OT AND PHYSIOTHERAPY

"For children with ASD, every movement, every touch, and every gesture is a step toward connection and independence, opening doors to a world where they can engage, explore, and grow."

Occupational therapy (OT) and physical therapy (PT) play essential roles in supporting children with neurodevelopmental disorders. Both therapies focus on improving the child's ability to engage in everyday activities, though they target different aspects of development. OT helps children develop the skills needed for daily living, such as dressing, feeding, and self-care, while also addressing sensory processing, fine motor skills, and social interaction. PT, on the other hand, focuses on improving physical abilities, such as gross motor skills, balance, strength, and coordination, to help children move through their environment more effectively.

Occupational Therapy

Sensory Regulation and Adaptation

A defining characteristic of autism spectrum disorder (ASD) is the way individuals process sensory information. People with ASD often experience heightened or diminished sensitivity to sensory stimuli, such as sounds, textures, or light. This sensory processing difference can make everyday activities challenging. For example, bright lights or loud noises may be overwhelming, causing stress, anxiety, and even meltdowns. Alternatively, individuals may underreact to sensory inputs, which can affect their ability to gauge temperature, pain, or personal space.

Occupational therapy (OT) offers targeted strategies to help individuals with ASD and other NDDs better regulate and respond to sensory stimuli. Sensory integration therapy is a key component, where therapists work to gradually expose individuals to sensory experiences in a controlled and supportive environment. The goal is to help them process sensory input in a way that reduces overwhelm and enhances overall functioning. Techniques might include:

Sensory Diets: Structured activities and exercises that provide sensory input to help individuals maintain optimal levels of alertness and focus.

Deep Pressure Stimulation: Activities like weighted blankets or squeeze toys that provide calming proprioceptive input to help soothe the nervous system.

Environmental Modifications: Adjustments to home, school, or work settings—such as noise-canceling headphones or dim lighting—to create more sensory-friendly environments.

These interventions may help children to navigate sensory challenges, reducing stress and improving their ability to engage in both structured and unstructured environments.

Enhancing Fine Motor Skills

Fine motor skills are essential for many daily activities, such as writing, eating, dressing, and using technology. For children and adults with NDDs, fine motor development can be delayed or impaired, which can make seemingly simple tasks more difficult (1). Occupational therapy works to improve fine motor coordination through a variety of exercises and activities. These include:

Handwriting Support: Occupational therapists help individuals develop proper grip, posture, and hand-eye coordination for writing tasks. Techniques might involve adaptive tools (e.g., special pencils) and activities to improve strength and dexterity.

Crafts and Play: Engaging in activities like drawing, cutting with scissors, or assembling puzzles helps improve hand-eye coordination and dexterity in a fun, motivating way.

Crafts and Play: Engaging in activities like drawing, cutting with scissors, or assembling puzzles helps improve hand-eye coordination and dexterity in a fun, motivating way.

Building Daily Living Skills

For any child, and particularly for a child affected by an NDD, learning everyday skills is important for becoming more independent at home, at school, and in the community. When these skills are taught early and step by step, they help build a sense of confidence.

Since each person with autism is unique, the life skills they learn and the speed at which they learn them will differ from one individual to the next.

Daily living skills (ADLs)—such as dressing, eating, bathing, and grooming—are often areas of difficulty for individuals with neurodevelopmental disorders. Occupational therapists work closely with a child and his family to break down these tasks into manageable steps, fostering independence and confidence.

Breaking Down Tasks for Independence:

OTs start by assessing the child's current abilities and their environment. By understanding their specific needs, OTs can help break down complex tasks into smaller, more manageable steps. For example, dressing might be broken into individual actions, such as putting on socks, then shoes, and finally clothes. By teaching these steps separately and using appropriate supports, individuals can gradually develop the confidence and skills to complete them independently.

