Tiptoe Walking and Autism
Persistent toe walking in autism
"The incidence of persistent toe walking (20.1%) and tight heel cords (12.0%) were found to be higher in 324 children with an autistic spectrum disorder but lower (10.0%/3.0%) in 30 children with Asperger syndrome."
Source: Barrow WJ, Jaworski M, Accardo PJ. (2011) Persistent toe walking in autism. Journal of Child Neurology. May;26(5):619-21.
Although tiptoe walking is not uncommon in children with autism, not all children with autism display this symptom. Also, not all tiptoe walkers have autism.
Sensory Integration and a Dysfunctional Vestibular System
Tip toe walking may be related to sensory issues and a dysfunctional vestibular system. Let me simplify this complex system with a brief lesson in sensory integration.
- Sensory integration is the communication of sensory stimulation from the environment to the brain.
- Sensory integration primarily focuses on three sensory systems - tactile, vestibular, and proprioceptive
With sensory integration in mind, consider the sensory issues that are common in children with autism. Here are a few examples -
- It is not uncommon for them to be sensitive to flickering or fluorescent lights (sight)
- To cover their ears due to a loud noise or sudden sound (hearing)
- To be sensitive to certain clothing or textures (touch)
- To smell food prior to tasting or eating (smell)
- To resist unfamiliar foods (taste)
Let's look at the three primary systems of sensory integration: tactile, vestibular, and proprioceptive.
- Tactile - through nerves under the skin one feels touch, pain, temperature, and pressure
- Vestibular - refers to structures within the inner ear. These structures detect movement and changes in the position of the upper body - primarily the head.
- Proprioceptive - refers to the combination of muscles, joints, and tendons that provide a person with a subconscious awareness of body position. This system helps you identify where to step on a ladder, where to sit on a chair or reach for a glass when not looking. Basically it is a spatial awareness of your body within its surroundings.
"A dysfunctional vestibular system, a common problem in autism, may be responsible for toe walking. The vestibular system provides the brain with feedback regarding body motion and position. It may be possible to reduce or eliminate toe walking by providing the person with therapeutic vestibular stimulation (e.g., being swung on a glider swing)." - Stephen M. Edelson, Ph.D.
As a researcher and a parent of a child in the spectrum I find Edelson's interpretation intriguing. Although my son did not display persistent tip toe walking he has displayed several other sensory issues. One of his favorite forms of play as a toddler was for me to rock him back and forth. We would both lie on the bed and he would lie on top of me. He would have me hug him tightly and quickly rock him from side to side. I noticed this activity greatly calmed him and seemed to reduce the more negative symptoms of autism. Interestingly, this motion of swinging or gliding was considered therapeutic by Edelson.
Understanding sensory integration does lead to a greater comprehension of the sensory reactions and physical outcomes our children display. It also supports symptoms such as tip toe walking are potential responses to an impaired vestibular system. Continued research is needed for effective therapies as well as for a potential cure for these impairments.
Interventions for reducing tip toe walking
These interventions may not be considered conventional by some, but have been found to be beneficial by others. Use your own due diligence when choosing alternative methods of therapy. Consider discussing the following therapies with your physician and therapist.
- Improve flexibility through stretching - The tendon is usually tight in those that tip toe walk. Flexibility exercises may help lengthen this area making it easier for walking from the heel to toe. Stretching the calf may also help alleviate tightness from toe walking.
- Swinging and rocking - Edelson suggests this activity helps improve vestibular functions.
- Vision Therapy and prism lenses - Prism lenses displace the person’s field of vision up, down, left or right. It has been reported that this has induced immediate heel walking while wearing the lenses.
The first two interventions can be easily practiced through exercise and play. Vision therapy would require a visit with an optometrist. Be sure to find an optometrist that practices vision therapy. Discuss experience with using prism lenses as a therapy for reducing tip toe walking. Consider the visual strain and long term effects this may cause. Prism in a lens basically moves the true optical center of the lens away from the view of the natural eye. Due diligence is strongly suggested.
Resources
- Sensory Integration Cindy Hatch-Rasmussen, M.A. legacy.autism.com
- Toe Walking - Dysfunctional Vestibular System Written by Stephen M. Edelson, Ph.D. legacy.autism.com
Further Reading
To learn more about my journey with my autistic son, you may read my article: Autism in Children: Raising an Autistic Child
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2012 Marisa Hammond Olivares
Comments
my daughter is 15 and still walks on her toes. We have been through casting, physical therapy, and stretching activities at home when she was little but nothing has worked. She can walk heel to toe but only for a little bit and resorts back to toes. It doesn't seem to bother her and surprisingly she hasn't complained about anyone at school saying anything about it. I'm not sure if this is a sensory thing or just out of habit at this point. My question is this, "Is it too late for her?" I should have done more research when she was younger.
Great article! Very informative!
