Physical Therapy for Autism: How It Helps With Movement, Balance and Everyday Play

Physical therapy for autism helps children build strength, balance, coordination and motor planning so they can move, play and take part in daily life more easily. A licensed physical therapist evaluates how your child moves, sets goals with your family and practices skills through play. Research on specific PT methods is still developing.

Maybe your child trips more than other kids their age, avoids the playground climber, or still finds jumping and catching hard. Maybe they walk on their toes, or their teacher mentions that gym class is a struggle. Movement differences like these are common in autism, and they're one of the reasons families start asking about physical therapy.

This guide explains what physical therapy for autism involves, what an evaluation looks like, what the research does and doesn't show, and how PT can work alongside ABA. For background on how autism can affect movement, see our article on autism and motor skills.

A quick note on who we are: Apex ABA Therapy provides applied behavior analysis (ABA). We don't provide physical therapy, but many of the children we work with also see a physical therapist, and we want you to have accurate information.

How Common Are Motor Challenges in Autism?

Motor differences aren't part of the diagnostic criteria for autism, but they show up often. A large study led by physical therapist and researcher Anjana Bhat used parent questionnaires for nearly 12,000 children ages 5 to 15 in the SPARK autism research cohort. It found that about 87% were likely to have motor difficulties. Only about 3 in 10 of the children were receiving physical therapy.

According to the American Physical Therapy Association's ChoosePT guide, common motor challenges in autism include:

• Limited coordination and postural control
• Difficulty planning movements and doing them in order
• Delays in large skills, such as walking, jumping and skipping, and small hand skills, such as buttoning
• Poor balance and unsteady walking
• Weaker eye-hand coordination
• Habitual toe walking

Some children have several of these, some have one, and some have none. If your child walks on their toes often, our article on autism and toe walking explains what it can mean. Motor planning challenges sometimes overlap with dyspraxia, which we cover in dyspraxia and autism.

What Does a Physical Therapist Do for an Autistic Child?

Physical therapists have specialized training in child development and how the body moves. The National Institute of Child Health and Human Development (NICHD) describes physical therapy for autism as activities and exercises that build motor skills and improve strength, posture and balance, with the goal of helping a child play more easily with other children.

The Evaluation

A PT starts with an evaluation. According to the ChoosePT guide, it usually includes your child's health and developmental history, plus a look at:

• Posture, mobility and balance
• Coordination and how your child plans movements
• Body and safety awareness
• Play skills and interests
• How your child moves between activities
• Daily routines at home and school

Goals and the Treatment Plan

From there, the therapist works with your family to set goals and build a plan. Good goals are tied to real life: climbing the playground ladder, keeping up in PE, riding a tricycle or getting on and off the school bus safely.

What Sessions Look Like

Physical therapy in autism treatment is usually built around play, because play keeps children engaged. The ChoosePT guide describes strategies such as consistent session routines, visual schedules, simple language, prompts and encouragement, and adjusting sensory input. Sessions might include:

• Obstacle courses for balance and motor planning
• Ball games for eye-hand coordination
• Jumping, hopping and climbing for strength
• Imitation games, such as copying the therapist's movements
• Practice for sports, PE or recess skills

The therapist tracks progress over time and adjusts the plan as your child grows.

What Does the Research Say?

Here's the honest picture. NICHD notes that there is not yet solid evidence that particular therapies can improve movement skills in autistic children. That doesn't mean physical therapy doesn't help. It means the research hasn't yet shown which specific methods work best for which children.

What is clear is that motor challenges are common and often go untreated, as the SPARK study found. For many families, the case for PT is practical: if movement difficulties make it harder for your child to play, stay safe or keep up at school, a physical therapist can assess them and work on specific goals.

Be cautious of any provider who promises a particular outcome. A good therapist will set measurable goals and show you how they're tracking progress.

How Physical Therapy and ABA Work Together

ABA and physical therapy are different services, delivered by different professionals. A physical therapist focuses on how the body moves. A behavior analyst focuses on learning and behavior, such as building skills, following routines and communicating needs.

They can complement each other in practical ways:

• Shared goals: If your PT is working on stairs or ball skills, your ABA team can build practice into daily routines.
• Following instructions and routines: ABA can help a child get comfortable with new activities, transitions and multi-step directions, which can make PT sessions smoother.
• Motivation: Both teams can use your child's interests to make practice something they want to do.
• Consistency: When therapists share notes, your child hears the same expectations in every setting.

Many families also use other therapies alongside PT. Occupational therapy often focuses on hand skills and daily tasks, and our guide to fine motor skills activities has ideas you can try at home. If your child loves music, music therapy and autism explains another option.

Apex provides in-home ABA therapy, which makes it easier to practice movement goals in the places your child actually uses them.

Building Movement Into Everyday Life

You don't need special equipment to support your child's motor skills at home:

• Head outside. Parks and playgrounds offer climbing, swinging and running without it feeling like practice. See the benefits of outdoor play for ideas.
• Make it a game. Animal walks, hopscotch and balloon volleyball all build coordination.
• Try a group activity. Swimming, dance or adaptive sports can build skills and friendships. Our list of recreational opportunities can help you find a fit.
• Keep it short and fun. A few minutes of movement, repeated often, usually works better than one long session.

If you'd like help building routines like these into your child's day, ask about parent training.

Frequently Asked Questions

Q: Does my child need a referral for physical therapy?

A: It depends on your state and your insurance plan. Some plans require a doctor's referral or prior authorization before covering PT. Call your insurer and ask, and talk with your pediatrician about your concerns.

Q: How do I find the right physical therapist?

A: Ask about the therapist's experience with autistic children. The APTA suggests looking for a pediatric specialist, such as a board-certified pediatric clinical specialist, and asking family, friends or other providers for referrals. The APTA's Find a PT directory can also help.

Q: At what age can a child start physical therapy?

A: There's no single starting age. Physical therapists work with infants, toddlers and older children. If you notice motor delays at any age, raise them with your pediatrician.

Q: Will physical therapy help with my child's social skills?

A: It may give your child more chances to play and join in, but research hasn't shown that PT directly improves social skills in autism. Focus on goals your PT can measure, such as balance, coordination or a specific playground skill.

Ready to Talk About ABA Therapy?

Physical therapy and ABA can work well together. If you're exploring ABA for your child in North Carolina, Georgia or Maryland, contact our team or call 888-690-0663 to talk through your child's needs and insurance options. You can also get a free consultation.

Sources

• American Physical Therapy Association (ChoosePT): Physical Therapy Guide to Autism Spectrum Disorder (author Anjana Bhat, PT, PhD; revised January 2024)
• NICHD: Physical Therapy for Autism
• SPARK: Motor Challenges Are Common in Autism, SPARK Study Confirms (summary of Bhat et al., Physical Therapy, 2020)