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Running head: SUPPORTING CHILDREN WITH AUTISM IN RECREATION

Supporting Children with Autism in Recreational Activities Bella S.M. Chan University of British Columbia

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES Introduction Topic: To provide knowledge and training on how to support children with ASD when

participating in recreational activities, such as swimming, painting, skating, or playing the piano. This paper examines behavioural strategies that have been used for promoting participation from children with ASD in recreational activities. The purpose of this project is to enrich the childrens quality of life by expanding their repertoire of interests and to cultivate talent.

What is Autism Autism spectrum disorder (ASD) describes a set of neurological developmental disabilities. The publication of DSM-5 diagnostic manual in 2013 officially merged all autism disorders under the diagnosis of ASD, which were previously known as: childhood disintegrative disorder, pervasive developmental disorder, autism, and Asperger syndrome (Coyne & Fullerton, 2014). The cause of ASD is not fully known, but there is a growing consensus that suggests ASD is a genetic condition. There are people with autism whom have various types of genes that are susceptible to genetic transmission of ASD, and the susceptibility differs between families ("Teaching students with," 2000). Tissue autopsies and neuro-chemical studies provide evidence of structural and functional differences in the brains of individuals with ASD from the brains of non-autistic people. For instance, studies found anomalies in the brain stem and cranial nerves ("Teaching students with," 2000). Finally, statistics show that 10 in 10,000 newborns will suffer from ASD and males are four times more likely to be autistic than females ("Teaching students with," 2000). As more investigation pinpoints the cause of ASD, more treatment methods will be developed to assist autistic people cope with and even overcome developmental disabilities associated with the disorder.

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES Syndromes of ASD There are different syndromes of ASD and commonly recognizable signs include withdrawal, deficits in verbal and non-verbal communication, difficulties in developing social skills and repetitive behaviours (APA, 2000). The most prevalent syndrome children with ASD face is the inability to verbally express their needs through language. Hence many children with

ASD are non-verbal or mute. Adults with autism have communicated that it is extremely difficult to process sensory information because their minds easily become overloaded with stimuli. Moreover, behavioural abnormalities identified in ASD are associated with intellectual disability as well as genetic abnormalities that contribute to difficulties in motor coordination ("Teaching students with," 2000). Further, ASD symptoms can also manifest in physical health problems such as difficulty with sleeping, headaches and gastrointestinal disturbances. This means that children with ASD likely experience a high amount of discomfort on a daily basis. On the other hand, children with ASD have acute sensitivity to external stimuli where they notice almost everything. In reaction to each overwhelming stimulus, children with ASD may display repetitive behaviours such as rocking, humming, stiffened body posture, teeth grinding as a means to communicate their concerns for what is happening around them (Fennick and Royle, 2003). In addition, children with ASD display abrasive behaviour such as yelling, bang their head against the wall or resistance to cooperate, because they are uncomfortable with certain stimulus that feels invasive to them. On the other hand, the heightened senses and superior intellectual abilities in children with ASD allow them to excel in mathematics, the arts, and to have strong visual recognition skills or have a photographic memory.

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES Why Community Recreational Activities for Children with ASD? Studies show that children with ASD who participated in recreational group activities

such as swimming and gymnastics expressed enjoyment, and the activities improved their social skills and recreational abilities (Fennick and Royle, 2003). Moreover, it has been found that participation in community oriented recreational physical activities help children with ASD improve physical and mental health, further develop motor coordination, reduce emotional and behavioural disorders, expand their range of interests, and help develop social skills (Potvin, Prelock & Snider, 2008). It has been observed that social interaction with peers that do not have developmental disorders helped increase appropriate play behaviors in children with ASD, Moreover, it encouraged participation in more advanced recreational activities (Fennick and Royle, 2003). What is more is that children not diagnosed with ASD in such studies learned to become more compassionate and understanding of developmental disabilities. Initiation to interact with others and willingness to participate in communal social activities is a skill that children with ASD may not develop easily. This is because social deficit in autism is marked by impairment in the use of verbal and non-verbal behaviors to regulate social interaction which include: gestures, eye contact, difficulty establishing and maintaining peer relationships, a lack of shared enjoyment of interests and accomplishments with others, a lack of social reciprocity, and trouble with expressing emotions (APA, 2000). As a result, it has been found that children with less developed verbal communication skills take less initiative to engage in social activities and peer interactions (Orsmond et al., 2004). However, engagement with peers and success in initiating interactions can increase with age and positive learning (Orsmond et al. 2004). Research on peer interactions of youth with ASD indicates that children make fewer initiations to engage on social exchange than their peers, but autistic adolescents