Adaptive Tools and Strategies:

One important way OTs support ADL development is by recommending adaptive tools or strategies that make tasks easier. These might include using Velcro instead of buttons, specially designed utensils, or providing visual supports such as schedules or step-by-step instructions for tasks. These modifications allow individuals to better manage everyday tasks and reduce frustration, making independence more achievable.

The Role of Visual Supports:

For individuals with autism, visual supports are particularly effective in helping to process expectations and follow through with tasks. Visuals can include things like step-by-step guides, schedules, or picture instructions. For example, a visual dressing sequence might help a child understand the order of steps involved in getting dressed. This provides consistency and serves as a permanent reference, reducing reliance on verbal prompts, which can be less consistent and harder to process.

Prompting and Fading Support:

OTs use a structured approach to prompting that focuses on gradually reducing assistance to encourage greater independence. This method, known as the "prompt hierarchy," involves using various levels of support, ranging from verbal instructions to physical assistance. The goal is to help individuals perform tasks on their own by systematically fading prompts over time.

Here’s an example of a prompt hierarchy for the task of putting on socks:

Independent: The child completes the task without support.
Permanent Visual: The child refers to a visual aid (e.g., follows a picture chart of a dressing sequence) to complete the task.
Proximity Positioning: The therapist is present in the same room but not directly involved in the task.
Gesture: The therapist uses a non-verbal cue (e.g., pointing to the socks) to prompt action.
Modeling: The therapist demonstrates the task, and the child imitates the action.
Touch Object: The therapist may touch the object (e.g., the sock) to prompt the child.
Partial Physical: The therapist provides minimal physical assistance, guiding the child’s hand to perform the task.
Full Physical: The therapist provides complete physical support, helping the child perform the task step by step.

This step-by-step fading of prompts encourages independence and ensures that the individual is only given as much support as they need to succeed.

Environmental Adaptations:

Simple environmental modifications can also make a big difference in supporting ADLs. By organizing the environment to make items more accessible, such as keeping utensils or clothing within easy reach, individuals can complete tasks with greater ease. Predictable organization and structure in the environment reduce confusion and make it easier for individuals to follow routines independently.

Cognitive and Learning Skills

In addition to motor skills, individuals with NDDs often face challenges related to cognitive functions, such as attention, problem-solving, and memory. Occupational therapists address these challenges by providing strategies to improve learning and academic performance.

Problem-Solving Skills: Through structured activities, occupational therapists help individuals develop strategies for breaking down tasks, planning, and solving problems step-by-step.
Attention and Focus: For children with ADHD or those with ASD, improving attention span can be a significant challenge. Therapists use techniques such as visual supports, reminders, and short, frequent activities to help sustain attention.
Cognitive Training: Occupational therapy may include cognitive exercises to improve memory, sequencing, and other executive functions necessary for academic success.

By strengthening these cognitive skills, OT helps individuals gain greater independence and academic abilities, which can positively affect their overall development.

Muscular and Gross Motor Skills Development

While OT typically focuses on fine motor skills, it also plays a key role in addressing gross motor development, particularly in children with developmental coordination disorder (DCD), cerebral palsy, or ASD. Gross motor skills involve large body movements such as walking, running, jumping, and climbing.

Balance and Coordination: Occupational therapists provide exercises to enhance postural control, balance, and coordination, which are essential for activities like riding a bike or participating in sports.
Strength Building: Gross motor activities like jumping, crawling, or climbing help children with NDDs build muscle strength, flexibility, and overall body awareness.
Motor Planning: Motor planning, the ability to organize and carry out complex movements, is often an area of difficulty for children with NDDs. OT programs target motor planning through activities like obstacle courses or multi-step exercises.

Improving gross motor skills through OT allows children and adults to gain better control over their bodies, which in turn leads to more confidence and greater physical independence (2)).

