Exercise and Autism Spectrum DisorderSavannah Hollifield and Karlee MooreEXSI 410

Introduction

Conclusion

Exercise Prescription

Special Considerations

References

Exercise Testing

Autismspectrumdisorder(ASD)isoftenaconditionthatiswidelyacknowledgedbutnotconsideredorconnectedwhenconsideringtheimportanceofexercise.ASDisagroupofconditions,typicallybehavioralconditions,thatcanhavedifferentetiologiesanddifferentseverities,causingittobeaspectrumdisorder(Jacobs,2018).ASDisoftendeterminedbyalackinone'sabilitytocommunicateandinteractsocially,repetitivebehaviors,repetitiveinterestsoractivities,sensitivitytosensorysimulationssuchassight,smell,sound,taste,andtouch,andcommonbodilybehaviorssuchashandclapping,repetitivevocalizations,andobsessivefixationsononeobjectorconceptatonetime(Jacobs,2018).

Thereareseveraldifferenttypesofconditionsundertheumbrellaofautismspectrumdisorder.Classicalautismiswhenanindividualiseitherextremelylowfunctioning,orextremelyhighfunctioning.Ifanindividualislowfunctioning,theycouldnotdobasictasksatall,andiftheyarehighfunctioning,theycandobasictasksbutstruggletodosobecauseofhowhighfunctioningtheirbrainis(Jacobs,2018).ThenexttypeisAsperger’ssyndromewhichisthemostwellknowntypeofASD.Thisiswhenthepersonhasdeficienciesinsocialinteractionbuttypicallyhaveabovenormalcognitivefunction(Jacobs,2018).Childhooddisintegrativedisorder(CDD)iswhenanindividualloseslanguage,social,andmotorskillsthatwerepreviouslylearned(Jacobs,2018).ThelastsubtypeofASDispervasivedevelopmentdisorder- nototherwisespecified(PDD-NOS).ThishappenstobethemostdifficultformtodiagnosebecausethisisusedwhenanindividualisshowingsomesignsofASD,butdoesnothaveenoughsignstobediagnosedwithoneofthepreviouslymentionedformssuchasAsperger’s(PDD-NOS,2018).

ThemostrecentdataontheprevalenceofASDisshowingthat1in58birthswillresultinachildwithautism(AutismSpectrumDisorder,2018).Withthisincreasingprevalence,ithasquicklybecomethefastestgrowingdisability(Jacobs,2018).Thisdisordercanbediagnosedasearlyasage2,butcanalsotakeuntillaterchildhoodtobenoticed,duetothesocialnatureofthecondition(AutismSpectrumDisorder,2018).TheCenterforDiseaseControlandPrevention(CDC)alsoshowthatitisfourtimesmorecommoninyoungboysthanitisingirls,withitbeingcommonamongallsocioeconomicandracialstatuses(AutismSpectrumDisorder,2018).ApotentialreasonfortheincreaseinASDisthatuntiljustafewyearsago,Asperger’sandPDD-NOSwerenotconsideredautism,causingthestatisticalprevalencetoincreasewhentheumbrellaforautismgrew.Anothersuggestedreasonisthegrowingawarenessofautism(Jacobs,2018).

TheexactcauseofASDisunknown.However,somecorrelationsareknowninregardstocooccuringconditions.ItisverylikelythatanindividualwithASDwillalsobediagnosedwithadevelopmental,neurological,chromosomal,orgeneticdisorderaswell,withthatbeingthecasein83%ofdiagnoses(AutismSpectrumDisorder,2018).OtherfactorssuchasoldermaternalgestationalageandprematurebirthsareriskfactorsforASD.PsychologicalandprofessionaltestingisdonetodiagnoseanindividualonthespectrumwiththeDiagnosticandStatisticalManualofMentalDisorders:DSM-5 (Jacobs,2018).Testingisnotinvasive,butratherobservatoryandinteractiveinnature.

Presently,therearenomedicationstocureASD.Itisratherdifficulttoformulateamedicationforadiseasewithoutaspecificetiology.Medicationisrarelygiven,butinsomecasesmedicationwillbeusedtomanagesymptomssuchashighenergylevels,depression,seizures,andinabilitytofocus(Jacobs,2018).Thefirstgroupofmedicationsprescribedarecalledselectiveserotoninreuptakeinhibitors(SSRIs).Essentially,thisdrugincreasesserotonininthebrainwhichcombatsdepression,butcomeswithsomesideeffectssuchasweightgain,sleepproblems,andappetitechanges(Ferguson,2001).Theothertypeofmedicationgivenisantipsychoticdrugswhichcanreduceaggressionandself-harmingbehaviors(Jacobs,2018).

