A recent criticism of Crossfit, to which I have zero affiliation or commercial interest, is that competing in Crossfit and the Crossfit games themselves are “competing to be the best exerciser,” which is damn funny.
The premise here is that we train for something, whether it be a team sport, martial arts, life in general. The criticism/joke relies on the idea that lifting weight, swinging fitness ropes, gymnastic hybrid movements, and any other fitness modality will provide a physical benefit in the “primary” sport/activity.
The importance of a particular sport is still abstract. Man picks up heavy object and carries it to designated line vs. Man takes wooden stick and hits leather-covered sphere thrown by other man. That the later activity (baseball, PLEASE let this have been your guess) generates huge interest worldwide and, subsequently, large amounts of money, does not make it any better as a competitive activity or sport.
Far from a being a philosophical-at-best discussion, this has real world implications. For the ASD population, our cultural obsession with youth sports has spawned “Adaptive” soccer, baseball, and other sports leagues. Why sports? Because that’s what we do. Sports are popular and so kids should play them, so goes the idea that led us to where we are today with a highly inactive young population but plenty of soccer fields. For many individuals with autism, the very abstract concepts of game play (offense, defense, outs, strikes, goals, winning, losing) hold no value.
We can, in some cases, teach the rules or contingencies of game play, but spending two months teaching that after you hit/kick the ball you run to first base and then stay there, there!, THERE! while waiting for someone else to take their turn does no pass my cost/benefit analysis.
Teach movement. Good movement. Build strength and stability and motor planning. Make it reinforcing and, over time, something to be sought out independently. Build social connections through non-competitive activities and use competitive activities if/when applicable.
So yes, competitive Crossfit does hold to high esteem the “best exerciser,” but in fairness, football holds in high esteem the guy who can hit hard enough to elicit early-onset dementia.
“Today you should have seen me and Mousy today, at school today” – “Drugs” Delany, Outside Providence, Greatest Comedic Movie Scene Ever
This afternoon I performed 7 PAC Profile Assessments in two and a half hours, which may or may not be a record.
While there are 18 exercises that I use to assess, programming for most of these new athletes will focus on perhaps 2-4 movement goals. Certainly I want to provide my athletes with a wide range of movement skills, but it is always necessary to provide a situation that is not overwhelming, enough opportunity with new movement activities to become proficient, and enough secondary reinforcement for this physical activity stuff to eventually become reinforcing.
One new athlete was able to perform just about every assessment activity. His movement patterns were very rote; lumped clay that will have to be shaped, molded, and strengthened to result in what we would look at and call good, healthy movement. But he was able to perform an approximation of each based on my demonstration.
On the other side of Adaptive Land, another new athlete was quite set on spending our time sitting on the floor, where we may wind up a few times over the next few sessions. We’ll meet at her current level of ability and motivation, building skills from there.
For both of these emerging athletes, initial goals will probably consist of 2-4 activities. Seems like a few. But these are necessary pillars of movement upon which we can develop new skills. From success with these primary goals, we can progress. Add movement, add resistance, add time, add locomotion. But we must start here.
Too many new activities will be overwhelming, and, generally, the ASD population needs an awful lot of practice to both master and enjoy exercise activities. Flight of the Pterodactyl? We will get there. However we will start as inchworms.
Recently I’ve been under some expert guidance in correcting some movement imbalances that I have accumulated. After nearly fifteen years of weightlifting in various forms, I can claim only a few injuries but some nuances that have become dysfunctional movement patterns. Rather than force my way through them and consider pain as part of the lifting life, I sought professional input from a highly trusted source. While pain is often associated with resistance training, the idea that pain and playing with heavy things are synonymous is somewhat hypocritical when considering that the practice is, or should be, part of a healthy active lifestyle. So, the sheet needs pulling.
Pulling the sheet is a mantra. Wrinkles and imbalances in the sheet will cause it to have less length, function, and comfort than it should. Of course, as human beings, sometimes the sheets will be tidier than on other occasions. When the sheet is too wrinkled, we can pull it off and evaluate just where things went awry.
