Tag Archives: Autism

The World is “Lighting Up Blue” for World Autism Month

By: Laura Bueche MOT OTR/L

Every April 2, in conjunction with the international autism community, Autism Speaks spreads awareness of autism spectrum disorder with its Light It Up Blue Campaign. Thousands of organizations around the world, such as Easter Seals DuPage & Fox Valley participate in this event to spread education, resources, and awareness for greater understanding and acceptance of Austism Spectrum Disorder (ASD).

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What is Autism Spectrum Disorder?

Autism, also known as autism spectrum disorder (ASD), is a neurodevelopment disorder. It refers to a wide range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and non-verbal communication. The Term “spectrum”
reflects the wide variation in challenges and strengths possessed by each person with autism.
https://www.autismspeaks.org/what-autism

08_Kai_JudyThere is no known single cause of autism, but increased awareness and early diagnosis/intervention and access to appropriate services/supports lead to significantly improved outcomes.

In 2016, the Centers for Disease Control and Prevention issued their ADDM autism prevalence report. The report concluded that the prevalence of autism had risen to 1 in every 68 births in the United States – nearly twice as great as the 2004 rate of 1 in 125 – and almost 1 in 54 boys.
http://www.autism-society.org/what-is/

Signs and Symptoms

People with ASD often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with ASD also have different ways of learning, paying attention, or reacting to things. Signs of ASD begin during early childhood and typically last throughout a person’s life.

Children or adults with ASD might:

  • not point at objects to show interest (for example, not point at an airplane flying overhead)
  • not look at objects when another person points at them
  • have trouble relating to others or not have an interest in other people at all
  • avoid eye contact and want to be alone
  • have trouble understanding other people’s feelings or talking about their own feelings
  • prefer not to be held or cuddled, or might cuddle only when they waAutism Diagnostic Clinic 2 - Richard Howent to
  • appear to be unaware when people talk to them, but respond to other sounds
  • be very interested in people, but not know how to talk, play, or relate to them
  • repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language
  • have trouble expressing their needs using typical words or motions
  • not play “pretend” games (for example, not pretend to feed a doll)
  • repeat actions over and over again
  • have trouble adapting when a routine changes
  • have unusual reactions to the way things smell, taste, look, feel, or sound
  • lose skills they once had (for example, stop saying words they were using)

https://www.cdc.gov/ncbddd/autism/facts.html

Meet Some People With Autism

Pierre https://www.youtube.com/watch?v=fnCzF2JdDWM

Max https://www.youtube.com/watch?v=IA5FHPUeWpQ

Lesey https://www.youtube.com/watch?v=GWPf9toT_3M

Cullen https://www.youtube.com/watch?v=EryEs1gIu4s

Ellie https://www.youtube.com/watch?v=56VCxks8jGA

Autism Diagnostic Clinic at Easter Seals DuPage & Fox Valley

Early detection and intervention is the best way to help children with Autism Spectrum Disorders and other developmental disabilities gain greater independence.  If you are concerned about your child’s development inquire about our medical diagnostic and autism diagnostic clinics.

Additional Services at Easter Seals DuPage & Fox Valley for Children & Young Adults with Autism Include:

  • Occupational therapy to learn daily life skills and help integrate sensory processing difficulties
  • Physical therapy to improve strength, endurance, and gait
  • Speech therapy to help children with ASD improve speech, articulation, language , and interaction
  • Assistive technology to give children a way to access language through technology devices
  • Social Work services to support families and provide behavior strategies
  • Parent Liaison services also offers parents support and are full of great recourses
  • Case Management services to help coordinate this complex network of caregivers and providers
  • Feeding Clinic and Nutrition Therapy provide families with feeding, digestive, allergy, food sensitivity, GI, and sensory related issues.
  • Easter Seals also offers families a variety of community outreach programs including: social groups, physical fitness groups, feeding groups, and aquatics.

To learn more about Easter Seals DuPage & Fox Valley’s Autism services visit our website.

A Super Sensory Summer

By: Laura Bueche MOT OTR/L

Summertime is the best time for some creative sensory play outside. Your child will have a blast learning and exploring with these sensory summer activities that won’t break the bank.

