
Physiotherapy and autism

Over the past few decades, research has helped increase our understanding of autism and neurodivergence. It has also helped to highlight the benefits of physiotherapy for autistic and neurodivergent people. Brendan Bugeja, Melissa Mitchell and Melissa Trudinger report.
It is estimated that around one in 40 Australians is an autistic or neurodivergent person, an increase on a previous estimate of one in 70.
This is possibly due to improved awareness and diagnosis of the condition, as reported by Aspect, an Australian autism-specific service provider (2024).
It is therefore important that health practitioners have a strong understanding of how best to support autistic and neurodivergent people.
Defining autism can be difficult, although it is usually characterised by ‘deficits in social communication and social interaction and restricted repetitive behaviours, interests, and activities’ (American Psychiatric Association 2013).
Autistic people may also have heightened sensory awareness, making them more sensitive to sounds, smells, tastes and physical touch (Aspect 2024a).
Diagnosis of autism has traditionally been made using the Diagnostic and Statistical Manual of Mental Disorders, produced by the American Psychiatric Association.
Changes to how autism is defined and diagnosed were made in the fifth edition of the manual— referred to as DSM-5-TR—whereby autism spectrum disorder (ASD) ‘now encompasses the previous DSM-IV autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified’ (American Psychiatric Association 2013).
For physiotherapists, understanding autism is now a crucial skill.
‘This area has become very important as we’ve realised the extent of neurodiversity and the number of autistic people in the community,’ says Professor Nora Shields, a physiotherapist and research director of the Olga Tennison Autism Research Centre at La Trobe University.
‘There’s real potential here for both physiotherapy and the autism community to gain.’
‘Research shows that autistic people are more likely to have physical and mental health conditions and be more socially isolated,’ says Nora.

Prof. Nora Shields
‘If someone has lower fitness to start off with, has a lot of anxiety or maybe has never exercised before, then the idea of walking into a gym by themselves is something that could make them incredibly apprehensive. Tailoring your approach to all of those things will be beneficial.’
Nora’s research has examined the feasibility of FitSkills (here), a community-based exercise program for young people aged 13–30 with a disability such as cerebral palsy, Down syndrome, autism or an intellectual disability (Shields et al 2021).
The program matched the young people with a university student mentor and each pair exercised together at a local community gym.
The research concluded, ‘Exercising in a real-world setting with a mentor had a positive effect on physical health outcomes (eg, muscle strength, walking capacity) and psychological well-being outcomes (eg, health related quality of life, participation).’
Research has shown that children with autism ‘often face unique challenges that can significantly impact their ability to engage in sports and physical activities.
These challenges can arise from a combination of motor deficits, sensory processing issues, social communication difficulties, and behavioural rigidity’ (Dowton 2024).
Children with autism are therefore at risk of lower levels of physical activity and higher levels of sedentary behaviours than their neurotypical peers.
This lack of movement puts them at risk of developing acute and chronic health conditions (Campos et al 2019).
‘In most assessment clinics, there isn’t a physiotherapist as part of the team.
'There’s a psychologist, occupational therapist and speech pathologist but I want a physiotherapist in there as well,’ says Nora.
‘For a high percentage of autisitc children, there’s an increased likelihood that they also have motor differences, which may not always be recognised, and there are no strategies in place to tackle that.
'There is debate at the moment about whether differences in motor skills should actually be part of an autism diagnosis and perhaps there is scope to recognise what physiotherapists can offer to give these children the best start to life.’
The idea that there might be a ‘cure’ for autism has been widely rejected by the autism community.
‘As a brain-based difference, autism cannot be cured. That said, there are some therapies and supports that can help autistic individuals develop skills and improve their quality of life’ (Aspect 2025b).
Even looking for a cure for autism may be considered offensive (Autism Awareness Australia 2024).
National guideline
In January this year, the Australian Government released the National Autism Strategy (detailed below), which ‘aims to improve inclusion, support and life outcomes for the almost 300,000 autistic people living in Australia’ (Department of Social Services 2025).
Prior to the National Autism Strategy, there was the National Guideline for the assessment and diagnosis of autism in Australia, first published in 2018 and updated in 2023 (here).
One of the people who worked on the guideline was Dr Kristy Nicola APAM, a paediatric physiotherapist and Queensland branch chair and national deputy chair of the APA Paediatric group.

