Further evaluation of a hands‐on‐shoulder plus praise procedure to reduce toe walking
A gentle shoulder touch plus praise quickly cut toe walking for four autistic kids, and earlier work shows you can swap in heel squeakers or add ankle drills if needed.
01Research in Context
What this study did
Wilder et al. (2024) worked with four autistic children who walked on their toes. The team first watched each child walk without saying or doing anything. This baseline showed the toe walking was not caused by adult attention.
Next the therapist placed a gentle hand on the child’s shoulder and said “flat feet” or “heels down.” When the child walked correctly for a few steps, the adult gave praise like “Nice walking!” Sessions lasted a few minutes and happened several times a week.
What they found
All four children quickly lowered their heels after the hand-on-shoulder prompt plus praise. Toe walking dropped in every case. Parents said the method felt kind and easy to use at home.
How this fits with other research
Wilder et al. (2020) got the same result with a different cue: heel squeakers that made noise each time the child stepped correctly. Both studies show a simple prompt plus praise can change gait, but the 2024 paper swaps sound for touch.
Semino et al. (2025) built a bigger package that added motor drills, ankle stretches, and precision teaching charts. Their four children also stopped toe walking and gained better ankle movement. The 2025 study does not cancel out the 2024 one; it just shows you can add more pieces if a basic prompt is not enough.
Together the papers form a ladder: start with light shoulder pressure and praise. If progress stalls, layer in stretches, feedback, and data charts.
Why it matters
You now have two fast, low-cost ways to try before calling in orthotics or casting. Begin with a hand on the shoulder and a quick “Nice heels!” during walks to the bus, the cafeteria, or the playground. If the child responds, keep the praise coming. If not, check Semino et al. (2025) for the full drill set. Either way you stay in your ABA wheelhouse and skip bulky equipment.
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02At a glance
03Original abstract
AbstractIdiopathic toe walking (ITW) refers to ambulation with a toe‐to‐toe gait in the absence of a known cause. Although it is exhibited by typically developing children, it is more common among children with autism spectrum disorder (ASD). Persistent ITW can cause several long‐term medical problems, including ankle deformities and balance and posture abnormalities. In the current study, we first conducted a series of no interaction or alone conditions to verify that ITW exhibited by four children with ASD persisted in the absence of social consequences. We then evaluated a hands‐on‐shoulder plus praise procedure in which gentle pressure is applied to participants' shoulders to prompt their heels to contact the ground, along with praise for appropriate steps in order to reduce ITW. Results suggest that the procedure was effective with all participants, and measures of social validity indicate that caregivers approved of the procedure. We discuss the results in terms of the putative mechanisms responsible for the effects of the procedure as well as the conditions under which the procedure might be used.
Behavioral Interventions, 2024 · doi:10.1002/bin.1991