IDEAS TO INSPIRE YOUR LITTLE SPROUT

Garden Party!

Fill a tub with soil. Hide plastic bugs, coins, or dinosaurs.
Use shovels or hands to find the treasures.

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Paint pots, plant seeds and watch them grow.
Overturn rocks to search for bugs and worms… or play with fake worms. Recipe here.

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Photo Credit: Learning4kids.net

Is real mud a difficult texture for your little one?  Start with “ghost mud”.
Recipe here

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Photo Credit: TreeHouseTV.com

Make a Splash with these Water Activities

Water Fun!

Fill a tub with water beads and ocean animals for an awesome, hands-on aquarium.

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Freeze toy animals, foam puzzle pieces, or pretend jewelry in ice. Have your kiddos use squeeze bottles, and eye droppers of warm water to get them out. Instructions here.

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Photo Credit: LittleBinsForLittlehands.com

Green gross swamp sensory table. Recipe here.

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Photo Credit: NoTimeForFlashCards.com

 

 

 

 

 

 

 

Shaving Cream Car wash. Recipe here.

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Photo Credit: TreeHouseTV.com

 

 

 

 

 

 

 

Let’s go to the Beach!

Feel the sand between your toes with these fun tactile activities.

Sand Slime. It’s ooey, it’s gooey…and sandy? Recipe: Here

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Photo Credit: GrowingAJeweledRose.com

 

 

 

 

 

 

 

Drawing letters in the sand, a perfect pairing of visual motor and tactile. Recipe here.

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Photo Credit: AnyGivenMoment.com

 

 

 

 

 

 

 

Kinetic Sand…semi sticky, and super moldable sand. Get it here.

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Good old sand box play…because nothing beats the classic, pale and shovel.

For more summer sensory ideas, or ways to adapt these activities to your child’s needs and goals, ask your occupational therapist at Easterseals DuPage & Fox Valley. For more information about occupational therapy visit our website.

Have a great summer!

 

Toe Walking in Toddlers…is it Normal?

By: Bridget Hobbs, PT, DPT

Walking on the balls of the feet or “toe-walking”, is quite common in children just learning to walk. The good news is that many children out-grow it within a few months of walking.  However, if your child is toe-walking beyond the age of 2, it is worth talking to your pediatrician about it, as there may be an underlying cause associated with this.

There are a few main reasons why children toe-walk:

  • Shortened Achilles tendon

A shortened Achilles tendon (bottom part of the calf) can cause less flexibility at the ankle, making it more difficult for a child to get his heel down when walking.  When this is thetoe walk case, physical therapy can help stretch the calf muscle group and strengthen muscles in the core and front part of the lower leg. This therapy can help the child learn to walk with a more typical “heel to toe” walking pattern.  Sometimes your therapist will recommend a brace to wear during the day and/or at night in order to help get a child’s heel down when walking and stretch the Achilles tendon at night.  In some cases, a series of casts may be used to help gain range of motion at the ankle.  Surgery may be recommended for correction in rare cases or when “toe-walking” persists into later childhood.

  • Sensory Processing

“Toe- walking” can also be a sensory-seeking behavior. Children who need more proprioceptive input will lock their knees and ankles. Children may also lock these joints to feel more stable and better prepare them for physical activities, such as running. Some children walk on their toes as they are hypersensitive to different textures or temperatures on the floor. “Toe-walking” can become a habit and if done frequently, can lead to tight Achilles tendons. This is why, if you or your pediatrician feel like your child has sensory concerns, that they are evaluated by an occupational therapist to help with strategies.

  • Underlying Medical Diagnosis

If “toe- walking” persists beyond the age of 2 or if it is accompanied by muscle stiffness, difficulty with communication or language delays, coordination problems, or if your child toe-walks just on one side, it is a good idea to speak with your pediatrician about it so you can find out if there is an under-lying cause.  Diagnoses including Cerebral Palsy, Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie Tooth and Tethered Cord have all been linked with early “toe-walking”. Some (but not all) children with Autism and other Pervasive Development Disorders (PDD) have also been noted to toe-walk.Caroline-PE Selected Photo

  • Idiopathic “Toe-Walking”

Idiopathic “toe-walking” is used to describe a child who toe-walks without any known reason.  Children who walk on their toes may have frequent falls, lean more forward when they walk, and show more difficulty with balance. “Toe-walking” may also be hereditary, where more than one child in the family toe-walks.   Early recognition and intervention is fundamental to prevent a shortened calf muscle and help develop a normal walking pattern and balance reactions.