- AUTHOR
justateacher, this comment slipped away from me. Thank you so much for reading and commenting. Two of my students in the spectrum this past year were toe walkers. Interesting clues and symptoms. Science and research will never cease to amaze me. Yes, our campus therapists definitely need refreshers as new therapies are introduced.
Thanks for the votes and the shares
Miss Olive- Thank you for sharing this! I have a student with autism and have noticed that he is a toe walker. I am very aware of sensory issues with children in the spectrum and try to include sensory integration daily with those students. I would LOVE to hear more ways to do this!!!! Our OT at the school knows very little about it and I am having difficulty finding new ways that work! Voted up and sharing all around!
- AUTHOR
Happyboomernurse, as moms we always want to comfort our children and keep them happy. Isn't it interesting how rocking/swinging turned out to be a natural therapy or treatment? Thank you for your votes of support and for your great comment.
homesteadbound, thank you Cindy. I'll do my best
B.Leekley, Thank you for sharing this. I greatly appreciate it and thank you for providing an additional source of information.
Teresa Coppens, thank you. This was one of those pieces of information that made me go hmmmmmm. I'm sure now that you see some of the children on tip toes you do the same. Thank you for stopping by to read.
kelleyward, wow, that makes me feel great. I'm glad I was able to provide some insight for you. I'm happy you came by to read and comment.
Cyber Scribe, that is really neat how the heelys helped alleviate her tip toe walking. That was a great and FUN idea. Thanks for sharing.
My daughter does not have autism, but she is a toe walker. She had years of therapy but nothing fixed it. Then I bought her some heelys (shoes with one wheel on the back). Now she wheels everywhere instead of going on tippy toes.
I didn't know about this and as a nurse and mother to three boys the information you provided is very important information. Voted up and shared! Take care, Kelley
Well written Marissa. I work with many children in the CASA rooms of our local schools. Some do show this tendency to tip toe walk. But not all of them do so. So much information is presented in all of your autism hubs for those parents with such special children. Thanks for sharing your expertise!
I shared this informative article. An auditory sensitivity therapy that I've heard of is Berard's Auditory Integration Training. http://www.drguyberard.com/
What a great article that provides options for someone with a child who has autism to ponder, consider and investigate. Keep up the good work.
Well written, informative hub about an important topic. I was touched by the fact that with your own son you instinctively did some of the things recommended in this hub.
Thanks for sharing this information on HubPages.
Voted up, useful, awesome, beautiful and interesting.
The way you write about autism brings hope and knowledge to other parents who have children with this disorder.
- AUTHOR
Ardie - Thank you for sharing that with me. Different families handle the reality of autism in different ways - it is not always easy. I'm glad my autism hubs have helped you in some shape or form.
Pamela n Red - Isn't it interesting how these childhood signs are now turning up to be possible symptoms? My son was fascinated by ceiling fans as a child and even sleeps with a somewhat noisy bedside fan at night - surprises me at times. What may seem bothersome for some may not be a problem for others. I have a student with Asperger's that refuses to sit at any desk that is directly under one of the lights.
Sunnie Day - Thank you for coming by. I'm starting to pay closer attention to students in the spectrum and finding more similarities. Tip toe walking isn't always present, but it is surely not uncommon. Thank you for your support. :)
Lord - Thank you! From your mouth to heaven. A cure would be a real blessing for many - a miracle no less. Researching all these aspects of autism has taught me so much. I'm glad to share what I am learning with you and others. May God Bless you and yours as well.
Gypsy Rose Lee - I appreciate you sharing this, thank you
alissaroberts - Thank you for sharing Alissa. I appreciate that. Thanks for the votes and social network sharing too.
HawaiiHeart - I totally understand how you feel. As the years have passed I have continued to do my own research into autism. Many times I will come across something that I wish I would have known during his early years. Best wishes to you and your son.
Very interesting. I can't remember if my son walked on his tip toes. So many things I know now I wish I knew when my son was little so he would've gotten the help he needed earlier.
This amazing collection of Autism hubs will help so many others out there. I have a friend who will greatly benefit from reading your hubs and will be passing these on to her to read. Thank you for sharing your experience with your son - voted up and socially sharing!
Voted up and interesting. This is a subject I know very little about but I do know a friend of mine in Canada has a wonderful little boy with autism. Passing this on. Thanks for sharing.
Amazed to learn more about this Vestibular process from the brain and stability in the kid's ear. Wsn't aware of vision therapy and prisms. There is so much to learn Marissa, if we join in the effort, a cure will be found one day. God bless Tony and you!
LORD
Great information Marisa. I have noticed the toe walking in many children with a form of Autism. I know this information will help many.Thank you for a great hub!
Great information. I know someone who did this when he was a boy and has autism.
My daughter has Aspergers and can't take some sensory things like electric guitars and ceiling fans.
MO - thank you for sharing this information. My niece has autism and I don't know a whole lot about it - only what I read since the family chooses NOT to talk about it. I appreciate all the articles you put together to educate other people.
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