Dr Kristy Nicola
‘I advocated for the role of physiotherapy in supporting the assessment and diagnosis of ASD in Australia and for the ongoing presence of physiotherapists in the multidisciplinary team involved in identifying the strengths and needs of children suspected of autism,’ says Kristy.
‘I was excited that I could advocate not only for physios but for children as well, so we can make sure that the assessment procedure for young people in Australia is an inclusive and ethical process.
‘Physiotherapy can offer several benefits to people with neurodiversity, including those with autism, by addressing both physical and developmental challenges.
'Physiotherapists are best equipped to tailor interventions to meet the unique needs of individuals with autism, recognising that each person’s abilities, challenges and preferences are different.
'These customised, evidence-based approaches make physiotherapy an effective option.’
Kristy says, ‘The 2023 guideline made several key updates to the 2018 edition to improve clarity, inclusivity and accessibility.’
These updates include:
- neurodiversity-affirming language—the guideline emphasises the use of neurodiversity-affirming language, reflecting a more inclusive and respectful approach to autism. This change aligns with a broader shift in the autism community towards affirming neurodiversity
- updated evidence—the new edition integrates the latest research and evidence from the autism field, ensuring that the guidelines are based on the most current understanding of autism and best practices for diagnosis
- clearer practical guidance—there is a stronger focus on providing practical, actionable guidance for professionals involved in the assessment and diagnosis process. This includes more detailed recommendations on tools, methods and strategies to ensure consistency and accuracy in diagnoses
- flexibility and adaptability—the revised guidelines allow for greater flexibility in their application, recognising the diversity of contexts in which autism assessments occur. This change makes the guidelines more adaptable to different clinical settings and needs.
‘The guideline aims to focus on the strengths of autistic people by promoting respect, emphasising the individual’s neurological capacities, embracing differences and avoiding any kind of stigma,’ says Kristy.
‘Using more neuro-affirming language in the guideline has been an important change.’
Language matters
The terminology used for autism and autistic people has changed over the years to the point where there is often some confusion over preferred terminology.
While with many conditions there is a preference for person-first language, some in the autistic community prefer identity-first language—‘autistic person’ versus ‘person with autism’.
According to research by Aspect (2025c), there are language preferences shared by most of the autistic community, such as:
- autism/autistic instead of autism spectrum disorder
- autistic person (identity first) instead of person with autism (person first)
- may be autistic or increased likelihood of autism instead of at risk of autism
- co-occurring instead of comorbidity
- specific support needs instead of high/low functioning or mild/moderate/severe autism.
It should be noted that individual preferences may differ and it is always worthwhile to check with the individual regarding their language choices.
‘This is something that we are still understanding,’ says Nora.
‘But I think it’s important to recognise other people’s preferences for language, which may not naturally fall into what our own preferences are.’
Autism Awareness Australia (2024a) shares this view.
‘How words are used is very important to us. We know there are many different perspectives in the autism space and we respect people’s personal preferences about how they refer to themselves and others,’ they wrote.
‘Many autistic people prefer to use identity-first language, like “I am autistic”.
'Parents and families often use person-first language, such as “I am a person with autism” or “My child has autism”.
‘Content from Autism Awareness Australia is written and produced by autistic people, as well as parents and carers of autistic children.
'These… people have used their own words and their personal language to share their stories.
'That’s why there are different versions of autism language references throughout this platform.’
Another common term is ‘neurodiversity’, which can be used to describe the range of natural human neurological development, including neurodivergent (encompassing autism, ADHD, OCD, dyslexia, dyspraxia, dyscalculia and Tourette syndrome) and neurotypical, which is used to describe someone whose brain development is considered typical or standard.
‘The neurodiversity paradigm offers us a framework by which we can celebrate who we are, how we exist, and what we have to offer. Neurodiversity allows us to be our whole authentic selves because of our differences, not despite them’ (Hayworth 2025).
Environment matters
Due to the heightened sensory awareness that many autistic people experience, it may be necessary to make changes to the physical environment to accommodate an autistic client’s needs in the physiotherapy clinic.
‘Physiotherapists are very good at setting up the physical environment—thinking about how people move within a space—so we need to extend that awareness and think about lighting, sound, smell and touch,’ says Nora.
