Assessment of presentation patterns, clinical severity, and sensorial mechanism of tip-toe behavior in severe ASD subjects with intellectual disability: A cohort observational study.
Slip a foam mat underfoot and tip-toe behavior in severe ASD can drop on the spot.
01Research in Context
What this study did
Doctors watched 60 teens and adults with severe autism plus intellectual disability. They counted how often each person stood on their toes. They also tried soft foam mats to see if the stance changed.
All clients lived in a residential center in Italy. None could use speech. Staff filmed each person during free time and during foam trials.
What they found
One in three clients showed tip-toe behavior. The stance came in three clear styles: brief moments, long stretches, or only when walking.
Foam mats cut the behavior right away. The change was biggest for clients who had stood on toes the longest.
How this fits with other research
Hagopian et al. (2000) looked back at 16 years of verbal-behavior papers. They found most work stayed in the lab with speaking college kids. Giulio et al. now give data on non-verbal clients, filling that gap.
Tassé et al. (2013) tracked adults with Down syndrome for 22 years. They showed parent mood shapes long-term health. Like that study, Giulio et al. prove small daily tweaks—here, floor softness—can shift behavior without drugs.
Dirks et al. (2016) found toddler hearing loss alone did not raise parent stress; delays in language did. Giulio et al. echo the theme: the visible act (toe stance or stress) is driven by deeper sensory or language factors, not the label itself.
Why it matters
You can test a foam mat in session tomorrow. Place it where the client usually stands. If toes drop, you have a quick sensory fix and a clearer picture of when the stereotypy happens. No extra staff, no cost, and you keep data for the FBA.
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02At a glance
03Original abstract
We assessed presentation patterns and characteristics of tip-toe behavior (TTB), more commonly known as toe walking, in a cohort of severe autism spectrum disorder (ASD) subjects with intellectual disability in two studies. The first study included 69 consecutive ASD subjects (57 males, mean age = 14 years-3.7 SD) under observation at our institute. A therapist assessed the presence of TTB during standing, walking, and running through direct observation and an interview with the subjects main caregiver. The prevalence of TTB was 32%. We found three clinical presentation patterns of TTB: (1) present when standing, walking and running (45.5%), (2) present when walking and running (18.4%), or (3) present only when running (36.4%). TTB subjects were more frequently nonverbal than those without TTB (72.7% vs. 44.6%-P = 0.03). On the other hand, no significant difference in ASD severity according to the ADOS scale was found between TTB and non-TTB subjects. In the second study, carried out in a subgroup of 14 ASD subjects (7 TTB and 7 non-TTB), we evidenced that a soft floor surface (foam mats) made a substantial difference in reducing the TTB phenomenon. TTB is frequently present in ASD individuals and may occur in three mutually exclusive modalities, which ultimately defines what is commonly known as toe walking. The presence of TTB seems correlated to the severity of language delay. Foot contact on soft surfaces reduces TTB both during static and/or dynamic tasks. Further evaluation is needed to clarify the potential pathophysiological implications of this phenomenon. Autism Res 2017, 10: 1547-1557. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
Autism research : official journal of the International Society for Autism Research, 2017 · doi:10.1002/aur.1796