Mere decades ago, it was unfathomable for baseball, football, soccer and basketball athletes to include strength and conditioning exercises in their training. Misinformation about what strength training would do (not for men and women, but to them) was pervasive then, and it persists to this day.
People with autism often experience similar misconceptions: Yes, some of these people have profound cognitive challenges and do not adapt easily to exercise regimens, but a carefully structured program and a patient, well-prepared trainer can help them become healthier and more fit.
An Autism Introduction
The population diagnosed with autism continues to grow. One in every 88 children is currently diagnosed somewhere on the autism spectrum (Autism Society 2013), so there is a good chance that fitness professionals working with young people will eventually work with one who has autism.
Autism is a neurobiological disorder (not a disease). According to the Autism Society (2013), its most prominent symptoms include the following:
• difficulty initiating and maintaining social interactions
• repetitive fixation on behaviors, topics and movements (including arm-flapping and pacing)
• anxiety in social situations or public places
• deficits in gross motor skills
• literal thinking, and difficulty understanding abstract or representational thought
Autism appears to result from a combination of genetic and environmental factors that disrupt normal development and often cause regression in emerging social and communicative skills in children aged 1.5–3 years (AAP 2013). Note that vaccines have no causal link to autism; this has been researched exhaustively by numerous independent organizations in the United States, Canada, Sweden and Japan.
Gross motor issues connected with autism can include low muscle tone/strength, poor stability, low strength endurance, compensatory movement patterning and poor gait (Staples & Reid 2010). These issues seem to occur prevalently in the Autism Spectrum Disorder population as a result of several factors, including
• deficits in neural firing when performing movement,
• lack of exploratory play during infancy and the toddler years,
• lack of vigorous physical play in childhood and adolescence, and
• poor access to appropriate and ongoing physical fitness programs.
The last point is one where our professional expertise can bear fruit. As numerous studies, anecdotal reports and extensive media coverage have shown, young people are at high risk for lifestyle-related medical complications and diseases—including type 2 diabetes, cardiovascular disease, obesity and some types of cancer. The ASD population is just as susceptible, and these young people may be even more so because of the lack of appropriate and available fitness programming (Curtin et al. 2009).
Dealing With Autism Issues
For fitness professionals who are serving this group, the most daunting task is to provide individualized programming that addresses the adaptive and cognitive deficits related to autism. Athletes with autism require specific adjustments to the movement screens we use to assess baseline physical functioning. These clients will often lack certain adaptive (self-regulation) and cognitive abilities typically required to start a fitness program. What we have to do is establish a hierarchy of goals springing from a simple question: “Where do I start?”
To realize fitness goals for people with autism, we need to make adaptive functioning the top priority. The first step is to assess and encourage motivation: As we all know, motivation keeps athletes engaged and focused; further, it ensures that they apply ample time under instruction to master exercises and activities, and that they seek enough exposure to physical activity to promote a training effect. Unfortunately, many people with autism simply do not have the motivation to perform a given (or any) physical activity, game or exercise.
These athletes may engage in “escape” or “avoidance” behaviors, such as wandering away; in more extreme cases they can become self-injurious or aggressive. In the latter situation, it is imperative that fitness professionals speak with the person’s behavior therapist to learn the right behavior protocols.
So, how does a fitness practitioner working with an ASD athlete establish motivation for performing a physical activity? Try using the Premack Principle (“If you do this, then you can have that”). to provide a “secondary reinforcer.” In other words, consider establishing a reward for performing the exercise(s)—such as access to a preferred activity (a break from exercise, listening to music, walking around, etc.). This increases the likelihood that the athlete will perform the activity again (Mancil & Pearl 2008). One of the most compelling and beneficial aspects of using the Premack Principle is that fitness activities can eventually become reinforcing themselves, calling for fewer secondary reinforcers.
Where to Focus Your Efforts
What do people with autism need from a physical standpoint? Just like other populations, they need strength and stability in pushing, pulling, squatting and rotation. Locomotion (getting from point A to point B) is important for gait patterning, movement sequencing (motor planning) and strength endurance. Activity selection should emphasize developing foundational movement skills. Once a person can perform essential complex movement patterns—including biomechanically correct squatting, pressing and pulling (in multiple planes)—an instructor can progress activities in a variety of ways:
• Add resistance by increasing the weight of the object(s) or changing the leverage.
• Add repetitions to the movement/exercise.
• Add time to the movement/exercise.
• Add additional movement.