Ferguson,J.M(2001).SSRIAntidepressantMedications:AdverseEffectsandTolerability.PrimaryCareCompanionJournalofClinicalPsychiatry.3(1),22-27.

Jacobs,P.L.(2018).NSCA'sEssentialsofTrainingSpecialPopulations.Champaign,IL:HumanKinetics.

Lang,R.,Koegel,L.K.,Ashbaugh,K.,Regester,A.,Ence,W.,&Smith,W.(2010).Physicalexerciseandindividualswithautismspectrumdisorders:Asystematicreview.ResearchinAutismSpectrumDisorders, 4(4),565-576.doi:10.1016/j.rasd.2010.01.006

PDD-NOS,(2018).AutismSpeaks.Retrievedfromhttps://www.autismspeaks.org/ppd-nos

Srinivasan,S.M.,Pescatello,L.S.,&Bhat,A.N.(2014).Currentperspectivesonphysicalactivityandexerciserecommendationsforchildrenandadolescentswithautismspectrumdisorders.Physicaltherapy,94(6),875–889.doi:10.2522/ptj.20130157

Stuart-Hamilton,I.(2013).PeopleWithAutismSpectrumDisorderTakeThingsLiterally.PsychologyToday.Retrievedfromhttps://www.psychologytoday.com/us/blog/the-gift-aging/201304/people-autism-spectrum-disorder-take-things-literally

https://www.youtube.com/watch?v=1_SDT-a8FNM

Exerciseisanextremelyimportantpartofeverydaylifeforallpeople,eventhosewithASD.Duetothenatureofthecondition,somespecialconsiderationsareneededwhencombiningexerciseandASD.Themainconsiderationsareprogressivetolerance,interest,andneutralenvironments(Jacobs,2018).

Thefirstspecialconsiderationisprogressivetolerance,whichisdifferentforeachindividual.ForthemajorityofpeoplewithASD,theyalsohaveatendencytohavegaitandposturalconcerns,whichrequiresmakingsureexercisesaresuitableforthatperson’sability(Jacobs,2018).Behaviormodificationssuchasreworkingagaitorposturemaybeneededaswell.Also,justlikeanormalexerciseprogram,thereshouldbeaprogressionofdifficulty,specificallytailoredtoeachclient’sneeds.

Thenextconcernwhichmaybeoneofthemostimportant,isinterest.AtypicalsymptomofASDisfixationoneonobject,andthelackofinterestinanythingelse.IfaclientwithASDdoesnotfindtheexercisesinterestingandengaging,theywillrefusetodothen.Theexercisespecialistwillneedtoensurethattheprogramsarecreativeandindividuallytailoredtoeachclient’slikes(Jacobs,2018).

Thelastconcernwhichoftencausesthemostfrustrationforexerciseprofessional’sandtheclientsismaintaininganeutralenvironment.Thisincludestheroom,clothing,andmusicintheroom.OftentimesindividualswithASDdonothandleloudsensoryinformationsuchasbrightclothing,loudmusic,fire,orevenjustachangeofroomsfromwhattheyexpected(Jacobs,2018).Otheraspectofneutralenvironmentisthetoneofvoiceusedwithclients.Individualswithautismspectrumdisorderlacktheinabilitytounderstandsarcasm,jokesandrhetoric,requiringtheexerciseprofessionaltotakeextremecautionintheirlanguagewhentrainingapersonwithASD.ThisisbecausewithASD,individualsonlytakethingsliterallyandcannotrealizethatwhatotherpeoplethinkisdifferentfromwhattheythinkorsay(Stuart-Hamilton,2013).IfthesefewspecialconsiderationsareobservedwhentrainingaclientwithASD,thesessionscanbebeneficialtotheclientandenjoyabletothetrainer.

ChildrenandadolescentswithASDmaybemoresusceptibletotrendsofdecreasingphysicalactivityandbemaymorevulnerableforbeingoverweightorobeseduetoalimitednumberofopportunitiesforphysicalactivityoutsideofschool(Srinivasan,Pescatello,&Bhat,2014).Specifically,thereareashortageofprogramsthataretailoredtotheneedsofanindividualwithASD.Ithasbecomecommonpracticetopreoccupythisspecialpopulationwithmovies,television,orotherformsofmedia.

