A Caregiver Survey on Medical and Behavior Analytic Treatments for Idiopathic Toe Walking

Toe walking, which is defined as walking with a bilateral toe-to-toe gait, is common among children with intellectual and developmental disabilities and can result in a number of medical problems. Both medical and behavioral treatments for toe walking have been evaluated. In the current study, we surveyed caregivers of individuals who engage in toe walking about their use of various medical and behavioral treatments. Results suggest that the use of medical treatments is more common, and most respondents reported that they were unaware that behavioral treatment of toe walking is an option. Most respondents reported that the hypothesized function of toe walking by their child is automatic positive reinforcement, although more than half attributed toe-walking to a disorder (e.g., autism spectrum disorder), a physical cause (e.g., tight muscles), or reported they did not know why their child engaged in toe walking. Surgery and increased response effort via weighted boots were the medical and behavioral treatments, respectively, perceived to be most effective in treating toe walking. To assist the behavior analytic community in managing toe-walking cases, we also provide some specific recommendations for practitioners, including a description of the advantages and disadvantages of behavioral treatments for toe walking and a decision tree for behavior analysts unfamiliar with the literature on this topic.