Many children “toe-walk” as they learn to walk, and with a proper heel-to-toe walking pattern, they learn fairly quickly. However, if you are concerned that your child is toe-walking beyond the age of 2, or is showing other difficulties with development, it is important to speak with your pediatrician.  They may refer you to a physical or occupational therapist who can further assist you and your child.

Learn more about Physical Therapy services at Easter Seals DuPage & Fox Valley: http://eastersealsdfvr.org/physical.therapy.

Sensory Regulation, What Is It?

By Maureen Karwowski, OT

As I sit at my desk typing this blog on my laptop, I am regulated enough to focus on this task.  I am able to filter out the sounds of the lights buzzing, my coworkers typing, the feeling of my clothing, and the light coming in from the window beside me.  I will admit that some times I am able to do this, and not others.  For a child with sensory processing challenges, the interpretation and responses to the  sensory experiences I described can be ineffective.  These ineffective responses can impact a child’s overall regulation and can affect many areas of development.  It is estimated 01_Mason Esquivelthat 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).

I have worked with many children with sensory processing challenges as a pediatric occupational therapist.  I know from my work that every person presents with their own unique sensory profile.  Since every child is so unique, I am required to closely assess each client to be sure that I understand where their challenges are and what I can do to assist them.  A skilled occupational therapist will use a variety of assessments, some are standardized evaluations, and others are from observations of the child.  A thorough assessment will address three areas of sensory processing: sensory regulation, sensory modulation, and sensory discrimination.  Today’s topic is sensory regulation.

Sensory regulation refers to a person’s ability to keep their arousal at the right level for the situation.  Adequate self-regulation is essential to the development of attention, regulation of sleep/wake cycles, control of emotions, as well as the daily transitions that make up a child’s routine.  Sensory regulation is necessary for social interactions and learning.

One of my clients, who has significant challenges with this skill described a story about how at school, he loves to run around on the playground at recess.  He told me that the problem is that all of the other kids can slow down after recess, line up and then go back into school.

“I get so revved up that I can’t control myself anymore.”10_Logan

His teachers stated that he ran into the building, bumping into other kids at times, and did not respond to verbal directions.  This is a great example of how regulation issues can impact transitions and school.  This story ends well for this little boy.  His mother and I worked together and identified what were the factors that were impacting his regulation challenges.  For this boy, he was sensitive to movement and visual input.  He was correct in his statement that running around on the playground “revved” him up.  In occupational therapy sessions, and at home with his parents, we worked to address his challenges with movement and with visual input.  This in turn assisted him with his transition from running around to lining up to go back inside the school much easier.  We also worked on using some “tools” to help him with this transition, such as being given an earlier warning than the other kids from the teacher, he blew the whistle which gave him a chance to take a deep breath, and was in charge of carrying the bin of recess equipment into school which gave him some heavy work.

We all have strategies that assist us in keeping our arousal level where they need to be.  People chew gum, drink coffee, fiddle with objects, all in an effort to keep alert.  We also have strategies to calm ourselves down such as deep breaths, working out, knitting, herbal tea.  It is very important for children with sensory regulation challenges that we identify what are the regulating strategies that they can use to assist them.  Something as simple as chair pushups, sucking on a piece of candy, squeezing a stress ball, or rocking in a rocking chair can be useful.  It is important to customize these strategies to your child, as everyone responds differently.

I find that my occupational therapy sessions are the most effective when the parents and I are working together to identify the child’s sensory processing challenges and how those challenges are impacting daily life.

