Refer to Pedia PT PH

Roles of PT in managing children with Autism Spectrum Disorder (ASD)

Current updates on ASD

Zampella and colleagues found that many children with ASD had motor impairments, BUT they were not explicitly diagnosed or addressed.1

In Licari and colleagues’ study in Western Australia…

79%

of the children had some degree of motor impairment

but

Only 1.3%

had motor difficulties explicitly diagnosed

In Bhat’s study on children in the United States

85-87%

of children were at risk for motor impairment (y2 = 104.9 , p<0.0001)

Only 15%

of children had a diagnosis of Developmental Coordination Disorder

Only 32%

of children were receiving PT services while 80% were receiving OT services

Diagnosis of ASD

stethoscope notebook and medicines on doctors office desk
Photo by Tima Miroshnichenko on Pexels.com
  • Zampella and colleagues mentioned that by 13 months, large differences in motor skills are evident among groups.
  • Some studies reported that by 6 months, fine and gross motor skills, as well as visuo-motor skills, in infants who later developed ASD were distinguishable from those of infants who developed typically. 
  • “Intervention should start when an Autism diagnosis is suspected, rather than when a formal diagnosis is made.”2
  • “No one behavioral or communication assessment that can detect Autism.”2
photo of baby s hand

Earliest detection efforts

routine motor assessment1

Photo by Ksenia Chernaya on Pexels.com

children s team building on green grassland

For older children

routine motor evaluation1

Developmental Coordination Disorder Questionnaire

  • can effectively screen for motor impairment in youth with ASD

Photo by Lukas Blazek on Pexels.com

Link of physical fitness and muscle strength to ASD

  • The presence of autism disorder is linked to
    • Lower muscle strength scores (β= -0.38, p<0.001)
    • Lower scores in executive function (β= -0.37, p<0.001) – Ludyga et al 
  • In Ludyga and colleagues’ study, high muscle strength scores in children with ASD were more likely to score higher in
    • Executive function (β=0.24, p<0.004)
    • Pattern comparison tests (β = 0.24, p<0.001)3  
a man holding a girl crawling on a wooden floor
Photo by cottonbro studio on Pexels.com
schoolchildren stretching on grass during an outdoor physical education class
Photo by Aleksandar Andreev on Pexels.com

Impact of physical exercise on children with ASD

  • Children with ASD who went through an individualized exercise program (30-60 mins. x 1-2x / wk. x 15 sessions) conducted by Jackson and colleagues had:
    • Significant improvements in strength
      • Push-up plank hold: baseline: 41.7 seconds, post: 61.8 seconds, p=0.007
      • Number of hurdles performed: baseline: 10.4, post: 11.8, P=0.04
      • Hamstring bridge time: B: 82.5, post 73.7, p=0.004
    • Significant decreases in repetitive behavior (B: 82.5, post: 73.7, p=0.004)4
    • Although the goal is not to “fix” the behavior, physical exercise may be a productive outlet that would lessen restrictive and repetitive behavior. 
  • In Wang and colleagues’ study, children who had higher scores in the following:
    • Sit-and-reach test (flexibility) also had significantly higher scores in emotional control, working memory, social cognition and autistic behavior (p<0.05)
    • Long jump scores (strength) also had significantly higher scores in emotional control, working memory, social cognition and autistic behavior (p<0.05)

References
1. Zampella CJ, Wang LAL, Haley M, Hutchinson AG, de Marchena A. Motor skill differences in autism spectrum disorder: A clinically focused review. Curr Psychiatry Rep. 2021;23(10):64. Published 2021 Aug 13. doi:10.1007/s11920-021-01280-6
2. Watsoncreative. Screening & Diagnosis | Autism Society. Autism Society. Published August 15, 2023. https://autismsociety.org/screening-diagnosis/
3. Ludyga S, Pühse U, Gerber M, Mücke M. Muscle strength and executive function in children and adolescents with autism spectrum disorder. Autism Res. 2021;14(12):2555-2563. doi:10.1002/aur.2587
4. Jackson SLJ, Abel EA, Reimer S, McPartland JC. Brief report: A specialized fitness program for individuals with autism spectrum disorder benefits physical, behavioral, and emotional outcomes. J Autism Dev Disord. 2024;54(6):2402-2410. doi:10.1007/s10803-022-05646-4
5. Wang Q, Jia S, Cai Z, Jiang W, Wang X, Wang J. The canonical correlation between executive function and social skills in children with autism spectrum disorder and potential pathways to physical fitness. Sci Rep. 2025;15(1):10367. Published 2025 Mar 26. doi:10.1038/s41598-025-94334-1