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES show increased interest in social interactions and continued development in social skills (Orsmond et al., 2004). Therefore, it is important to help children with ASD become familiar with being in the presence of other people and to encourage interaction. Additionally, it is important for trainers, family and friends of children with ASD to remember that the abrasive, withdrawn or destructive behaviour of the child is rooted in biological abnormalities and neurological disabilities, rather than character flaws or

unwillingness to cooperate. However, community recreation activities facilitated by trained staff and therapists offer children with ASD opportunities to develop appropriate social skills, physical coordination, behavioural patterns, and coping mechanisms that may improve their quality life. Another reason why recreational physical activities are highly important is because the prevalence of being obese or over-weight is on the rise for children with ASD. In a recent study consisting of 376 children with ASD, 18.1% of the children are overweight and an additional 17% are considered obese (Zuckerman et al. 2014). The weight gain is partially attributed to insufficient physical exercise, difficulties with sleep, melatonin use and sensitive digestive systems. Therefore, recreational sports are pertinent for helping children with ASD to prevent and fight complications associated with obesity. Moreover, recreation activities such as swimming and self-defence embed autistic children with important safety and survival skills. Strategies for Supporting Children with ASD in Community Based Recreation As cases of ASD are on the rise, more studies have been conducted to develop relevant treatment programs to support children with autism. Since there is evidence that show the benefits of community recreation activities for children with ASD, there is an effort to implement more community based recreation programs that are inclusive for children with

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES developmental disorders. To facilitate recreational programs for children with ASD is not an easy task. But there are many effective evidence supported strategies that program leaders and trainers can incorporate to activities that will assist with running successful and rewarding recreational programs.

Collaborate to Support Recreation: Bridging the Gap Family members of autistic children are often very in tuned with the needs of their child and they know helpful information that will be helpful toward facilitating a successful recreational activity. Hence activity coaches should be required to meet with the family prior to recreational programs in order to develop a sense of trust and to establish stronger relationships between all parties involved (Potvin, Prelock & Snider, 2008). The training process of activity coaches should be lengthy in order to 1) Establish a relationship with family members 2) To spend more time learning about the needs of individual children, their difficulties with sensory systems and prerequisite skill levels before recreational programs are executed 3) Allow the child with ASD to become familiar with the trainer and to hopefully earn their trust 4) Collaborate with the family and/or therapists to develop individualized education plan (IEP) for working with each child. Visual Support One of the most effective approaches for working with children with ASD is to use visual aids to draw and to maintain the attention of autistic children by stimulating their sensitivity to visuals. It is strongly recommended for program trainers to keep in mind that when planning the itinerary for recreational programs or giving an instruction to consider: how can this information be presented visually in a clear and simple format? ("Teaching students with," p 28, 2000) It is common for children with ASD to find it difficult to block out background stimulation, thus

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES using pictographs, images, pictorial signs, tangible objects and videos will help program

participants focus better on the message ("Teaching students with," p 27, 2000) or on the activity in which they are engaged. Activity trainers can employ visual aids to organize mini-schedules, charts, activity check-list, safety tips and calendars relevant to the recreational activity. One of the advantages of using tangible visual aids is that ASD participants can use them for as long as they need to process the information ("Teaching students with," p 27, 2000). Whereas, verbal cues are fleeting, so they are more difficult to grasp. To assist children with ASD understand the environment where the recreational activities are held, use labels to identify: objects required for the recreational activity, containers, rules and doors that they are not allowed to use. Trainers can employ visual aids to organize mini-schedules, activity check-list, routines, safety tips and calendars relevant to the recreational activity to help participants stay on track. Furthermore, visual aids can be used to help cultivate social skills, self-control and appropriate behaviour amongst the participants ("Teaching students with," p 28, 2000). Rules with visuals, images alongside steps to activity routines and pictographs that provide a cue for behaviour expectations offer children with ASD with an idea of what is expected of them. For instance, trainers facilitating swimming lessons open to children with ASD can: 1) label the container or area where the life-jackets are held, 2) have pictographs indicate the types of stretches that should be completed before going into the pool, 3) have visual aids on a list of rules that specify no eating before swimming, and no running or pushing around the pool and, 4) use pictographs to teach participants how to ask for help. Finally, one of the main purposes of facilitating integrative recreational activities for children with and without ASD is to help develop social skills, teach social skills. Therefore, pictorial representations of specific social situations with appropriate social cues and responses,

