Literature Review

As an Accredited Exercise Physiologist, researcher and passionate autism clinician, it is important to stay up to date with relevant literature in the field. I intend to provide easy to read, concise summaries of important or relevant articles on this page. Please find below a breakdown of a recent influential paper, titled:

Prevalence of Motor Difficulties in Autism Spectrum Disorder: Analysis of a Populationā€Based Cohort

Melissa K. Licari, Gail A. Alvares, Kandice Varcin, Kiah L. Evans, Dominique Cleary, Siobhan L. Reid, Emma J. Glasson, Keely Bebbington, Jess E. Reynolds, John Wray, Andrew J.O. Whitehouse

Published: 18 October 2019, International Society of Autism Research https://doi.org/10.1002/aur.2230

Background/Rationale

Motor impairment is not currently listed in the diagnostic criteria for autism, despite being a commonly considered clinical feature of autism. Motor impairments can include difficulties with planning movement, muscle tone and strength, timing and execution, balance and gait. This lack of documentation is in part, due to the lack of large-scale studies instigating motor ability in this population. Previous small studies have shown motor difficulties as high as 50% among people with autism, which is as high as other known diagnostic specifiers such as intellectual or language impairments.

In Western Australia, a population-based register of new ASD diagnoses called the WA Autism Register has been in place since 2017 (https://www.telethonkids.org.au/projects/autismregister/). This study aimed to utilise the register to collect large, population level data on motor impairment among children with a recent autism diagnosis, using a standardised assessment.

Method

All families on the register were contacted (N=5941), and those who consented to participation in the study complted the Vineland Adapative Behaviour Scale (N=2711). Of those participants, 2175 reported a motor score.

Results

Scores on the Vineland indicated that 35.4% met the criteria for motor difficulties (standard score<70), almost as prevalent as intellectual impairment (37.7%). This is astounding, considering diagnostic clinicians only report motor difficulties at a rate of 1.3%!

It was also reported that the prevalence of motor difficulties was significantly correlated with age of diagnosis (p<0.001), meaning that early diagnosis may play a key role in overcoming motor deficits.

Discussion

The study provides the largest investigation into autism and motor difficulties and demonstrates that that motor difficulties are a prevalent, and often over-looked factor related to autism spectrum disorder.

Summary by Joshua Knuiman

All credit goes to the original authors listed above.

The Journey So Far

When I started university I had no idea that I would be in the career I am now. In fact, when I enrolled I knew only a few things:

  1. I liked kids and young people
  2. I wanted to help people
  3. I wanted to work in a hands-on environment in the community
  4. I loved exercise and movement

It wasn’t until I began working at a program for young people with movement difficulties in 2014 that I worked with my first client with autism. It was HARD. Every session was filled with challenges that I had not previously considered or given a thought to. How did he sleep that night? Have there been changes to his medications? How am I assisting him to regulate his sensory needs? Does he understand the cues I am giving him? Are we safe in this space?

These were questions that until now I had never asked myself, or even considered when facilitating exercise for young people. Over the next 5 years, I would go on a journey of ups and downs, personal and professional development, and many, many hours working with young people on the spectrum. Over this time I have worked with countless amazing, kind and determined kids, teens and adults who overcome obstacles that I previously would not have seen to achieve amazing things. I have learnt so much from them, and I hope they have learnt a little from me too!

In my time working with young people on the spectrum, I have learnt some valuable lessons:

  1. No one with or without autism is the same. We all have individual strengths, weaknesses and areas to grow!
  2. Just because you can’t “see” a disability doesn’t mean it isn’t there.
  3. EVERYONE seeks connection and inclusion
  4. People with autism are capable of extraordinary things, many of which I am not!
  5. You will always learn more from a place of compassion, patience and understanding

In 2017 I became accredited as an Exercise Physiologist, and realized that while I had learnt a lot at university and work so far, there was still so much more I needed to know to be an effective clinician. With that in mind, I continued working with young people, and enrolled in a Master’s Research program to gain a better understanding of working with young people with disabilities. My project was titled, “The impact of specialized exercise programs for young people with complex conditions” and investigated the factors that contributed to the success of exercise programs by asking the staff, parents and young people themselves what mattered most. A number of key themes jumped out immediately;

  1. The relationship that is formed between the clinician and the young person is critical in the success of their work together
  2. Individualization is important to foster engagement, motivation and enjoyment, as well as tailor to the individual needs of each child
  3. The goal should be participation, enjoyment and inclusion, not mastery

Following my studies, I began working for a registered NDIS provider as part of a multidisciplinary team. This has been an amazing learning experience; learning from, and working with clinicians with diverse skill-sets, experiences and backgrounds for one primary goal: facilitating functional independence for young people with disability. I love this work, and am still engaged in this space today, however I found a number of areas that the NDIS provider system was allowing people, and funding to “slip through the cracks”. The NDIS is revolutionary- and also a giant pain. For many, this is the first time that they have access to critical supports for their families, and for others, the NDIS represents a change that may feel like a negative one.

Image result for ndis logo

Wherever you are, the NDIS is an opportunity.

The NDIS offers access to funding in a way that has never been seen before in Australia; a way that allows YOU, the parent, carer, person whose life is affected by disability in what ever shape it takes, to make the decisions. Autonomy and choice in therapy, as well as transparency and quality assurance from providers is essential in my view to deliver therapy and supports that provide the most benefit to the client.

Despite this, I saw an area where this system was letting me, as an Exercise Physiologist, as well as some clients down. Allied health services on the NDIS are expensive, and the amount of funding that families receive can sometimes mean that hard choices need to be made. Moreover, many families don’t know that people like me exist, and if they did, this would drastically change the way that they chose to allocate their funding. I saw a need for a mobile service, that provides individualized exercise programming and support that only costs what the clinicians receives, and simplifies the process for clients.

