Thursday, 28 November 2013

ASD and Comorbid Anxiety

Autism spectrum disorders (ASDs), including Autistic Disorder, Asperger’s Disorder and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), are characterized by impairments in social reciprocity and communication, together with repetitive and restricted behaviors and interests. In addition to these core symptoms, an estimated 40 % of children with ASDs fulfill diagnostic criteria for an anxiety disorder (van Steensel et al. 2011) and as many as 84 % have impairing, subclinical anxiety symptoms (White et al. 2009). Co-occurring anxiety can cause acute distress, amplify the core symptoms of ASD and trigger behavioral difficulties including tantrums, aggression and self-injury (Canitano 2006). Despite the prevalence of anxiety in ASDs, it remains unclear whether anxiety difficulties constitute a separate condition or align more closely with core ASD features. 
From Hallett V, Lecavalier L, Sukhodolsky DG, Cipriano N, Aman MG, McCracken JT, McDougle CJ, Tierney E, King BH, Hollander E, Sikich L, Bregman J,Anagnostou E, Donnelly C, Katsovich L, Dukes K, Vitiello B, Gadow K, Scahill L (2013). Exploring the manifestations of anxiety in children with autism spectrum disorders. Oct;43(10):2341-52. doi: 10.1007/s10803-013-1775-1.

Plato Had it Right

‘‘On order for man to succeed in life, god provided him
with two means, education and physical activity. Not
separately, one for the soul and the other for the body but
for the two together. With these two means, men can attain
perfection’’ (Plato, fourth century BC).

Physical activity is associated with a range of health benefits, and its absence can have harmful effects on health and well being, increasing the risk for coronary heart disease, diabetes, certain cancers, obesity, hypertension and all cause mortality (CDC 1996). Physical inactivity may also be associated with the development of mental disorders: some clinical and epidemiological studies have shown associations between physical activity and symptoms of depression and anxiety in crosssectional and prospective-longitudinal studies (Abu-Omar et al. 2004a, b; Bhui and Fletcher 2000; Farmer et al.
1988; Dunn et al. 2001; Goodwin 2003; Haarasilta et al. 2004; Lampinen et al. 2000; Motl et al. 2004). Moreover, exercise is an integral part in the treatment and rehabilitation of many medical conditions. Improving physical well being may also lead to improved psychological well being and is generally accepted that physical activity may have positive effects on mood and anxiety. What is the empirical evidence for this belief: what do we not know about the association of physical activity and depression or anxiety (disorders) and can/should exercise (training) be used in the treatment of depression or anxiety disorders?
From  Ströhle, A. (2009). Physical activity, exercise, depression and anxiety disorders. Journal Of Neural Transmission (Vienna, Austria: 1996)116(6), 777-784. doi:10.1007/s00702-008-0092-x

The more I read the more I find out that there has not been enough 'good' research done to scientifically state that exercise can alleviate symptoms of anxiety and mood disorders.

But we know it does.

Wednesday, 27 November 2013

Do motor skills impact social success in children with autism?

From an AAHPERD conference preamble:
Autism spectrum disorder is a pervasive developmental disorder characterized by deficits in social skills, communication and repetitive or restricted interests (American Psychological Association, 1994). In addition to these disability-specific behaviors, symptoms of movement disturbance are present (Green et el., 2009; Leery & Hill, 1996). Unmistakably, the emphases of intervention programs for these children are focused on improving social skills. But, it is possible that motor skill deficits are affecting success in social skills programs. The purpose of this study is to understand the role of motor skills in the success of a social skills intervention program for school-aged children with autism. Thirty children with a clinical diagnosis of autism or pervasive developmental disorder not otherwise specified were recruited for this study. All participants took part in a school-based social skills intervention. Social skill and motor skill measures were taken at multiple time points. It was hypothesized that children with better motor skills would have more success in a school-based social skills intervention. At baseline motor skills were highly correlated with higher standardized social skills measures ([r.sup.2] = .67). A linear regression analysis revealed a trend that higher motor skills positively affected success in a schoolbased social skills intervention, based on standardized social skills measures. Motor skills affect the social success of children with autism. Teaching age-appropriate motor skills could add to a practitioners 'toolbox' of strategies. Opportunities to increase motor skills could positively impact other domains. Implications for educators will be discussed.
Megan I. MacDonald and Dale A. Ulrich (F), University of Michigan

Tuesday, 26 November 2013

Exercise,While, Learning. Google It.

