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The Importance of Physical Activities for Children and Adolescents with Autism

 

Agnes Wong

Have you participated in any physical activities this week? It is well understood that physical activities are beneficial for our physical and mental health. For example, you may feel happier, more relaxed, and more energetic after exercising. Physical activity is important for everyone, and it is especially crucial for the mental health of people in certain populations, such as those with autism spectrum disorder (ASD). In this article, the importance of physical activities for the mental health of children and adolescents with ASD will be discussed, and some tips for implementation will be suggested. 

Why physical activity is especially important for the mental health of children and adolescents with ASD? 

ASD is a neurodevelopmental disorder commonly characterized by deficits in social communication and social interactions, and the presence of restricted and repetitive patterns of behaviors, interests, or activities such as hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.1 Difficulties in sensory processing and social communication, together with difficulties in balance and motor coordination may limit activity choices among children and adolescents with ASD.2,3 Recent research findings showed that the physical activity levels in people with ASD are lower than the remainder of the population.4,5 According to the World Health Organization, people with ASD constitute a special risk group due to their more sedentary lifestyle, which can lead to other health problems like obesity.6  In fact, children with ASD are at particularly high risk for obesity due to a lack of structure in nutritional intake and excess television to calm them.7 It is predicted that the problem of sedentary lifestyle and obesity may increase even more among children with ASD due to COVID-19.8 Understandably, the difficulties in multiple aspects such as social communication, limited interests, hyper- or hyporeactivity to sensory input, and sedentary lifestyles may put this vulnerable population at increased risk of insufficient physical activity and poor mental health. It is alarming that the prevalence of depression in teens with ASD was found to be about seven times higher than their peers,9 and a significant proportion of children with ASD have a psychiatric comorbidity.10 Understandably, sometimes we may forget to do physical activities on a regular basis and the benefits of doing so may be overlooked. Remaining physically active is beneficial for our physical and mental health, and it is especially important for certain populations, such as children and adolescents with ASD.

Benefits of physical activities in ASD

Numerous studies suggested that moderate to vigorous physical activity may be especially beneficial to children with ASD as it helps to decrease their stereotyped behaviours,11,12 reduce off-task behaviors,13 improve academic engagement and cognitive performance,13,14 enhance quality of life,15 and improve social and emotional functioning.16 According to a recent systematic review about the benefits of physical activity in adolescents with ASD, there is strong empirical support for benefits in self-regulation, health, and motor skills.17 The review, however, showed limited improvements to cognitive and sensorimotor functioning.17 Many forms of physical activity can yield beneficial effects, and dance can be one of the options. A systematic review concluded that dance could improve social involvement, communication skills, body awareness, and mental health in ASD.18 Remaining physically active leads to a wide range of positive outcomes, such as better motor coordination and communication skills, which in turn brings positive effects on our quality of life and mental health.

Suggestions for implementation

Caregivers may need to pay attention to many aspects to facilitate regular physical activity in children and adolescents with ASD. First, determine what kind of physical activities to do every day.8 Some short and simple physical activities can keep them active throughout the day. Dancing, walking, climbing stairs, sit-ups, push-ups, playing games with the whole family, and performing chores, such as mopping and gardening, are good options for them to stay active at home.8,19 Depending on the age and health status of the children or adolescents with ASD, as well as their preferences, caregivers may consider providing them opportunities for exercising for about 30 minutes at moderate intensity each day.8,20 The European region of the World Health Organization recommended some home-based exercises such as knee to elbow, plank, back extensions, squats, superman, and bridge, that caregivers may demonstrate and participate together with the younger ones at home.19 Remember to give sufficient breaks and avoid overwhelming the child to ensure adherence to physical activities in the long run.21 

Second, predictability, familiarity, and sensory issues are important considerations when planning activities for individuals with ASD. It is useful to prepare the environment for the selected activities in advance so that the child can participate in the activity more efficiently.8 Conducting physical activity in the same physical environment and incorporating visual schedules may help the child understand the structure of the session and anticipate the transitions between exercises.21 Allow time for the child to adapt to any new pose or activity. Also, consider the sensory needs of the child. For example, avoid distractions, bright lights, and certain noises, especially for those with hypersensitivity.21 

Third, the importance of caregivers’ interventions during the activities cannot be underestimated. Praise, prompting, and modelling are some of the highly effective intervention mechanisms that can be used.17 It may also be useful to combine verbal and visual instructions.21 When necessary, provide breaks from the activity so that the child can enjoy other favourite sensory activities such as tactile balls or healthy snacks.21 Furthermore, active involvement of parents and siblings in physical activities may lead to greater outcomes and should be considered if applicable.8,22 

To conclude, physical activities are particularly important for children and adolescents with ASD. It is essential to include physical activities in their daily lives, but this is easier said than done. Good planning and preparation may facilitate successful implementation in the long run.  