Stay tuned, as my next blog post will discuss sensory modulation.  Sensory modulation is the amount of sensitivity a person experiences towards a sensory experience.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

How to Talk With Your Child About Their Disability

By: Susan Diver, MSW, LSW

I have been working with families and children with disabilities for more years than I care to admit.  It is a great job that I love very much.  The best days are when you feel like you have made just the smallest difference in the life of a child, a sibling or a parent.  I talk to parents every day about a large variety of topics dealing with their children; potty training, behavior, siblings, school, anxiety, bullying, respite, the list goes on and on.  If I was to address every topic that caused a family to be stressed, this blog would turn into a very long research project.  For today, I am going to talk about a topic that parent of children with a disability often ask me, “how do I talk to my child about their disability?”

You know your child the best; you understand their many moods and your strong personality will get you through a difficult but necessary conversation.  So put on your gym shoes and jump right in and get started.

Here are a few suggestions to remember when you have that conversation with your child about their disability:

  • Think about your child’s cognitive level, start there.
  • Be comfortable in what you are saying, rehearse, practice, talk it thru several times before talking to your child.
  • Be honest!  My Grandmother told me, if you always tell the truth, you’ll never have to remember the story you told and tell it again, stick with the truth, it’s safe, easy and there is nothing to remember. if you always tell the truth, you’ll
  • Be Consistent…….once you have decided on what to say, how to say it, always use the same story, wordage to talk to your child.
  • Be strong!  You cannot be sad, cry or talk about how bad you feel.  You are simply telling your child what is their disability.  The stronger you are, the stronger they are!  The more positive you are about who your child is, the more positive they will see themselves.
  • Check your guilt at the door!  You cannot use this as a time to relieve your guilt about your child’s disability, this is a time that it’s not about you, it is about your child!
  • Pick teachable moments; when your child brings up the topic, when a question is ask, when he’s in the back seat of the car, when something has happened at school or a party.  But make it when your child is calm, not upset or crying.  This is not a good time, when your child is upset, just like you; they won’t hear you or what you are saying.
  • Follow your child’s lead-Long before they ask you about being different, they will know they are different!  Use questions to see what they know, what they have overheard, what they understand.
  • Try to talk when your child is alone.  You will know their cognitive level, what they understand, how best to talk to them, a sibling or other family member may have a higher or lower level of understanding and they will ask too many questions that will interfere with your talk.
  • Be ready…the time will come that your child will ask, “why am I different,”  “why can’t I run like Billy?”  It’s coming, so the sooner you are ready, the better prepared you will be!

Siblings will want to know too! Use the same skills we’ve just talked about, use the same “story” you have used with your child.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

Why Swimming is a Great Sport for Children and Adults with an Autism Spectrum Disorder

By: Bridget Hobbs, PT, DPT

Photo by Joann Hartley
Photo by Joann Hartley

With April being Autism Awareness Month, I wanted to shed some light on providing physical fitness to children and adults with autism spectrum disorders.  According to the newest statistics from the Centers for Disease Control and Prevention, 1 in 68 US children have been diagnosed with an autism spectrum disorder.  As an aquatic therapy instructor, I have seen tremendous improvements in physical fitness level, behavior and survival skills in children with autism in the aquatic environment.  Here are some reasons why children and adults with autism thrive in the aquatic setting.

  • Swimming is a life-saving skill. Because children with autism have an increased rate of wandering off, drowning in a near-by lake or pool is a concern.  Swimming incorporates techniques such as floating and treading water so a child would be able to get out of a potential life-threatening situation.
  • Water provides an excellent sensory experience. The resistive and buoyant properties of water make it a very calming environment for children with autism.  Undesired behaviors are often reduced in the aquatic setting and children are more grounded by the water.  Even children that have aversions to textures such as grass and sand will likely feel more at peace in the water.

    Photo by Julie Hermes
    Photo by Julie Hermes
  • Swimming is an excellent aerobic activity. Children with autism are at a higher risk for obesity.  According to a report published in the July-August issue of American Pediatrics, at least one in every three children and adolescents with autism is overweight or obese.  Getting children moving is key, and if they are in an environment they can enjoy, such as the pool, the easier it is to motivate them to get their bodies working.
  • Because many children with autism have difficulty with motor planning and coordination, swimming is a great way for children with autism to work on activities such as: reciprocating both sides of the body, timing of breathing, core and extremity strengthening. These skills transfer well to land-based activities such as throwing, catching and running.
  • Swimming is social! Often times, jumping in the water or swimming the length of the pool can help induce talking in children that are limited verbally.  Kids can also learn a lot from watching each other and can encourage them to try a new skill in the water.