Cons of Occupational Therapy

While occupational therapy (OT) offers many benefits for children with physical, cognitive, and developmental challenges, there are also potential drawbacks. These can vary depending on the child’s needs, the type of therapy required, and the resources available. Here are some of the common cons to consider:

1. Cost

A major downside of OT is its cost. In many cases, OT sessions can be quite expensive, especially if they aren't covered by insurance or public healthcare programs. Even when insurance provides some coverage, there may be limits on the number of sessions, co-pays, or out-of-pocket costs. The price per session can range from $100 to $200 USD or more. For families who need ongoing or frequent therapy, the financial burden can quickly become overwhelming.

2. Limited Access to Providers

In some regions, there is a shortage of qualified occupational therapists, which can make it difficult to find an experienced provider. This issue is more common in rural areas or countries with limited healthcare infrastructure. Additionally, long wait times for appointments or limited therapy availability may delay the start of treatment, potentially impacting progress and outcomes. This can be frustrating for families eager to begin therapy as soon as possible.

3. Time Commitment

OT requires a significant time commitment. Many children need therapy sessions on a regular basis, which could range from weekly to several times a week, depending on their needs. On top of attending sessions, families often need to spend extra time practicing skills at home and coordinating with other healthcare providers. For families with busy schedules, balancing therapy with school, work, and other responsibilities can be challenging.

4. Emotional and Mental Strain

The process of OT can also be emotionally and mentally taxing. Children may face frustrations, setbacks, or failures as they work to develop new skills. For some, particularly those with developmental disorders or adults adjusting to a new condition, therapy can be a stressful and exhausting experience. The emotional strain of repeated efforts, combined with occasional slow progress, can lead to burnout or reluctance to continue therapy.

5. Variable Results

The results of OT can be unpredictable. While many children benefit from therapy, the outcomes can vary widely. Not every child responds to therapy in the same way, and some may not achieve the level of improvement their families had hoped for. Factors like the severity of the condition, the frequency of therapy, and the child’s engagement in the process can all influence the results. For some, progress may be slow or limited, which can lead to disappointment and doubts about the effectiveness of the therapy.

6. Dependence on External Support

Another downside is the potential for dependence on the therapist. If a child does not fully internalize the skills being taught, they may struggle to function independently without continued therapy. Although OT is designed to foster independence, some children may require ongoing support, which can create a sense of dependency on the therapist. This is particularly concerning for families who wish to minimize reliance on external services in the long term.

7. Inconvenience and Disruption to Daily Life

Regular OT sessions can be disruptive to daily life. For families, traveling to and from appointments—especially if the therapy center is far from home—can take up valuable time and energy. Additionally, if sessions occur during school or work hours, it may interfere with other commitments and activities, causing stress and scheduling conflicts.

8. Lack of Immediate Results

Unlike some treatments or therapies that provide faster results, OT often requires patience. Progress can be slow, and improvements may not be immediately visible. This lack of instant gratification can be frustrating for families who are eager to see quick results.

9. Intensive Effort from Caregivers

Finally, caregivers play a crucial role in the therapy process. Parents and family members are often asked to practice new skills with the child at home, implement strategies in everyday activities, and offer continuous support outside of therapy sessions. While this involvement is essential for success, it can add stress to already demanding parental roles and lead to burnout.

Physiotherapy

Motor Development in Children with ASD.

Children with NDDs, often experience delayed and atypical motor development. This can include a variety of motor challenges, such as hypotonia (low muscle tone), motor apraxia (difficulty planning and coordinating movements), toe-walking, and delays in gross motor skills. These motor difficulties, whether they are primary to autism or secondary to other factors, can have significant implications for individualized educational interventions.

Motor delays in children with ASD are often overlooked but are important to address. Without proper intervention, these motor challenges may become more pronounced as the child ages, potentially leading to chronic issues and impairments that affect overall development (3). Motor difficulties are not just a physical concern; they can also impact other areas of development, including social behavior, communication, academic engagement, and sensory processing.

Physical exercise has long been known to reduce the risk of general health problems, but there is growing recognition that motor skills are critical for learning in other areas. Given this, it is essential to incorporate motor skill development as a core component of early childhood education and therapeutic services. Addressing motor-related difficulties should be prioritized to help children gain the physical and cognitive skills they need to thrive.

