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Movement Matters - Bringing Fitness into the Lives of Children with Autism Spectrum Disorder Part II
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Movement Matters - Bringing Fitness into the Lives of Children with Autism Spectrum Disorder -- Part II
In the first part of this article, I provided an overview of autism, its characteristics and some of the common challenges that any parent or therapist may face when integrating a fitness program. In this second half, I will explore in further detail some of the behavioral complications, as well as exercise selection and progressions for individuals on the autism spectrum.
By Eric Chessen
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Back to Part I.
As individuals on the autism spectrum do differ greatly in their abilities, both cognitive and physiological, it is important that exercise programs reflect and account for the needs of the individual. From a physiological perspective, there is typically little variation in the "needs and deficits" area. In my experience, most young individuals with autism (ages 6-12) present a compromised or imbalanced gait, difficulty during level change (squatting, bending), poor motor control during compound movement, and an aversion to dynamic activities (climbing, running, jumping.
The fantastic part is evident when we recognize that there are no true limitations for these [autistic] individuals. All of these obstacles can be bested, and physical fitness can become a life skill when we plan accordingly.
Gross motor assessment of an individual with autism reads like stereo instructions. With different behaviors to account for, types of movement to consider, and maintaining a motivating, reinforcing environment, the task can seem daunting. To efficiently transition from initial assessment to exercise implementation, I satisfy for the 3G's.
The 3G's are:
-Gaze
-Gait
-Grip
These three components can provide most of the information necessary to develop a highly effective physical fitness program.
Gaze
Gaze refers to the quality of eye contact an individual establishes with both the instructor/parent and with objects such as balls, cones, or obstacles. As autism is a communicative disorder that most often involves deficits in social skills, eye contact is a common point of weakness. Gaze can also reveal an athlete's ability to attend to a task or activity. If during catch, my athlete begins to avert his gaze, the attention to the activity has diminished and there is the possibility that the chain of behavior will continue, often resulting in the athlete running across the room (referred to as escape behavior). A simple game of catch or even handing the ball back and forth can provide the instructor with a general understanding of the athlete's ability to tolerate and focus on extended activity.
Gait
Gait refers to how a person walks, but for the fitness professional can provide clues about hip alignment, motor planning, gross motor skills, and muscular imbalances/compensations. As the research cited in the first article suggested, young individuals with autism tend to have greater deficits in gait than neurotypical peers. Whether the deficit is a result of physiological or cognitive impairment is difficult to deduce; however, a well-planned fitness program can enhance motor skills and strengthen weak muscle groups, alleviating a compromised gait and promoting more challenging and dynamic activities.
Grip
Grip is the final G in the 3G process. While grip might initially convey more of an "OT" realm of existence, I have come to realize that an assessment of grip is crucial in determining several factors of physical function, from upper body strength to coordination. Grip strength is closely related to functional quality of the shoulders, both of which are quite important in both athletic/play activities and life skills. Many of the athletes with whom I work exhibit an odd grip, using only three or four fingers to grasp an object, minimizing their control over a ball or laundry basket, and placing undue stress on the hand and wrist. While grip may be compartmentalized as a fine motor skill, it has vast implications on progression in gross motor abilities, from handstands and deadlifts to taking out the garbage and typing on the keyboard. Grip and hand strength is essential.
I've described all these physical and behavior variables that exist in the world of fitness for the autism population. I would not use the term "simplify" at this point, but I will provide some semblance of clarity and information for direct application. To satisfy assessment of the 3G's, I use the "Ball Grab Complex," a simple series of challenges that requires the use of all three skills. The ball grab complex begins with the athlete standing on two spot markers. Spot markers come in all shapes, sizes, and forms.
The instructor begins by holding the ball out in front of the athlete, who then grabs the ball and either hands or throws the ball back to the instructor. The first few times this sequence is achieved (standing on markers, grabbing ball, handing back) high rates of reinforcement in the form of verbal praise should be provided. The more specific the praise, the better; "Great job grabbing the ball and looking at me!."
In the picture above, the athlete is grabbing the ball, but not making eye contact. I would hold off on providing verbal praise and/or other forms of reinforcement until the athlete is both looking at the ball AND grabbing it.
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