In Applied Behavior Analysis (ABA) jargon, we call this backstepping; making an error and then returning to the last point of success and starting again. We do this to ensure that practice is met with success. Sometimes when we backstep we have to regress a little. In my case, taking a little weight off the bar and addressing some mobility issues. In many of my athlete’s cases, providing some graduated guidance/prompting to promote kinesthetic awareness of the movement pattern.
Coolio was half right when he penned “Gotta get up to get down.” Sometimes, on further inspection, we must get down to get up.
Some of my Autism Fitness athletes have a tendency to wait a couple seconds before performing the activity-in-question. Sometimes it is a processing delay, and, on occasion (see also; Regularly), it is because the exercise/activity is not inherently reinforcing enough for them to immediately invest their effort into it. There is also the occasion where the athlete will perform a not-so-outstanding variation of the activity-in-question (Target Task). Sometimes (See also; often), an instructor will tell me; “Oh, he/she can’t do that.”
Can’t or Won’t?
Suppose I am introducing a star jump for the first time. I say something like “Bruno, do a star jump.” I demonstrate it once or not at all. Bruno stands there. Or walks away. Or, remarkably, does some odd variation of the star jump. I am suffering from an assumption bias here. Couple things:
Thing 1) I cannot assume that Bruno is going to have a preexisting understanding of what a star jump is or how to perform one.
Thing 2) I cannot assume that Bruno is going to be able to perform the star jump correctly by my single demonstration. He may not have been paying attention. He may be more of a kinesthetic learner with respect to this movement. He may need to see it several times before he will attempt it on his own.
Thing 3) He may not be sufficiently motivated to perform the star jump.
When developing fitness programs for the autism population (or any population but since I own a company called “Autism Fitness” and hardly anybody else really writes about this stuff I’ll keep it to those with ASD), we have to consider Physical, Adaptive, and Cognitive abilities. Setting up an environment for success requires some fitness detective work. CAN Bruno perform a star jump? What about a modified/regressed version? What does his best possible right now star jump look like? Is Bruno motivated enough to perform the star jump? I don’t know. Initially. But I can find out.
Using one of our favorite ABA practices, the Premack Principle, we can tie a new/novel/non-preferred stimuli (The Star Jump), with a known reinforcer (something the indivdual already enjoys). Usually with my athletes it is simply taking a break from the target tasks and walking around, or listening to music, or even throwing the medicine ball back and forth.
This scenario may sound something like:
“Bruno, do a star jump and then you can listen to Warrant’s Greatest Hits” (I demonstrate the star jump)
*Bruno stands there. I demonstrate it again and he does a very rote imitation of said star jump*
“Nice getting your arms out on that star jump, Bruno. You can listen to Warrant for two minutes“
In this scenario, Bruno could do a variation of the star jump, he just needed an extra demo. He was sufficiently motivated to perform the activity. After all, c’mon, Warrant. *For the record, no athlete I’ve ever coached has ever had listening to Warrant as a reinforcer.
Point: The physical ability to perform a movement/exercise and the adaptive quality of being motivated to perform it are two different issues. Figuring out the missing piece in these situations is a proactive measure against frustration, and allows us to provide high quality physical education. If we want to do that sort of thing.
If you don’t already know (and you should, every last one of you), there will be a full day Autism Fitness seminar in Lafayette, LA on April 4, 2014.
Here’s the black and white of it:
When: Friday, April 4, 2014, 8:00am-3:00pm
Where: Blackham (<– Ha! Ham!) Coliseum, 2330 Johnston St., Lafayette, LA 70503
An Operational Definition clarifies exactly what we are talking about in relation to a “thing,” whether it be performing a squat or asking politely for a sombrero. Because we human beings often have different expectations, it is important to distinguish just what we’re talking about, particularly with respect to performing physical tasks.
