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Clinical research: Toe walking in toddlers signals autism

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Jessica Wright
1 March 2011

Toeing the line: Many children with autism cannot easily flex their ankles past 90 degrees, causing them to walk on tiptoes.

Children who walk on their toes are more likely to have autism than other forms of developmental delay, according to a study published in January in The Journal of Child Neurology.

Many studies of children with autism report problems with gait, or alignment while walking. Of these, one of the most commonly
described is persistent toe walking — for longer than three months after learning to walk — and tight heel cords, which restrict ankles to a 90 degree angle.

Of 954 children referred to a developmental pediatrics clinic, 115 had at one time shown persistent toe walking and 75 still had tight heel cords.

The ratios are higher in the subset of children diagnosed with an autism spectrum disorder: of 324 children with autism, 65 had shown toe walking and 39 had tight heel cords.

The results suggest that children who persistently walk on their toes should be tested for autism. Likewise, children with autism should have their gait examined and be referred to physical therapy when appropriate.


Name: Rose Walker
13 March 2011 - 8:37AM

Yes...my son at 17 still toe-walks. He also is kind of a clod-hopper! It seems that his extremities have been affected by autism, and this is the way I see it...not a scientific, but an observing mind here!

Ben seemed to have a palsy in his hands, when holding a drink, it seemed he was "swishing" it until I realized he could not hold it steady at age 3. This later seemed to reiterate itself in the dysgraphia he suffers from that makes it laborious to write, which he seems to do sloppily, although he is as careful as he can be, if yo watch him. He does much better to type, and it is legible.

Does he have this same "palsy" in his feet, which affect his gait? The strength seems to be in his ankles/heels, and the lower foot seems a bit deadened, unless he is on his toes.

Thank you for what you do. I feel we are on the cusp of an answer.

Name: Rose
14 July 2014 - 2:59PM


Toe walking, autism and Ehlers Danlos Syndrome. I know 3 women with autism who have ED. One is quite famous and recently diagnosed. http://www.donnawilliams.net/359.0.html

I think this is one of the most important indicators of autism, and glad to see Sfari has 100+ search items on it. It used to be far less. I think there is too much emphasis on a language/eye gaze poor environment. I would bet one hundred dollars the current emphasis will lead nowhere.

It has been nearly 50 years ago that Dr. Rimland suggested autism was a neurological disease, but we still fight the shades of Bettlehiem in some researchers who believe it can be changed by environmental enrichment. I do believe in environmental enrichment, but it must be based on the needs of the child, not on what neurotypical children need. There is a very important difference. Constantly demanding eyegaze from an infant may be damaging to his psyche....haven't enough adult autistics said they find eye gaze painful, too sensorily stimulating?

Here again, rather than the suggestion of needed physical therapy, like the CP child whose tight heel cords return to the same tightness following surgery, we need to realize it is neurological, not physical. The brain tells the body (muscles) what to do, and it is an atypical message.

Let's pay attention to what the body is telling us about the brain, what the behavior tells us about the brain, and not demand "normal" gait or behavior.

Please read Paul Whitely's post in the first line. Here is a bit "I've talked previously on this blog about how the seminal 1943 paper from Kanner [2] contained so much more than just descriptions of the triad (now dyad) of behaviours which make up the clinical diagnosis of the condition (see here). Aspects which we have perhaps ignored for too long..."

He is one of few researchers who listens to parents. He seems to operate on the assumption he is here to learn, and not to be an expert.

Name: Rose
14 July 2014 - 3:01PM

OOPS, this might have been a better quote from Paul's paper:

"I found the Shetreat-Klein paper to be quite an intriguing read. Not only for the results obtained but because nestled in the paper introduction was reference to some of the original descriptions of autism by Leo Kanner, and how he "commented on the motor deficits in many of his patients"."

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