Further evaluation of a hands-on-shoulder plus praise procedure to reduce toe walking

Abstract

Idiopathic 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.