When we say “He/She can do that.” Do we require an asterisk (*)? Some * moments include:
“He/She can do that” *When prompted multiple times
“He/She can do that” *With me doing most of the task for them
“He/She can do that” *With extremely poor form
“He/She can do that” *In limited situations
I notice this occurring often in situations where an instructor cites that an individual has mastered a particular skill. A few questions on this:
1) What is the criteria for mastery?
2) Has the skill been performed in other settings with other people?
3) Is the skill at a level where it can be performed without an instructor present? (for example, will the individual perform a healthy squat in non-fitness/PE situations?
These are not questions directed towards uncovering some conspiratorial attempt on behalf of an instructor, rather to raise the point of whether or not the “mastered” skill is just that, mastered. Physical fitness, in addition to the adaptive/behavioral and cognitive benefits, should serve the function of providing movement skills and abilities that transcend the “lab,” and become part of healthier, more productive and efficient performance in a variety of situations. For perhaps the last 10 years, the term “functional fitness/training” has been thrown around like a horseshoe. There has been a large quantity of debate within the fitness industry as to what “functional” actually means. From a general/macro perspective, functional should entail the “big” movement patterns that make up the foundation of everything we (should) do; squatting, pushing, pulling, locomotion (point A to point B), and rotation. From the specific/micro vantage, “functional” applies to what an individual needs/wants to do on a daily basis.
There are certain movement patterns/exercises that just about every one of us need to perform for optimal physical functioning regardless of what else we are doing movement-wise. These should be the foundation for fitness programs, autism-specific or otherwise. From there, we can develop more individualized goals if necessary and/or desirable.
A mastered skill on paper does little in the way of providing the individual with the actual skill, unless that “mastered skill” is actually mastered. We don’t need to hold our students/athletes to a perfect, 100%, A+ standard every day. They are human, and have their off and their way-off days. Hell, there are certainly occasions where I want to have a melt down in line at a store or, worse, in a meeting that goes over an hour. What we want to do is be honest about what our athletes can and cannot do, what appropriate goals are and how we intend to get there, and ensure that the environment is conducive to their success.
Powerlifting focuses on three lifts; Squat, Deadlift, and Bench press. The highly-specified programming in powerlifting requires a lot of time and focus on those three movements to ensure a high level of mastery. Each lift is practiced many, many times to develop proper mechanics, feel for the movement, and even neurological optimization (yes, the overused and oft-misunderstood mind-body connection that somehow, according to common lore, only yoga can provide). Suffice that powerlifters become very proficient in these three lifts because they practice very often. There is a conceptual carryover to building movement skills with the autism population.
In my experience, individuals with autism, who often have strength and motor deficits even if they have one or two “splinter” skills (preternatural balance, for example) require a lot of repetition prior to mastering a movement pattern. There are typically several items of consideration here:
1) The physical deficit requires regular practice to develop the strength, stability, and coordination to master the activity
2) Cognitively, there may exist some challenges with regard to working memory, establishing contingencies/associations between the name of the exercise and the exercise itself, and motor planning (auditory and/or representational processing)
3) Becoming comfortable enough with the activity to perform it independently (without prompting)
I won’t use numbers, I don’t have any and have not seen any studies yet that demonstrate the distinction, but it is not outlandish to suggest that individuals with autism, on average, need a lot more practice with specific movement activities than their neurotypical peers. If we accept this as true, it follows that the difference between a fitness/active play/PE session for individuals with ASD versus neurotypical individuals will require more repetition, or more exposure and practice to the same activities.
There has to be a balance between structure and novelty, and the answer lies in skill development. I may want to teach ten new activities at once to provide variety, however an individual who has little practice moving on a regular basis will likely not receive enough practice with each activity to become proficient. Developing a “needs hierarchy” is helpful to decide what to teach and when.