Edited by Elizabeth Karvarsarski & Curtis D' Hollander

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013 May 22.

2. Green D, Charman T, Pickles A, Chandler S, Loucas TO, Simonoff E, Baird G. Impairment in movement skills of children with autistic spectrum disorders. Developmental Medicine & Child Neurology. 2009 Apr;51(4):311-6.

3. Potvin MC, Snider L, Prelock P, Kehayia E, Wood-Dauphinee S. Recreational participation of children with high functioning autism. Journal of Autism and Developmental Disorders. 2013 Feb;43(2):445-57.

4. Hillier A, Buckingham A, Schena D. Physical activity among adults with autism: participation, attitudes, and barriers. Perceptual and Motor Skills. 2020 Oct;127(5):874-90.

5. Pan CY. Objectively measured physical activity between children with autism spectrum disorders and children without disabilities during inclusive recess settings in Taiwan. Journal of autism and developmental disorders. 2008 Aug;38(7):1292-301.

6. World Health Organization. The world health report 2008: primary health care now more than ever. World Health Organization; 2008. Retrieved from: https://www.who.int/whr/2008/whr08_en.pdf 

7. Must A, Eliasziw M, Phillips SM, Curtin C, Kral TV, Segal M, Sherwood NE, Sikich L, Stanish HI, Bandini LG. The Effect of Age on the Prevalence of Obesity among US Youth with Autism Spectrum Disorder. Childhood Obesity. 2017 Feb 1;13(1):25.

8. Yarımkaya E, Esentürk OK. Promoting physical activity for children with autism spectrum disorders during Coronavirus outbreak: benefits, strategies, and examples. International Journal of Developmental Disabilities. 2020 Apr 21:1-6.

9. Hedges S, White T, Smith L. Depression in Adolescents with ASD. Autism at-a-Glance. Center on Secondary Education for Students with Autism Spectrum Disorder. 2014 May.

10. Leyfer OT, Folstein SE, Bacalman S, Davis NO, Dinh E, Morgan J, Tager-Flusberg H, Lainhart JE. Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of autism and developmental disorders. 2006 Oct;36(7):849-61.

11. Bahrami F, Movahedi A, Marandi SM, Abedi A. Kata techniques training consistently decreases stereotypy in children with autism spectrum disorder. Research in developmental disabilities. 2012 Jul 1;33(4):1183-93.

12. Iliadis I, Apteslis N. The role of physical education and exercise for children with autism spectrum disorder and the effects on socialization, communication, behavior, fitness and quality of life. Dialog. Clin. Neurosci. Ment. Health. 2020;3:71-81.

13. Lang R, Koegel LK, Ashbaugh K, Regester A, Ence W, Smith W. Physical exercise and individuals with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders. 2010 Oct 1;4(4):565-76.

14. Tomporowski PD, Lambourne K, Okumura MS. Physical activity interventions and children's mental function: an introduction and overview. Preventive medicine. 2011 Jun 1;52:S3-9.

15. Toscano CV, Carvalho HM, Ferreira JP. Exercise effects for children with autism spectrum disorder: metabolic health, autistic traits, and quality of life. Perceptual and motor skills. 2018 Feb;125(1):126-46.

16. Pan CY. The efficacy of an aquatic program on physical fitness and aquatic skills in children with and without autism spectrum disorders. Research in Autism Spectrum Disorders. 2011 Jan 1;5(1):657-65.

17. Sorensen C, Zarrett N. Benefits of physical activity for adolescents with autism spectrum disorders: A comprehensive review. Review Journal of Autism and Developmental Disorders. 2014 Dec;1(4):344-53.

18. DeJesus BM, Oliveira RC, de Carvalho FO, de Jesus Mari J, Arida RM, Teixeira-Machado L. Dance promotes positive benefits for negative symptoms in autism spectrum disorder (ASD): a systematic review. Complementary therapies in medicine. 2020 Mar 1;49:102299.

20. U.S. Department of Health and Human Services. 2018. Physical activity guidelines for Americans. 2nd ed. Washington, DC: U.S. Department of Health and Human Services. Retrieved from: https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf 

21. Srinivasan SM, Pescatello LS, Bhat AN. Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders. Physical therapy. 2014 Jun 1;94(6):875-89.

22. Sefen JA, Al-Salmi S, Shaikh Z, AlMulhem JT, Rajab E, Fredericks S. Beneficial Use and Potential Effectiveness of Physical Activity in Managing Autism Spectrum Disorder. Frontiers in behavioral neuroscience. 2020 Oct 22;14:186.

 

 

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