et al. (2010) A Prospective Study of the Emergence of Early Behavioral Signs of 

Autism.  Journal of  American Academy of Child and AdolescentPsychiatry .  49(3): 256–66.