Virginia Commonwealth University
November 5, 2014
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Kira Austin, Ph.D.

You walk into Ms. Fitzpatrick’s kindergarten classroom and you’re surprised to see all of the students stretching in a “downward dog” yoga position. You ask your colleague what the students are doing and she pleasantly replies, “They’re doing yoga. I’ve found that it really helps them concentrate after lunchtime.” You’ve heard of teachers taking brain breaks, using brain gym, and doing movement stretches, but you wonder if this can help your students with autism, too. A few days later in your mailbox you find a report from the National Professional Development Center on Autism Spectrum Disorders (NPDC on ASD), describing exercise as an evidence-based practice for students with Autism Spectrum Disorder (ASD). The attached sticky note attached reads, “Thought you might find this interesting! Smiles, Ms. Fitzpatrick.”

Children stretching in a classroom

Regular, moderate-to-high intensity exercises can decrease problem behaviors and increase desired behaviors.

You immediately begin reading the fact sheet and are thrilled to see that this is a practice you could put in place in your classroom. However, you are familiar with the NPDC on ASD evidence-based practice (EBP) briefs and are a little befuddled that the information is only one-page long. Where are the step-by-step directions? Where are the easy to use data collection sheets? You decide to do a little investigating and this is what you find: In 2010, NPDC on ASD conducted their first comprehensive review of the literature to establish 24 EBPs. Their review spanned from 1997 to 2007 (Odom, et al., 2010). The field of autism research has grown significantly since 2007, so NPDC staff reviewed the literature again to encompass research completed between 1990 and 2011 (Wong, et al., 2013). As a result, NPDC identified 27 EBPs and released them in a report in early 2014. This new report provided fact sheets regarding each EBP, including the EBP for exercise.

According to NPDC on ASD (Wong, et al., 2013), as long as it occurred on a regular basis, exercise programs can take many forms and still help improve behavior. Aerobic activities could include jogging, jumping, swimming, strength training, and/or stretching. Exercise’s effectiveness was not limited to a particular environment. Interventions occurred indoors, outdoors, in school, and in the community. Most interventions followed a typical schedule of a warm-up activity, aerobics, and a cool-down activity such as stretching. Although the research specific to students with autism was limited to those in preschool and middle school, other research has shown exercise to be helpful for people with developmental disabilities across the lifespan (Ellis, MacLean, & Gazdag, 1989; Kern, Koegel, & Dunlap, 1984; McGimsey & Favell, 1988; Powers, Thibadeau & Rose, 1992; Yell, 1988).

You quickly draw the connection that exercise is an antecedent-based intervention and you can use the steps in the NPDC on ASD brief to develop your exercise intervention for your classroom. As with other antecedent based interventions, you need to follow a specific process (Neitzel, 2009). The first step is to identify the interfering behavior. Research studies have shown that exercise can help increase appropriate behaviors such as physical fitness and attention to task and decrease problem behaviors such as self-stimulatory behaviors and aggression (Lang et al., 2010). These behaviors are highly relevant for your students with ASD. Many individuals with ASD have low levels of movement and poor motor control (Cairney, Hay, Faught, Corna, & Flouris, 2006; Ming, Brimacombe, & Wagner, 2007). This lack of physical fitness impacts their overall health and ability to participate fully in social physical activities (Pan & Frey, 2006; Piek, Baynam, & Barrett, 2006). Furthermore, many persons with ASD display problem behaviors such as stereotypy, off-task, aggression, and self-injury. Studies have shown that exercise can help to significantly decrease the frequency of negative behaviors (Allison, Basile, & MacDonald, 1991; Baumeister & MacLean, 1984, Cannella-Malone, Tullis, & Kazee, 2011; Celiberti, Bobo, Kelly, Harris, & Handleman, 1997; Yell, 1988).

