The use of auditory feedback and edible reinforcement to decrease toe walking among children with autism

Wilder et al. (2020) worked with three autistic children who walked on their toes. The team stuck small squeakers on the heels of the kids' shoes. Each heel press made a fun squeak. The sound acted as instant feedback for correct flat-foot steps.

For one child the squeak alone worked. For the other two the team added tiny edible treats when the heels squeaked. They tracked toe-walking across school hallways and play areas.

All three children quickly lowered toe-walking when the heel squeakers were on. Two kids needed the extra candy to keep the gains. When the squeakers came off, the correct walking stuck around for all of them.

The simple sound cue plus optional snack gave a cheap, fast fix that traveled across rooms and people.

Wilder et al. (2024) later swapped the sound for a gentle hand on the shoulder plus praise. Four new children also cut toe-walking. Together the two studies show you can pick either auditory or tactile prompts; both beat baseline.

Semino et al. (2025) kept the 2020 idea of sound and treats but added ankle stretches and motor drills. Their four preschoolers gained better ankle movement plus less toe-walking. The newer package keeps the easy squeaker start and layers on physical-therapy moves when you want faster body change.

Way back, Foster et al. (1979) paired beeps with candy to calm hyperactive kids in class. Wilkie et al. (1981) proved that lights, music, or vibration can reinforce autistic kids as well as food. Wilder et al. (2020) simply aimed those same tools at a gait problem.

You can try heel squeakers today. Stick them on, walk the hallway, and graph toe steps. If the sound alone is not enough, add a skittle for each squeak then thin the treats. If the family wants more, layer in ankle stretches like Semino et al. (2025). Either way you have a low-cost, socially valid first step before moving to braces or surgery.