Text: Nicole Schnackenberg, taken with thanks from the Special Yoga Blog.
'I am different, not less.' -Dr. Temple Grandin
Autism Spectrum Disorders (ASD) affect the ways in which an individual communicates and interacts with others, and experiences the world around them. Individuals with ASD can also experience co-occurring difficulties with anxiety and low-mood, with a significant subgroup presenting with anxiety disorders or high levels of anxiety traits (White, Oswald, Ollendick and Scahill, 2009). The presence of such anxiety has been associated with, and even proposed to be caused by, sensory hyper-reactivity (Green and Ben-Sasson, 2010), with the most recent edition of the Diagnostic and Statistical Manual (APA, 2013) introducing sensory hypo-reactivity and hyper-reactivity as features of ASD. Current estimates indicate that more than 80% of children with ASD exhibit co-occurring sensory processing problems (Ben-Sassoon, Hen and Fluss, 2009).
In general, children with ASD have a heightened or reduced sensory response in one or more of the five main senses (sight, hearing, smell, taste and touch) and are also often sensitive in the body’s general awareness of its position, posture, movement and balance in relation to the surrounding environment. Families report that sensory difficulties significantly restrict full participation in daily activities and create social isolation both for their child with ASD and themselves (Dickie et al, 2009).
Children with ASD are also reported to have a greater prevalence of sleep problems than typically developing children with reported sleep problems in children with ASD ranging from 44% to 83% (Richdale, 1999). Furthermore, children with ASD are more likely to suffer from gastrointestinal symptoms including abnormal stool patterns and frequent abdominal pain, with 66% of children in one study being found to have one or more lifetime gastrointestinal difficulties (Valicenti-McDermott et al. 2014). Problem eating behaviours are also reported in more than 75% of children with ASD (Cermak, Curtin and Bandini, 2010) which include selective eating, the consumption of non-food items (pica), insistence of specific mealtime routines and meal-related distress such as tantrums.
In an attempt to alleviate some of these distressing symptoms, up to one third of parents with children with ASD have sought out complementary or alternative therapies (Levy, 2003). Complementary and alternative therapies have been defined by the National Centre for Complementary and Alternative Medicine as a ‘group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional medicine’ and include homeopathy, biofeedback, hypnosis, diet protocols and yoga amongst others. With the vast and daunting assortment of treatment options available, children with ASD are often enrolled in numerous treatments and interventions simultaneously. From an Internet survey of parents of children with autism, Green and colleagues (2006) found that, on average, parents reported using seven different treatments with their children.
One Complementary and Alternative treatment option available to children with ASD is yoga. Regular yoga practice has been shown to increase brain GABA levels and to improve both mood and anxiety (Streeter, 2010). In one systematic review, Pilkington, Kirkwood, Rampes and Richardson (2005) located five studies describing the outcomes of yoga interventions for alleviating low mood and found yoga to have beneficial effects. Yogic breathing has also been repeatedly shown to be a valuable resource for people suffering from stress (Zucker et al., 2009), and as a useful aid for enhancing emotional regulation (Arch and Craske, 2006).
In terms of gastrointestinal distress, Salmon et al (2009) explain that ‘yoga and other repetitive motion patterns, appear to restore and entrain the rhythmicity of biological functions that are often disrupted during times of stress’, which can include the entrainment of bowel functioning. In addition, yoga has been shown to be beneficial for sleep difficulties, with one study evaluating the effects of yogic breathing on chronic insomnia reporting longer sleep and improved sleep efficiency (Khalsa, 2004).
School children practicing yoga for ten days improved spatial memory scores and the ability to concentrate (Telles et al., 1993). Yoga practice would also appear to positively influence emotional states, with children experiencing higher levels of wellbeing and self-esteem after a series of yoga sessions (Berger, Silver and Stein, 2009). In a review of the literature of the clinical applications of yoga for the paediatric population (Birdee et al., 2009), yoga was found to have benefits for spatial perception, muscle strength and respiratory capacity.
Mindfulness-based approaches, such as yoga, have also been shown to improve self-regulatory processes. Mindfulness is often defined as paying attention to the immediate experience in a non-judgmental way, the cultivation of ‘present moment’ awareness and an acceptance of moment-to-moment experience, all of which are elements of the practice of yoga. A twelve-week pilot randomised control trial assessed the effectiveness of a school-based mindfulness and yoga intervention on 97 children, and found a positive impact on problematic responses to stress, including intrusive thoughts and emotional arousal (Mendelson et al., 2010). Mindfulness practices have also been shown to induce the relaxation response in children (Edenfield and Saeed, 2012).
