Effect of yoga on children with autism spectrum disorder (ASD) in special school environments

Abstract

BACKGROUND Autism spectrum disorder (ASD), the most common neurodevelopmental disorder, refers to a group of disorders distinctly characterized by core symptoms of deficits in social communication and interaction and restrictive, repetitive behaviors. Other psychological and physiological comorbidities frequently accompany this disorder. As a heterogeneous condition, ASD ranges from mild to severe across a continuum with varying degrees of impairments in functioning involving communication, cognition, language, behavior, and other health conditions. Autism severity defines the level of support needed by the children for their day-to-day functioning. This disorder is increasingly reported amongst school-age children in India, where many children with ASD attend special schools to receive support for learning basic functional and academic skills. Most of the major challenges associated with children in school environments include social skills deficits and problem behaviors. Other common physiological conditions prevalent in children with ASD are poor motor proficiency, food and digestion problems, and sleep disorders. Such challenges usually manifest in the form of various behavioral issues and chronic stress, significantly affecting learning in school environments. Yoga is recognized as a mind-body intervention that promotes physical, physiological, and psychological well-being in children with ASD and aids in the reduction of many autism-related symptoms. Yoga classes as group intervention for the children with ASD within the familiar and conductive school environment benefit all children by providing a consistent opportunity for participation to all students. Evidence-based studies suggest that yoga can be an effective alternative mind-body intervention that positively impacts various aspects of autism. 6 AIMS AND OBJECTIVES The aims and objectives of the present study were to assess the effect of yoga on children with ASD across four special schools: - Autism severity - Social skills deficits - Problem behaviors - Motor proficiency - Food and digestion problems - Sleep disorders - Evaluate the feasibility of conducting a regular group yoga intervention for children with ASD in special school environments METHODS A total of 43 children with ASD from 4 special schools were randomly divided into two groups: the experimental yoga group (n=23) and the waitlist control group (n=20) based on the Autism Treatment Evaluation Checklist (ATEC) scores taken as a measure of autism severity as evaluated by the parents of children with ASD. Participants Participants consisted of 43 children with ASD having a formal diagnosis of autism under the International Classification of Diseases (ICD-10) for assessing children under the Autism Spectrum Disorder. The participants consisted of male and female children (M: F=19:4) between the age group of 5-15 years across four special schools. 7 Design A randomized controlled open-label trial was employed for the study across four special schools to explore the effect of the yoga intervention as a daily school group program for children with ASD Assessments Autism Evaluation Checklist (ATEC) Social Responsiveness Scale-2 (SRS-2) Aberrant Behavior Checklist -2 (ABC-2) Bruininks- Oseretsky Test of Motor Proficiency, Brief Form-2 (BOT-2 Brief) Food and Digestion Checklist Sleep Checklist Yoga Feedback Checklist Intervention The yoga intervention consisted of a school-based group yoga program for children with ASD conducted on all school days for 12 weeks. The yoga program consisted of twelve structured yoga modules consisting of simple yoga practices compatible with the needs and benefits of children with ASD. The structured yoga program of 45 minutes was delivered by two trained yoga teachers in each special school. 8 Results As a group intervention, yoga was feasible to be delivered in special schools for children with ASD with high participation and performance responses. The parents reported a significant decrease in the yoga group compared to the control group in autism severity (p = .001). No significant changes were found in food and digestion problems and sleep disorders. The teachers reported improvement in the social withdrawal aspect of problem behaviors in children (p = .005), with no changes in social skills deficits. Yoga was found to positively impact the motor proficiency of children with ASD (p = .007). Conclusions The study has shown that it is feasible to conduct a regular group yoga intervention for children with ASD in terms of participation and performance responses. The study has demonstrated that children with ASD have benefitted in many aspects, such as autism severity, problem behaviors, and motor proficiency, with a carefully planned intervention suited for special school environments. Thus, yoga can be integrated into special school environments for the holistic management and well-being of children with ASD.