WhenstartinganexercisetrainingprogramwithclientwithASD,enjoyableanddevelopmentallyappropriateactivitiesshouldbeincorporatedintotheexercisetraining(Lang,Koegel,Ashbaugh,Regester,Ence,&Smith,2010).Itmaybedifficultfortheclienttoperformexercisessuchasjumping,pulling,andpushing,sotheclient’sinitialabilityshouldbeevaluatedpriortoestablishinganexerciseprogram.However,theworkoutsshouldprogressandincorporatemoredifficultactivitiesovertime.

ItisimportantforverbalexchangetobemadesimplefortheclientwithASDtocomprehend.Theconversationsshouldbeemotionallyneutralandfreeofjargon,sarcasm,andrhetoric(Langetal.,2010).Doingsowillminimizefrustrationsanddistractionsanddecreasethelikelihoodofanoutburst.Additionally,aneaseofcommunicationwillincreasethelearningabilityoftheclient.Similarly,sensorystimulationshouldbeminimized.Therefore,theroomclothing,andmusicshouldbekeptasneutralaspossibleduringexercisesessions(Jacobs,2018).

AccordingtoSrinivasanandcolleagues(2014),reliableteststoevaluatecardiovascularfitnessarethesix-minutewalktest,submaximalcycleergometerortreadmilltest,1-milewalktest,andtheshuttleruntest.Further,recommendedteststoevaluatemuscularfitnessincludesit-ups,push-ups,flexedarmhang-up,standinglongjump,andthedynamometerforlimbmuscles(Srinivasanetal.,2014).Theinstructormaydecidewhichtestisbestbasedontheclient’scurrentabilitiesorlackofabilities.

EXERCISECOMPONENT PRESCRIPTION PROGRESSION

AerobicExerciseProgram

Frequency 3days/week 5days/week

Intensity Moderatephysicalactivity Vigorousphysicalactivity

Time 20-30min/day 45-60min/day

TypeCycling,swimming,jogging,walk/runintervaltraining,andgamesencouragingexercise(ex.WiiSports,cyber

cycling)

ResistanceExerciseProgram

Frequency 1day/week 2days/week

Intensity 10-15reps/min After6months,8-10reps/min

Time 1setof6-15reps 2-3setsof8-12repswith2-3minbreak,graduallyreducebreaksbetweensets

Type

Childrenunder10yearsold:calisthenicsandactivitiessuchasjumping,climbing,throwing

Over10yearsold:strengtheningprogramforupperandlowerextremitiesandtrunkusingfreeweights,elasticbands,andbodyweightresistance;constantweight

machinesusedwithcautionandsupervision

FlexibilityTraining

Frequency 1-2times/week

Time 1hour

Type Musclestretchingformajorarmandlegmuscles,yoga,aquaticexercises,andtai-chi

PhysicalactivitiesisespeciallyimportantfortheASDpopulation.Aninstructorshouldbewell-preparedtakeonaclientwithASD.Theexerciseenvironmentandverbalcommunicationshouldbekeptneutraltoavoidanypossibleoutburstsduringsessions.Exercisetestingconductedpriortoestablishingtheexerciseprescriptionshoulddeterminetheclient’scapabilitiesinadditiontocardiovascularandmuscularfitness.Progressionsintrainingprogramswilldependonanindividual’sabilities.Enjoyableactivitychoicesshouldbeincorporatedtoengagetheclientandhelptheclientmaintainphysicalfitness.Anticipatedoutcomesincludeanimprovecognitivefunction,increasesincardiovascularhealthandbalance,anddecreasesinadiposityandriskfactorsforcardiovasculardiseases.

ThebenefitsprovidedbyregularphysicalactivityareprimarilythesameforboththosewithandwithoutASD,includingincreasesincardiovascularhealth,leanbodymass,balanceandcoordination,andstrength,anddecreasesinadiposityandriskfactorsforcardiovasculardisease.ForthosewithASD,cognitivefunctionfollowingphysicalactivityhavedisplayedsignificantimprovements(Jacobs,2018).Thisisduetotheeffectexercisehasonreducinganxiety.

AccordingtheSrinivasanandcolleagues(2014),theexerciseprescriptionfoundinTable1isrecommended.

Table1ExercisePrescriptionforIndividualswithASD

Figure1ChildwithASDPerformsExercises