Quantitative assessment of tip-toe behavior in individuals with autism spectrum disorder and intellectual disability: A cross-sectional study.
A quick video-coding method now gives BCBAs a reliable number for tip-toe behavior in autism.
01Research in Context
What this study did
The team built a simple video-coding tool that measures tip-toe walking in children and adults with autism. They watched short clips and scored how much of each step was spent on the toes. The study placed each person into one of three clear groups: mild, moderate, or severe tip-toe behavior.
What they found
The new protocol worked: coders agreed on the scores, and the three groups held steady across two different days. Age, IQ, and other background facts did not predict which group a person landed in. The tool gives clinicians a fast, objective baseline they can track over time.
How this fits with other research
Valagussa et al. (2018) had warned that no structured test for toe walking existed; this 2024 paper now fills that gap. Hodges et al. (2018) and Wilder et al. (2022) showed that wristband cues or rough shoe inserts can cut toe walking; the new coding scheme gives those treatments a common ruler to show change. Zhao et al. (2022) and Kwon et al. (2025) also pull digital markers from video or motion sensors, proving camera-based metrics are ready for everyday clinic use.
Why it matters
You no longer have to guess if toe walking is getting better. Record a 5-minute hallway walk, code it once, and you have a number you can graph after each session. Pair this baseline with any intervention—shoe inserts, praise for flat feet, or stretching—and you can show families clear, visual progress.
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02At a glance
03Original abstract
The term "toe walking" describes walking on the toes with a lack of heel strike upon initiation of the stance phase of gait. In individuals with autism spectrum disorder (ASD), this phenomenon, or "tip-toe behavior" (TTB), can be present in a substantial proportion of subjects even during standing. In this study, we investigated TTB in 50 persons with ASD (age range 4-26 years). We evaluated TTB through an observational/report-based assessment protocol. Subsequently, we employed a new structured video-based coding protocol based on standardized video recordings, focusing on static and dynamic conditions. Finally, the findings of the two protocols were compared. Twenty-four subjects with TTB were identified and classified according to three functional groups: TTB1, present only during running (6 subjects); TTB2, present during walking and running (11 subjects); and TTB3, present during standing, walking, and running (7 subjects). Moreover, we found that TTB3 subjects exhibited a significantly higher quantity of TTB compared with subjects in the TTB1 and TTB2 groups during both standing and walking tests. Additionally, a high quantity of TTB in the static test was found to be related to a high quantity of TTB in the dynamic test. Variables such as age, autism severity, intellectual disability, and gender were not significantly associated with the mean percent of TTB both in static and dynamic tests in multivariate analysis. This structured video-based coding approach appears feasible and useful for assessing TTB in individuals with ASD and it has the potential to provide insights into TTB trajectories and aid in designing possible interventions.
Autism research : official journal of the International Society for Autism Research, 2024 · doi:10.1002/aur.3072