Autism, Motor Development and the NDIS | Physio Advice

Aug 6, 2021 | Disability and NDIS

Autism, Motor Development and the NDIS – Advice from a Physiotherapist

Autism spectrum disorders are estimated to affect around one in 100 individuals in Australia. For a person to be diagnosed with autism spectrum disorder (ASD), they need to have characteristics including social and communication difficulties and repetitive behaviours.

It’s important to note, however, that every person diagnosed with ASD is unique, with their own set of likes and dislikes, challenges and strengths.

What’s not as well-known is that people with ASD commonly experience challenges with motor (movement) development. In fact, recent research showed 87% of children with ASD aged 5-15 years were at risk of movement difficulties. The same study found children with more severe problems in other areas, such as communication and social skills, were also at higher risk for movement problems.

Another recent study of Western Australian children found those diagnosed with ASD had a similar prevalence of motor difficulties to that of intellectual impairment. Despite this, only 1.34 per cent of these children were identified as having motor issues by those making the ASD diagnosis, such as a paediatrician.

When to See a Physiotherapist About Motor Development in Autism


Physiotherapists are highly trained and skilled in the assessment and management of movement disorders. Given the high rate of motor difficulties in children with ASD, and that diagnosticians may miss motor problems, it makes sense to see a physiotherapist if you have any concerns about your child’s movement.

If you are seeking expert assessment, advice and management about motor development, referral to an NDIS registered physiotherapist may be indicated for the following reasons:

  • Screening and assessment of developmental delays
  • Assessment and treatment for gross and fine motor skill development
  • Management of muscle tone problems (low muscle tone and/or spasticity)
  • Advice and management of posture and coordination
  • Mobility assessment and training

Autism and Motor Development

As noted above, movement disorders are common in individuals with ASD. Children with ASD may experience difficulties with muscle tone, fine and gross motor skill development, coordination, posture, and balance.

These issues can impact a child’s ability to perform activities of daily living, such as tying up their shoelaces, doing up buttons, holding a pencil at school, or sitting upright in a chair in class for long periods.

It can also affect their ability to participate in sports and other activities. If a child has difficulty running or throwing/catching/kicking a ball, for example, it will be harder for them to participate with their peers in a game of soccer, basketball or netball.

In fact, research has shown children and youth with ASD are at risk of having low levels of physical activity and more sedentary behaviours[iii]. In children and adolescents, adequate physical activity is vital for bone health, physical fitness, cardiometabolic health, cognitive function, healthy weight maintenance, and mental health[iv].

Lack of physical activity can lead to a negative cycle in which its effects – such as reduced sleep duration, weight gain, social isolation, poorer cognitive outcomes and poorer fitness and cardiometabolic health – lead to further inactivity and increased sedentary behaviour. As a result, children can continue to fall increasingly behind their peers.

A Physiotherapist’s Role in Supporting Motor Development

As experts in movement, physiotherapists play a key role in helping children with ASD to achieve their potential and participate in their families, schools and communities. Here are some ways a physio may be involved in supporting motor development in people with autism.

Early identification and assessment

Studies have suggested early childhood motor developmental delays can be an early indicator of ASD, arising before other signs develop[v]. Physiotherapists are highly trained in normal development, and in identifying disruptions to typical development.

Physiotherapists working with children have the skills to screen for motor disorders. Furthermore, those working with a child over time have an opportunity to observe their overall development, and to refer for further screening and diagnosis if they feel it is warranted.

Early identification of movement problems fosters access to appropriate early intervention programs, helping to enhance short and long-term outcomes.

Young children running after a ball outside on the grass.

Management

Once a motor development issue has been identified, a physiotherapist is likely to be involved in management. NDIS Physiotherapists work with children with autism to support motor control and functional skill development. They use tailored exercise programs, and sometimes other therapies (such as massage, stretching, electrotherapy and hydrotherapy), to support:

  • gross motor skill development – such as sitting, crawling, standing, walking, and kicking
  • fine motor skill development – such as holding scissors, doing up buttons, and handwriting
  • posture and alignment – for sitting and standing, including wheelchair seating
  • coordination – including hand/eye coordination and complex tasks such as ball skills
  • managing muscle tone issues – including high and low muscle tone
  • strength development – such as upper and lower body strength for participating in play-based activities and sports
  • improved balance – for participation in games, sports and group activities.

A physiotherapy program is always based on assessment of an individual’s needs and goals. It will include practise of engaging and age-appropriate functional tasks. Therapy is often play-based to ensure strong engagement, which is important for the best outcomes. Physios may also use technology-based interventions, such as movement activities using tablets and computer games.

Studies have shown that physiotherapy interventions are effective for improving motor skills. For example, a systematic review looking at 20 movement interventions (like those that physios use) found they were effective for improving gross motor skills[vi].

Where appropriate, a physio will also train support people to perform therapies at home, such as specific types of play, therapeutic exercises or stretches.

Promoting Physical Fitness and Sports Participation

As mentioned, children with ASD tend to have low rates of participation in physical activity. They may face barriers to participation such as sensorimotor and communication difficulties, in addition to motor skill issues which make it hard for them to keep up with their peers when participating in sport.