This morning my 11-year-old athlete was working on squats to a Dynamax ball and Sandbell overhead presses, two compound movements with which he needs some improvement. During his breaks, he decided to start playing with the big resistance band that happened to be lying on the floor. He really enjoys putting it around his waist while I hold the other end and walking backwards (a great lower body activity that can be used with just about any level of athlete). So we do this. It is not an activity on which I am focused, but provides a nifty extra movement between what I consider the main priorities.
These play-seeking movements are perfect buffers when we are performing a lot of repetition with two or three exercises. There is little instruction, because the activity is participant-guided, it provides a novel physical stimulus, and serves as an active rest between sets. These types of activities also incorporate creative thinking, play, and autonomy, three concepts often difficult for the ASD population.
Balancing repetition with boredom is an un-ignorable issue. Of course, I’ve found that on occasion it is my potential boredom that is the issue. There’s a reason that successful children’s TV shows (Blue’s Clues, That Dora One) have long pauses. While faux-agonizing for most adults, the lag time allows for the intended viewer to process all the information. The best coaching/teaching is derived from a state of empathy; “What is it like for YOU to do this (squat, throw, crawl, jump).”
Focusing on developing foundational movement patterns also allows for scaffolding, building new skills on top of existing ones. We’re not performing calculus unless we have the rudimentary abilities to add, subtract, multiply, divide, and stay put for longer than 30 seconds. For the record, I do not perform calculus. A proper hierarchy of movement programming depends on figuring out what skills are most important, how they need to be taught, and what steps need to be taken to ensure enough practice is available.
Individual-centered programming, and this includes groups as well, means assessing what is needed and providing a strategy that actually achieves the goal, most often independent mastery of a skill that is then generalized to new environments and situations. Your basics are the center hub upon which spokes (new skills) can be added, but not before satisfying the need for basic motor development. A bunch of P-things to finish this off; Patience, Persistence, Practice, Persevering, and Practicality. They all have their…proper place.
I’ve worked with a range of individuals on the autism spectrum with respect to Physical, Adaptive, and Cognitive functioning. On the low end of adaptive/behavioral abilities, aggressive or self-injurious behavior can be a concern. As a fitness professional, or someone who is providing an ongoing adaptive PE, active play, or movement program, the questions becomes; “What do I do to safely eliminate this behavior and how do I modify programming?”
The easy thing to do would be to forego all demands/programming. However this is in nobody’s best interest. First let’s consider what aggressive/self-injurious behavior actually signifies. ALL behavior has meaning, and all communication attempts to convey something. Typically with fitness programs, the instructor is providing a demand (whatever they want the individual to do), and regardless of how fun I, or any instructor thinks the activity may be, the individual wants no part. This can be activity-specific or simply because we’ve changed up the individual’s typical routine (which may very well have been walking in circles, but is still a routine). Something new, something that requires effort, may be enough to elicit maladaptive behavior.
Aggression and/or self-injury are usually “escape-maintained” behaviors. Their purpose is to get the individual out of the current situation. Particularly with non-verbal individuals, who lack more appropriate means of expressing needs and wants, this strategy may be met with reinforcement (removal of the demand situation). In the immediate, we want to ensure safety. Given. Absolutely. However the contingency that may form would, from the individual’s perspective, look like this:
He/She wants me to do something I don’t want to do —> I hit/bite/kick myself or them —> I no longer have to do that thing I don’t want to do.
The first proactive step is a behavior modification program, preferably developed by a licensed BCBA or other clinical therapist. It is impossible to eliminate a problematic behavior, particularly one involving communication, without providing at least one (and preferably more) appropriate option. One strategy that has been quite successful is to provide breaks after completing a task.
Suppose Chris is currently able to perform three push throws with a medicine ball and the next goal is four throws. If we are providing secondary reinforcement following the fourth throw (access to a break or preferred activity), we may ALSO provide a break when he asks appropriately (rather than engaging in the aggressive or self-injurious behavior), establishing the contingency between asking/pointing to a picture or using a different mode of communication, and access to the reinfrocer (in this case, a break). This strategy serves two very important purposes; Preempting the maladaptive behavior and providing a more appropriate response in its place.