Sources:
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders 5th Edn (DSM-V). Washington, DC: American Psychiatric Association.
Arch, J. J., and Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44, 1849-1858.
Ben-Sasson A., Hen, L., and Fluss, R., (2009) A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39: 1–11.
Berger, D.L., Silver, E.J. and Stein, R.E. (2009). Effects of yoga on inner-city children’s well-being: a pilot study. Alternative Therapy Health Medicine, 15:36–42.
Birdee, G. S., Yeh, G. Y., Wayne, P. M., Phillips, R. S., Davis, R. B., & Gardiner, P. (2009). Clinical applications of yoga for the paediatric population: A systematic review. Academic Paediatrics, 9, 212–220.
Cermak, S.A., Curtin, C. and Bandini, L.G. (2010) Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of American Dietary Association, 110:238-246.
Dickie V, Baranek G, Schultz B, Watson L and McComish C (2009) Parent reports of sensory experiences of preschool children with and without autism: A qualitative study. American Journal of Occupational Therapy, 63(2): 172–181.
Edenfield, T.M. and Saeed, S.A. (2012). An update on mindfulness meditation as a self-help treatment for anxiety and depression. Psychology Research and Behaviour Management, 5:131-141.
Green, V. A., Pituch, K. A., Itchon, J., Choi, A., O’Reilly, M., & Sigofoos, J. (2006). Internet survey of treatments used by parents of children with autism. Research in Developmental Disabilities, 27, 70–84.
Green, S.A. and Ben-Sasson, A. (2010) Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: is there a causal relationship? Journal of Autism and Developmental Disorders, 40(12): 1495–1504.
Khalsa, S. B. (2004). Treatment of chronic insomnia with yoga: A preliminary study with sleep-wake diaries. Applied Psychophysiology and Biofeedback, 29, 269-278.
Levy, S. (2003) Complementary and Alternative Medicine Among Children Recently Diagnosed with Autistic Spectrum Disorder; Journal of Developmental and Behavioural Paediatrics, 24, 418-423.
Mendelson, T., Greenberg, M. T., Dariotis, J. K., Gould, L. F., Rhoades, B. L., & Leaf, P. J. (2010). Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. Journal of Abnormal Child Psychology, 38, 985–994.
Pilkington, K., Kirkwood, G., Rampes, H., & Richardson, J. (2005). Yoga for depression: The research evidence. Journal of Affective Disorders, 89, 13-24.
Richdale, A. L. (1999). Sleep problems in autism: Prevalence, cause and intervention. Developmental Medicine & Child Neurology, 41, 60–66.
Salmon, P., Lush, E., Jablonski, M., & Sephton, S. E. (2009). Yoga and mindfulness: Clinical aspects of an ancient mind/body practice. Cognitive and Behavioural Practice, 16, 59-72.
Streeter, C.C. (2010). Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study.” Journal of Alternative & Complementary Medicine, 16, 11: 1145-115.
Telles, S., Narendran, S., Raghuraj, P., Nagarathna, R., & Nagendra, H. R. (1997). Comparison of changes in autonomic and respiratory parameters of girls after yoga and games at a community home. Perceptual and Motor Skills, 84, 251–257.
Valicenti-McDermott, M., Burrows, B., Bernstein, L., Hottinger, K., Lawson, K., Seijo, R., Schechtman, M., Shulman, L. and Shinnar, S. (2014) Use of Complementary and Alternative Medicine in Children With Autism and Other Developmental Disabilities: Associations With Ethnicity, Child Comorbid Symptoms, and Parental Stress. Journal of Child Neurology, 2014 29: 360.
White S, Oswald D, Ollendick T and Scahill, L. (2009) Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29: 216–229.
Zucker, T., Samuelson, K., Muench, F., Greenberg, M., Gevirtz, R. (2009). The Effects of Rhythmic Breathing Intervention on Posttraumatic Stress Disorder (PTSD) Symptoms and Heart Rate Variability (HRV), Applied Psychophysiology and Biofeedback 34: 135–143