Autism: How physiotherapy helps your child

Published: Daily Mirror 31/05/2012

What is Autism? Autism is a pervasive developmental disorder. The correct terminology should be Autism Spectrum Disorders (ASD) as people with autism may show mild to severe symptoms depending on where they are in the spectrum. Although the etiology of it has not been identified yet research has shown that the condition arises due to disorders in the neural development. Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize. The working hypothesis is that this could be to genetic and certainenvironmental factors.

Features of Autism According to DSM Manual (Diagnostic and Statistical Manual of Mental Disorders-4th edition)the current diagnostic criteria for autism is to have qualitative impairments in 3 main regions. 1. Qualitative impairment in social interaction Absence of eye contact, unable to share interests with parent/siblings, unable to show/understand emotions in facial expression or body language 2. Qualitative impairments in social communication Delay in speech development, understand few words only when spoken one word at a time, has limited vocabulary 3. Restricted repetitive and stereotyped patterns of behavior (narrow focus) Has routines, gets confused or angry when trying to change the pattern of activities, likes to play with same toys, like to wear particular colour, texture of clothes, has a repetitive movements (eg: rocking, spinning) Children with autism often have difficulties with their motor skills and coordination. These difficulties, combined with challenges from the 3 main impairment regions, can obstruct them learning morecomplex playground and sports skills.

How do I know whether my child has coordination or balance difficulties? The physiotherapist will conduct a developmental and motor assessment to identify your childs movement and physical challenges. Your child may display the following characteristics: Gross motor difficulties: poor balance (often trips over their feet) bumping into objects tires easily difficulty in linking movements into a sequence or a more complicated activity avoids physical activities (lacks motivation, doesnt like jumping/running) slowness in performing and finishing tasks

Fine motor difficulties: find it difficult to write (hard to hold a pencil/ handle a scissor) poor hand-eye coordination (may find it difficult to fix a simple jigsaw puzzle) does not know how much pressure/ force to apply (turning off a light switch vs turning off the tv) may find it hard to coordinate both hands together (for actions such as clapping/ rolling hands)

Autism and Physiotherapy The focus of physiotherapy in children with autism is to help them with their fine/gross motor difficulties and balance/coordination. However people with autism are already having difficulties with adapting to the environment and expressing their thoughts. Thus it is important to remember the 3 main features of autism and tailor the therapy in an autism friendly way. To ensure this our special education specialist advices us to take note of the 5 senses. We all learn using the 5 senses, visual (sight), auditory (hearing), tactile (touch), olfaction (smell) and taste (gustatory). For movement learning purpose the highlight would be mostly on sight, auditory and tactile senses.

Therapy for a child with Autism

Visual learning: break down the skill (this is to ensure high rate of success eg: practice climbing with a stepper before going up an actual staircase) reinforce every little effort by the child (increase motivation) model the action (look at me do the same) show clear pictures of the action (let the child see what we expect from him) label the activity (jumping clapping) start with small parts and build up from there but know when to stop and give rest

Auditory assistance: some may need longer time to process auditory instructions, give them that time to process if the child does not like noise/talking, try to use verbal commands as little as possible (model actions or use visuals) keep sentences short and clear (instead of saying take a seat say sit down) be consistent (start, 1,2,3,4,5, finish: always the same routine with little modifications if necessary)

These methods help the child to be calmer in the environment so he will be able to concentrate better on the task. Visual learning also helps them to be less anxious, as they will be shown what is they are going to do (picture of jumping) and when it will be finished (start, 5 times, finish) and what will happen next (reinforcement: gets to play with favorite toy). The therapist will work with your child to teach him and eventually getting him to complete the task by himself. They often work with parents and caregivers so that you can create opportunities to practice the learnt skill at home in a fun way (eg: to get him to crawl, make a tunnel using cushions and make a game of it!). If you have a child with autism look out for the mentioned gross/ fine motor difficulties. Sooner you seek help from a professional physiotherapist, higher the chances of success (not moving certain muscles for longer periods makes it difficult to readjusts them for movements). Ms.NilakshiKasilingam The writer is the chief physiotherapist at PHYSIO MEDiCARE