By Joanna Blanchard MOTR/L
Have you ever wondered, “Just how many more repetitions of that same obstacle course does he really need? What is this doing for him?” while watching your child’s occupational therapy session?
It is likely your OT is working on multiple things, however one area I am always assessing while working with patients is endurance and level of fitness. This helps to find activities that the family can do at home to have fun and find success. I often push my kids to the edge of fatigue to help them build endurance—all in addition to motor planning, sensory processing and other goals commonly outlined in an OT evaluation.
It’s important to remember that sensory processing is not just about finding the “magical” sensory strategy combination that helps us feel more comfortable in our world. Weighted vests and swings are wonderful strategies to utilize for interventions and to create comfort within the nervous system. But working with a child’s sensory system also involves looking at the whole body’s health and function. A healthy cardiovascular, respiratory and even digestive system helps support the nervous system by providing the body with the tools it needs to achieve organization—and stay there.
A child who struggles to find where his or her body is at in space might feel great after 20 minutes of spinning on the platform swing. However, the challenge is how to help them achieve that intensity on their own, without all the fancy equipment, in a community setting as they grow older? If a child is mostly sedentary, how will they ever be able to have the strength and endurance to meet his or her own sensory thresholds independently and safely?
I volunteer in a yoga class for adults with disabilities and often witness how decades of low activity levels affect our bodies over time. With decreased processing, and thus ability to navigate through our community independently, these adults often have a harder time finding sensory friendly, adaptive gym settings or classes. Just getting to a community gym can be challenging for the non-driver and many people cannot safely participate in an exercise program alone. Having been sedentary for years, many are uncomfortable moving their bodies.
Even very gentle adaptive yoga can be challenging, but oh, how wonderful it is to watch them find movement again in this class!
Ideally, if we can start kids moving and loving it early in life, they will continue to move throughout his or her lifespan. This can be hard for many children on the spectrum due to apraxia, poor body awareness and common sensory issues.
Combined with the difficulty of moving, we’ve seen technology advance by leaps and bounds—as well as the ease in which children can access it. As parents focus on encouraging our kids in areas they are interested and successful in, and with the advance of the tablet and touchscreen technology, life has changed for the better in many ways. But I notice that there seems to be a decrease in activity levels with children on the autism spectrum compared to their peers for this reason, too. Other reasons for sedentary lifestyles within the ASD community are related to the advanced social skills, communication and processing often required for participation in team sports as children get into middle and high school, which is when things get competitive.
I worry about what this group of adults will look like in 20 years, with this decreased motivation to move combined with the ease that our world can be accessed without moving anything but our fingers. Luckily, there are options such as Miracle League, Kiwanis Camp and other opportunities, but not as much or as often as needed.
As a result, I am constantly thinking ahead to a child’s future. What will get them moving? What do they love to do? What can they continue to do for the rest of their lives?
It generally takes a while to build trust and connect with a child to figure out what incentivizes them to keep moving, and understanding his or her sensory preferences is part of the process. Adults often have their own sensory diet and are able to self-regulate without realizing it.
- Perhaps a person on the spectrum needs short bursts of movement followed by “down time.” It could be that baseball or basketball is a good activity of choice. Flag football (I can’t recommend tackle for kids even though the pads and helmets provide great compression and weight) is also great but following complex plays can be hard.
- Or does a long, sustained activity with repetition help with sleep at night and calm high levels of anxiety? Try cross-country running or swimming. Marathon runners often are sensory seekers who have found the way to sleep at night and meet their high energy thresholds, after hours of meditative, repetitive movement running and breathing with a steady rhythm of the body.
- Rock climbers are often deep pressure and heavy work folks, with long, sustained muscle engagement and resulting fatigue being the goal as well as the adrenaline rush and then relaxation provided through the danger component.
- Golfers are detail-oriented planners, seeking a quiet, low-impact activity over a long duration.
- Basketball can provide both heavy work (contact with other players and that ball is heavy!), vestibular input and adrenaline rush (lots of sprinting) and sustained exercise over time.
- Yoga teaches calming techniques for anxiety, quieting the mind and flexibility as well as weight bearing and strengthening.
- Find something the whole family wants to participate in either by watching, coaching, or doing it together so that it’s not just another chauffer trip for the parent and everyone is invested. Hiking and skiing are awesome family activities.
All of these activities can provide opportunities to get out into the community and be active with peers. They also require a measure of endurance that is needed to participate for the duration of the game or class. Pushing through that initial fatigue is something you often see your therapists do to both reach a sensory threshold and to get a child in a place where they can participate with peers.
Other things to consider:
- Many times the medications that both children and adults are placed on to help with sleep and behavior can also affect activity level and make it more challenging to get them up and going.
- Deep and full breathing creates oxygenated blood which improves cognition and movement, and decreases anxiety. Practice and coach good breathing
- Studies have shown improving endurance and increasing activity levels can decrease levels of self-stimulatory behavior in people with autism, as well as improve attention.
- Endurance takes time and some patience to build, but can happen gradually and with small victories.
- Think about levels of endurance for the children in your child’s age group. Do peers his age (or slightly younger) maintain energy for an entire soccer game? Adapt your expectations for your child, and then develop goals together.
- Kids with autism process motor skills differently, but they have the same biological needs to support development and optimal bodily function. Bone density, digestion and emotional state are all affected by activity levels.
- The result is having a healthier, happier kiddo!
Joanna Blanchard is an occupational therapist and the mother of two boys on opposite ends of the autism spectrum. She is the owner of Everybody Stims Occupational Therapy in Vancouver, Washington. Have a question for Joanna? Email firstname.lastname@example.org.
Physical Exercise and Individuals with Autism Spectrum Disorders: A Systematic Review
Lang, Russell; Koegel, Lynn Kern; Ashbaugh, Kristen; Regester, April; Ence, Whitney; Smith, Whitney
Research in Autism Spectrum Disorders, v4 n4 p565-576 Oct-Dec 2010