A high rate of reinforcement to workload/demand may be necessary when first introducing exercise to an individual with low adaptive skills. It may also occur with changes of environment. One of my long-term athletes will become self-injurious when we move our sessions from outdoor in the Spring, Summer, and Fall to indoors during the Winter. It may be the confined space (he likes to wander around), or that fact that I am now instructing him in his home, but as soon as we move inside the hits to the head and arm biting (his, not mine) commence. So I back off the demands and give him longer breaks between activities. He can ask, appropriately, for a break at any point and it is granted. Eventually, we get some exercise in.
It is always easier to do nothing rather than something, or decide that an individual just “doesn’t want to” or “can’t” participate in an activity, particularly when an extreme behavior is involved. We have to promote more respect and regard for ASD individuals than relegating them to situations that are not challenging or promoting healthy new skills.
None of this is theoretical. Some of the athletes who I now coach through intense, fun sessions, were hitting or biting themselves or me (particularly if I intervened in their self-injurious behavior) when we first began together. Take things at the pace of individual, from all three areas of functioning (Physical, Adaptive, and Cognitive). Remember that something aversive can be made less-so (and even enjoyable), by pairing it with known reinforcers and, just as importantly, with consistency over time. Becoming familiar with an instructor, program, activities, and new words/association can alleviate anxiety, which may also be contributing to problem behavior.
Everyone deserves an opportunity to move, grow stronger, and become physically healthier. As professionals and providers we sometimes have to strategize a bit more, be willing to change things almost immediately, and keep in mind our priorities. Good information used intelligently leads to positive outcomes.
Consistency in expectation is a key component of Autism Fitness programming. My athletes know what to expect from me, and I know what they are capable of doing. This is not an immediate situation, but one that develops through building a rapport with an individual. It begins with a basic equation common to Applied Behavior Analysis (ABA):
Antecedent, Behavior, Consequence (ABC)
What comes first? What is the reaction? What is the consequence of that reaction?
In the context of fitness activities, I ask my athlete to perform a med ball push throw, he does successfully, and earns some break time. While the expectation becomes greater over time (more push throws, push throws + another activity), the sequence remains; The request, the performance, the reinforcement.
Proactivity is damn better than reacttivity when teaching movement stuff. Rather than correct a movement that is too difficult for an athlete to perform, start off simpler. This is where the concept of regression becomes invaluable. With movement andgeneral learning, we are all human beings on different points of the same continuum. We meet our athletes at their current level of ability and progress from that point. Yes, it takes time, and no, it is not always a directly linear process.
Having consistent expectations can help in alleviating anxiety, something quite common to those with autism. Removing the element of uncertainty can have a calming effect. Many individuals with ASD are comfortable, sometimes to a detrimental degree, with repetition and sameness. Introducing new activities can be overwhelming if there is too much too soon. If the goal is to make fitness and active play reinforcing/fun, you have to take your time with establishing first a positive relationship, and second, making sure that you are consistent in your expectations for physical performance. Yes, day-to-day abilities will vary slightly, but understanding what an athlete can and cannot do (yet) on a regular basis will allow a coach/instructor to plan successful programs.
Respect is a word that is tossed around with relation to special needs populations. From my perspective, to respect an individual is to provide appropriate instruction, and make sure that they accomplish something prior to accessing rewards, as the rest of us have to do in society. Developing skills, mastering challenges, and overcoming deficits is not a passive endeavor.
One of our we-don’t-want-it-to-be-a-secret secrets in the strength and fitness community is that we ( the learned and practiced strength and fitness community, both professional and enthusiast), have know a lot about gaining and maintaining health for some time (circa early 1900′s). Resistance training for women? Knew it prior to cars being commonly owned. Whole fat foods (milk, butter, avocado, coconut) being heart-healthy? We espoused it the first time handlebar mustaches were hip and when Brooklyn was acres of grass-fed farm land. Kettlebells? Around when bells were the epitome of rocking out. Preventing illness and enhancing physical fitness because it creates a sound constitution and can be a healthy social pursuit? Indubitably.
