POSITIVE IMPACTS OF EXERCISE FOR CHILDREN WITH AUTISM
Elyse Morin, Undergraduate Student; College of Health and Human Performance; University of Florida

Diagnosed in children before the age of three, autism is a developmental disorder that is distinguished by its impairment of social interface and communication, and restrictive and repetitive patterns of behavior, interests, and activities. Autism now affects close to 20 out of every 10,000 children and is diagnosed by the presence or absence of certain developmental behaviors.¹ (Fact: Experts estimate that two to six children out of every 1,000 will have autism. Males are four times more likely to have autism than females. Also, more Autism Facts and Statistics.)

The severity of its effects on each child are of a spectrum. No child is effected the same as another, and even one child may not have the same consistent effects day to day. Due to its irregularity, there are many aspects that remain curious, especially those of treatment and therapy. Children that do not have the social and behavioral deficits of autism generally get their physical activity from playing with other children. Because children with autism have trouble participating socially, making eye contact, playing creatively, and making friends, they have fewer occasions to partake in physical activity than their socially-able peers, and are generally less active. Exercise not only effects the child’s physical health, but also serves to combat the manifestations of the disorder. In addition, opportunities are severely limited, and most recreational activities available involve extensive social cues. More supportive exercise would include adapted and integrated sports, sports focused on inclusion, and in general preferred lifetime activities.²

The most effective therapies for children with autism are those that involve movement. Along with the social and behavioral effects of autism, children also have vestibular system dysfunction. This obstruction is caused by ineffective sensory processing which manifests itself in “problems in attention, behavior, learning, speech development, movement and co-ordination.”³ One study looked at the effects of target-oriented kinetic exercises on the stabilization of static balance, an important factor in coordination and the normal development of a child in order to function in their environment. The children carried out repetitive kinetic exercises five times a week for the duration of the 3 month program. Their results were determined using the stato-kineto-metric test, which graphically determines the child’s sway during balancing. Children’s balance after the kinetic exercise program improved by 47.9%.⁴ Such repetitive kinetic exercises include serial gymnastic exercises. As the intensity and repetition of the child-chosen movement increases, changes in the child’s behavior begin to occur based on the feedback to the vestibular system.

Other self-stimulatory behaviors, such as rocking, aim to establish the same feedback, however, it is the increasing intensity of the gymnastic movements that produces therapeutic effects. The stronger the external stimuli for the child, the more data is processed, which then activates the cortex. This stimulation is necessary for proper brain development, and can show significant effects in the behavior of children with autism when used as therapy.⁵

Self-stimulatory behaviors are a defining characteristic of autism because they are maintained by sensory feedback. Sensory input is sustained by the repetitive behaviors, which are maintained by rhythm. Children will continuously and rhythmically rock, jump, flap their arms, pace, spin, stare, eye roll, or toe-walk in order to receive sensory feedback. These behaviors distract a child from response cues from the environment, and interrupt previously learned behaviors and learning.

One study aimed at disrupting this feedback loop through the use of exercise, as to halt the nonfunctional behaviors. The behavior of the subjects was observed, followed by a mild exercise program (walking), or a vigorous exercise program (jogging), as determined by change in heart rate. After each 15 min. program, observations were made for changes in the amount of self-stimulatory behaviors. It was found that the mean of stereotypic behaviors after vigorous exercise was decreased by 17.5%. After 90 minutes, behavior returned to previous levels. This large decrease shows that exercise could replace the motor component of the stereotypic behavior when it was of sufficient intensity. Exercise can be used most effectively when it mimics the feedback that the child would receive from the self-stimulatory behavior.⁶

Another study looked at the effects on behavior of aerobic activity, general motor training, and non-exercise activity in subjects with autism as well as subjects with intellectual disabilities. Results showed that the only decrease on maladaptive behaviors was caused by exercise. These findings agree that vigor of the activity is responsible for the decrease in behaviors.⁷ The appropriate intensity to maintain cardiorespiratory fitness, and therefore improve disruptive behavior, is calculated as 60-90% of the heart rate maximum for a minimum 20 minutes of exercise, where 60-79% is moderate and 80-89% is heavy.⁸ Any form of vigorous aerobic exercise can therefore be utilized to control nonfunctional behaviors associated with autism so that individuals can function more easily in the workplace, social and academic settings, and beyond.

