Is W Sitting a Red Flag for Autism?

Written by: John Hookway

February 15, 2024

Updated on May 09, 2024

W-sitting is a seated position where a child sits on their bottom with their legs bent outward and feet pointing behind them. This makes their legs form a “W” shape. In this position, the child is sitting on the bottom between their feet rather than having their legs out front.

W-sitting gets its name from the W shape the child’s legs make in this seated pose. Their feet are tucked under or behind them and their bottom is resting on the floor between their bent legs. This makes their hips rotate outward and their knees spread wide, causing the legs to create the “W” shape. Some key features of the W-sitting posture include:

• Knees and feet pointed outwards with bottom on the floor
• Hip joints externally rotated and abducted
• Legs bent at approximately 90-degree angles
• Feet tucked under the bottom or pointed behind
• Low tripod base of support rather than legs out front

W-sitting may look similar to the “crisscross applesauce” pose, but the key difference is that in W-sitting the bottom is on the floor rather than being lifted. The legs are also bent at sharper angles with feet pointing behind rather than to the side.

Is W-sitting bad?

W-sitting, where a child sits on their bottom with their legs bent and feet pointing outwards to the side, has some potential downsides to be aware of.

The position can put a strain on a child’s hips, legs, and lower back if done excessively or for long periods. W-sitting requires the hips and thighs to externally rotate and the ankles to dorsiflex. This can cause tightness in the hips, legs, and ankles over time.

Sitting with legs bent out to the sides can also cause a child’s posture to suffer. It encourages a rounded back and slouched position, rather than an upright, aligned spine. Poor posture from w-sitting could contribute to back pain later on.

W-sitting also makes it more challenging for a child to get up from the floor into standing. The position is quite stable and grounding but requires more effort to rotate the hips and lift than a cross-legged ‘criss-cross applesauce’ position would.

Some children naturally favor w-sitting, while others grow out of it over time as their mobility improves. Keeping an eye on how long and often a child w-sits can help minimize any long-term tightness or postural imbalances. Gentle encouragement to sit ‘crisscross’ sometimes can also help increase flexibility.

W-Sitting and Autism

W-sitting, also called “W-sit” or “frog position”, is a sitting position where a child’s knees are bent and feet are tucked under the buttocks with the legs splayed out to the side. This position causes the legs to form a “W” shape when viewed from above.

W-sitting is very common in children with autism spectrum disorder (ASD). Estimates indicate that over 90% of autistic children habitually sit in the W-position compared to around 15-20% of neurotypical kids.

There are several reasons why autistic children tend to W-sit:

• Sensory seeking – The deep compression against the floor and tightly tucked legs provide calming sensory feedback that autistic children often seek. W-sitting helps them regulate and focus.
• Proprioceptive differences – Autistic kids may have a reduced perception of body position and movement (proprioception). W-sitting provides more stimulation to help increase body awareness.
• Postural control differences – Sitting with legs tucked in the W-position helps autistic children maintain an upright posture and stabilize their core muscles, which can be weak.
• Narrow focus – When engrossed in an activity, autistic children may default to W-sitting without concern for posture or appearance.
• Social differences – Autistic children are less aware of social norms, such as sitting “correctly.” W-sitting may persist without social motivation to change positions.

The strong association between W-sitting and ASD demonstrates how autism involves differences in sensory processing, cognition, posture, focus, and behavior. While not a specific diagnostic sign, W-sitting can be one indicator among many that may prompt evaluation for autism.

Other Signs of Autism

Autism is a complex condition that involves challenges in social communication and interaction, as well as restricted interests and repetitive behaviors. Here are some of the other common signs of autism spectrum disorder (ASD) to look out for in addition to W-sitting:

Communication Challenges

• Delayed speech and language development
• Difficulty initiating or maintaining conversations
• Stereotyped or repetitive speech
• Echolalia – repeating words or phrases said by others
• Difficulty understanding non-literal language like sarcasm or idioms

Restricted Interests

• Intense interest in specific topics, especially numbers, facts, or science
• Rigid adherence to rules and routines
• Ritualized patterns of behavior like lining up toys
• Distress with small changes in the environment or schedule

