Recent figures estimate that approximately 1% of the population in the United Kingdom has an Autism Spectrum Disorder (ASD), which is almost twelve times higher than estimates made in the 1970s. According to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, individuals with autism experience communication difficulties alongside repetitive and restrictive behaviours and sensory hypo/hyper reactivity. Those of us who parent and work with children with autism, however, know this is only part of the story.
Children with autism often experience high levels of anxiety, with some presenting with anxiety disorders or high levels of anxiety traits. The presence of such anxiety has been associated with, and even proposed to be caused by, sensory hyper-reactivity with current estimates indicating that more than 80% of children with autism exhibit sensory difficulties. In general, children with autism have a heightened or reduced sensory response in one or more of the five senses (sight, hearing, smell, taste and touch) and are often sensitive to the body’s position, posture, movement and balance in relation to the surrounding environment. Families report that sensory difficulties significantly restrict full participation in daily activities and create social isolation both for their child and for the family as a whole.
In addition to these sensory difficulties, children with autism are reported to have a greater prevalence of sleep problems, with estimates ranging from 44% to 83%. They are also more likely to suffer from gastrointestinal symptoms, including abnormal stool patterns and frequent abdominal pain. Problem eating behaviours are also reported in more than 75% of children with autism, which include selective eating, the consumption of non-food items (pica), insistence on specific mealtime routines and meal-related distress such as tantrums.
In an effort to alleviate some of these distressing symptoms, up to one third of parents with a child with autism have sought out complementary or alternative therapies, with one Internet survey finding that, on average, parents reported using seven different treatments. One complementary and alternative treatment option available is yoga. Yoga is an ancient practice, originating in India, which involves physical, mental and spiritual disciplines. It is comprised of three elements, namely gentle stretching (asana), exercises for breath control (pranayama) and meditation. According to Doctor Bessel van der Kolk, an esteemed psychiatrist best known for his treatment and research into stress, yoga teaches us that “there are things we can do to change our brainstem arousal system, our sympathetic and parasympathetic nervous systems and to quieten the brain”.
Numerous studies have explored the effectiveness of yoga in typically developing children. In one twelve-week study with 97 children, a positive impact was found on problematic responses to stress, including intrusive thoughts and emotional arousal. In another study, school children practising yoga for just ten days improved spatial memory scores and their ability to concentrate. Yoga practice would also appear to positively influence emotional states, with the children in one study experiencing higher levels of wellbeing and self-esteem after a series of yoga sessions. There is also evidence to suggest that yoga can improve executive functions in children, possibly due to the mental techniques involved in yoga beyond the physical. In a review of the literature, yoga was additionally found to have benefits for spatial perception, muscle strength and respiratory capacity.
Given the growing body of research indicating yoga’s benefits for typically developing children, it is perhaps not difficult to imagine how yoga may also be beneficial for children with autism, although there is much less research on this specific area. Researchers have suggested that deep pressure from the strengthening poses may provide relief from the constant over-stimulation of the nervous system known to be an element of autism, promoting greater sensory integration. Yoga poses may also provide a present-moment focal point for these children, who often feel overwhelmed by bodily sensations.
Yoga has also been shown to reduce the symptoms of Obsessive Compulsive Disorder (OCD), many traits of which are shared by children with autism. Autism is also a risk factor for aggression, with regular yoga practice benefitting children suffering from aggressive behaviour in one study. Stress and anxiety, high levels of which are often experienced by children with autism, have also been shown to be alleviated by regular yoga practice. In one small-scale study of 6 children with autism, an 82-week yoga intervention (5 hour-long sessions per week) was demonstrated to promote significant changes in communication, language, play and joint attention in addition to a reduction in anxiety. Yoga has also been found to have positive benefits for sleeping and eating difficulties, including gastrointestinal symptoms, although these studies have been conducted with typically developed adults and are yet to be conducted with children.
In my own therapeutic work, I have been astounded by the benefits of yoga to children with autism and their families. Yoga is frequently used, for example, as a tool for self-regulation; I have received many reports of children spontaneously practising yoga, particularly the chanting and breathing exercises, when they find themselves becoming anxious and overwhelmed. One little girl, for example, now uses breathing exercises on public transport as a way of alleviating her anxiety, even imploring other passengers on occasion to join in! I have also received numerous reports of improved sleep, increased verbalisations and more focused concentration.
Parents also note many personal benefits, not least an increased sense of connection to their child. I have received many reports of children using yoga to communicate, perhaps by chanting a family member’s name or initiating physical touch by assuming an asana in close proximity to their parent’s body. Many families also find that it is finally something they can all do together, with one mother recently explaining to me that the whole family now practised yoga for ten minutes before school and that it had completely transformed their mornings; everyone was calmer, went off to work and school happier and experienced less anxiety throughout their day.
Sensory benefits are among the most often cited by parents. The theory and treatment of sensory integration was developed by Anna Jean Ayres in 1972 and proposes that if a child is engaged in tailored sensory-motor activities, their nervous system is better able to modulate, organise and integrate sensory information and more likely to use sensory information in adaptive ways. Such ideas have been taken up by occupational therapists working in special education, who speak of the importance of a sensory diet for children with autism. The parents I work with often express a desire for yoga to become part of their child’s sensory diet, with many citing greater body awareness as a benefit of the yoga sessions.
Such benefits hark back to the early work of Frances Tustin, a child psychotherapist specialised in autism, who wrote about children who “are beset with terrors of un-containment, and dreads of spilling out or forever falling and losing their continuity with existence”. Yoga has been shown to enhance a sense of embodiment, which can be defined as the sense of being a distinct person with an experience of the body ‘from the inside’. Regular yoga practice promotes the sense of being a person with a body over which one has some level of connection and control and can promote the sense of containment so many children with autism lack.
So many complex and costly approaches exist for the alleviation of distressing symptoms related to autism. Wouldn’t it be wonderful if something as simple as yoga could promote embodiment, connection, sensory integration and anxiety-reduction in these children? It is my firm belief that it does.
Nicole Schnackenberg is a qualified teacher and psychotherapist, currently working as a school counsellor. She is also a certified yoga therapist offering sessions with Special Yoga Ltd: www.specialyoga.org.uk
Her book False Bodies, True Selves: Moving Beyond Body Image Struggles and Returning to the True Self will be published by Karnac Books in 2016.