Exercise as it relates to Disease/The effects of exercise on Autism

 Effects of exercise on Autism Spectrum Disorders 

Background
Autism Spectrum Disorders (ASDs) are a collection of neurodevelopmental disorders characterized by atypical development in social interactions and communication skills. People with an ASD can also present with repetitive and stereotypical behaviours and interests and activities. Decreased communication and social interaction domains such as reduced eye contact, atypical social reciprocity, and verbal and nonverbal communication delays are all typical of children with an ASD.

Autism is more frequent in boys than girls and will affect the person throughout their life. There are no cures available for this syndrome. Other developmental disorders including Asperger’s disorder and Pervasive Development Disorder – Not Otherwise Specified (PDD-NOS) along with Autistic Disorder are classed as Autism Spectrum Disorders (ASD’s) and are usually diagnosed during childhood.

Identification
For most cases of an ASD parents will be worried about their child’s development and will seek medical advice after observing strange behaviours and not meeting milestones. Medical practitioners will then assess the child and determine if further investigation is necessary.

Treatments for Autism Spectrum Disorders
There are no treatments for ASDs directly but some pharmaceutical and non-pharmaceutical interventions can be used to treat the interfering symptoms which if left untreated can diminish the quality of life for themselves and caregivers.

Pharmaceutical
Medication that is prescribed to ASD sufferers are used to provide some relief to the associated symptoms that are typical of ASDs. Before pharmaceutical intervention is prescribed, pediatric professionals must assess whether the benefits of the medication outweigh the negative side-effects. Some of the symptoms that are treated with medication are:

•	Repetitive and stereotypical behaviour,

•	Hyperactivity and inattention,

•	Irritability (including aggression, self-injurious behaviour and severe tantrums),

•	And core social impairments.

Drugs used to treat attention-deficit/hyperactivity disorder (ADHD) such as psychostimulants have been used to control hyperactivity in ASD sufferers. Atypical antipsychotics are clinically used to target irritability (including aggression, self-injurious behaviour and severe tantrums). No medication has been approved for use to improve core social impairments as none trialed have shown improvements in socialization and communication.

Other interventions
Early diagnosis and behavioural therapy interventions have shown to improve the quality of life and helps to support families through the initial stages.

Some of the interventions can be found below with links to more information on each.
 * 1) Dr. Ivor Lovaas has over 40 years experience with supporting and implementing behavioural interventions for people with an ASD.  For a outline of what his program offers click here.
 * 2) For Australian families this link will take you to information and resources that can be accessed in Australia.
 * 3) Early Intervention strategies are widely used with children under the age of 4 years of age.  Aspect is Australia's leading service provider for Autism and other disabilities.  They have a wide range of resources and information for families and care givers and can also help to locate further support in your area.

Physical Activity
Studies have shown that the prevalence of obesity in children with ASDs is 30.4% when compared to children of the same age without an ASD is currently at 23.6%. Furthermore, people with ASDs have been found to be less likely to participate in physical activity.

Some reasons for non-participation in physical activity are:
 * Sensory modulation problems may affect competence in play and lead to avoidance behaviours
 * Behavioural problems or preferences (highly restricted interests, the need for inflexible schedules, and preference for highly predictable, structured activities) may lead to limited activity choices
 * Environmental factors such as lack of time and resources or unsupportive peer groups will affect the physical activity levels of individuals with ASD

This shows a need for pediatricians and other health care providers to help ASD patients to become more active. There is also a need for people in the fitness, sport and recreation industry to be given opportunities to expand their skills to become more inclusive of people with a disability.

Gymnastics Australia has introduced a new program called Rebound Therapy. This is a program aimed at any child with a disability or learning disorder and incorporates the use of trampolines as the physical activity. Gymnastics New South Wales and Castle Hill RSL Gymnastics Club have endorsed the program with positive results. The video at the link describes the benefits of Rebound Therapy which include improvements in muscle development, balance, coordination, and most importantly social interaction and communication skills. Research has shown that the use of Rebound Therapy along with additional exercises decreases the frequency of challenging behaviours and increases in quality of life (freedom scores) and alertness.

The use of aquatic environments are generally enjoyed by people with an ASD. Studies have shown that the aquatic environment can be used to enhance learning and performance. Results show that improvements in water orientation skills, basic swimming skills, aquatic play skills, and health and motor related fitness. Interestingly involvement in an aquatic environment has decreased stereotypical behaviours and increased social interactions.

The health benefits of physical activity is well documented and can improve the quality of life of the individual and decrease the likelihood of debilitating chronic disease or premature death in an individual later in life. People with ASD will see the same benefits from regular physical activity as typically developed people along with additional benefits including increased social interactions and communication skills making it a vital part of their treatment.

Recommendations
Regular participation in physical activity for individuals with an Autism Spectrum Disorder should be a regular strategy in their management plan. Medical practitioners should encourage people with an ASD to utilize the sport and recreation providers in their area to help integrate and practice behavioural skills learnt in therapy sessions and with a fun and engaging program may help these people live more healthy lifestyles. The benefits received by individuals with ASDs from physical activity complement other intervention strategies and will reinforce what is taught in the clinical settings. Some sporting bodies have well established programs for special needs clients but a wider range of resources and education needs to be supported for further development in a wider range of sports and recreation activities.

Further Readings/Resources

 * 1) First signs is a not for profit organization with the intent to increase awareness and provide information to parents/care givers and professionals about autism and related disorders.
 * 2) Aspect is Australia's leading service provider for Autism and other disabilities.  Follow the link for more information.
 * 3) Gymnastics Australia have programs in Rebound Therapy and are helping gymnastics clubs around Australia to train staff to deliver this exercise therapy.