‘It can be through reasonably simple things like having the right type of lighting with dimmer switches, having quieter areas for waiting, scheduling an autistic patient at a time when the clinic will be less busy or using gels/creams that don’t have a strong scent on them.
‘In relation to touch, it’s very much about preparation, gaining consent, making it very clear what’s going to happen and honouring dissent if that’s the case.
'If we know that something will be uncomfortable for somebody, such as touch, we can make sure that all their other sensory needs are taken care of so they only have to deal with that rather than having to deal with different levels of sensory stimulation.
'These sorts of changes aren’t earthshattering but they can actually make a big difference to autistic people.’ Kristy says,
‘When I meet physios who either find it difficult to work with an autistic person or might steer away from doing so, all it really takes is a bit of encouragement and telling them “Just be patient; it’s different”.
'With children, in particular, you’re likely to work with the family a lot more than you have in the past.
'Physios really depend on the family, who know that child or young person best, to support us to connect with them.’
In its fact sheet ‘How to be autism-friendly’, Aspect (2024d) describes the importance of:
- structured environments and interactions, with clear routines and expectations
- keeping explanations simple because autistic people may have trouble ‘reading between the lines’
- respecting personal space and always asking before initiating physical contact
- not mistaking honesty for rudeness; frankness may come across as tactlessness but is completely unintentional
- being careful not to overwhelm and understanding if an autistic person wants to leave a situation quickly.
‘A lot of neurodivergent individuals enjoy routine and structure,’ says Kristy.
‘So once you’ve had the opportunity to develop rapport with them, you may structure your sessions in a way that embraces routine and structure and they will really appreciate it because they know what to expect.’
The younger autistic person
Tanmayi ‘Tammy’ Patgaonkar APAM, Victoria branch Paediatric group chair, has seen the evolving role of physiotherapy in supporting autistic children firsthand.
As a paediatric physiotherapist and director of First Step Therapy Services, Tammy advocates for physiotherapy’s place in multidisciplinary care for autistic children. Before starting her practice in 2022, Tammy was a paediatric physiotherapist and key worker in Chicago, USA for three years and then with childhood intervention services, specifically the not-for-profit EACH, for more than seven years.

Tanmayi ‘Tammy’ Patgaonkar
‘Autism referrals were limited due to lack of awareness about how physiotherapy can benefit children with autism,’ she says.
The service, which caters to children and adolescents in metropolitan Melbourne, has a team of physiotherapists trained in global development including milestones, sensory-motor development, movement and play skills.
Through education and collaboration with occupational speech therapists and other allied health professionals, Tammy has been able to demonstrate the value of physiotherapy in a holistic development model.
‘Parents started seeing the importance of physios’ role and began advocating for physiotherapy themselves,’ Tammy says.
However, the process hasn’t been without its challenges.
She recalls having to provide extensive justifications and research-backed reports to convince the National Disability Insurance Agency that physiotherapy was a necessary intervention for autistic children.
‘I had to fight back a lot with the NDIS. I wrote justification reports to get monthly sessions approved.
'Once progress became evident, we could request increased frequency,’ she says.
‘Initially, we requested with caution and got the monthly sessions.
'Then we demonstrated how we completed the set goals for the child and showed progression.
'Eventually they agreed, saying, “This is important” and approved increased frequency equivalent to other allied health professionals.’
Tammy says that physiotherapists working with autistic children need to first understand the complexity of autism.
‘Autism isn’t just about difficulties with social interaction; it often comes with sensory processing disorders, motor learning challenges, communication barriers, intellectual disability and executive functioning deficits,’ she says.
She highlights the gap in undergraduate physiotherapy education, noting that conditions such as cerebral palsy or hip dysplasia receive in-depth coverage but autism is largely absent from curriculums.
‘Physiotherapists often have to learn on the job,’ she adds.
One of the biggest hurdles that physiotherapists face when working with autistic children is engagement.
‘Most physios know which exercises to prescribe but the challenge is getting the child to do them,’ Tammy says.
‘Understanding sensory behaviours and communication strategies is key.’
Tammy has undertaken professional development in sensory processing and augmentative and alternative communication devices, allowing her to better connect with her clients.