I Googled these three words together:

It is undeniable that exercise benefits the body and brain.  Strong research in the area of neuroplasticity is finding that exercise promotes neurogenesis and synaptic connections, particularly in the hippocampus, the region of the brain responsible for learning.
Next focusing on the hippocampus, a brain structure known to be important in learning and memory, the researchers determined that organ's volume was on average 12 percent larger relative to brain size in the children with the greatest aerobic capacity. Previous studies in older adults and in animals have shown that exercise can increase the size of the hippocampus. A bigger hippocampus is associated with better performance on spatial reasoning and other cognitive tasks.
"Study: fit children think better." Running & FitNews May-June 2011. Health Reference Center Academic. Web. 26 Nov. 2013.

Research has also indicated that exercising while learning is has huge benefits for cognitive processes and memory.
Hillman et al. (2009) conducted a study where students exercised for 20 minutes on a treadmill before being assessed in reading, spelling, and math. Students performed better after the exercise, especially in the area of reading comprehension. In a study involving overweight children, exercising 20–40 minutes showed an improvement in the areas of decision-making and math (Baker and Shepard 2007).

It is true that exercise is good for all of us.  Much of the learning that infants are doing is mostly physical.  Research is strong in using exercise as a preventative measure to combat the onset of Alzheimer's  disease.  Individuals post concussion are prescribed bilateral movement and activities to 'repair' the effects of the injury.

Children with neurodevelopmental disabilities are NO different from developing infants, aging octogenarians, or neurotypical peers.

Exercise is good for your brain.

Tuesday, 12 November 2013

Exercise. It needs to be part of a Behaviour Plan

I have been on a LinkedIn mission of late.  I have been deliberately making connections with Board Certified Behaviour Analysts (BCBAs).

There is a reason:  I want to convince BCBAs that exercise can be a valuable tool in the development of a behaviour plan for their clients!

Exercise has so many benefits for all humans young, old, special needs or not.  An improvement of overall fitness can lead to lower incidences of obesity (which will also reduce the incidence of diabetes and cardiovascular disease).

Exercise reduces stress, anxiety and the effects of depression .  Kids with autism, ADHD, OCD have a high comorbidity rates with anxiety.  Exercise releases a cascade of hormones and neurotransmitters that appear to be as effective as medication.

Exercise protects your brain.  Exercise causes the brain to release Brain Derived Neurotrophic Factor which has been shown to protect neurons, promote neurogenesis and synaptic connections.  Research around the subject of brain plasticity has been investigating what BDNF does within the brain.

Dr. John Ratey calls BDNF the "'Miracle Grow' of the brain".


How can you fit exercise into YOUR behaviour plans?

Wednesday, 6 November 2013

Kinesiology and Autism Spectrum Disorder

Kinesiology and Autism Spectrum Disorder

I joined the BC Association of Kinesiologists in 2013 to support my practice in providing exercise as therapy for children with special needs.  Although the purpose may have been more practical as a source of insurance for my services when working with clients I have found the response of belonging to an association of professionals very positive, especially when speaking to members of like minded individuals who belong to other professional associations like the  College of Physical Therapists of British Columbia and the College of Occupational Therapists of B.C.

My practice is unique in that I focus on working with children with special needs, in particular, children on the autism spectrum disorder.  It may sound odd, but I am servicing my clients as a personal trainer and focus on the (perhaps not so) unique physical limitations of children on the autism spectrum.

