Course:KIN366/ConceptLibrary/Autism Spectrum Disorder

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Movement Experiences for Children
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KIN 366
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Instructor: Dr. Shannon S.D. Bredin
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Autism Spectrum Disorder (ASD) is a neurologically based behavioural syndrome that is commonly associated with the inability to relate to people in an age appropriate manner (Gillberg, 1990). The social deficit that accompanies autism is combined with deficits in language, as well as behavioural abnormalities that reflect “underlying impairments of imaginative abilities” (Gillberg, 1990, p. 61). Autism is known to cause significant social, communication, and behavioural challenges that are likely to affect individuals throughout their life (CDC, 2015). As well, people with autism usually demonstrate poor motor skills (Yilmaz et. al, 2004). Because it is called autism spectrum disorder, the disorder actually exists on a spectrum and symptoms can range in severity, affecting each person in a different way. Though there is no known cure for autism, many special education interventions have been put in place in an attempt to help children from a young age. The difficult part however, is that there is neither a specific phenotype nor a consistent genotype that is associated with ASD (Johnson, 2004).

About Autism Spectrum Disorder

What is it?

Autism is a neurodevelopmental syndrome that manifests in deficits in social skills and restricted behaviours thought to result from abnormal neuronal circuitry (Binder, M., Hirokawa, N., Windhorst, U., 2009). In children, they are affected by difficulty in social reciprocity and communication that affects their social interactions (Lord, C., Cook, E., Leventhal, B., & Amaral, D., 2000). In some instances, the severity can be seen in youth who are less able than the typically developed child to vocalize their intentions. Their behaviours are often repetitive while some individuals exhibit language delay problems (Binder et. al., 2009). When a child who has autism grows into an adult age, they usually fall into 3 major groups. These include: the group with continued aloofness, the passive and friendly group, and the active but odd group (Gillberg, 1990). Nonetheless, autism spectrum disorder affects each individual in a different manner; thus, each individual will show different signs and symptoms of autism with different severities.

Characteristics

People with ASD generally demonstrate lower overall IQ scores (Gillberg, 1990) and most exhibit abnormal social functioning. The onset of symptoms for a child with autism is usually within the first year of life, and there are many cues that may give parents clues that their child is not developing along a typical path. Characteristics have been categorized into subcategories, which include social interaction impairments, speech language and communication impairments, and sensory impairments (Brown et. al, 2012). Examples of some of these may be “delayed speech/language development, delayed or unusual play routines, stereotypic behaviours (e.g., spinning or hand flapping), narrow ranges of interest, and a tendency to display rigid and/or perseverative behavioural repertoires” (Curtin et. al, 2005, p. 2). Self-stimulatory behaviour is commonly seen as well, such as “body rocking, spinning, hand flapping, head-nodding, object-tapping, gazing at lights, and mouthing” (Rosenthal-Malek & Mitchell, 1997, p. 193). Because of all these symptoms, speech, language and communication will often develop later or sometimes not at all in children with autism. A few cues include not responding to their name by 12 months, avoiding eye contact and wanting to be alone, and having obsessive interests (CDC, 2013). Finally, children with autism will also experience sensory differences, which may cause them to react to environmental stimuli such as heat, cold, light, smells, and tastes in unusual ways (Johnson, 2004).

Impact on Motor Development

A major factor that makes autism spectrum disorder such a difficult condition to study is this variability. This presents a challenge for health care practitioners, teachers, researchers, and parents in developing intervention methods (Haywood, K., Roberton, M., & Getchell, N., 2012). What researchers have found are trends that affect the motor development of children with autism spectrum disorder that may be affecting their learning and development of fundamental movement skills. For instance, infants with autism spectrum disorder have been found to have hypotonia and this affects their ability to have the strength to hold up their proportionally large head (Haywood et. al., 2012). Therefore, their ability to sit upright and balance is greatly disadvantaged. Other researchers have found that children with autism spectrum disorder exhibit a delay in motor milestones. For example, movements such as rolling, crawling, walking, and sitting are delayed and affect subsequent movements that build on these foundations (Haywood et. al., 2012).

Causes and Treatment

There is no known cure autism spectrum disorder (Gillberg, 1990). However, intervention, treatment programs, and support services are necessary for the majority of people with ASDs to help them reach their full potential (Autism Society Canada, 2012). Researchers have focused on several areas in order to attempt to solve particular problems associated with autism, although a whole cure has yet to be created. Such areas focus on behaviour-based programming, speech therapy, and individualized educational plans (Autism Society Canada, 2012). Individuals with ASD also have co-occurring problems associated with them, such as seizures, sensory problems, anxiety, and gastrointestinal issues that researchers have attempted to solve (Autism Society Canada, 2012). Finally, dietary correction of lactic acidosis has been thought to lead to major improvements of autistic symptoms – an area of research that is still being examined into great depth today (Gillberg, 1990).

