April 20, 2015 3:00 pm Published by Anya K. Silver, MA, BCBA
When we think of autism spectrum disorders, we often think of the children on the spectrum. We know that 1 in 68 school children has autism (CDC) and that the NYCDOE estimates that 1 in 10 city school children will have an autism diagnosis before they graduate. What we don’t often focus on is that over the next ten years, 500,000 children with autism will become adults, 90% of adults with autism are unemployed or underemployed, and 79.1% of young adults with autism experience residential living after their secondary education (Roux et al., 2013). This tells us that we have to do a better job at increasing independence and vocational skills in our adults with autism; and we need to determine how this can be accomplished, how students are taught, what skills are essential for the best outcomes and when do we start teaching these skills. There is a tremendous amount of research conducted with children with autism and very little published research on adults. We as educators/clinicians need to know what will enable a 21 year old program graduate to be prepared enough to get a paid job and live independently or as close to that goal as possible.
Of particular concern would be what skills need to be taught, what systems have to be faded, the level of prompt dependency, the schedule of reinforcement, and the dependency on 1:1 instruction. Skills in communication, social interaction, self help/independent living, pre-vocational/vocational, and leisure pursuit are essential for a productive adult life; what are we doing to teach our elementary and school age students these skills? We as educators/ clinicians have to focus on ensuring a smooth transition, focusing on teaching these skills in the elementary and secondary school years, fading out 1:1 instruction earlier, understanding that adult services do not support a 1:1 ratio, focusing on small/large group instruction and increasing independence and vocational skills across the board. Ultimately we need to shift our focus and ensure that everything we are doing for our younger students on the autism spectrum is translating to effectively supporting our adults on the autism spectrum.
Gerhardt, P.F. & Lainer, I. (2011), Adressing the Needs of Adolescents and Adults with Autism; A crises on the Horizon. Journal of Contemporary Psychotherapy, 41: 37-45.
Roux, A.M., Shattuck, P.T., Cooper, B.P., Anderson, K.A., Wagner, M., & Narendorf, S.C. (2013), Postsecondary Employment Experiences among Young Adults with an Autism Spectrum Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 52 (9): 931-939.
April 13, 2015 3:00 pm Published by Rocio E. Chavez, MA., MSEd., LBA
April is not only autism awareness month, but it is also the time of the year when we begin to see life return to the city. The weather is getting warmer, the trees and flowers are beginning to bloom, and we are enthused about going out and getting active; however, for families who have children with an autism spectrum disorder (ASD), participating in activities is not always easy. Individuals with autism may be resistant to physical activity, overstimulated by their environment, and difficult to motivate. As a result, they may get left out of activities with important opportunities. Participating in physical activity is important for the individual with an ASD in order to be able to integrate into the community, interact with peers, and for their overall health. When implemented correctly, a physical activity routine can provide the individual with great benefits. Physical activity does not have to be strenuous or uncomfortable, it can be as simple as taking a short walk.
The following is an article by Geraldine Dawson, Ph.D., Chief Science Officer, Autism Speaks and Michael Rosanoff, MPH, Assistant Director of Research and Public Health, Autism Speaks who discuss the positive impact of fitness for individuals with an ASD using the same behavioral interventions utilized to teach other skills (e.g., tooth brushing).
Autism is a complex neurobiological, developmental disorder that is typically diagnosed in childhood and often lasts throughout a person’s lifetime. The hallmark characteristics of autism include an impaired ability to communicate and relate to others socially, a restricted range of activities, and repetitive behaviors such as following very specific routines. While the causes of autism are unknown and preventative measures have yet to be discovered, there does exist effective behavioral therapy that can result in significant improvements for many young children with autism. The most widely used behavioral intervention programs focus on developing communication, social, and cognitive skills. However, new research and anecdotal evidence suggest that some alternative therapeutic choices that include sports, exercise, and other physical activities can be a useful adjunct to traditional behavioral interventions, leading to improvement in symptoms, behaviors, and quality of life for individuals with autism.
Physical activity is important for children with and without disabilities alike as it promotes a healthy lifestyle, but can benefit individuals with autism in unique ways. In the U.S., 16% of children ages 2-19 are overweight*, whereas the prevalence of overweight among children with ASD is increased to 19% with an additional 36% at risk for being overweight.* This means that more than half of all children with ASD are either overweight or at risk. Being overweight can put children at increased risk for numerous health problems, both in childhood and as adults, including diabetes, cardiovascular disease, bone and joint problems, and even depression. The effects of these conditions may take an even greater toll on individuals with autism in combination with common autism symptoms and some highly co-morbid conditions such as gastrointestinal problems as well as depression and anxiety.
It has been suggested that decreased physical activity is the primary reason for the increased rate of overweight in children with autism, while unusual dietary patterns and the use of antipsychotic prescription drugs that can lead weight gain may also contribute. Participation in physical activity may be challenging for individuals with autism because of reasons such as limited motor functioning, low motivation, difficulty in planning, and difficulty in self-monitoring. Increased auditory, visual, and tactile stimuli may too prove challenging for affected individuals. Furthermore, physical activity involving social interaction such as team sports can present a difficult situation for someone with autism. However, if implemented appropriately, the addition of physical activity to an autism intervention program can help overcome many of these challenges and improve one’s overall quality of life.