Role of Pediatric Physical Therapy

Physical therapy plays a crucial role in supporting children who struggle with functional movement, poor balance, and difficulties navigating their environment. Many children on the autism spectrum experience issues like low muscle tone, poor balance, and poor coordination. Others may experience a combination of these challenges. A physical therapist can help address these areas of concern by designing individualized therapy programs.

After assessing the child's specific needs, the physical therapist will create a targeted program to improve motor function, strengthen muscles, enhance coordination, and promote independence. The goal of pediatric physical therapy is not only to improve movement but also to increase overall participation in daily activities.

Areas of Intervention in Pediatric Physical Therapy

Pediatric physical therapists focus on several key areas to improve motor function and enhance a child's overall development.

These areas include:

Gross Motor Skills:

These involve using large muscle groups for activities like sitting, standing, walking, and running. Developing these skills is essential for mobility and physical independence.

Balance and Coordination:

Balance and coordination skills involve the brain, bones, and muscles working together to produce smooth, controlled movements. These skills are vital for activities like climbing stairs, jumping, and maintaining stability in various environments.

Strengthening:

Building muscle strength supports overall movement and endurance. Strengthening exercises help children improve stamina, enabling them to walk longer distances or engage in physical activities without tiring quickly.

Functional Mobility and Motor Planning:

This refers to the ability to move efficiently and independently through space. For example, learning to climb onto a rocking chair and move it back and forth. Motor planning also involves understanding how to sequence and execute movements for daily tasks.

Challenges in Accessing Physical Therapy

The considerations for physical therapy (PT) in NDDs are quite similar to those for occupational therapy (OT), as both therapies often require a personalized, adaptive approach to meet the child’s unique needs. Just like OT, PT for children with autism can face challenges related to sensory sensitivities, difficulty engaging with the therapy, and variability in the effectiveness of treatment depending on the child’s specific profile. One of the biggest hurdles, however, is the cost and the lack of qualified professionals (4). Access to experienced physical therapists who are familiar with ASD can be limited, especially in certain regions, and the financial burden of ongoing therapy can be significant for many families. Once families do access services from qualified therapists, the cost can often become a barrier to continued treatment, as it may not be sustainable long-term, especially without adequate insurance coverage or financial support. This can, unfortunately, prevent children from receiving the consistent, ongoing care they need to make meaningful progress.

Sport... Sport? Sport!

Physical activity is more than just a means to improve health—it is a critical tool for enhancing the quality of life for children with neurodevelopmental disorders, including autism. Beyond the obvious physical benefits, exercise offers a unique opportunity to improve social skills, reduce problematic behaviors, and build confidence. For children with ASD, the physical and mental benefits of exercise are transformative. From strengthening the body to improving social interactions and emotional regulation, regular physical activity can help unlock potential in ways that few other interventions can.

Parents are well aware of the physical health benefits of exercise—it promotes healthy weight, strengthens bones, reduces stress, and improves cardiovascular function. But not everyone knows about the mental health and behavioral advantages that physical activity offers. Exercise can help the entire body, including the brain, function at its best.

The Link Between Physical Activity and ASD Outcomes

Studies have shown that just 20 minutes of exercise can improve sleep, behavior, cognitive function, and school performance in children, whether they have ADHD/ASD or not. It also leads to better self-control and reduces impulsive behavior. These same benefits can be particularly impactful for children with ASD, and research shows that regular exercise provides similar positive outcomes for both children and adults on the spectrum.(6)

In particular, studies highlight how exercise helps reduce common challenging behaviors, such as:

Anxiety
Repetitive behaviors
Off-task behavior
Mouthing objects
Self-injury
Disruptiveness
Aggression

At the same time, PE help to improve:

Self-esteem
Communication skills
Self-confidence
Psychosocial development
Academic performance
General health perception
Physical fitness parameters (e.g., strength, endurance, and body mass index)

So how can parents encourage their children with autism to exercise daily?

