Autism Therapies and Motor Impairment: What Parents Need to Know
If you’re the parent of a child with autism, you’ve likely been introduced to a wide variety of therapies—speech therapy, occupational therapy, Applied Behavioral Analysis (ABA), and maybe even physical therapy. Each of these has its place, but there’s something important that’s often overlooked in mainstream autism treatment plans: whole body apraxia.
In fact, many children on the spectrum experience profound challenges with intentional movement, motor planning, and sensory integration—and yet, these motor issues are rarely prioritized in early intervention. Instead, most services focus heavily on observable behavior, assuming that what we see on the surface reflects what’s going on inside.
In this blog post, we’ll explore why this assumption can be misleading, how traditional autism therapies fall short when it comes to motor impairment, and what kind of support may be missing from your child’s current plan.
The Current Landscape of Autism Therapy
When a child is diagnosed with autism spectrum disorder (ASD), most families are offered a similar menu of options:
- Applied Behavioral Analysis (ABA)
- Speech Therapy
- Occupational Therapy (OT)
- Physical Therapy (PT) (occasionally)
ABA is often the dominant recommendation, especially in public or insurance-funded programs. Speech and OT may be layered in, but PT is less commonly suggested—despite high rates of motor impairment in children with autism.
Let’s take a closer look at what each of these therapies is designed to do.
Behavior-Focused Therapies: ABA and PRT
Applied Behavioral Analysis (ABA) is the most widely used intervention for children with autism. Its offshoots, like Pivotal Response Training (PRT), aim to shape socially “appropriate” behaviors and reduce those considered “maladaptive,” such as stimming, aggression, or elopement. These methods rely on reinforcement systems—rewards and consequences—to increase desired behavior.
PRT, for example, is designed to integrate behavioral strategies into a child’s natural environment, including home and school, and emphasizes the development of spoken language.
While ABA-based approaches have helped some families gain structure and clarity, they’re often grounded in behaviorist assumptions that overlook critical components of autism—namely, neurodevelopmental differences, motor impairments, and sensory processing challenges.
More concerning is the underlying assumption in many ABA programs: that behavior equals cognition. In other words, if a child can’t perform a task or respond to a prompt, the assumption is often that they don’t understand or aren’t capable. This belief leaves little room for the possibility that motor challenges—not cognitive delays—are the root issue. Ultimately, the majority of ABA programs do not presume competence. They don’t believe that the individual has the ability to learn and understand age appropriate content.
The Neuromotor Side of Autism
One of the most overlooked aspects of autism is its connection to motor dysfunction. According to the massive SPARK study of over 16,000 children with autism, a staggering 86.9% showed significant motor impairments (Bhat, 2020). That’s nearly 9 out of 10 children.
And yet, only:
- 79.8% received occupational therapy
- 31.6% received physical therapy
- 13% participated in recreational therapies like aquatic therapy or hippotherapy
Clearly, there’s a disconnect between what the research shows and what most kids are actually receiving.
What OT and PT Are Supposed to Do
Occupational therapy (OT) in autism care often focuses on:
- Fine motor skills (e.g., writing, cutting)
- Activities of daily living (e.g., dressing, feeding)
- Sensory processing
- Basic motor planning
Speech therapists may also work on motor aspects of verbal expression, such as breath support or articulation. Physical therapists (PTs) address broader motor concerns like posture, walking, and core strength.
The problem? Even in these fields, training in the neuromotor complexities unique to autism is limited.
Many therapists aren’t trained to recognize or treat:
- Motor initiation difficulties
- Sequencing and timing issues
- Whole-body apraxia
- Regulation challenges tied to motor output
These issues go far beyond just being clumsy or having trouble holding a pencil—they affect how a child moves through and interacts with the world. At Spellers Center Tampa, we office Occupational Therapy, we key in on vision assessments and we offer Spelling as communication.
Why Motor Challenges Get Ignored
The most severely impacted individuals—those who are nonspeaking, have high sensory needs, or engage in self-injurious behavior—are often steered straight into behavior-focused therapy. Their underlying motor dysfunction is often missed, misinterpreted, or dismissed.
Here’s the pattern we see far too often:
- A child can’t follow verbal instructions or complete fine motor tasks.
- Therapists assume the child lacks comprehension or cognitive ability.
- The intervention focuses on shaping compliance, rather than supporting motor development.
- The child becomes more frustrated, misunderstood, and dysregulated.
This isn’t just ineffective—it’s harmful.
When we assume that what we see is all there is, we strip these children of their agency and potential. In reality, many of them understand far more than they can express. They just need a different way to communicate—and that starts with presuming competence.
What Does “Presuming Competence” Mean?
Presuming competence means that we assume every individual has the ability to understand, think, and learn—even if they can’t show it through traditional means like speech or writing. It shifts our mindset from “they can’t” to “what support do they need in order to?”
It also means recognizing that behaviors we often label as “noncompliant” may be signs of:
- Sensory overwhelm
- Motor planning difficulties
- Communication frustration
- Anxiety or trauma
- Dysregulation from internal health issues
Rather than trying to “correct” the behavior, we should be asking, “What is this behavior telling us about the child’s experience?”
A Better Approach: Integrating Neuromotor Support
So what would a better therapy model look like?
Instead of starting with behavior, we start with the body—how it moves, processes, and regulates. Here’s what a holistic, neuromotor-informed therapy plan could include:
- Comprehensive sensory-motor evaluations
- Individualized motor coaching for whole-body apraxia
- Vision assessments
- Targeted OT and PT with a neurodevelopmental lens
- Parent and caregiver education on motor planning
- Communication methods like Spellers Method or AAC that support motor-based expression
- Medical collaboration to address underlying health issues that may affect motor function
This approach isn’t just more accurate—it’s more respectful. It honors the child’s body, brain, and potential, and it allows for therapies that build true functional independence.
Why This Matters for Your Child
If your child is struggling to participate in therapy, to express themselves, or to make meaningful progress—it may not be because they lack ability. It may be because they’ve been given the wrong tools.
Motor challenges are real, measurable, and impactful—and when we ignore them, we risk reinforcing false narratives about our children’s intelligence and capacity.
The truth is, many children with autism—especially those with unreliable speech or profound motor differences—understand far more than they can demonstrate.
They need therapies that support movement, regulation, vision, and communication, not just behavior modification.
In Summary: What Parents Can Do
Here are some practical steps you can take today:
✅ Ask your child’s team to evaluate motor planning and whole-body movement, not just fine motor or gross motor skills.
✅ Learn more about whole-body apraxia, sensory-motor integration, and how they impact the whole child.
✅ Request therapies that support neuromotor development alongside traditional OT or speech services.
✅ Challenge assumptions—especially if your child is nonspeaking or struggles with behavior.
✅ Presume competence. Always. Assume your child understands, and advocate for tools that let them show it.
Final Thoughts
Your child is not broken. They are not “just behavioral.” They are navigating a complex world with a body and brain that don’t always cooperate—and they need support that respects that complexity.
Therapies that focus only on behavior may miss the very things that could unlock your child’s true potential. Motor impairments are not a side issue in autism. For many, they are central—and when addressed properly, they can open the door to communication, confidence, and connection.
If you’ve ever felt like something was missing from your child’s therapy plan… you were probably right.
Let’s start building something better.
Be sure to check out the Spellers Documentary to see how Spellers Method has impacted people lives.