It is not surprising to discover that physical activity has been shown to improve fitness levels and general motor function of individuals with autism. A study of a 9-month treadmill walking program on weight reduction in adolescents with severe autism revealed that the program significantly decreased body mass index among the participants. Additionally, as time progressed through the study, the frequency, duration, speed, and elevation of the treadmill walking all increased, indicating a general rise in exercise capacity and physical fitness. In a study of swimming training and water exercise among children with autism, ten weeks of hydrotherapy which included three, 60-minute sessions per week, resulted in significant increases in fitness levels indicated by changes in balance, speed, agility, strength, flexibility, and endurance.
Research has also demonstrated that increased aerobic exercise can significantly decrease the frequency of negative, self-stimulating behaviors that are common among individuals with autism, while not decreasing other positive behaviors. Behaviors such as body rocking, spinning, head-nodding, hand flapping, object-tapping, and light gazing, that have been shown to interfere with positive social behavior and learning, can thus be controlled by the use of exercise. Additionally, exercise can discourage aggressive and self-injurious behavior14 while improving attention span. In this study, aerobic exercise included 20 minutes of mildly strenuous jogging, however the aforementioned swimming and water exercise study also revealed a significant decrease in stereotypical behaviors in children with autism following a 60 minute session in the pool. One theory behind these findings is that the highly structured routines, or repetitive behaviors involved in running or swimming, may be similar to and/or distract from those self-stimulating, repetitive behaviors associated with autism.
Besides improving fitness, motor function, and behavior in individuals with autism, among the most important advantages of physical activity are the social implications of participating in sports and exercise. Physical activity can promote self-esteem, increase general levels of happiness, and can lead to positive social outcomes, all highly beneficial outcomes for individuals with autism. For those with autism who are able to participate in team sports, this presents an opportunity to develop social relationships among teammates and learn how to recognize the social cues required for successful performance on the field or court. However, individuals that prefer individual sports such as running or swimming that do not rely as heavily on social cues may still benefit from the positive attributes of physical activity while forming social relationships with coaches or trainers. In all cases, participating in sports provides individuals with autism with a role in society that may not have existed otherwise.
While there is evidence to support the role of physical activity in improving autism symptoms, behaviors and life-outcomes, sports and exercise should not replace proven behavioral interventions, but may be effective supplements to these therapies and potentially enhance the benefits. In fact, many of the key components of a successful physical activity program for individuals with autism mirror those that make up some of the most common treatments and behavioral interventions. For instance teaching new skills to children by breaking them down into smaller, organized tasks and then rewarding them for successful achievement is a core component of proven interventions such as ABA and TEACCH. This technique can be readily implemented in teaching physical education to children with autism.
There is increasing interest in establishing program guidelines for enhancing physical activity among individuals with autism. A major reason for this is because research suggests that autism prevalence is increasing and has reached an all-time high. This means that there will be an increasing number of children with autism in schools, physical education classes, and on sports teams. While different individuals with autism may face different challenges in participating in physical activity, these children should still be given the opportunity to experience the benefits of physical activity. And while the results may vary, based on all the available research and that which has been presented in this paper, the potential behavioral, physiological, emotional, and social benefits of physical activity for individuals with autism are numerous and should be further explored.
*Statistics are subject to change from the time data were collected.
April 6, 2015 3:00 pm Published by Nevena Savic, MA, BCBA
A lot of parents that I have an opportunity to work with, continuously report that their children often display resistance to bedtime. The most usual forms of bedtime resistance include crying, leaving the bedroom, and an inability to stay in own bed. Frequent approaches for this problem behavior include prescribing soporific drugs, letting children sleep with their parents, and ignoring bedtime crying. Each of these interventions may reduce bedtime problems, but can also produce adverse effects and make parents resistant to use them with their kids. A research on this topic has been conducted with typically developing children, however I believe that many higher functioning children with ASD might benefit as well from the intervention explained below (see PDF file). “The Bedtime Pass” intervention has been used to reduce bedtime crying and leaving the room while minimizing the likelihood of a problem behavior (Friman et al. 1999). Results showed that crying and coming out from the bedroom reduced to zero rates after the intervention was used. Both parents and pediatricians rated using “the bedtime pass” as a more acceptable intervention than letting children sleep with their parents or ignoring a problem behavior.
“The bedtime pass” intervention has been proven to provide parents with a practical and effective intervention for bedtime problems. If you struggle with this kind of problem with your child, please see the PDF file by clicking here for a detailed explanation of “The Bedtime Pass intervention”. I hope it works for you and your child!
References: Friman, P. C., K. E. Hoff, C. Shnoes, K. A. Freeman, D. W. Woods, and N. Blum (1999). The bedtime pass: An approach to bedtime crying and leaving the room. Arch. Pediatr. Adolesc. Med. 153: 1027-1029.
Nevena Savic, MA, BCBA