Pediatric Physical Therapy:
Section Editor(s): Van Sant, Ann F. PT, PhD, FAPTA; Editor-in-Chief
The first 3 articles in this issue are focused on autism spectrum disorder (ASD). These articles lay out both opportunities and challenges for pediatric physical therapy. As therapists, our primary concern rightfully should be the movement disorders that accompany ASD. To that end, each of us should read and contemplate the work done by Downey and Rapport1 in their systematic review of literature on motor activity in ADS. In the literature they reviewed, they found slowing of motor development, difficulty with motor imitation and gesturing, postural control and coordination difficulties, and dyspraxia. However, at times these reports present conflicting evidence. In addition to the activity limitations presented in this review, it is also well known that children with ASD demonstrate repetitive, stereotypic, and sometimes self-injurious motor behaviors. Further, physical therapists seem to be ideally placed to carefully document and identify the clusters of movement system impairments that present in children with autism. Indeed, that would be an important opportunity and challenge that may lead to movement system diagnoses. I believe that movement system diagnoses are needed for clear communication and ultimately to guide interventions in a manner that allows us to determine the effectiveness of physical therapy for this population of children.
In the second article, Lane, Harpster, and Heathcock2 point out another opportunity and challenge. After studying the results of testing children referred to an autism clinic using the Bayley III, they describe the findings of gross motor developmental delay of about 6 months in this sample of children, but they note that the Bayley III did not discriminate between those who ultimately received a diagnosis of ASD and those children who did not. This finding poses the challenge and opportunity to develop tests and measures that will be sensitive to the array of motor disorders that present in children with ASD.
The last article in this series is by Mieres and her colleagues,3 who advocate for physical therapists taking a more prominent role in serving the needs of children with ASD. With this opportunity comes the recognition that ASD has been considered primarily a cognitive and social disorder. The movement system impairments have been seen as secondary, and thus the challenge to carefully describe the motor disorders associated with ASD and develop tests that are sensitive to the specific motor signs of children with ASD, should be followed by exploration of the relationships between the motor disorders and those in the social and cognitive domains. Downey and Rapport have rightfully suggested that we need to examine the effect of these movement impairments on children's functional activity. Ideally, treatment by physical therapists would affect not only the motor impairments but also the children's overall function. Clearly a very rich opportunity and mighty challenge lies ahead.
Ann F. Van Sant, PT, PhD, FAPTA
1. Downey R, Rapport MJK. Motor activity in children with autism: A review of current literature. Pediatr Phys Ther. 2012;24(1):2–20.
2. Lane A, Harpster K, Heathcock J. Motor characteristics of young children referred for possible autism spectrum disorder. Pediatr Phys Ther. 2012;24(1):21–30.
3. Mieres AC, Kirby RS, Armstrong K, Murphy T, Grossman L. Autism spectrum disorder: an emerging opportunity for physical therapy. Pediatr Phys Ther. 2012;24(1):31–37.
© 2012 Lippincott Williams & Wilkins, Inc.