Once again, you reflect on the students in your classroom and identify several behaviors you would like to increase and decrease. For all students, you would like to increase their physical fitness and for a few students, you would like to decrease their self-stimulatory behavior. Prior to implementing your intervention, you know you need to define the behavior and collect baseline data for a minimum of four days prior to implementing the exercise intervention. You decide to measure physical fitness by having your students wear a pedometer during their exercise time and count the number of steps. In this way, you also can have students work on math concepts by graphing their daily number of steps walked. Your goal is to increase their total number of steps walked by 25%. You also have two students that engage in self-stimulatory behavior. One student engages in bouncing up and down, both in and out of his seat; another student frequently rubs his hands together. You’ve been tracking their behavior using a frequency count throughout the day. You decide to stick with this measure and set a goal to decrease this behavior by 25% across the day.

After looking at the research, you noticed that the effects had the most impact directly after the exercise, so you decide to purposefully plan for 15 minutes of exercise three times a day. Many of your students have long bus rides, so in the morning your students will come to class, unpack, and then engage in their morning exercise routine. You decide that after mid-morning snack and lunch would also be beneficial times to build in an exercise time. For consistency you choose to make the routine consist of a three minute warm-up, ten minutes of aerobics, and a two minute cool down. During warm-ups students can select from a variety of activities such as the following: jumping on a mini trampoline, jumping jacks, doing wall pushes, hopping over a jump rope, doing a crab walk, a bear crawl, jump-ups, leg kicks, or knee raises. Aerobics can consist of jogging or brisk walking and students can choose to either walk the perimeter of the gym or walk on a treadmill. Finally, students will cool down by stretching using yoga poses.

Many of your students struggle with physical activity and poor motor planning. You know you will need to put supports in place prior to begin your intervention. You talk with your paraprofessional and she helps create visual cue cards for each warm-up choice and several kid-friendly yoga poses. You also create a mini-schedule for students that includes pictures of the warm-up, aerobics, and cool-down. Research also suggests pairing antecedent-based interventions with prompting and reinforcement (Cox, 2013). You put a token system in place in which students can earn a token for each of the three sections of the exercise intervention (i.e., warm-up, aerobics, and cool-down) for a total of nine tokens a day. At the end of the day, if students have six tokens or more they are able to choose a reward from the class reinforcer menu.

You discuss your exercise plan with the classroom paraprofessional and are ready to begin collecting baseline data. You collect data for one week and then begin your intervention. Even though many of the exercises are new to them, your students are eager to participate in their new exercise routine. After two weeks you begin anecdotally noticing changes in student behavior, but you want to know what the data say. After three weeks you review the data and are pleasantly surprised: all of your students have increased their total number of steps. Your two targeted students have decreased their number of self-stimulatory behaviors but haven’t reached their goals yet. You decide to continue with the intervention.

A few weeks later Mr. Jordan, a third grade teacher, peeks into your classroom window and sees your students crab walking around the classroom. Curious, he knocks on the door and asks what your students are doing. You smile and reply, “They’re exercising! It has really helped to improve behavior throughout the day.” Mr. Jordan slowly nods as if processing what you have to say, and then politely heads back to his class. A few days later, Mr. Jordan finds in his mailbox the report from NPDC on ASD describing exercise as an EBP with a sticky note attached which reads, “Thought you might find this helpful! Best, Mrs. Marks.”

After implementing the exercise intervention in your classroom for several months, you take time to reflect on this routine. You were able to see first hand that regular, moderate-to-high intensity activity decreased problem behaviors and increased desired behaviors. In order for exercise to be effective, it needed to be planned and implemented purposefully throughout the day. This proactive approach not only helped your students focus on their classwork, it also increased their physical fitness and overall health. You realize that incorporating exercise into the classroom is more than just a passing fad—it’s an evidence-based practice.

Mrs. Marks’ Lessons Learned:

  • Determine how and where students will exercise. Research suggests students exercise across settings and throughout the day.
  • Decide if this should be a whole class intervention or for a particular student.
  • Determine how often it will occur throughout the day. The effects of exercise tend to wear off after 90 minutes or more.
  • What resources or materials will you need? Can you borrow items and/or space from the physical education department?
  • Decide how you will support the learning of the skills. Do you need visual supports, prompts, physical boundary markers, or video modeling?
  • How will you measure change?
  • Aquatics have been shown to be an EBP. Even as few as two times per week is sufficient enough to make behavioral change. Is your school close to a community pool? Can you incorporate this into community-based instruction?
  • Do any of your students have health conditions that might impact their ability to participate? Consider receiving parent permission prior to implementation.
  • Make sure you take appropriate safety measures, such as ensuring appropriate foot wear and adequate space in the classroom for students to have room to stretch out. If students touch the floor at any point, have them wash their hands after exercise time.