She follows an early intervention model, meeting children in their own environments—whether at home, at school or in a playground—to maximise their comfort and participation.
‘If a child is sensitive to noise, I might suggest noise-cancelling headphones or working in a quieter environment.
'If they communicate using an AAC [augmentative and alternative communication] device, I make sure I can use it too,’ Tammy says.
Tammy recalls a particularly rewarding case of a non-verbal child diagnosed with autism and intellectual disability.
‘He was a sensory toe walker, meaning his toe walking wasn’t due to tightness but sensory processing differences,’ she says.
Although traditional physiotherapy hadn’t helped the child, after conducting a sensory assessment Tammy recommended a specialised orthotic to reduce sensory impact.
‘His toe walking reduced from 80 per cent of the time to 50 per cent almost immediately.
'Then we could focus on strength and coordination and within six months he could independently climb the stairs at home,’ Tammy says.
Another autistic child Tammy worked with had severe anxiety around water, making swimming lessons distressing.
Through sensory profiling, collaboration with a speech therapist and gradual exposure to water, Tammy helped the boy to progress from avoiding public pools to participating in school swimming lessons.
‘These small but significant milestones are life-changing for these children and their families,’ she says.
Tammy believes that physiotherapists must be part of a collaborative team when working with autistic children.
‘Unlike other conditions, where a physio might work independently, autism requires a multidisciplinary approach,’ she says.
While the increasing recognition of physiotherapy within autism interventions is promising, she stresses that more education and awareness are needed.
‘Physiotherapy should be a standard part of early intervention, not an afterthought,’ she says.
The parenting perspective
Sue Diggins APAM brings a dual perspective to her physiotherapy practice—that of an experienced clinician and that of a parent of an autistic young adult.
Sue worked in paediatrics in Melbourne for decades, including at the Royal Children’s Hospital, Yooralla and Scope, before transitioning to her private practice.
‘I didn’t have much experience with autism before my son was diagnosed,’ Sue says.
‘In early intervention, I worked mainly with children with physical disabilities. Autism wasn’t really on my radar.’
The autism diagnosis for her son changed Sue’s outlook, professionally and personally.
‘I wouldn’t call myself an autism expert but lived experience has given me insight into the challenges families face,’ Sue says.

Sue Diggins
While she emphasises that every autistic child is different, Sue says her experience as a parent has deepened her understanding and empathy.
‘It’s incredibly hard work parenting a neurodivergent child.
'The level of background organisation needed to support their development and participation in life is huge.’
Sue has witnessed the evolution of physiotherapy in autism care, particularly since the introduction of the NDIS.
‘Before the NDIS, autistic children rarely accessed physiotherapy.
'There was always an understanding that they had physical challenges but the role of physiotherapy wasn’t well recognised,’ Sue says.
Today, research supports the link between autism and motor difficulties such as impaired motor planning and coordination, which affect participation in sport and recreational activities.
‘Physio has a major role in helping these kids develop the skills and confidence to engage in physical activity,’ Sue says.
One of Sue’s biggest concerns is the burden placed on families.
‘I wish more physios understood how overwhelming it is to raise an autistic child.
'Therapists often have high expectations of parents but many families are already stretched thin,’ she says.
Sue takes a holistic approach, sometimes prioritising practical support—helping families apply for carer allowances or access disability resources—over direct therapy.
‘If basic needs aren’t met, it’s unrealistic to expect families to implement complex home programs,’ she explains.
Sue incorporates strength-based and routines-based intervention strategies in her work.
‘I tailor my approach to each family’s circumstances.
'Physio isn’t just about an hourlong session—it’s about integrating movement into daily routines so children get the practice they need,’ she says.
She shares a success story of a young autistic boy who wanted to play soccer but lacked the skills.
‘He couldn’t kick, catch or understand the rules of the game.
'We broke down each skill and practised in a structured way.
'Over time, he gained confidence and started playing with his peers at school,’ Sue says.
Another young client struggled to understand informal playground games.
‘I explained the rules and practised with him and now he can join in with his friends rather than being left out.’
Sue is passionate about promoting physical activity for autistic children.
‘Many autistic kids want to be involved in sports but face barriers.
'We need to create inclusive opportunities and provide them with the skills to succeed,’ she says.
She also encourages families to nurture their child’s special interests.
