Planned Physical Activity Involving Individuals with Autism: Benefits and Guidelines
By, Stephanie Todd, Undergraduate Students, College of Health and Human Performance, University of Florida, Gainesville, FL

It is estimated that more children in the United States have autism than pediatric cancer, diabetes, and AIDS combined [1]. According to the National Institute of Neurological Disorders and Stroke, one out of every 150 children in the United States has some form of autism [1]. Campaigns urging parents, teachers and health professionals to, "Learn the Signs. Act Early." spawn from research indicating the overwhelming benefits of early intervention with this spectrum of disorders [5]. Although there is no cure for autism, recent studies have demonstrated the effectiveness of intensive treatment programs which include educational and behavioral treatment plans, medications, and even exercise therapy. Utilizing vigorous physical activity as a means of therapy for children with autism has show to be a successful means of improving both physical fitness and managing inappropriate behaviors like stereotypical behaviors, outbursts, and pacing, which are common to this disorder [4].

Autism is a complex neurobiological disorder that is the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASDs) [1]. Autism spectrum disorders are developmental disabilities that cause impaired social interaction, difficulties with both non-verbal and verbal communication, and the presence of unusual, repetitive, or severely limited activities and interests [2]. Other disorders in the autism spectrum include Rhett syndrome, Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) [2].

Scientists have yet to pin-point what causes autism. However, investigative studies indicate that both environmental and genetic components play a role. Research has also revealed several other possible factors leading to ASDs. One potential environmental source that has received much attention in the media over the last decade is a chemical contained in childhood immunization shots known as Thimerosal. Thimerosal is a mercury-containing preservative that has been used in vaccinations and other products since the 1930's [2]. According to the United States Center for Disease Control (CDC), "Since 2001, with the exception of some influenza (flu) vaccines, thimerosal is not used as a preservative in routinely recommended childhood vaccines" [2]. The chemical was removed as a precautionary measure. Furthermore, extensive investigation into the possible connection between Thimerosal and autism has allowed the CDC to temporarily conclude that, "the weight of the evidence indicates that vaccines are not associated with autism" [2]. It is important to note that much more research into this possible linkage is necessary before any conclusions are drawn.

Children with autism are often plagued with difficulties interacting in a group social setting and may avoid playing with peers or participation in physical activities altogether [4]. These children may instead prefer to engage in self-stimulatory or stereotypic behaviors with the main focus on obsessive or repetitive routines and interests [1]. Examples of such behaviors include hand flapping, finger flicking, toe walking, being upset by changes, and being very rigid about object placement.

According to a recent study investigating the effects of physical activity on children with autism, it has been found that, "Physical activity programs for children with autism may promote appropriate behaviors, and improve cardiovascular endurance at the same time - two for one benefits" [4]. Specifically, the use of aerobic exercise with students in various special populations has been shown to reduce unproductive, aggressive, stereotypical, self-injurious and disruptive behavior, as well as purposeless wandering [4]. In addition, structured aerobic exercise has been shown to improve attention span, on-task behavior, and increasing endurance which is associated with improved work performance [4].

Although research indicates that aerobic exercise helps reduce the level of self-stimulatory behavior of individuals with autism, the "fatigue effect" has remained a chief concern [5]. The "fatigue effect" describes a phenomenon in which vigorous exercise reduces both positive and negative behaviors due to physical exhaustion rather than learned social interaction [6]. This occurrence is viewed as hindering overall behavioral changes.

On the contrary, researchers have confirmed that, "mildly strenuous aerobic exercise, such as jogging, decreases the self-stimulatory behavior of persons with autism while also increasing the level of academic performance" [6]. In addition, this study showed improvement in work-related performance. Evidence indicates that aerobic exercise both directly decreases the self-stimulatory behaviors of persons with autism, and increases positive behaviors in populations this population [6].