References

Allison, D. B., Basile, V. C., & MaDonald, R. B. (1991). Brief report: Comparative effects of antecedent exercise and Lorazepam on the aggressive behavior of an autistic man. Journal of Autism and Developmental Disorders, 21, 89-94.

Baumeister, A. A., & MacLean, W. E. (1984). Deceleration of self-injurious and stereotypic responding by exercise. Applied Research in Mental Retardation, 5, 385-393.

Cairney, J., Hay, J., Faught, B. E., Corna, L. M., & Flouris, A. D. (2006). Developmental coordination disorders, age, and play: A test of the divergence in activity-deficit with age hypothesis. Adapted Physical Activity Quarterly, 23, 261-276.

Cannella-Malone, H. I., Tullis, C. A., Kazee, A. R. (2011). Using antecedent exercise to decrease challenging behavior in boys with developmental disabilities and an emotional disorder. Journal of Positive Behavior Interventions, 13(4), 230-239. doi: 10.1177/109830071140612

Celiberti, D. A., Bobo, H. E., Kelly, K. S., Harris, S. L., & Handleman, J. S. (1997). The differential and temporal effects of antecedent exercise on the self-stimulatory behavior of a child with autism. Research in Developmental Disabilities, 18(2), 139-150. doi: 10.1016/S0891-4222(96)00032-7

Cox, A. W. (2013). Exercise (ECE) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, The National Professional Development Center on Autism Spectrum Disorders.

Ellis, D. N., MacLean, W. E., & Gazdag, G. (1989). The effects of exercise and cardiovascular fitness on stereotyped bodyrocking. Journal of Behavior Therapy and Experimental Psychiatry, 20, 251-256.

Kern, L., Koegel, R. L., & Dunlap, G. (1984). The influence of vigorous versus mild exercise on autistic stereotyped behaviors. Journal of Autism and Developmental Disorders, 14, 57-67.

Lang, R., Koegel, L. K., Ashbaugh, K. Regester, A., Ence, W., & Smith, W. (2010). Physical exercise and individuals with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 4, 565-576. doi: 10.1016/j.rasd.2010.01.006

McGimsey, J. F., & Favell, J. E. (1988). The effects of increased physical exercise on disruptive behavior in retarded persons. Journal of Autism and Developmental Disorders, 18, 167-179.

Ming, X., Brimacombe, M., & Wagner, G. C. (2007). Prevalence of motor impairments in autism spectrum disorders. Brain and Development, 29, 565-570.

Neitzel, J. (2009). Overview of antecedent-based interventions. Chapel Hill, NC: The National Professional Development Center on Autism Spectrum Disorders, Frank Porter Graham Child Development Institute, The University of North Carolina.

Odom, S. L., Collet-Klingenberg, L., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure, 54(4), 275-282. doi: 10.1080/10459881003785506

Pan, C. Y., & Frey, G. C. (2006). Physical activity patterns in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(5), 597-606.

Piek, J. P., Baynam, G. B., & Barett, N. C. (2006). The relationship between fine and gross motor ability, self-perceptions and self-worth in children and adolescent. Human Movement Science, 25, 65-75.

Powers, S., Thibadeau, S., & Rose, K. (1992). Antecedent exercise and its effects on self-stimulation. Behavioral Residential Treatment, 7, 15-22.

Wong, C., Odom, S. L., Hume, K., Cox, A. W., Fettig, A. Kucharczyk, S., & Schultz, T. R. (2013). Evidence-based practices for children, youth, and young adults with Autism Spectrum Disorder. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, Autism Evidence-Based Practice Review Group.

Yell, M. L. (1988). The effects of jogging on the rates of selected target behaviors of behaviorally disordered students. Behavioral Disorders, 13, 273-279.

 

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