Behavioural outcomes in autism following exercise

It's our birthday today (this blog I mean). We've reached the ripe old age of 5. Many happy returns Questioning Answers. According to some people (one person anyway) "Those who can, publish. Those who can't, blog". Personally, I enjoy doing a bit of both and when it comes to peer-reviewed science, quantity does not always trump quality. That's my excuse anyway.

And onwards...

Today I'm talking about the paper by Emily Bremer and colleagues [1] who set out to "systematically search and critically analyse the literature pertaining to behavioural outcomes of exercise interventions for individuals with autism spectrum disorder aged ⩽16 years."

Researchers concluded that pretty consistently, various exercise interventions "can result in improvements to numerous behavioural outcomes including stereotypic behaviours, social-emotional functioning, cognition and attention." At the very least, adverse side-effects and harms were minimal and it goes without saying that any sort of physical activity is normally quite a good thing anyway. The sorts of activity included in the review ranged from swimming to yoga/dance and quite a bit in-between. Further: "Horseback riding and martial arts interventions may produce the greatest results with moderate to large effect sizes, respectively."

Martial arts in particular cutting the scientific mustard? Well, I'm impressed. Indeed I've said as much about the use of martial arts such as karate for autism before (see here and see here) realising that certain aspects of the discipline such as kumite might not initially be to everyone's taste. That being said, karate and other martial arts might tend to instil a degree of confidence in their practitioners [2], so even those who might not be natural-born 'fighters' might eventually develop a liking (and talent) for this side of the activity. A sprinkling of competition can also sometimes be a good thing (head to 2m36s to see how kata can translate into action)...

Of course the authors are correct in their assertion that further: "well-controlled designs, standardized assessments, larger sample sizes and longitudinal follow-ups is necessary". I might add that a focus on the biology associated with using particular exercise regimes as well as the behavioural effects might also be a good idea so as to potentially ascertain what it is about particular sports/pastimes that seem to produce the behavioural outcomes noted.

I think more people are cottoning on to the idea that sports and physical activity might hold lots of different promises for many people with autism. Most people on the autism spectrum do not lack the capacity to engage in sports and exercise (see here) but again, it tends to be about the provision of opportunities and putting forward a good case as to why taking up a physical activity might be a good thing (see here). I say this keeping in mind individual tastes.

Finally, with again the martial arts in mind, at least one of the governing bodies here in Blighty is starting to open doors. The question is: what's stopping you? Kiai!

Music to close, and given some enthusiasm from some of my brood for Ferris Bueller's Day Off, Yello and Oh Yeah...

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[1] Bremer E. et al. A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism. 2016. Jan 28.

[2] Chen MA. & Cheesman DJ. Mental toughness of mixed martial arts athletes at different levels of competition. Percept Mot Skills. 2013 Jun;116(3):905-17.

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Bremer, E., Crozier, M., & Lloyd, M. (2016). A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder Autism DOI: 10.1177/1362361315616002

Therapeutic horseback riding for autism?

"This is the first large-scale randomized, controlled trial demonstrating efficacy of THR [therapeutic horseback riding] for the ASD [autism spectrum disorder] population, and findings are consistent with previous equine-assisted intervention studies."

So said the results of the study by Robin Gabriels and colleagues [1] who, under randomised controlled trial conditions, set about "evaluating the effectiveness of therapeutic horseback riding (THR) on self-regulation, socialization, communication, adaptive, and motor behaviors in children with autism spectrum disorder (ASD)." The authors, including one Gary Mesibov, looked at horse riding vs. barn activities over a 10 week period for a cohort aged 6-16 years old and concluded that under intention-to-treat (ITT) analysis, significant improvements in measures of social cognition and social communication were evident in those following the THR regime. The ClinicalTrials.gov entry for the study can be seen here.

Whilst the methodological quality of the Gabriels study is quite a bit better than anything else so far in this area of investigation, this is not the first time that equine activities have been looked at with autism in mind. The paper by Lanning and colleagues [2] reported a 'favourable outcome' in their small trial "utilizing EAA [equines assisted activities] in the treatment of children with ASD." Similar things were also reported by Bass and colleagues [3] including an important note about less "sedentary behaviors."

Accepting that animal interactions are probably not for everyone on the autism spectrum, the Gabriels and other findings do seem to tie into a growing body of peer-reviewed research suggesting that such interactions might be something to think about when it comes to [some] autism (see here). This also complements other accounts (see here for example). I'm not altogether sure about the hows and whys of animals potentially impacting on the presentation of autism despite previous suggestions about 'parts of the brain' being attuned to animal interactions (see here). One could speculate about animals not perhaps being as socially complicated as people insofar as things like their (general) lack of verbal language for example and the appeal that this would hold. The idea that "animals may act as social buffers for children with ASD" [4] has been banded around. This might, alongside other non-verbal communication variables, also tap into why robots in robot-assisted interventions seem to be also finding some therapeutic favour [5] with [some] autism in mind with lower arousal / stress reduction as a modifying factor.

Whatever the reasons for the potential success behind strategies such as THR and other animal-assisted therapies (where subjected to the appropriate scientific scrutiny) when it comes to autism, one might expect some further research developments in this area. That exposure to animals might also have some hidden 'bacterial' benefits might also be something that autism science should consider particularly in light of emerging data on allergy and atopy with autism in mind...

To close, how could I not link to one of the best horse names ever: hoof-hearted...

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[1] Gabriels RL. et al. Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2015. May 5.

[2] Lanning BA. et al. Effects of equine assisted activities on autism spectrum disorder. J Autism Dev Disord. 2014 Aug;44(8):1897-907.

[3] Bass MM. et al. The effect of therapeutic horseback riding on social functioning in children with autism. J Autism Dev Disord. 2009 Sep;39(9):1261-7.

[4] O'Haire ME. et al. Animals may act as social buffers: Skin conductance arousal in children with autism spectrum disorder in a social context. Dev. Psychobiol. 2015. 27 April.

[5] Diehl JJ. et al. The Clinical Use of Robots for Individuals with Autism Spectrum Disorders: A Critical Review. Res Autism Spectr Disord. 2012 Jan;6(1):249-262.

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Gabriels, R., Pan, Z., Dechant, B., Agnew, J., Brim, N., & Mesibov, G. (2015). Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder Journal of the American Academy of Child & Adolescent Psychiatry DOI: 10.1016/j.jaac.2015.04.007