Adding resistance improves muscle strength and boosts physical abilities in the daily lives of people with autism. Existing deficits and potential limitations due to adaptive abilities (less on-task behavior) make it much more time-consuming for these athletes to develop strong, stable multijoint movement patterns compared with people who have normal development patterns. Also, some exercises may require regression rather than progression.
Exercise regressions simplify, or “break down,” complex movement patterns that are too difficult for ASD athletes. Regressing a movement may include using a physical prompt (guiding the athlete through the movement to ensure proper technique) or providing a less challenging variation. Using a soft medicine ball with a large (10- to 12-inch) diameter for squats is an excellent way to teach “sitting” into the movement. It provides the athlete both a visual cue and proprioceptive feedback from sitting (briefly) on the ball.
Below is a complex movement regressed into its component movements. You can start at the athlete’s base level of performance and work your way up to the final movement in steps:
MEDICINE BALL PUSH-THROW
1. Push-throw with nonweighted ball from 3 feet away.
2. Push-throw with nonweighted ball from 5 feet away.
3. Push-throw with nonweighted ball from 10 feet away.
4. Push-throw with 2-pound medicine ball from 3 feet away.
5. Push-throw with 2-pound medicine ball from 5 feet away.
6. Push-throw with 2-pound medicine ball from 10 feet away.
7. Squat, and then push-throw with 2-pound medicine ball from 10 feet away.
In the first few goals, the athlete is learning the movement pattern and, likely, is overcoming deficits in upper-body strength (vertical push). By step 5, the activity has become more dynamic, with a heavier ball and an increase in the distance between partners. Physical goals typically will not progress in perfectly linear fashion; the athlete may increase push-throw distance from 5 feet to 8 feet in three sessions, and then plateau for 2 months before adding 2 feet of distance. Also, as is typical of adolescent and teen populations, growth spurts and structural changes can be both a benefit and a temporary hindrance to performance.
Those on the autism spectrum may have difficulty following multistep verbal directions. An instruction like “Go over and pick up the small sandbag, slam it on the floor five times, then run around the cones” may be too much information to process. Cognitive abilities are not necessarily measured by comparisons like “low” or “high”; the key is to determine how best an individual learns. Does a particular athlete respond better to visual cues (having you demonstrate the exercise) or kinesthetic cues (being physically guided)? Depending on the exercise or activity, a combination of kinesthetic and visual cues may work best.
Provided the athlete is accepting your directions, demonstrate the movement slowly, and follow by guiding the learner through the movement. This ensures that the person experiences early success and does not repeatedly perform the movement incorrectly. Having to constantly correct the activity frustrates the athlete and the instructor. It leads to a problematic feedback loop of “No, not that way. Do it this way,” or to similar situations where the expectation becomes unclear and the annoyance factor escalates.
Matching your instruction to the athlete’s learning style and pace alleviates anxiety and disappointment. Because many young people on the autism spectrum are averse to structured physical activity, using cues (short verbal directions, demonstration of the exercise, and/or physical prompts) and teaching methods (starting at baseline abilities, then regressing and/or progressing the activities) accomplishes much more in less time with fewer unnecessary challenges. Figure 1 condenses the three areas of ability into conceptual/practical actions.
Condensing the Density
Providing exercise programming for the autism population may require more planning and more consideration of aspects of human ability that are usually insignificant, or less significant, in achieving client goals. Still, it is our responsibility as an industry to provide fitness as a gateway toward better performance and life enhancement for all populations. The autism community should be no exception.
Eric Chessen, MS, is the founder of Autism Fitness. He is an exercise physiologist with an extensive educational and clinical background in applied behavior analysis. He has spent over a decade developing and implementing successful individual and group exercise programs in a variety of settings. More information can be found at www.autismfitness.com and www.strongerthanu.com
AAP (American Academy of Pediatrics). 2013. www2.aap.org/immunization/families/autismfacts.html; retrieved June 1, 2013.
Autism Society. 2013. www.autism-society.org/about-autism; retrieved June 1, 2013.
Curtin, C., et al. 2009. The prevalence of obesity in children with autism: A secondary data analysis using nationally representative data from the National Survey of Children’s Health. BMC Pediatrics, 10 (11). www.biomedcentral.com/1471-2431/10/11/
Mancil, G.R., & Pearl, C.E. 2008. Restricted interests as motivators: Improving academic engagement and outcomes of children on the autism spectrum. Teaching Exceptional Children Plus, 4 (6), 1-15. http://journals.cec.sped.org/cgi/viewcontent.cgi?article=1554&context=tecplus
Staples, K.L., & Reid, G. 2010. Fundamental movement skills and autism spectrum disorders. Journal of Autism and Developmental Disorders, 40 (2), 209-17.