Before beginning any exercise therapy program, it is important to evaluate the client's physical limitations, and establish learning objectives and guidelines. Assessing maximal oxygen uptake (VO2 max) and coordination abilities can help to determine the client's overall physical fitness level and plan appropriate activities. Especially in those individuals with autism, it is critical to follow the necessary protocol and establish goals for the exercise plan. For example, exercise therapy in the initial stages should focus on the physical benefits gained from participating more than correcting inappropriate behavior. Improving physical fitness, coordination, and confidence may be more important in the preliminary stages than upsetting the child by attempting to address behaviors [4]. Steps can be taken to address behaviors as the as the child becomes acclimated to the changes in routine that are related to initiating participation in a physical activity program. Implementing exercise and group activities into the routine of an individual with autism must be done gradually to help prevent anxiety, and encourage the development of proper social skills.

Another important guideline that must be followed involves employing creative teaching techniques geared specifically towards those pupils with autism. Instructors who use creative teaching techniques may be able to increase the participation of children with autism [4]. Additionally, successful behavioral changes are observed in classrooms where instructors: Frequently changing activities, use learning stations, and plan transitions between stations to help overcome short attention spans [5].

According to an article published in Palestra, "Care should be taken to address one sensory modality at a time, making certain a child's preferred sensory modality is targeted" [4].This can be accomplished by first evaluating each child closely to determine his or her preferred sensory modality. Understanding the preferred sensory modality is a necessary element to developing personalized lessons and to experience the benefits of such activities [4]. The aforementioned guideline is essential to follow because presenting more than one pertinent stimulus at a time may cause the child with autism to miss some important objectives of the activity [6].

Initial fitness testing is also beneficial when selecting activities for the patient with autism to ensure that he or she is challenged to the appropriate degree. Examples of activities that may provide benefits to children with autism and low fitness levels include walking/jogging, "going on a Bear Hunt, going to the Zoo, chasing butterflies, chasing my shadow, song about slow and fast, tricycling and cycling" [4].

To help students attend to new skills while maintaining previously learned skills, the task variation method of teaching is often employed. This involves, "teaching new skills with maintenance tasks randomly interspersed and changed every two or three minutes" [4]. Use of task variations appeared to contribute to greater retention of previously learned materials [4].

Important considerations regarding the durability of the positive behavior changes must be questioned. Currently, almost no longitudinal studies investigating the effectiveness of exercise therapy to promote lasting behavioral change have been published. Thus, very little evidence is available regarding the long-term effects of aerobic exercise on maladaptive behaviors of individuals with autism. "Those studies which found the greatest degree of change immediately following the exercise found that within 2 weeks after exercise, maladaptive behaviors returned to original levels for adults with developmental disabilities" [6] Further study is needed to develop adapted exercise programs that produce lasting results.

Although there is no cure for autism or any of the other ASDs, there is hope. Hope in the fact that early diagnosis and intervention often allows individuals with autism to function productively in school, at work, and in their lives as a whole. Hope in research, and one day being able to determine the risk factors for the disease. But most importantly, hope in knowing that inexpensive and easy treatments such as aerobic activity can produce remarkable results.



References:
1. http://www.ninds.nih.gov/disorders/autism/detail_autism.htm. (Accessed: March 3, 2008).
2. http://www.cdc.gov/ncbddd/autism/overview.htm. (Accessed: March 3, 2008).
3. http://www.autismspeaks.org/whatisit/index.php. (Accessed: March 4, 2008).
4. O'Connor J.H., French R., Henderson H. Palestra. Use of Physical Activity to Improve Behavior of Children with Autism - Two for One Benefits.    
       2000:16: 3. 5.
5. Handleman, J.S., Harris, S., eds. Preschool Education Programs for Children with Autism (2nd ed). Austin, TX: Pro-Ed. 2000.
6. Rosenthal-Malek, A., & Mitchell, S. (1997). Brief report: The effects of exercise on the self-stimulating behaviors and positive responding of adolescents with autism. Journal of Autism and Developmental Disorders, 27(2), 193-202.

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