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES developed for a specific situation can encourage positive behaviour. Images that encourage harmony, participation and cooperation can also be very helpful in creating a positive learning environment for all participants. Provide Structure and a Predictable Program Schedule Provide structure, consistency and clarity when planning community program activates

create a learning environment that is predictable and will not confuse children with ASD. This in turn will help participants better enjoy and participate in the recreational activities ("Teaching students with," p 34, 2000). For many children with autism, they get anxiety when they feel too much is changing around them or when they do not know what to expect. Therefore, implementing structure and clear boundaries that allow children with ASD know what to expect will prevent difficult behaviour. Use Simple Language When teaching and working with children with ASD, activity coaches should employ verbal information that is short, simple and clear. Run-on sentences, big words and long-winded verbal instructions are not effective at encouraging participation of children with ASD and it may frustrate them. Instead, activity leaders need to use physical gestures and visual aids to offer supportive instruction for recreational activities. Trainers can also ask participants to copy their body movements in order to help children learn through body mimicry and muscle memory. Use Alternative Methods of Communication Social interactions and utilizing verbal and non-verbal communication are common areas of challenges for autistic children. Thus, establishing alternative communication strategies can help children with ASD better express themselves without having to speak. An alternative

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES

communication system between trainers and participants can consist of sign language, PECS and other pictorial representations gestures, and movement of people or objects to indicate the need to do something. However, in implementing alternative communication systems, trainers should assess the learners level of motor coordination, cognitive ability, skills and spectrum of interests. Provide Opportunities for Choice When planning and facilitating recreational activities, trainers should incorporate an element of choice for children with ASD, because they are often infuriated by their inability to make themselves understood ("Teaching students with," p 30, 2000). The lives of children with ASD are highly controlled by adults and they need instruction and practice to learn how to make decisions on their own. Recreation coaches can teach children with ASD to make decisions by offering opportunities to decide between limited amounts of choices. For instance, two choices of rewards can be available for participants to choose from during break-time or participants can choose their 3 favourite exercises to warm-up with. Asking open-ended questions or offering too many options to choose may frustrate autistic children ("Teaching students with," p 30, 2000). Task Analysis Activity coaches or teachers will be required to break some activity instructions and tasks into sub tasks that are easy to learn and replicate. For instance, at beginning of a yoga class for children with ADS, the teacher should explain: 1) take a yoga mat 2) place it on a spot along the wall 3) unroll it 4) sit or lay on it 5) start to deeply inhale and exhale. It is also pertinent for activity trainers to target age-appropriate motor skills, which means asking age 5-8 children with ASD in a yoga class to balance on only their hands or to do a headstand would not be

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES appropriate. Finally, in conjunction with the parents, activity coaches should decide of the recreational activity is a good fit for each child. Provide Prompting

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Listening to information, understanding, preparing a response and utilizing the necessary motor skills to communicate that response is a reflexive process for most people, but it is very difficult for children with ASD. To focus on hearing and seeing, to formulate an appropriate response, and to complete the motor planning necessary to offer a response requires tremendous effort. However, activity trainers can elicit responses through intensive verbal, auditory, visual and/or tactile prompts. The use of prompts helps develop competence to increase the participants' interest, confidence and self-esteem (Coyne & Fullerton, 2004). Prompting competes with the childs self-stimulatory behavior in order to help initiate a response. Response techniques may range from picking up, pointing to, and providing physical assistance (Coyne & Fullerton, 2004). Prompts are supplemental teaching aids and there are numerous types that could be used. The 3-second rule is useful in getting the childs attention or to develop discipline. Reinforcement System One of the most effective methods to motivate children with ASD is through positive reinforcement. Common approaches include smiling, a warm pad on the shoulder and offering positive praise directed at specific tasks or behaviour. In a gymnastic class that integrates children with ASD, the teacher can say, June, you are very good at taking deep breathes or you are great at focusing on standing on one foot! It is important to note that generalized praise may not be effective at motivating individual children. Worse yet, it may lead to unintended learning ("Teaching students with," p 29, 2000). For instance, if an activity trainer says, you are all doing well when a child with ASD is stiffening his body, it may reinforce him to always