Trends and Statistics

Children with ASD have limited access to physical activity opportunities. The trend shows increasing prevalence of overweight with increasing age for children with ASD (Curtin et. al, 2005). Autism is now more common than previously believed (Gillberg, 1990). However, this may be because more attention has been brought to the disease and health professionals are now more aware of autism and of learning disabilities in general (Autism Society Canada, 2012). Though there is no federal government monitoring system to provide us with statistics on the exact prevalence of ASDs in Canada, we do know that ASD is the most common form of any neurological disorder or severe developmental disability in childhood (Scott, 2009). However, a statistic was released from multiple communities in the United States in 2012, which reported that the prevalence of ASD was 1 in 88 (Autism Society Canada, 2012). Autism is more commonly found in girls, as the ratio is 3:4.1 (Gillberg, 1990). Other statistics include that 70-85% of children with autism are mentally retarded (Rosenthal-Malek & Mitchell, 1997) which is related to the fact that nearly 70% of cases never become independent adults (Gillberg, 1990). Finally, children with autism are 40% more likely to be obese compared to children without autism, because of their limited access to appropriate physical activity centers (Curtin et. al, 2010).

Common Problems

Motor Development

Children with autism spectrum disorder are vulnerable to motor development impairments. For instance, their perception is less acute and can impact children in their perceptual-motor skills (Fournier, K., Hass, C., Naik, S., Lodha, N., & Cauraugh, J., 2010). Studies have shown that children with autism spectrum disorder have had “substantial motor coordination deficits and postural stability issues” (Fournier et. al., 2010). Poor posture in these children can affect children in acquiring other motor skills. For example, hand and head manipulation skills and the ability to inhibit reflexes can constrain the development of other mobility and hand manipulation skills (Fournier et. al., 2010).

Even from birth, children with autism spectrum disorder have trouble recognizing human movement, which affects their observational learning capabilities (Wang, L., Chien, S., Hu, S., Chen, T., & Chen, H., 2015). They are generally found to be slower and less accurate at identifying human movement than the typically developing child (Wang et. al., 2015). This was tested in a recent study that utilized point-light displays to represent biological motion displays. Typically developed subjects were more prone to recognizing biological movements over rigid rotating objects (Wang et. al., 2015). However, children with autism spectrum disorder had much less activity in their superior temporal sulcus compared to the control population (Wang et. al., 2015). The superior temporal sulcus has been associated with the perception of biological motions (Wang et. al., 2015).

Motor skills are essential because they constrain the development of other vital skills such as exploration and the development of visual and spatial skills. Exploration, visual, and spatial skills are also then related to fine motor skills such as unilateral reaching (Hellendoorn, A., Wijnroks, L., Daalen, E., Dietz, C., Buitelaar, J., & Leseman, P., 2015).

Social Implications

Children with autism spectrum disorder may also experience delays pertaining to social skills. This may be attributed to their cognitive functioning that develops later in life; however, some impairments may persist (Lartseva, A., Dijkstra, T., & Buitelaar, J., 2015). For example, some individuals have the capacity to interpret emotions yet may just need explicit cues in order to formulate a proper emotional response. This may be explained by the theory that individuals with autism spectrum disorder are able to conceptualize emotions but struggle with the application of processing appropriate responses themselves (Lartseva et. al., 2015). Another school of thought believes that the emotional concepts of those with autism spectrum disorder are more similar to “neutral concepts” (Lartseva et. a., 2015).

Delayed motor development can also affect a child’s ability to develop social skills. Social interaction skills such as the ability to respond to others and stopping during an activity are examples where social skills can affect game play and the development of motor skills (Fournier et. al., 2010). The impact can impede gait, balance, and motor coordination skills for those with autism spectrum disorder. Children may also have impairments in gross and fine motor skills, motor coordination, postural stability, and abnormal weight distribution (Pace, M. & Bricout, V., 2015). These impairments were found to be further exacerbated when they were challenged with cognitive questioning (Pace et. al., 2015).

