Kata training and autism

The actor and musician Steven Seagal is probably not natural fodder for this blog about autism research but he does nevertheless make an appearance today. More readily known for his action films - my favourite was always 'Under Siege' - one of the appeals of Mr Seagal was his knowledge and use of martial arts in his various roles, as a function of his quite impressive real-life black belt in Aikido.

Obi Wan... no Obi knot @ Wikipedia 

It is with martial arts in mind that today I'm talking about an interesting paper by Ahmadreza Movahedi and colleagues [1] and some observations on the use of kata techniques on social interactive abilities in a small group of children diagnosed with an autism spectrum disorder (ASD). Kata by the way, refer to the various structured patterns of movements practised as part of martial arts like karate. Normally incorporating various blocks and offensive (attacking) movements, kata are an integral part of martial arts training and vary in their complexity and number of moves (see here). Practice makes perfect is the primary tenet of kata training.

A few details about the Movahedi paper might be useful:

• Thirty children diagnosed with ASD formed the participant group. None had any experience or training in kata techniques. They were randomly assigned to an exercise group (n=15) or a control group (n=15). Heian Shodan (see this video for what this encompasses) kata was the chosen "experimental task" (one of the first kata taught in Shotokan karate). Training was delivered to the exercise group as part of a structured schedule; all sessions were videotaped to "control the trainers' teaching method as precisely as possible".
• Exercise group participants received kata instruction "1 session/day. 4 days/week for 14 weeks (56 sessions)". Sessions involved initially watching a video of someone performing the kata and then receiving personal instruction from trainers onwards to performing the kata. Warm-up and cool-down exercise started and finished each session whilst "Persian music" was playing (this study was completed in Iran).
• Social interaction was measured at baseline before intervention and post-intervention at 14 weeks based on the use of the Gilliam Autism Rating Scale (GARS-2). Observations were carried out by "caregivers, parents and teachers" and based on the "frequency of occurrence of each social behaviour under ordinary circumstances in a 6-h period".
• Results: there was no significant differences on the social interaction subscale of the GARS at baseline (before intervention) between the groups. After intervention however "the participants of the exercise group demonstrated a substantial improvement in social interaction" compared to the control participants. This improvement also seemed to last even after 30 days of no training at the conclusion of the kata training for the exercise group. 
• The authors concluded that kata training is an effective avenue for improving social interaction for children with ASD. Perhaps wider that their results may help providers to "decide to establish strategic plans under which martial arts techniques will best be instructed to children with ASD".

Bearing in mind the small numbers of participants included in this study, I was impressed by these findings. I'm quite a fan of the martial arts and some of the philosophy behind them and how they might relate to various facets of autism, be it stress (see here and see here), self-confidence (see here) or just getting someone more active (see here). Most people who take part in and/or watch loved ones take part in activities such as karate, whether diagnosed with autism or not, see very quickly how such training offers a multitude of benefits outside of just increased physical activity (and onwards academic performance?). Self-confidence and self-regulation (difficult concepts to measure) tend to be some of the primary psychological benefits of the martial arts. Whether this comes from the actual training or as a result of the knowledge that the training brings is still a question open to some debate. Anger and aggression can also be 'channelled' as a function of certain martial arts training [2]. Given the principles on which something like karate is based, this is perhaps not all that surprising. The social interactive aspect included in martial arts reflects interaction with both Sensei (teacher) and other students, who, in a real-life setting, will generally include various ages and various different grades (see here) and hence incorporates a spirit of partner practising and helping out those less experienced. All these elements can positively combine together to promote a sense of belonging.

Other research has also looked at the effects of kata training on other aspects of autism. The paper by Bahrami and colleagues [3] (yes, the same authorship group) talked (I think) about the same participant group also showing "significantly reduced stereotypy" following training. Again, the benefits were seen even after the training period had been completed. A further case study paper by the same authors showed similar things [4].

The paper by Torres [5] using martial arts training as a means to assess movement in relation to autism hints at another interesting area of potential study. It's long been discussed in autism research circles that movement and gait seem to be 'affected' in quite a few instances of autism [6]. I've covered some of the peripheral issues on this blog including toe walking (see here) and that curious issue of joint hypermobility (see here) talked about further in a paper by Shetreat-Klein and colleagues [7]. The intriguing question is whether the often very intricate and certainly 'balance-orientated' movements included in kata training might likewise have some positive effects on autism. Indeed if, as is starting to be discussed, motor skills do show a connection with autism characteristics [8], whether the effects of kata training on motor skills may be a route to affecting other core issues associated with autism?

So, music to close. I'll forgo the obvious music with a martial arts slant (no, not Kung-Fu fighting) and instead go for some Arctic Monkeys.... I bet that you look good on the dance floor (well, do yer?)

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[1] Movahedi A. et al. Improvement in social dysfunction of children with autism spectrum disorder following long term Kata techniques training. Research in Autism Spectrum Disorders. 2013; 7: 1054-1061.

[2] Lotfian S. et al. An analysis of anger in adolescent girls who practice the martial arts. Int J Pediatr. 2011;2011:630604.

[3] Bahrami F. et al. Kata techniques training consistently decreases stereotypy in children with autism spectrum disorder. Research in Developmental Disabilities. 2012; 3: 1183-1193.

[4] Bahrami F. et al. Effect of Kata Training on Stereotypic Behaviors in Three Boys with Asperger Syndrome. Iranian Journal of Psychiatry & Clinical Psychology. 2013; 19: 54-64.

[5] Torres EB. Atypical signatures of motor variability found in an individual with ASD. Neurocase. 2013 Apr;19(2):150-65.

[6] Calhoun M. et al. Gait patterns in children with autism. Clin Biomech (Bristol, Avon). 2011 Feb;26(2):200-6.

[7] Shetreat-Klein M. et al. Abnormalities of joint mobility and gait in children with autism spectrum disorders. Brain & Development. 2014; 36: 91-96.

[8] MacDonald M. et al. Motor skills and calibrated autism severity in young children with autism spectrum disorder. Adapt Phys Activ Q. 2014 Apr;31(2):95-105.

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Movahedi, A., Bahrami, F., Marandi, S., & Abedi, A. (2013). Improvement in social dysfunction of children with autism spectrum disorder following long term Kata techniques training Research in Autism Spectrum Disorders, 7 (9), 1054-1061 DOI: 10.1016/j.rasd.2013.04.012