Sensory Issues

• Hypersensitivity or lack of sensitivity to sound, light, texture, taste, or smell
• Adverse response to specific sounds or textures
• Excessive smelling or touching of objects
• Fascination with lights or spinning objects

Getting an Evaluation

If you are concerned that your child’s W-sitting may be a sign of autism, it’s important to have them evaluated by a professional. Here’s what you need to know about getting an evaluation:

• Your pediatrician – At your child’s next well visit, share your concerns about W-sitting and other potential signs of autism. The doctor can refer you for further evaluation.
• Early intervention program – If your child is under 3 years old, contact your local early intervention program. They provide free developmental evaluations.
• Your school district – For children 3 and older, contact the special education department at your local public school system. They manage evaluations.
• Developmental pediatrician – Your pediatrician may refer you to a specialist who focuses on autism and developmental delays.
• Psychologist – A psychologist can do a comprehensive evaluation to test for autism and other conditions.

What to Expect During the Evaluation Process

The evaluation process involves multiple appointments and may include:

• Developmental screening – A short questionnaire or activity to identify any areas of concern.
• In-depth interview – Discussing your child’s development and medical history in detail.
• Observation – Watching your child play and interact to look for signs of autism.
• Hearing/vision tests – To rule out issues with senses impacting development.
• Standardized testing – Formal tests of development, language, motor skills, etc.
• Autism-specific evaluation – Specific tools to assess for autism, like the ADOS-2.
• Medical exam – A physical to identify any genetic factors or other health issues.

The full evaluation provides a comprehensive picture to diagnose autism or other developmental disorders. It’s important to have your child evaluated as soon as possible if you have any concerns. Early diagnosis leads to earlier interventions that can improve outcomes.

Support and Interventions

Many therapies and interventions are available to support children with autism spectrum disorder (ASD). The earlier these interventions begin, the better the outcome for the child. Some of the most common and effective interventions include:

Applied Behavior Analysis (ABA) – This uses positive reinforcement to improve behaviors like communication, social skills, attention span, and learning. Studies show ABA can improve IQ, language skills, adaptive behaviors, and social skills in children with ASD. It’s considered the gold standard treatment.

Speech Therapy – A speech-language pathologist helps the child improve verbal and nonverbal communication skills. This may involve using pictures, sign language, or devices to supplement speech.

Occupational Therapy – Occupational therapists help kids with ASD engage in everyday activities like eating, dressing, and playing. They may use sensory integration techniques to address sensory issues.

Physical Therapy – Improving motor skills, balance, coordination, and strength through structured exercises. This helps with coordination issues common with ASD.

Early Intensive Behavioral Intervention (EIBI) – This begins ABA therapy as early as age 2-3. Delivering 20-40 hours per week of ABA for 1-4 years. EIBI during the preschool years yields the best outcomes.

The earlier a child is diagnosed and enrolled in interventions like applied behavior analysis and speech therapy, the greater their gains in language, cognition, and social skills. Early intensive therapy capitalizes on neuroplasticity in young brains. So beginning therapy by age 3-4 is ideal. Research shows earlier treatment results in dramatically improved outcomes later in life.

Encouraging better sitting

Sitting in a W-shape puts stress on a child’s hips, knees, and ankles over time. While it likely won’t cause permanent damage, it’s a good idea to discourage it. Here are some tips:

• Gentle redirection – If you see your child sitting in a W, gently guide their legs into a different position. You can say “Let’s sit criss-cross applesauce” or “Legs out front”. Don’t force it.
• Praise good sitting – When you see your child sitting with legs outstretched or crossed, praise them. “Great job sitting nicely!” Reinforce good habits.
• Cushions/bolsters – Place cushions or rolled-up towels under their knees to make W-sitting physically uncomfortable.
• Floor time – Increase floor play time to strengthen the core and legs. Have them play on their stomachs, in tall kneeling, and with their legs extended.
• Sitting supports – Use small stools, cushions, or folded blankets to prop their legs and encourage better alignment. A small footrest can help keep your legs forward.
• Take breaks – Have them get up and move every 15-20 minutes during seated activities to reset their position.
• Modeling – Demonstrate proper sitting regularly so they learn from you.