If a more structured swim team would be too much for your child, look into aquatic therapy. The physical and occupational therapy teams at Easter Seals provide aquatic therapy for children with special needs twice a week at local pools.  Please call Easter Seals at 630-620-4433 for more information.

References:

Broder-Fingert S. et al. Acad. Pediatr. 14, 408-414 (2014) PubMed

American Academy of Pediatrics http://www.aap.org

 For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

Keeping your Wandering Child Safe

By: Cara Long, Parent Liaison

For years I have worried about my daughter, who is non-verbal and has Down syndrome, wandering from our home – and I know that I am not alone!  A 2011 study conducted by the Interactive Autism Network found that nearly half (or 49% of children with autism) attempted to elope from a safe environment, a rate nearly four times higher than their unaffected siblings.  In addition, wandering is ranked among the most stressful behaviors by parents of children with autism who wander.                                                                                                              Caregiver toolkit

Thankfully, my daughter has always returned safely, but sadly that is not always the case.  According to the National Autism Association, between 2009 through 2011, accidental drowning accounted for 91% of the total U.S. deaths reported in children with autism ages 14 and younger subsequent to wandering.  Two out of three parents of wanderers reported that their missing children had a “close call” with a traffic injury with 32% having a “close call” with drowning.

The Interactive Autism Network study also found that more than 1/3 of children with autism who wander are never or rarely able to communicate their name, address or phone number.   These children should wear/carry some type of ID.  There are a number of great products available — bracelets, anklets, necklaces, shoe or jacket tags, ID cards, clothing labels, permanent ink ID on t-shirts or undergarments are all good options.

ProductSquare-SPORT-v2-gray-blueSome products to consider include:  RoadID.com, medicalert.org or MyIDsport.com.  However, in order for an ID to be useful, parents must consider what is best for their child.  Parents must take into consideration the specific needs of their child, including sensory issues.  If the child will remove a bracelet/necklace or anklet, it is obviously not a good choice.   When my daughter wandered away, she left the house without her shoes (which included an ID tag), and her communication device (which also contained personal information). An innovative option is the use of prepared washable tattoos that bear ID information, Tattoos with a Purpose.  In order for an ID to be effective, parents must consider the unique needs of their child when choosing an appropriate ID.

The Autism Wandering Awareness Alerts Response and Education (AWAARE) collaboration, whose mission it is to prevent autism-related wandering incidents and deaths, has some wonderful information and resources for parents.  Their Autism-Wandering Prevention Brochure covers information about securing your home including installing locks, alarms and stop signs (as a visual prompt) on all doors and windows.  It also emphasizes the importance of teaching your child how to swim and even practicing with shoes and clothes on.  Although they are quick to point out that knowing how to swim DOES NOT ENSURE that your child will be safe in the water.  The brochure also provides information and resources on tracking devices, and how to alert and educate your neighbors and first-responders about your child.

AWAARE’s Big Red Safety Toolkit includes toolkits for both care-givers and first responders. bigredsafetyboxlogoonly

Their Caregiver Toolkit includes:

  • Family Wandering Emergency Plan (FWEP)
  • First-responder profile form
  • Swimming Lessons Tool
  • Root-cause Scenario & Strategies Tool
  • Stop Sign Prompts
  • Social Stories
  • Caregiver Log
  • Sample IEP Letter   (Never allow restraint/seclusion practices into any IEP)
  • How to Get Tracking Technology in Your Town
  • General Awareness Letter to share with schools, homeowners’ associations, law enforcement
  • Five Affordable Safety Tools
  • Caregiver Resources One-sheeter

The First Responder Toolkit is something that should be shared with first responders in your area prior to any wandering incident.  It includes basic information on autism, wandering, checklists, resources and tips on how to interact with a missing child with autism once found. It is very important that first responders understand that children with autism have a decreased sense of fear causing them to engage in high-risk behaviors such as seeking water, active road ways, heavy equipment or railroad tracks.  Responders must also be made aware that the missing child may not be able to respond to the rescuer and may, in fact, run and hide from rescue teams.  Every effort should be made to educate all children to “go to” police or other uniformed first-responders.  As children get older, parents should be aware that wandering can also lead to high-risk contacts with law enforcement or members of the general public.