Learning

Children with autism spectrum disorder exhibit a deficit in learning that affects their ability to learn, whether this is learning in school or learning motor development skills. In particular, these individuals see a slower rate of imitative development. Williams et. al. states that it can result from a lack of symbolic functioning or a perhaps actions in the environment that are not properly represented for these individuals (Williams, J., Whiten, A., & Singh, T., 2004). Thus, their ability to imitate and repeat movement is impaired if the initial demonstration was not conceptualized internally for the individual. Nonetheless, they can also be experiencing a lack of engagement that has prompted this deficit or they may have a dyspraxic problem (Williams et. al., 2004). The impact of this learning deficit holds consequences in future motor execution. Some motor skills hinge on the development of motor skills through this imitative learning style (Williams et. al., 2004).

Recess

Recess has been used as a time for children to have a break from their schoolwork, to go play with their peers for a short period of time. This can be thought of as a good opportunity for children with ASD to engage in playtime with their peers, because it encourages structured play and social interaction (Pan & Frey, 2006). However, recess has proven to be a slight issue as it only lasts 15 minutes and it led to children with ASD to feel even more isolated. This is because while typically developing children get to play for the full period of time, children with autism are removed early by teachers to either ease their transition back to class, or to have extra time to work on their assignments (Pan & Frey, 2006). Therefore recess is not enough physical activity for a child with ASD.

Obesity

Statistics suggest that children with autism are 40% more likely to be obese compared to children without autism (Curtin et. al, 2010). Studies have been performed to examine the prevalence of overweight among a population of children diagnosed with autism, and they have found statistics to be higher because of fewer opportunities to engage in structured physical activity, as well as increased sedentary behaviour, such as time spent watching television or time spent on computers (Curtin et. al, 2005). Also, social and behavioural deficits may limit opportunities for individuals to engage in physical activity, because most exercise programs among youth are associated with peers, and children with ASD may find these interactions too difficult to handle (Pan & Frey, 2006). They may feel excluded and not welcome by their peers, which can lead to drop out. Weight gain is often a side effect of the medication that children with ASD commonly take (Pan & Frey, 2006). Adding to this, usual and picky dietary patterns of children with ASD contribute to the overweight crisis (Curtin et. al, 2005). All these factors will further limit the chance of a child living independently in adulthood. Researchers have now identified specific environmental factors that will be important to help direct efforts at health promotion and disease prevention for children with ASD. Often, children are prohibited from joining after-school programs due to concerns by staff regarding their behaviour (Pan & Frey, 2006). However, there are now many intervention programs and highly trained staff that know how to handle and care for children with autistic spectrum disorder. The need for necessary supports for children with ASD to successfully engage in physical activity cannot be stressed enough.

Family Stress

When a family has an autistic child, it increases the demands necessary to take care of this child, and as the caretakers, parents must do everything they can to make the life of their child as easy as possible. Older boys who are autistic cause the most stress (Bebko et. al, 1987). Home support is very important in an autistic child’s life, and as a result of this, it is important that parents provide an appropriate environment and that caregivers to encourage a smooth upbringing. About two-thirds of autistic cases do not become independent adults, and therefore rely on others for most of their daily needs (Gillberg, 1990). The impact of a child with autism on his/her family may be related to sleep patterns, bowel/bladder problems, self-injury, and aggressions (Bebko et. al, 1987). This then leads to both financial and emotional stress on a family, which can impact the health of them and others around them.

Practical Applications

Early Intervention

Early diagnosis and detection of symptoms can be crucial, as researchers are now finding areas that they are able to target and attempt to make easier for children with autism spectrum disorder. Children who are identified before the age of 5 were able to attend preschool, join a school with special educational support, and receive speech and language therapy (Rosenthal-Malek & Mitchell, 1997). These children will be far better off because their condition was identified early, in comparison to children who do not get the extra help that they deserve. Community support and early identification have proven to be related to overall family well being (Rosenthal-Malek & Mitchell, 1997).

Each individual with autism spectrum disorder is unique. The concern for parents then becomes the question of what they can do to help their child acquire fundamental skills for life. One such study tackled this issue and administered a parent-implemented intervention for infants with autism spectrum disorder (Rogers, S., Vismara, L., Wagner, A., McCormick, C., Young, G., & Ozonoff, S., 2014). This study was performed on infants aged 6 months to 12 months. Due to the rapid progression of symptoms of early onset in this population they are considered a high-risk group (Rogers, et. al., 2014). The symptoms that can manifest include visual fixation, repetitive patterns, inadequate communication skills, uncoordinated gaze, and “decreased eye contact, social interest, and engagement” (Rogers et. al., 2014). During the study, different intervention methods were tested. Parent coaching was implemented daily and supplemented with parent education via therapists (Rogers et. al., 2014). Some interventions included individualized programming tailored for each infant and interventions were also varied in length and frequency. Researchers found an overall lower rate of symptoms in the treated group but have yet to test the efficacy of each intervention method (Rogers et. al., 2014). According to Rivard et. al., early intensive behavioural intervention is the most effective treatment method for children with autism spectrum disorder (Rivard, M., Terroux, A., & Mercier, C., 2014). Improvements were seen in adaptive behaviour and “global intellectual functioning” (Rivard et. al., 2014).

