Evaluation of shoe inserts to reduce toe walking in young children with autism

Abstract

AbstractToe walking is relatively common among children with autism spectrum disorder and, if untreated, can contribute to a number of medical problems. Previous research has suggested that toe walking may vary by walking surface. Some (e.g., rough) surfaces may inhibit toe walking, whereas other surfaces may encourage it. In the current study, we first conducted a functional analysis screening to verify that toe walking exhibited by two young children with autism was maintained by automatic reinforcement. Next, we assessed toe walking on a variety of surfaces, including tile, artificial grass, and grip tape. Finally, we placed inserts of the surface associated with the lowest level of toe walking into each participant's shoes. The inserts were effective to nearly eliminate toe walking by one participant and reduce toe walking to low levels for the second participant. To decrease the second participant's toe walking further, we added a hand‐on‐shoulder procedure, which was also effective. We discuss the results in terms of the putative mechanisms responsible for the reduction.