Exercise on the Spectrum was born to serve a number of purposes:

  1. To provide self-managed and plan-managed NDIS clients an affordable opportunity to access Exercise Physiology alongside their other supports
  2. To provide a mobile service, that is client-focused and flexible in delivery
  3. To support young people on the spectrum to engage in physical activity
  4. To provide an affordable service to families who don’t have funding, or don’t have enough!
  5. To provide specialist consulting services for schools, physical activity programs and sporting clubs to facilitate understanding and inclusion

At Exercise on the Spectrum, I offer free 30 minute consultation sessions at your convenience to explore if i would be a good fit for your family.

Send me an email or call me today to find out more!

josh.knuiman@gmail.com

0432285681

Exercise during youth: why is it so important?

Young people who are given more opportunities to be active are not only exposed to a large range of movement skills that enable them to confidently and safely participate in a wide range of activities, but are also more likely to engage in physical activity across their lifespan, and physical activity behaviours that begin during childhood have been demonstrated to be relatively stable into adolescence, and into adulthood. A longitudinal study in 2014 reported that across the lifespan, children who were regularly active were the most likely to physically active adults (Telama et al., 2014).

So why is this so important? Physical inactivity is associated with a wide range of chronic diseases such as obesity, diabetes, osteoporosis and cardiovascular disease, and is a significant contributor to early mortality around the world. A recent Lancet paper estimated the economic cost of physical inactivity globally at around $55 billion dollars a year (Ding et al, 2016)- yes, I said billion! Inactivity is strongly associated with poor mental and physical health outcomes, and a significant predictor of ill health. Physical activity is an essential part of living a healthy life.

So what is recommended? How much exercise should we all be getting? And is this the same for children and youth? For adults, the global recommendations for physical activity are 150 minutes of moderate to vigorous exercise per week, or more simply, 30 minutes, 5 days a week. Unfortunately, only an estimated 20% of adults are achieving this target in first-world countries (Piercy et al., 2018). The inactivity problem is even more significant for youth and children.

It is recommended that young people aged 5-18 years get 60 minutes of moderate to vigorous activity every day, including activities that strengthen muscles and bones such as jumping, climbing, lifting and carrying.

Globally, less than a quarter of young people are achieving the current recommended amount of daily physical activity, and this number is declining rapidly. In Australia where I am writing from, only 11% of children are meeting the recommended levels of physical activity as reported in a recent global study. Given what we know about exercise behaviour over the lifetime, these rates of physical activity are alarming.It is critical that young people develop positive behaviours surrounding exercise to set themselves up for a healthy, happy and long life. Fortunately, all is not lost; the same study that demonstrated that inactive children become inactive, unhealthy adults demonstrated that if positive exercise behaviours are adopted during adolescence, this result can be reversed (Telama et al., 2014). It is never too late to start exercising!

So what are the benefits of exercise for young people?

  1. Active kids learn better! Children who are physically active perform better on standardized tests, are more attentive in class and outperform inactive peers
  2. It can improve our brains! Using neuroimaging, differences in structural brain volumes between active and inactive children in areas related to attention, regulation and memory
  3. Improved strength and fitness– Children who participate in exercise have increased muscle strength, bone density and aerobic fitness allowing them to have more energy and participate in more of life.
  4. Improved co-ordination, gait and mobility– Participation in physical activity is shown to improve motor planning, co-ordination and movement patterns.
  5. Decreased cardiovascular risk factors– It’s simple, exercise more, decrease your risk of obesity, cardiovascular disease and diabetes!
  6. Social and communication skills– Exercise offers a unique opportunity to develop teamwork, language and non-verbal communication skills that can be used to build friendships and resilience.
  7. Many more!

How can you help your child be active?

  1. Reduce screen time, and head outdoors! Kick a ball at the park, walk the dog, or even just go to the playground!
  2. Listen to their interests, and provide them with opportunities to explore physical activity that is in line with their interests- not everyone is a triathlete!
  3. Provide opportunities to be active with peers (after school, sporting clubs, dancing, martial arts)
  4. Talk to the school- they spend the day with your child!
  5. Be active yourself. Active parents make active kids.

All young people deserve the opportunity to feel confident and supported to move their body and participate in physical activity. For more information on how to engage your child in physical activity, feel free to contact me: https://exerciseonthespectrum.com/contact/

Until next time,

Josh

Who Am I?

My name is Josh Knuiman and I am an Accredited Exercise Physiologist who works with young people with developmental disabilities. I have had a passion for working with people with disability since I was in high school and worked as a volunteer teaching basketball skills to a group of young men with a passion for sport. Since then I have worked at an exercise clinic for youth, on multidisciplinary therapy teams, and in the community in varied roles supporting physical activity participation, movement confidence, strength, fitness and much more!

In 2018 I completed a Master of Exercise Science by Research investigating the factors that related to physical activity participation, enjoyment and motivation for young people with disability. Following this I presented at the Autism West Symposium on the benefits of physical activity for young people with autism spectrum disorders.

It is my firm belief, and passion that ALL people deserve the opportunity to feel confident and supported to move their body and participate in physical activity. On this blog I will be sharing the latest research on autism and exercise, as well as practical information on how to support people with autism to engage in physical activity and achieve their full potential, but most importantly, I hope to build a community of people who are passionate about supporting people with autism.

Until next time,

Josh

Want to work with me?
https://exerciseonthespectrum.com/contact/