Evaluating a Treatment Package to Reduce Toe Walking and Improve Ankle Mobility in Children with Autism Spectrum Disorder: A Multi-Component Intervention
A short mix of leg stretches, praise, and heel-step drills quickly cut toe walking in four preschool boys with autism.
01Research in Context
What this study did
Four preschool boys with autism walked mostly on their toes. The team mixed four tools: leg stretches, heel-walk games, praise for flat steps, and quick timing drills. They ran the drills in clinic rooms for a few weeks and counted how often each child landed on his heel.
What they found
Every boy cut toe walking by a lot and could bend his ankle farther. Parents saw flatter steps at home too, but the study did not check if the gains lasted after sessions stopped.
How this fits with other research
Wilder et al. (2024) got the same result with a simpler move: light hand on the shoulder plus praise. The new package adds stretches and timing charts, so you can pick simple or full based on your setting.
Wilder et al. (2020) used heel squeakers and candy first. The 2025 study shows you can drop the noise makers and still win if you keep the praise and add leg drills.
Ketcheson et al. (2017) ran a big daily motor class and saw wide motor gains. Semino et al. shrink that idea into short, one-on-one bursts that fit a clinic slot.
Why it matters
You now have two clear roads to curb toe walking: a quick shoulder prompt or a fuller stretch-plus-reinforce plan. If you have 5 minutes between clients, try the prompt. If parents want a home program, teach the stretch games and chart heel contacts. Either way, you can start next week without new gear.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pick one child who toe walks, set a 2-minute stretch then heel-walk game, praise every flat step, and count heel contacts with a clicker.
02At a glance
03Original abstract
This study evaluates the effects of a treatment package to reduce toe-walking (TW) in four male children with autism spectrum disorder, aged between three and six years, with persistent TW. The treatment package involved a combination of motor exercises, positive reinforcement, corrective feedback, and precision teaching. We used concurrent multiple probes across participants design, with RESA checks, to evaluate the effectiveness of the intervention. We measured the correct steps during probe sessions, the rate per minute of correct steps during the training, the ankle joint’s passive range of motion, and social validity, measured through caregiver questionnaires before and after the intervention. The results indicated a decrease in TW across all participants, with a beneficial effect on the participants’ gait patterns and overall physical mobility. It also underscored the potential for applying such an intervention to improve the daily lives of children with ASD. However, the study has several limitations, including not directly measuring generalization, the brief follow-up period post-intervention, and the absence of a component analysis to determine the differential effects of the intervention components. The online version contains supplementary material available at 10.1007/s40617-024-01035-8.
Behavior Analysis in Practice, 2025 · doi:10.1007/s40617-024-01035-8