This recent and well-written article by Dr. Arshya Vahabzadeh in the Huffington Post discusses one of the most frustrating problems with regard to autism and the general issue of healthcare; (yes, I fancily used a semicolon) everything is reactive. Dr. Vahabzadeh discusses both the complications of gaining access to therapeutic treatments and the confusing and seemingly unending hailstorm of information and misinformation (thank you/screw you, Internet) that parents and caregivers of individuals on the spectrum encounter. From the onset of symptoms and diagnosis, nearly every step is reactive. The paragraph that caught me goes like this:
Some people with autism find it difficult to engage in regular exercise, through a combination of a lack of suitable opportunities, their own social difficulties, and stigma against them. Let me jump now to my other truth: As medical professionals we often prescribe medications but “there is no pill that can replicate the health benefits of exercise.” It is not limited to exercise either, what about diet? Many people with autism also find they are particularly picky about the food that they eat, often ending up on a “yellow diet” that includes starchy or fatty foods such as fries, cheese, burgers, and pizza. What are health care systems doing to address these issues? Unfortunately far less than they could be doing. – Arshya Vahabzadeh, M.D.
Each sign-up I get on my email newsletter suggests that some nice person is at least curious about physical activity for the autism population. I’ve likely mentioned it in past posts (or ranted about it during seminars), but when I started Autism Fitness ten years ago the idea that exercise was highly important for young people with autism wasn’t initially received with fiesta-level enthusiasm. Much as the “weightlifting-will-make-you-bulky-and-turn-you-into-a-goat” dogma, there was a gap between perception of exercise/fitness/active play and it’s benefits. Add to that the near-constant upkeep of educational, vocational, behavioral, and social therapies (and fighting to receive those therapies), and the basics become less than an afterthought.
The basics relate to health; Nutrition, Physical Activity, Sleep, Positive Support, and having Self-time. Ironically, it is all, or most, of these that are pushed away in the pursuit of enhancement. And you just can’t have optimal enhancement without them.
This, as are all big problems, is one of those pesky multi-faceted things. It is not cured by a change in one area (Electro-conducive ionized wheat grass reverse osmosis water baths), but a meaningful and practical synergy of all participants, meaning parents and professionals begin to share information across disciplines and practitioner guidelines, Federal and State mandates, and social expectations and behaviors change as a result. This is called progress and depending on the issue, can happen in one large sweep or gradually. I would argue that a national movement towards a more proactive approach to autism wellness will be on the gradual side. It’s not really an “add Vitamin C to Cheeze Curlz” type of fix.
I’ve developed an, as titled, overly generalized visual chart for establishing a more fitness-forward autism community. You can see it by clicking the link below
* (Thanks to one of my closest friends and colleagues Dr. Kwame Brown for introducing me to Prezi)
In our vocational capacities, we tend to view things through a rather narrow set of contingencies. I think everything from goldfish dandruff to nuclear disarmament can be cured through squats and monkey bars. Financial advisers cannot fathom how families do not have weekly budget meetings to alleviate social anxiety, and Dietitians know that cucumbers and kale will raise social reciprocity. We’re all kind of right when things have proper balance.
I’m proposing, as I suspect Dr. Vahabzadeh (whose name I deeply hope I’ve spelled consistently correct in this post), would agree that in addition to access to services, the appropriate services are offered. Ignoring the practices of a healthy lifestyle has been an interesting social experiment and I think we can surmise that it has failed spectacularly. Our generation of young people with autism deserve a little more of what we (should) already know, that a healthier, more active foundation will lead to greater outcomes. Simple, bold declaration. Now all we have to do is make large, sweeping changes…one brush stroke at a time.