Exercise that capitalizes on the movement itself, and deemphasizes social communication, can also be used as a therapy to achieve social gains. The use of creative dance as a therapy for children with autism is based on its opportunity for social feedback. One study compared social competence during creative dance and classroom simulating “circle time.” Verbal students increased their social competency during both creative dance and “circle time,” with a greater increase during dance. Nonverbal students benefitted primarily from creative dance. Overall, it is apparent that the creative dance, which removes the social pressures from interaction with other children, has the ability of including children with autism more effectively. In these exercises, children with language and communication impairments are able to perform similarly to their non-disabled peers and therefore allowing the children, especially those that are nonverbal, to adapt to and enjoy the social situation.⁹

Horse riding, or Hippotherapy, is also an exercise that offers benefits ranging from the therapeutic effects of the repetitive movement of the horse’s gait, to the gradual social interaction that it provides to the rider. As the child rides, he is able to create a relationship with the horse as he is calmed by the sensory feedback that he is getting from the movement of the horse’s hips as it walks. He is also able to create relationships with the instructor, therapist, volunteers, and possibly other riders. This exercise is also generally nonverbal, and allows for the child to interact with the horse and others without anxieties caused by their social and communicative deficits.¹⁰

Performing physical activates in a pool also provide added benefits for children with autism. The weightlessness of the water allows for greater range of motion and fluidity, and ease of movements. The sensory signals that the child receives from being surrounded and supported by the water also help to calm and steady the child. In general, children with autism exhibit poor motor skills, therefore, the rehabilitation that would be most beneficial or them would emphasize “fundamental motor skills and patterns of movement, individual games and sports, and developmental activities that increase physical proficiency.” One study looked at the effects of ten weeks of various swimming training lessons on general physical fitness and orientation in the water. Children were found to have increased balance, speed, agility, power, hand grip, arm and leg muscle strength, flexibility, and endurance after training. Greater orientation in the water was also observed along with a decrease in self-stimulatory stereotypical behaviors.

The later decrease was a result of the increasing vigor of the swim training, as the sensory feedback matched that of the nonfunctional behavior itself, the behavior stopped. In addition, children were found to have a greater confidence and self awareness in the water after the training period. This water exercise not only benefits the cardiovascular health and autistic-specific therapies, but is also thought to aid in “language development and self-concept, and to improve adaptive behavior and provide an appropriate setting for early educational intervention.”¹¹

Exercise is especially important for children with autism early, during their sensitive period of development when their brain and behavior have the most plasticity. Research looking to prevent the development of stereotypic repetitive behaviors in autistic children has found that early environmental complexity has led to changes in neuronal metabolic activity, primarily in the motor cortex and basal ganglia, which control motor movements, especially voluntary. This increased activity has led to a decrease in repetitive behaviors, as seen in deer mice. Early exercise, such as taking a walk outside or swimming, helps to increase sensory input and environmental complexity, which leads to these neuronal changes. The study also found that increased environmental complexity later in life also shows some reduction in repetitive behaviors, to a lesser extent. Although meaningful interaction with the environment is generally overwhelming for children with autism, the effects that it has on the brain are sizeable. The coupling of this environmental interaction with exercise helps to make the activity more meaningful and pleasurable for the child.¹²

Exercise for children with autism would not be an effective therapy if it were not approved by, or chosen by, the child, and if the child was not supported in the physical activity setting. As with all children, the activities that they enjoy the most, they do the most. If a child has a fear of water, exercise in a pool may not be as beneficial as another activity that they would enjoy, such as creative dance, running, or horse riding. As the developmental disorder itself affects each child in a spectrum, the exercise therapy that will work for each child should be specialized for their own interests and likes so that it is less a therapy tool and more fun. In addition, as most physical activity at a young age occurs at school, children with autism should be made to feel comfortable, confident, and included in the activities with their non-disabled peers.