‘Autistic people often have deep, lasting interests.
'If we can develop those into meaningful skills, they can become sources of joy and even employment in adulthood,’ she says.
The demand for experienced physiotherapists in disability care is growing but Sue acknowledges there are challenges.
‘There’s a shortage of allied health professionals and families value consistency.
'Having the same therapist over time builds trust, which is crucial,’ Sue says.
Both Sue and Tammy emphasise that physiotherapy is an essential, though often overlooked, component of autism intervention.
‘We’re not just helping kids move better,’ Tammy says.
‘We’re helping them engage with their world,’ Sue says, adding that ‘physio should always be about improving quality of life, not just meeting clinical milestones.’
New strategy to overcome barriers
Earlier this year, the Australian Government announced the National Autism Strategy 2025–2031 (the Strategy) and the associated National Autism Strategy First Action Plan 2025–2026 (the Action Plan) to improve inclusion, support and life outcomes for autistic Australians (here).
The Strategy was developed with the guidance of the National Autism Strategy Oversight Council and through extensive consultation with key stakeholders including autistic people, their families and carers and the broader autism and disability sector as well as researchers and experts.
Both the Strategy and the Action Plan focus on four key outcome areas that will help guide policies and solutions to overcome the distinct barriers and challenges autistic people face regarding:
- social inclusion
- economic inclusion
- diagnosis, services and supports
- health and mental health.
The Strategy has access to $42.3 million to use over the next several years.
This includes $12.2 million over a five-year period for knowledge translation and research into neurodiversity to inform and improve the policies and services affecting autistic people’s lives.
A further $3.7 million over two years will fund evaluations of existing programs with the help of the autism community.
Health and mental health outcomes for autistic people will be supported by a National Roadmap to Improve the Health and Mental Health of Autistic People 2025–2035, released in late February.
Professor Nora Shields says that the Olga Tennison Autism Research Centre made 50 recommendations to the National Autism Strategy Oversight Council, focusing on creating a society where autistic people could thrive.
‘We recognised the diversity within the autistic community and the unique challenges faced by those with higher support needs or by older adults,’ Nora said in a statement about the Strategy.
‘Our goal in contributing to the Strategy was to inspire change that respects individuality while addressing systemic barriers.
'The Strategy is a fundamental step to acknowledging autistic Australians and we look forward to understanding how these ideals will be implemented in practice.’
Rethinking physiotherapy for autistic patients
For many, the journey to physiotherapy is driven by a passion for movement and healing.
For physiotherapist Isabelle Kelly, pursuing physiotherapy as a career was deeply personal.
Diagnosed as autistic in her early 30s, Isabelle has discovered the strengths and navigated the challenges that come with being a neurodivergent physiotherapist.
Isabelle Kelly’s path to physiotherapy began with a love of ballet.
As a child she found structure and rhythm in dance—a form of self-regulation that, in hindsight, aligned with her then-undiagnosed autistic traits.
She first had contact with the physiotherapy profession when she sustained a dance injury as a teenager.

Isabelle Kelly
Unfortunately, her experience with rehabilitation left a lot to be desired.
‘I had a really poor experience with the rehab process and the physios I had access to at the time,’ Isabelle says.
‘I had always been interested in science and the human body so I started doing my own research.’
With encouragement from her doctor who saw her aptitude for problem-solving and her ability to understand complex systems, Isabelle pursued physiotherapy at James Cook University in Brisbane.
Graduating in 2014, Isabelle spent years working in private practice, in military settings and in sports medicine before discovering the full extent of her own neurodivergence.
For much of her life, Isabelle, an APA Titled Sports and Exercise Physiotherapist, grappled with mental health challenges.
She had long been diagnosed with treatment-resistant depression but it wasn’t until she sought deeper answers that she realised that her difficulties stemmed from undiagnosed autism, ADHD and the often comorbid cPTSD.
‘I was misdiagnosed over and over,’ Isabelle says.
‘I started demanding more from my medical team and when I finally got the diagnoses, there was this massive grieving process.
'It was a relief but also frustrating— why didn’t anyone pay attention when I was a kid?’
The self-discovery not only reframed Isabelle’s personal experiences but also her professional approach.
It allowed her to develop a deeper understanding of her sensory processing differences, communication style and unique cognitive strengths—traits that she says ultimately make her a better clinician.