Physically speaking, children with ASD suffer from poor muscle tone and core strength, motor planning deficiencies, balance, coordination, and cardiovascular fitness.  This is in part due to fewer opportunities to play with peers effectively because of social limitations they may experience, but also because of the limited opportunities they may have in participating in the typical group activities (like gym class) because of their unique personalities.

My practice focuses on a few basic principals:  strength, balance, cardiovascular fitness, sport and play rules or etiquette.

For strength I rely on plyometric activities using weighted balls for throwing and catching and hopping/bounding for leg strength.  Hand grip strength is a valid tool to determine overall strength ) and it has been shown that individuals diagnosed ASD have significantly lower handgrip strength than neurotypical children (Kern et al., 2012).  Overall strength greatly affects a person’s ability to perform gross (like 2 foot hopping) and fine (like printing) motor skills .  As wel,l hopping up, down, and over benches and picnic tables provides equipment that one can rarely see in a fitness centre!
Dynamic movement is the goal of the plyometric exercises.

Balance is provided by feedback from both our proprioceptive and vestibular systems.  My goal with my clients is to provide them an opportunity to blossom into ‘Secret Ninja Agents of the Playground’.  I incorporate the use of slackline work, stepping stones, bongo boards, bicycles, scooters, and roadside curbs, and of course “playground follow the leader” to engage and practice these skills.  I often apologise to parents if they suddenly find their child attempting to climb over things that may not be part of the walk they envisioned with their child!

Cardiovascular training is a little tougher….not many people on a fitness program want to run.  What about flying a kite?  This can be very effective for raising the heart rate especially when there is little or no wind!

Hand eye coordination is also a very important concept to teach: it involves the concept of motor planning. Catching and throwing a ball, catching and throwing a ball while standing on a ‘wiggle seat’, hitting a tennis ball on solid ground and on the wiggle seat, juggling, hitting a golf ball, or hitting a baseball.  All of these activities require effective thought processing, planning, and execution.  For some it is a natural progression of active play and movement literacy, for others the lack of these skills can be a source of embarrassment and exclusion.

A dimension of ASD has a social aspect and impacts their ability to participate in group activities.  In turn, the peer acceptance can be a major stumbling block for people with ASD to participate in group or team activities.  Essentially these two concepts act as a negative feedback system for the individual.  It is paramount to try and teach individuals with ASD the social skills around play and sports in order to join their peers on the playground as an equal.

The most exciting thing I am learning about exercise in relation to my practice is the body’s response to increasing the production of brain derived neurotrophic factor (BDNF).  BDNF acts as an agent for neuron protection and defense, neurogenesis, synaptic growth, particularly in the hippocampus--the region of the brain associated with learning.  There has recently been a tremendous amount of investigation into the effect of exercise and neuroplasticity (think motor planning abilities), as well how exercise can affect conditions of anxiety and depression (both highly comorbid with ASD).

At the end of the day all of us practitioners can state that exercise is good for everybody, but as we learn more about special populations we can state with even more confidence that exercise is not just good for is essential.

Have the Conversation With Your Feet

Your feet speak to you.  You should listen!

I have been playing with a couple of boys and we do a lot of Parkour type climbing and jumping.  A few times feet slip on the playground equipment and they appears SO surprised!

I have started the mantra "listen to your feet".

Your feet are full of nerve endings called proprioceptors.  They communicate with instant feedback to your body about what type of ground (or object) your feet are in contact with.  They innervate the necessary muscles required to respond to the stimuli they are receiving.

Can you play in your bare feet?  Even better.  Open up the lines of communication between you and your feet.  They will keep you upright and safe.

Go.  Get Grounded!

ps...your hands speak to you as well...just a little differently.  Elbows and armpits do not speak to you very well at all so keep using your hands to hang on to things....

Go Play Outside