The first step is understanding your child’s preferences. Does your child enjoy jogging, riding a bike, or swimming? Identifying activities that they find fun and motivating is key to fostering a lasting interest in physical exercise.

Children may not exercise for the same reasons adults do (e.g., weight loss or competition). Instead, they may need more immediate rewards or reinforcement. For example, offering an incentive like screen time (computer or TV) after exercise can provide that extra motivation.

Additionally, parents can set a positive example by joining their child in exercise activities. Being an active participant not only provides a role model but also allows both of you to enjoy the health benefits together. Setting aside 30 minutes each day for shared physical activity is a simple yet effective way to make exercise a routine in your family’s day. You have nothing to lose—and a lot to gain, including a boost in your own health!

Physical activity in the first years of life is absolutely crucial for growth and development. In addition, physical activity has important benefits in terms of preventing secondary health problems that children affected by an NDD may experience and supporting communication skills, self-confidence, and psychosocial development.

The Power of Physical Activity: More on Research Findings

1. Social Skills:

One of the most exciting findings is that physical activity can significantly improve social and communication skills in children with autism. A meta-analysis revealed that youth who participated in exercise programs, such as horseback riding, group play, running/jogging, and even exergaming (e.g., Nintendo Wii), showed notable gains in social interactions.

Sport activities offer a natural, low-pressure environment for children to practice social skills, such as taking turns, sharing, and communicating with peers. Additionally, activities involving animals (e.g., horseback riding) allow for both verbal and nonverbal interaction, providing a unique and enriching way to connect.

2. Fitness and Strength

It’s well-established that children with ASD tend to have lower levels of muscular strength and endurance compared to their typically developing peers. But regular participation in sport activities—such as gymnastics, swimming, climbing, and horseback riding—has shown to improve both strength and endurance. This is crucial not only for physical health but also for engaging in social activities that involve physical exertion, such as recreational sports or casual play.

3. Skill-Related Fitness

Children with NDDs often experience delays in skill-related fitness, including balance, coordination, visual-motor control, and other mobility skills. However, research indicates that various physical activities can enhance these skills. Activities like trampoline jumping, motor skill training (e.g., dance, badminton, ball throwing), cycling, swimming and skiing have proven beneficial for improving these motor skills, helping children gain more confidence in their physical abilities.

4. Motor Skills

Fundamental motor skills, such as running, throwing, and catching, are essential for many physical activities and social interactions. Exercise programs that focus on these skills have been shown to significantly improve motor abilities in children with autism, opening the door to greater participation in games, sports, and other social activities.

Swimming, gymnastics, aerobic exercises, strength training, and game-based activities have all been shown to significantly increase physical activity levels. Research indicates that these types of sports and exercises typically lead to improvements in several key areas, including maximum oxygen consumption, heart rate, upper and lower body strength, as well as optimal body weight and body fat percentage.

Moving with Purpose: Can We Tailor Physical Activity for neurodiverse Kids?

To be truly effective for children with NDDs, physical activity programs must be adapted to meet their unique needs. Tailoring these activities ensures that children are not only able to participate but can also benefit from the physical, social, and emotional advantages exercise offers (7). Here are three practical strategies for creating neurodiversity-friendly activities that are purposeful and engaging:

Supportive, Understanding Facilitators:

Physical activities should be led by coaches who understand how to communicate with and motivate children with special needs. While specialists in NDDs are always beneficial, it’s not always necessary—sometimes a peer tutor, another child or young adult who knows how to engage with your child, can be just as effective. A patient, empathetic and knowledgeable instructor can help make the child feel more comfortable, confident, and motivated to participate in physical activities.

Routine and Structure:

Children with ASD usually thrive on routine and predictability. To help make the activity purposeful, it’s important to incorporate a consistent structure into physical programs. A visual schedule can reinforce this routine, making the activity feel more manageable and predictable, which in turn supports the child’s engagement and enjoyment.