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tense-up his body. In order to establish meaningful reinforcement, activity coaches need to first assess and record the strengths and needs of individual children and then discover what type of rewards and reinforcement each child respond positively toward. Activity trainers should also have a list that identifies the likes and dislikes of each child, such as: prefer to have quiet alone time, loves to eat kale chips, prefers to have frequent breaks, and loves playing with my key chain. These records of preferences, skills and needs of each child with ASD are highly useful for remembering how to offer meaningful reinforcement for all participants. Plan Tasks at an Appropriate Level and Pre-teach in Less Difficult Environments In order to help participants get the most out of the recreation program, trainers need to understand the skill levels of individual children, so that they can learn and excel at their own level. To teach age-appropriate activities, trainers should conduct a survey to determine the critical motor skills that individual children with ASD already have, and compare it to motor skills that the children must have to perform a physical activity. This process helps develop targeted motor skills. Further, teaching age-appropriate motor coordination to children with ASD is an effective method to help them feel included and confident in recreational activities (Zhang & Griffin, 2007). Moreover, children with ASD may be more prone to anxiety, impatience, and frustration if they cannot perform the tasks assigned. Therefore, increasing the level of difficulty gradually and to support the learning process with visual aids in conjunction with verbal explanations will work to minimize feelings of frustration and difficult behaviour ("Teaching students with," p 29, 2000). Moreover, children with ASD suffer from genetic abnormalities and developmental disabilities that cause them to have less developed motor skills and reflexes. Thus, it is pertinent for activity trainers to teach children with ASD preparatory exercises under less difficult circumstances before embarking on the actual activity and its levels of

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advancements. For example, if participants cant perform an activity on ice or in water, try it on ground first. At a swimming lesson, trainers can teach children to practice the upper body movements of the breast stroke or doggy-style before sending participants into the pool. Conclusion There are many benefits for children with ASD to participate in recreational activities, such as swimming, skating, yoga or playing the piano. The purpose of recreation services are intended to help children with ASD learn how to use their leisure time constructively, and to enrich the childs quality of life by expanding their repertoire of interests in leisure skills and to cultivate talent. The community based recreational programs can offered to all youth at school during school hours or in after-school programs in an environment that is familiar for the children with ASD. It is crucial for recreational activities to be clearly presented in a manner that is inclusive for children with disabilities to encourage enrollment. Studies have shown that being integrated with other youth help children with developmental disabilities establish appropriate social behaviour more easily, as well as inspire greater compassion and patience in youth without a disability. Further, through the discussed strategies for eliciting participation in recreational activities, participants can learn appropriate social and functional skills for recreation and in life.

SUPPORTING CHILDREN WITH AUTISM IN RECREATIONAL ACTIVITIES References American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders-fourth edition, text revision. Washington, DC: Author.

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Berry, M. R. (2011). Including children with autism spectrum disorder in community recreation programs. (Doctoral dissertation, Palo Alto University). Coyne, P. & Fullerton, A. (2004). Supporting individuals with autism spectrum disorder in recreation-second edition. Urbana, IL: Sagamore Publishing. Fennick, E., & Royle, J. (2003). Community inclusion for children and youth with developmental disabilities. Focus on Autism and Other Developmental Disabilities, 18, 2027. Jull, S. (2008). Staff training for community swimming instructors: Supporting children with autism in local recreation settings. (Unpublished doctoral dissertation). University of British Columbia, Vancouver, Canada. Ministry of Education, Special Programs Branch. (2000). Teaching students with autism: A resource guide for schools (RB0102). Victoria, BC. Orsmond, G. I., Krauss, M. W., & Seltzer, M. M. (2004). Peer Relationships and Social and Recreational Activities Among Adolescents and Adults with Autism. Journal of Autism and Developmental Disorders, 34(3), 245256. doi:10.1023/B:JADD.0000029547.96610.df Potvin, M., Prelock, P. A. & Snider, L. (2008). Collaborating to support meaningful participation in recreational activities of children with autism spectrum disorder. Topics in language disorders, 28 (4), 365-374.

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Zhang, J., & Griffin, A. J. (2007). Including children with autism in general physical education: Eight possible solutions. JOPERD, 78(3), 33-50. Zucherman, K. E., Hill, A. P., Gulion, K., Voltolina, L., & Fombonne, E. (2014). Overweight and obesity: Prevalence and correlates in a large clinical sample of children with autism spectrum disorder. Journal of Autism Developmental Disorders. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24488158