Isabelle currently works part-time at SportsPlus Physiotherapy, a private practice in Highgate Hill, Brisbane.
She also recently started working as an academy physiotherapist with the Queensland Ballet Academy.
One of Isabelle’s greatest strengths as a physiotherapist is her ability to recognise patterns, a skill she attributes to her autism.
Her unique way of processing information also allows her to tailor treatment approaches for neurodivergent patients.
She recognises that traditional assessment methods may not work for autistic patients, who often experience sensory input and therefore pain differently.
‘I call it my “spidey sense”,’ Isabelle says.
‘Someone will describe their symptoms and I just know something more is there—I can’t always put my finger on it right away but I start connecting dots that others might not see.
'It makes me good at problem-solving and diagnostics.
‘Autistic people experience pain in unique ways.
'Consequently, when treating autistic patients, I spend more time explaining what I’m going to do, asking permission and adapting the assessment to minimise discomfort.
'I focus on functional movement and self-led assessments rather than just hands-on testing.’
The ability to adapt her methods as a physiotherapist makes her a sought-after clinician among neurodivergent patients, who often struggle to find healthcare providers who truly understand their specific needs.
Navigating the healthcare system as an autistic patient can be incredibly challenging, as Isabelle discovered after her own diagnosis.
Many people with autism who access healthcare experience overwhelm due to sensory and communication barriers.
Isabelle has become something of an advocate for making physiotherapy more accessible.
‘One of the biggest challenges is that many autistic people don’t even realise they experience pain differently.
'They’ve spent their whole lives being told they’re “overreacting” or that their symptoms don’t match the textbook definition,’ she says.
‘I take the time to validate their experience and help them understand their bodies in a way that makes sense to them.’
Isabelle uses several signals, such as wearing a Hidden Disabilities Sunflower lanyard, to let patients know that they are in a safe and understanding space.
She might also have some fidget toys on her desk.
In her practice, Isabelle integrates elements of occupational therapy, sensory profiling and trauma-informed care to help autistic patients feel comfortable and respected.
When asked how neurotypical physiotherapists can better support autistic patients, Isabelle is clear: listen, learn and adapt.
‘We spend our entire lives pretending to be neurotypical so that we can be taken seriously.
'It’s exhausting,’ she says.
‘If you really want to support autistic patients, take the time to learn about neurodivergence.
'Meet autistic people, listen to their experiences and change your approach accordingly.’
She emphasises that small changes can make a huge difference.
Things like offering a quiet waiting area, reducing unnecessary touch during assessments and providing clear, direct communication can significantly improve a neurodivergent patient’s experience.
Through her work, Isabelle is not just treating patients; she is reshaping the landscape of physiotherapy for neurodivergent individuals.
By advocating for better understanding, inclusive practices and the value of neurodivergent clinicians, Isabelle is paving the way for a more compassionate healthcare system.
‘For me, physiotherapy isn’t just a job—it’s my special interest, my passion,’ Isabelle says.
‘I get to be the clinician that I wish I’d had when I was younger.
'That’s what makes it all worth it.’
For physiotherapists looking to improve their care for autistic patients, Isabelle offers these key recommendations:
- prioritise informed consent—always explain what you are going to do before touching a patient and give them an option to decline
- minimise sensory overload—offer a quiet space, avoid strong scents and dim bright lights where possible
- adapt your communication style—be direct, avoid vague language and don’t rely on body language or implied meaning
- understand pain perception differences—autistic patients may not describe their pain in conventional ways; take their concerns seriously even if they don’t use expected terminology
- offer self-led assessments—many autistic individuals prefer to move their own bodies rather than be passively examined
- give processing time—silence isn’t discomfort; sometimes autistic patients just need a moment to process before responding
- respect routine and predictability—unexpected changes to treatment plans can cause distress; keep sessions as predictable as possible
- use visual aids—diagrams, written instructions or video demonstrations can be incredibly helpful
- recognise the role of special interests—if a patient is passionate about a topic, using it in their treatment plan can improve engagement
- be open to feedback—every autistic patient is different. Ask what accommodations they need and be willing to adjust accordingly.
Quick links:
Read the 5 Facts about Physiotherapy and autism from the June 2021 edition of InMotion.
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