Babies with autism are thought to be late to meet physical milestones, such as pointing and sitting. But a new report finds that most babies with autism and intellectual disability take their first steps — a major motor milestone — on time or earlier than those with other conditions that affect cognition1.
Delayed walking has also been reported in other specific developmental disabilities, including autism spectrum disorder (ASD).
When combined with language delays, persistent toe-walking may be a sign of autism spectrum disorder (ASD), a neurodevelopmental condition marked by repetitive behaviors and difficulties with communication and social skills.
On the other hand, Damasio and Maurer (2) and Vilensky et al. (3) showed that autistic children between the ages of 3 and 10 walk somewhat like Parkinsonian adults in that they walk more slowly than normal, with shorter steps.
There may be some delays in spoken language or differences in how they interact with peers. However, children on the autism spectrum usually sit, crawl, and walk on time. So, the subtler differences in the development of gestures (pointing), pretend play and social language often go unnoticed by families and doctors.
Children with ASD tend to augment their walking stability with a reduced stride length, increased step width and therefore wider base of support, and increased time in the stance phase. Children with ASD have reduced range of motion at the ankle and knee during gait, with increased hip flexion.
Delayed walking is generally considered to be when a baby has not taken their first steps by 18 months of age. However, it is important to keep in mind that every baby develops at their own pace and some may take longer to reach this milestone.
By contrast, Rinehart says, children with autism tend to have a wide stance, and their stride length and width vary from step to step. These patterns may explain why some people with autism seem to have an unusual walking style — even if it's difficult to pinpoint exactly what's odd about their movements.
Late walking can also be associated with having low muscle tone or hypermobile joints. Other causes include neurological issues affecting muscle tone, inherited conditions affecting muscle strength or bones and hip joints, all of which may be identified earlier than 16 months old.
The findings may point to a unique developmental trajectory for children who have both autism and intellectual disability. About 97 percent of children will have begun walking by 16 months of age, according to the World Health Organization2.
In some cases, a child may appear to have clumsiness and awkwardness in doing normal activities like walking and running. Some children also have repetitive behaviors such as hand clapping, twisting, or twirling.
In the case of vocal stimming (or verbal stimming), the child might make noises such as groaning, grunting, high- pitched screeching, squealing, humming, or repeating random words, words to a familiar song, phrases, or lines from a movie.
The study brings hope to those parents who worry that children who are not talking by age 4 or 5 are unlikely to develop speech at all. Some children with ASD develop meaningful language after age 5. "There is a burst of kids in the 6- to 7- age range who do get language," Dr. Wodka said.
About stimming and autism
Stimming might include: hand and finger mannerisms – for example, finger-flicking and hand-flapping. unusual body movements – for example, rocking back and forth while sitting or standing. posturing – for example, holding hands or fingers out at an angle or arching the back while sitting.
Autistic children can have particular sleep and settling problems, including: irregular sleeping and waking patterns – for example, lying awake until very late or waking very early in the morning. sleeping much less than expected for their age, or being awake for more than an hour during the night.
Children with ASD often have problems with their feet and ankles. Some of the common problems that podiatrists help with in children with ASD are sensation issues, such as not being able to feel pain in the feet; and alignment issues, such as toe walking (tip-toeing) or flat feet.
Relation to Autism
However, in 2019 a large-scale review of trends and treatment patterns found that 9% of children with ASD are diagnosed with persistent/idiopathic toe walking compared to less than 0.5% of children without an autism diagnosis (Leyden et al., 2019).
The tilting test can be used as an early indicator for possible autism or Asperger's. At 6–8 months a typically developed infant maintains his/her head vertical as the body is being tilted (A–C). A negative response is evident when the infant carries the head in line with the rest of the tilted body (D).
Babies usually start walking sometime between about 10 and 18 months old. Before walking, babies will usually have been crawling (between 7 and 12 months) and pulling themselves up to stand (usually between ages 9 and 12 months).
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.
Children who have an autism diagnosis may toe walk as they have sensory difficulties. Some children with autism spectrum disorder experience a feeling of discomfort in certain areas of the feet when they touch the ground.