Benefits of Physical Activity

The implications of delayed motor development skills affects children on a global scale. Placing a greater emphasis on developing these motor skills can benefit the child in increasing their confidence and even decrease negative behaviour in children with autism spectrum disorder (Pace et. al., 2015). However, those with autism spectrum disorder have fewer opportunities to engage in physical activity and gravitate towards a sedentary lifestyle (Pace et. al., 2015). This puts them at risk for early morbidity and mortality compounded by their deficiency in daily living skills. Children with autism spectrum disorder can benefit from physical activity because their physical health can improve and positive effects have also been found in perception, personality, and intellectual function (Pace et. al., 2015).

In order to encourage physical activity, access to resources must be created through appropriate programming, staff training, and activity modification in order for youth with ASD to successfully engage in physical activity (Pan & Frey, 2006). It is important to focus on individual or dual activities rather than team sports because they require fewer demands, fewer people to participate, they are less reliant on others, and they can be performed using family resources without relying on external support (Pan & Frey, 2006).

Physical activity fosters physical changes such as increased bone and muscle strength. It also reduces the onset of health complications in adulthood, as well as increases the quality of life during one’s youth ages. For youth, exercise will lead to positive self-esteem, better behaviour, happiness, and good social outcomes. In children with ASD, exercise has shown to reduce aggressive behaviour, unproductive and disruptive behaviour, stereotyped and self-injurious behaviour, and purposeless wandering (Rosenthal-Malek & Mitchell, 1997). Structured aerobic exercise has also proven to improve attention span, work performance, and on-task behaviour (Rosenthal-Malek & Mitchell, 1997). Because the prevalence of obesity in children with autism was 30.4% compared to that of 23.6% among children without autism, the effects of exercise are magnified even further.

Benefits of Swimming

Children with autism generally demonstrate poor motor skills, and in order to build on this, it is important to help them develop responses to stimuli in the environment (Yilmaz et. al, 2004). Professionals have found that swimming pool activities have catered to this area of development, and have been successful in doing so. This is because the therapeutic stimulation associated with swimming is thought to foster language development and improve adaptive behaviour, while providing an appropriate setting for early educational intervention (Yilmaz et. al, 2004). A study was done in which this theory was tested, and after 10 weeks of the swimming training, the scores of children with ASDs in areas such as balance, speed, agility, and power all increased (Yilmaz et. al, 2004). This was a breakthrough discovery, because swimming contributes to the child’s motor development. Swimming pool activities have the potential to offer huge learning opportunities for autistic individuals (Yilmaz et. al, 2004).

Adaptations for Children with ASD

When working with children with autism, there are many adjustments that can be made to activities and play areas that will contribute to positive engagement in physical activity. Because every child has unique needs, there are strategies that should be considered when planning activities. There are many repetitive traits that are associated with ASD, and because of this, activities that are individual and therefore more rhythmic in nature are better suited for them. Practitioners should also take into consideration the fact that children with ASD have heightened sensory awareness; therefore they can be sensitive to small changes in the environment (Brown et. al, 2004). Soft, natural lighting versus artificial would be beneficial to use (Scott, 2009) as well as limiting the amount of vibrant colours or loud noises in the rooms.

References

Autism Society Canada. (2012). Prevalence in Canada. Retrieved from http://www.autismsocietycanada.ca/index.php?option=com_content&view=article&id=55&Itemid=85&lang=en

Bebko, J. M., Konstantareas, M. M., & Springer, J. (1987). Parent and professional evaluations of family stress associated with characteristics of autism. US National Library of Medicine, 17, 565-576. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3680156

Binder, M., Hirokawa, N., & Windhorst, U. (2009). Autism. In Encyclopedia of Neuroscience. (pp.332) Springer Berlin Heidelberg.