Physiotherapists are well qualified to provide physical activity and movement interventions that support participation in physical activity programs and equip children and adolescents with ASD with the skills and confidence to re-join group-based programs with their peers.

A meta-analysis published in the journal Autism Research in 2018 looked at 29 studies examining the effect of physical activity interventions on youth diagnosed with ASD. The researchers found these interventions can lead to improved muscle strength/endurance, skill-related fitness, locomotor and manipulative skills, and social functioning of participants with ASD aged 2-22 years[vii] . The study authors concluded their findings reinforce physical activity’s status as an evidence-based strategy for youth with ASD.

Smaller studies have indicated other potential benefits of physical activity interventions in children with ASD. For example, a 2020 study published in the Journal of Autism and Developmental Disorders[viii] looked at the impact on behavioural, social and communication outcomes of a community-based, organised football program in children aged 5-12 with ASD. The 19 children who completed the football program demonstrated a significant reduction in parent-reported anxiety, plus a non-significant increase in organised physical activity separate to the program, compared to the 21 children in the comparison group.

Autism and Accessing Physio Through the NDIS

According to figures from the NDIS, 29 per cent of participants with an approved plan had a primary disability of ASD – meaning it is the NDIS’s largest primary disability category.[ix] If you are seeking physiotherapy services for your child through the NDIS, you will need to make an access request to become a scheme participant.
You can do this by calling 1800 800 110 or completing and submitting a form via email.

If your child is aged 0-6 years, the Early Childhood Early Intervention pathway may allow you to access appropriate services before your child becomes an NDIS participant.

Find out more at https://www.ndis.gov.au/applying-access-ndis/how-apply

A Note on Effective Therapy for Motor Development

When comparing potential strategies for supporting motor development in a child with ASD, it’s essential to look for therapies that are backed by research. As tertiary-qualified and registered allied health professionals, physios use therapies backed by sound evidence.

A physio working with individuals with disability will be up to date with current research and can advise you about the best, evidence-based strategies for supporting someone with autism to achieve their movement potential and participate at home, school and in their community.

Like more information before arranging a service agreement with Active Ability?

Contact us or call us on (02) 8678 7874 (Monday to Friday) and one of our friendly team members will gladly answer your questions.

If you’re keen to get started with an NDIS registered physiotherapist to help with motor skill development and are ready for a service agreement, please fill out our NDIS referral form.

References

[i] Bhat, A. N. (2020). Motor Impairment Increases in Children With Autism Spectrum Disorder as a Function of Social Communication, Cognitive and Functional Impairment, Repetitive Behavior Severity, and Comorbid Diagnoses: A SPARK Study Report. Autism Research. doi:10.1002/aur.2453

[ii] Licari, M. K., Alvares, G. A., Varcin, K., Evans, K. L., Cleary, D., Reid, S. L., . . . Whitehouse, A. J. O. (2020). Prevalence of Motor Difficulties in Autism Spectrum Disorder: Analysis of a Population-Based Cohort. Autism Research, 13(2), 298-306. doi:10.1002/aur.2230

[iii] Cynthia, C., Duck, M., McQuillan, R., Brazill, L., Malik, S., Hartman, L., . . . Jachyra*, P. (2019). Exploring the Role of Physiotherapists in the Care of Children with Autism Spectrum Disorder. Physical & Occupational Therapy in Pediatrics, 39(6), 614-628. doi:10.1080/01942638.2019.1585405

[iv] https://www.who.int/news-room/fact-sheets/detail/physical-activity

[v] Harris, S. R. (2017). Early motor delays as diagnostic clues in autism spectrum disorder. European Journal of Pediatrics, 176(9), 1259-1262. doi:10.1007/s00431-017-2951-7

[vi] Case, L., & Yun, J. (2019). The effect of different intervention approaches on gross motor outcomes of children with autism spectrum disorder: a meta-analysis. Adapted Physical Activity Quarterly, 36(4), 501-526. doi:10.1123/apaq.2018-0174

[vii] Healy, S., Nacario, A., Braithwaite, R. E., & Hopper, C. (2018). The effect of physical activity interventions on youth with autism spectrum disorder: A meta-analysis. Autism Research, 11(6), 818-833. doi:https://doi.org/10.1002/aur.1955

[viii] Howells, K., Sivaratnam, C., Lindor, E. et al. Can Participation in a Community Organised Football Program Improve Social Behaviour Functioning and Communication in Children with Austism Spectrum Disorder? A Pilot Study. J Autism Dev Disord 50, 3714-3727 (2020).

[ix] https://data.ndis.gov.au/reports-and-analyses/participant-groups/outcomes-participants-autism-spectrum-disorder

[x] Reedman, S., Truscott, L. (2021, June 1) Five facts about… physiotherapy and autism spectrum disorder. Australian Physiotherapy Association InMotion Magazine. pp45-47. https://australian.physio/inmotion/five-facts-about%E2%80%A6-physiotherapy-and-autism-spectrum-disorder