Important strategies for creating a supportive environment for children with autism to participate include establishing a clear structure to activities with visual cues, a routine, a clear end to class, using positive reinforcement, and communicating in a way that the child responds well to. It is also crucial for instructors to prepare for challenging behavior by being aware of each child’s sensory sensitivity and providing a private space for the child to calm down. By creating an autism friendly environment, the child will not associate exercise with stress, and will enjoy it more and continue to practice it.¹³

Comorbidities of autism, including “anxiety, depression, sleeping and eating disturbances, attention issues, temper tantrums, and aggression or self-injury” have individually seen improvement with exercise.¹ Hormones such as endorphins that are released during exercise block pain, create a sense of euphoria, and also alleviate tension and stress. In addition, the motor competency, social competency, attention, and interaction that children with autism build and receive from exercise helps them gain confidence and self awareness, which may have some greater effect on alleviating the above disorders.

Exercise is an effective therapy for children, adolescents, and adults with autism. In addition to the health benefits that it provides everyone, it presents children with autism the ability to improve balance and voluntary motor movement, decrease the occurrence of interruptive stereotypic behaviors, improve social competence, attain agility and confidence in sports activities, activate behavioral neurons in the brain, and relief for comorbidities. As with most other habits that are important for our health, it is best to teach children with autism the gratification that they receive from exercise early on so that it becomes a daily activity and not a chore. The patterns that children practice growing up carry into their adult life, and even pass on to their children. It is important to make the transition gradual and consistently supportive for the child, and to ensure that the activities are child-picked. Exercise provides so many positive outcomes for children with autism, but the most important part is that the child is comfortable and is having fun.

Resources

1. Ospina, Seida, Clark, Karkhaneh, Hartling, Tjosovold, Vandermeer, & Smith (2008). Behavioural and Developmental Interventions for Autism Spectrum Disorder: A Clinical Systematic Review. PLoS ONE, 3 (11): e3755.
2. Reid (2005). Understanding Physical Activity in Youths with Autism Spectrum Disorders. Palaestra, 21 (4), 6-7.
3. Bhojne & Chitnis (2002). Vestibular Dysfuntion in Children with Pervasive Developmental Disorder. The Indian Journal of Occupational Therapy, 34 (1), 3
4. Szot (2005). The Influence of Kinetic Exercises on the Static Balance of People with Autism. Research Yearbook, 11 (1), 45-48.
5. Szot (1997). The Method of Stimulated Serial Repetitions of Gymnastic Exercises in Therapy of Autistic Children. Journal of Autism and Developmental Disorders, 27 (3), 341-342.
6. Rosenthal-Malek & Mitchell (1997). The Effects of Exercise on the Self-Stimulatory Behaviors of Adolescents with Autism. Journal of Autism and Developmental Disorders, 27 (2), 193-201.
7. Elliott, Dobbin, Rose, & Soper (1994). Vigorous, Aerobic Exercise Versus General Motor Training Activities: Effects on Maladaptive and Stereotypic Behaviors of Adults with Both Autism and Mental Retardation. Journal of Autism and Developmental Disorders, 24 (5), 565-576.
8. American College of Sports Medicine (1990). Position Stand on the Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness in Healthy Adults. Medicine and Science in Sport and Exercise, 22, 265-274.
9. Greer-Paglia (2006). Examining the effects of creative dance on social competence in children with autism: a hierarchical linear growth modeling approach. Harvard University.
10. Mason (2005). Effects of therapeutic riding in children with autism [dissertation]. Capella University.
11. Yilmaz, Yanardag, Birkan, & Bumin (2004). Effects of Swimming Training on Physical Fitness and Water Orientation in Autism. Pediatrics International, 46, 624-626.
12. Lewis (2004). Environmental Complexity and Central Nervous System Development and Function. Mental Retardation and Developmental Disabilities Research Reviews, 10, 91-95.
13. Groft-Jones & Block (2006). Strategies for Teaching Children with Autism in Physical Education. Teaching Elementary Physical Education, 25-28.
    

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