Brown, F., Gerber, S., & Oliva, C. (2012). How to Help Children with Autism. Retrieved from http://www.pbs.org/parents/inclusivecommunities/autism.html

Centers for Disease Control and Prevention (CDC). (2013). Autism Spectrum Disorders (ASDs). Retrieved from http://www.cdc.gov/ncbddd/autism/signs.html

Curtin, C., Anderson S. E., Must, A., Bandini L. (2010). 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, 1-5. doi:10.1186/1471-2431-10-11

Curtin, C., Bandini, L., Perrin, E., Tybor, D., & Must, A. (2005). Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: a chart review. BMC Pediatrics,5, 1-7. doi:10.1186/1471-2431-5-48

Fournier, K., Hass, C., Naik, S., Lodha, N., & Cauraugh, J. (2010). Motor coordination in autism spectrum disorders: A synthesis and meta-analysis. Journal of Autism and Developmental Disorders, 40, 1227-1240.

Gillberg, C. (1990). What is autism? International Review of Psychiatry, 2, 61-66. doi:10.3109/09540269009028272

Haywood, K., Roberton, M., & Getchell, N. (2012). Motor development differences in children with autism spectrum disorders. Advanced Analysis of Motor Development. Champaign, IL: Human Kinetics.

Hellendoorn, A., Wijnroks, L., Daalen, E., Dietz, C., Buitelaar, J., & Leseman, P. (2015). Motor functioning, exploration, visuospatial cognition and language development in preschool children with autism. Research in Developmental Disabilities, 39, 32-42. doi:10.1016/j.ridd.2014.12.033

Johnson, C. P. (2004). Early clinical characteristics of children with autism. Retrieved from ftp://175.45.187.195/ebooks/Pediatri/autis/DK1197_ch05.pdf

Lartseva, A., Dijkstra, T., & Buitelaar, J. (2015). Emotional language processing in autism spectrum disorders: A systematic review. Frontiers in Human Neuroscience, 8, 1-24. doi: 10.3389/fnhum.2014.00991

Lord, C., Cook, E., Leventhal, B., & Amaral, D. (2000). Autism spectrum disorders. Neuron, 28, 355-363. doi: http://dx.doi.org/10.1016/S0896-6273(00)00115-X

Pace, M. & Bricout, V. (2015). Low heart rate response of children with autism spectrum disorders in comparison to controls during physical exercise. Physiology & Behavior, 141, 63-68. doi: 10.1016/j.physbeh.2015.01.011

Pan, C. Y., & Frey, G. C. (2006). Physical activity patterns in youth with autism spectrum disorders. US National Library of Medicine, 36, 597-606. doi:10.1007/s10803-006-0101-6

Rivard, M., Terroux, A., & Mercier, C. (2014). Effectiveness of early behavioral intervention in public and mainstream settings: The case of preschool-age children with autism spectrum disorder. Research in Autism Spectrum Disorders, 8, 1031-1043. doi:10.1016/j.rasd.2014.05.010

Rogers, S., Vismara, L., Wagner, A., McCormick, C., Young, G., & Ozonoff, S. (2014). Autism treatment in the first year of life: a pilot study of infant start, a parent-implemented intervention for symptomatic infants. Journal of Autism and Dvelopmental Disorders, 44, 2981-2998. doi: 10.1007/s10803-014-2202-y

Rosenthal-Malek, A. & Mitchell, S. (1997) Brief Report: The Effects of Exercise on the Self-Stimulatory Behaviours and Positive Responding of Adolescent with Autism. Journal of Autism and Development Disorders, 27, 193-202. Retrieved from http://link.springer.com/article/10.1023%2FA%3A1025848009248?LI=true

Scott, I. (2009). Designing learning spaces for children on the autism spectrum. Good Autism Practice. Retrieved from http://www.aettraininghubs.org.uk/wp-content/uploads/2012/05/37.3-Scott-article-4-designs.pdf

Wang, L., Chien, S., Hu, S., Chen, T., & Chen, H. (2015). Children with autism spectrum disorders are less proficient in action identification and lacking a preference for upright point-light biological motion displays. Research in Autism Spectrum Disorders, 11, 63-76. doi:10.1016/j.rasd.2014.12.004

Williams, J., Whiten, A., & Singh, T. (2004). A systematic review of action imitation in autism spectrum disorder. Journal of Autism and Developmental Disorders, 34, 285-299.

Yilmaz, I. et al. (2004). The Effects of swimming training on physical fitness and water orientation in autism. Pediatrics International, 46, 624-626. doi:10.1111/j.1442-200x.2004.01938.x