Visual Supports:

As visual learners, many children with autism benefit greatly from visual aids. Task cards, physical demonstrations, and video modeling can all enhance a child's understanding of the activity. These supports are especially useful when introducing new or unfamiliar exercises, helping to make the activity more accessible, engaging, and purposeful.

The Power of Basics.

Swimming and Gymnastics provide a solid athletic foundation that allows children to participate in a variety of sports. The skills developed in these these two sports—strength, flexibility, coordination, and mental toughness—are universal and can be applied to any athletic endeavor (8). This makes gymnastics and swimming ideal starting point for any child.

Swimming enhances cardiovascular fitness, coordination, and flexibility, while also fostering water safety awareness and confidence. It helps children develop strong core muscles, improve their breath control, and increase their overall endurance (9).

Gymnastics, on the other hand, is a dynamic sport that emphasizes balance, strength, agility, and flexibility. It encourages body awareness and spatial orientation, while also teaching discipline, focus, and perseverance (10).

Both sports require full-body movement, which supports motor skills, while simultaneously cultivating mental resilience and a strong sense of achievement. Together, swimming and gymnastics offer an integrative approach to addressing the unique needs of children with NDDs, providing a foundation for both physical health and emotional growth.

References:

Tanner, K., Schmidt, E., Martin, K., & Bassi, M. Interventions Within the Scope of Occupational Therapy Practice to Improve Motor Performance for Children Ages 0–5 Years: A Systematic Review. (2020) American Journal of Occupational Therapy, 74(2), 7402180060p1-7402180060p40. https://doi.org/10.5014/ajot.2020.039644
Bertilsson, I., Gard, G., & Sjödahl Hammarlund, C. Physiotherapists experiences of the meaning of movement quality in autism: a descriptive phenomenological study. (2020) Physiotherapy Theory and Practice, 38(2), 299–308. https://doi.org/10.1080/09593985.2020.1759166
Gladen, C. Physical Therapy for Autism: What Parents Need to Know. (2024) Retrieved from https://blueabatherapy.com/autism/physical-therapy-for-autism/
Bieleninik Ł, Gold C. Estimating Components and Costs of Standard Care for Children with Autism Spectrum Disorder in Europe from a Large International Sample. Brain Sciences. 2021; 11(3):340. https://doi.org/10.3390/brainsci11030340
Tse, A. C., Lee, P. H., Zhang, J., Chan, R. C., Ho, A. W., & Lai, E. W. Effects of exercise on sleep, melatonin level, and behavioral functioning in children with autism. (2022) Autism, 26(7), 1712-1722. https://doi.org/10.1177/13623613211062952
Hynes, J., Block, M. Effects of Physical Activity on Social, Behavioral, and Cognitive Skills in Children and Young Adults with Autism Spectrum Disorder: a Systematic Review of the Literature. (2023) Rev J Autism Dev Disord 10, 749–770. https://doi.org/10.1007/s40489-022-00319-5
Healy, S. Autism and exercise: Special benefits. https://www.autismspeaks.org/expert-opinion/autism-exercise-benefits
Candiri, B., Arikan, A.N., Colak, S.C. Balance and Physical Activity in Children with Neurodevelopmental Disorders. (2023) Current Researches in Health Sciences III, Chapter 10. DOI: https://doi.org/10.58830/ozgur.pub305.
Hosokawa, K., Yano, N., & Sumimoto, A. Scoping Review of Swimming and Aquatic Exercise Intervention Studies for Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder. (2024) International Journal of Sport and Health Science, 22(0), 86–96. https://doi.org/10.5432/ijshs.202324
Lourenço, C. C. V., Burhaeın, E., Phytanza, D. T. P., Coelho, E. Is There an Effect of the Trampoline Program for Autism Spectrum Disorder Children in Portugal? (2024) International Journal of Disabilities Sports and Health Sciences, 7(2), 458-468. https://doi.org/10.33438/ijdshs.1342102