Please take the time to visit the AWAARE website to learn more.  Hopefully, by becoming more educated on this issue and instituting these strategies, you can decrease the risks associated with your child wandering, and maybe even decrease your stress level a little.

Parents can receive a 25% discount at MyIDSport.com by entering promo code carlon15 at checkout.

 *  The links mentioned in this article are offered by the manufacturer to the consumer.  Easter Seals DuPage & Fox Valley does not endorse nor support the content of third-party links, benefit from this linkage and is not responsible for the content of a third-party web site.

 For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.

The Benefits of Exercise in Children with Autism Spectrum Disorders

Blog by Bridget Hobbs, PT, DPT

1 in 68. Most of us have heard this statistic in the news recently. The latest research from the CDC indicates that this is the prevalence of autism spectrum disorders, or ASD, in America’s youth. Because April is Autism Awareness Month, I wanted to shed some light on a topic that often may be overlooked, which is how physical activity can have such a positive influence on the quality of life in children with ASD.

Autism Diagnostic Clinic 2 - Richard Howe

According to Curtin et al., 16% of children ages 6-19 are overweight, whereas the prevalence of being overweight among children with ASD is increased to 19% with an additional 35.7% at risk for being overweight.1 Being overweight can put these children at risk for gastrointestinal issues, diabetes, cardiovascular and joint problems. Physical activity not only encourages a healthy lifestyle, but also assists with providing children with ASD social, emotional and behavioral benefits as well.

When children with ASD participate in team sports, whether through their school park district or special-rec association, they are part of a larger entity. Team sports can do wonders for a child’s self-esteem, ability to communicate with peers and overall sense of well-being.

Swimming and aquatic therapy are great means of exercise for children with ASD. In a study conducted by Yilmaz et al, after 10 weeks of swimming training, the balance, speed, agility, power, hand grip, upper and lower extremity muscle strength, flexibility and cardiorespiratory endurance increased. Also after the hydrotherapy, the amount of repetitive stereotyped movement patterns (spinning, swinging and delayed echolalia) decreased.2

We cannot forget that kids on the autism spectrum are still kids. They like to run, jump, swim and shoot baskets just like typically developing kids. Often these skills need to be broken down so that children with ASD are able to understand how to complete a task. For example, when teaching a child with ASD how to play hopscotch, start by doing side to side jumps, then adding bringing feet together and apart in a jump, followed by helping the child to draw the hopscotch course and finally, demonstration from another peer can help the child understand how the skill is performed.

Physical activity for children with ASD can sometimes be more challenging because of other issues such as low muscle tone, poor motor planning, behavioral issues and decreased attention. However, when encouraged properly and in the right setting, children with ASD can really flourish physically, emotionally and mentally with the addition of more physical activity in their lives. Physical activity should be used as a fun, engaging, supplement to a child’s therapeutic daily activities.

References

1 Curtin, Bandini, Perrin, Tybor, Must (2005). Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: a chart review. BMC Pediatr 2005: 5:48

2 Yilmaz, Yanardag, Birkan and Bumin (2004). Effects of Swimming Training on Physical Fitness and Water Orientation in Autism. Pediatrics International, 46, 624-626.
http://www.autismspeaks.org

About the Author

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Bridget Hobbs, PT, DPT, is a licensed physical therapist with a passion for working with kids with special needs. She received her Bachelor of Science degree in Biomedical Sciences from Marquette University and then continued at Marquette to receive her clinical doctorate in Physical Therapy in 2006. Bridget started her physical therapy career working with adults who had orthopedic, cardiac and neurological injuries. In 2009, she began working in the pediatric realm and has found her home in this setting. Areas of interest for Bridget include treating children with torticollis, orthopedic injuries, autism, gross motor delays and neuro-muscular disorders. Bridget has advanced training in aquatic therapy, respiratory treatment, treatment of torticollis, gait and working with premature infants. She looks forward to using her experience and passion for kids to translate to great therapy with your child.