With consistent cues and alternatives, you can help minimize W-sitting without a struggle. Pay attention to periods of fatigue when it may occur more. Other sitting positions to try:

• Crisscross/Tailor pose
• Long sitting/Legs out straight
• Side sitting/Leg to one side
• Tall kneeling/Kneeling upright

The key is providing gentle reminders and making the physical environment less conducive to W-sitting. With time, good sitting habits will form.

Adapting Activities

W-sitting can present challenges during certain activities at home or school. However, there are ways to adapt activities to accommodate different sitting styles.

• Provide pillows, cushions, or wedges to make floor sitting more comfortable. This allows w-sitters to participate while maintaining their sitting preference.
• Use lap desks or clipboards so kids can draw or do activities while w-sitting. Look for vertical surfaces to use.
• During storytime or circle time, allow w-sitters to face the wall and lean back for support. Or let them lie on their stomachs.
• Set up work stations for activities like puzzles or crafts at an appropriate height for w-sitting. A coffee table or ottoman can work.
• Encourage regular movement breaks during long seated activities. This gives w-sitters a chance to stretch and move.
• For group activities that require kneeling, provide soft mats or pads for w-sitters to kneel on.
• During meals, use a small chair rather than a bench to let w-sitters eat at the table comfortably.
• Allow different sitting positions during play. Bean bag chairs, inflatable seats, and squishy floor mats provide options.
• Avoid forcing a child out of w-sitting if it’s their preferred style. Work with them to adapt activities instead.

The key is providing an environment where w-sitting kids can participate fully in activities alongside peers. Simple accommodations go a long way to support diverse sitting needs.

Outlook and prognosis

The long-term impact of persistent W-sitting in young children is an area requiring more research. However, some potential effects include:

• Decreased range of motion in the hips and legs. W-sitting requires external hip rotation and abduction, which can cause tightness and stiffness over time if not counteracted with stretching and exercises. This may make other sitting positions less comfortable.
• Delayed motor skills. W-sitting is less stable than other sitting positions, requiring more effort to balance. This can interfere with the development and coordination of movements and motor planning.
• Postural and gait abnormalities. Persistently sitting in the W-position may contribute to poor posture, distorted pelvic alignment, and inefficient ambulation patterns.

If autism is diagnosed along with W-sitting behaviors, the prognosis depends on the child’s level of support and intervention services. With early intensive therapy and accommodations, many children with autism can learn, develop, and lead fulfilling lives. Key factors include:

• Early intervention, starts as young as possible once autism is suspected. This allows important skills to be built during key developmental windows.
• Behavioral therapies are based on principles of applied behavior analysis (ABA), which teach communication, social, motor, and life skills in a structured, personalized manner.
• Speech, occupational, and physical therapies to address specific needs like communication, sensory issues, or motor deficits.
• Accommodations and support services in educational settings tailored to the child’s challenges and strengths.
• Medications to help manage co-occurring conditions like anxiety, ADHD, or sleep issues, when recommended by a doctor.
• Parent education, training, and support groups to empower families to advocate for their child’s needs.
• Taking advantage of windows of opportunity as the child grows and develops to encourage learning and independence.

The exact prognosis depends on the child’s symptom severity. However, with proper treatment and support, many children with autism can go on to lead productive, independent lives within their communities.

When to seek help

If your child is consistently sitting in a W position and also showing other signs of a potential developmental delay, it may be time to speak to their pediatrician and request a formal evaluation.

Some red flags that indicate an evaluation is warranted include:

• Your child is over 3 years old and sits in a W most of the time
• Your child has poor muscle tone or loose joints
• Your child has delayed speech development
• Your child avoids eye contact or doesn’t respond to their name
• Your child has sensory issues, such as heightened sensitivity to sound
• Your child shows repetitive behaviors or intense interest in specific objects/topics
• Your child has difficulty relating to other children

Sitting in a W beyond the age of 3-4 years frequently correlates with an underlying condition like autism, sensory processing disorder, or developmental delay. While W-sitting on its own is likely not a cause for alarm, combined with other red flags it’s important to seek professional advice.

Early intervention is key for supporting autism and other developmental conditions. An experienced pediatrician can provide guidance, referrals, and next steps if your child displays multiple concerning symptoms. Don’t ignore signs that appear outside the “typical” range – you know your child best. Seeking help early can make a world of difference.