Quality,Rigor,and Outcomes of Antecedent Exercise Strategies for Supporting Autistic Individuals: A Synthesis and Multilevel Meta-Analysis

Abstract

Physical activity is a promising strategy for strengthening behavior and social engagement through its physiological and psychological benefits. Antecedent Exercise (AE) is a structured behavioral intervention aimed at mitigating meltdowns and promoting adaptive behaviors in Autistic individuals. This synthesis and multilevel meta-analysis of 34 studies, including diverse settings and exercise types, provides a nuanced examination of AE's effectiveness. AE demonstrated moderate efficacy with effect sizes of −0.342 (SE = 0.089, p < .005, 95% CI [−0.517, −0.168]) for reducing meltdowns, and a substantial improvement of 0.806 (SE = 0.166, p < .005, 95% CI [0.481, 1.13]) for increasing adaptive behaviors. Special education settings such as day centers and schools yielded robust outcomes, thus highlighting AE's effectiveness in an educational context. Interventions involving accessible activities like aerobic exercise routines and jogging also showed to be effective. Despite variability in study rigor and some indications of publication bias, AE appears to be a scalable intervention for educators and clinicians. Future research should address the long-term maintenance effects and optimal implementation strategies for maximizing AE's benefits in educational and clinical settings. This evidence supports the integration of AE into practices for improving the quality of life and educational outcomes for Autistic individuals.

Keywords

Autism antecedent exercise meltdown behaviors adaptive skills behavioral intervention SCARF

Get full access to this article

View all access options for this article.

References

Allison

D. B.

Basile

V. C.

Bruce MacDonald

(1991). Brief report: Comparative effects of antecedent exercise and lorazepam on the aggressive behavior of an autistic man. Journal of Autism and Developmental Disorders, 21(1), 89–94. https://doi.org/10.1007/BF02207001

American Psychiatric Association (2022). Autism spectrum disorder. In Diagnostic and statistical manual of mental disorders (5th ed.)). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425787 .

Bachman

J. E.

Fuqua

R. W.

(1983). Management of inappropriate behaviors of trainable mentally impaired students using antecedent exercise. Journal of Applied Behavior Analysis, 16(4), 477–484. https://doi.org/10.1901/jaba.1983.16-477

Bachman

J. E.

Sluyter

(1988). Reducing inappropriate behaviors of developmentally disabled adults using antecedent aerobic dance exercises. Research in Developmental Disabilities, 9(1), 73–83. https://doi.org/10.1016/0891-4222(88)90021-2

Baek

Luo

(2023). Modeling multiple dependent variables in meta-analysis of single case experimental design using multilevel modeling. Behavior Research Methods, 55(7), 3760–3771. https://doi.org/10.3758/s13428-022-01987-1

Barnard-Brak

Watkins

Richman

D. M.

(2021). Autocorrelation and estimates of treatment effect size for single-case experimental design data. Behavioral Interventions, 36(3), 595–605. https://doi.org/10.1002/bin.1783

Bassette

Titus‐Dieringer

Zoder‐Martell

Kim

Cremeans

(2020). The use of video‐based instruction to promote independent performance of physical activity skills in students with developmental disabilities in a school and community setting. Psychology in the Schools, 57(9), 1439–1456. https://doi.org/10.1002/pits.v57.9

Baumeister

A. A.

MacLean

W. E.

(1984). Deceleration of self-injurious and stereotypie responding by exercise. Applied Research in Mental Retardation, 5(3), 385–393. https://doi.org/10.1016/S0270-3092(84)80059-4

Bottema-Beutel

Kapp

S. K.

Lester

J. N.

Sasson

N. J.

Hand

B. N.

(2021). Avoiding Ableist Language: Suggestions for Autism Researchers. Autism in Adulthood: Challenges and Management, 3(1), 18–29. https://doi.org/10.1089/aut.2020.0014

10.

Bruhn

A. L.

Rila

Mahatmya

Estrapala

Hendrix

(2020). The effects of data-based, individualized interventions for behavior. Journal of Emotional and Behavioral Disorders, 28(1), 3–16. https://doi.org/10.1080/00220388.2020.1715941

11.

Cannella-Malone

H. I.

Tullis

C. A.

Kazee

A. R.

(2011). Using antecedent exercise to decrease challenging behavior in boys with developmental disabilities and an emotional disorder. Journal of Positive Behavior Interventions, 13(4), 230–239. https://doi.org/10.1177/1098300711406122

12.

Celiberti

D. A.

Bobo

H. E.

Kelly

K. S.

Harris

S. L.

Handleman

J. S.

(1997). The differential and temporal effects of antecedent exercise on the self-stimulatory behavior of a child with autism. Research in Developmental Disabilities, 18(2), 139–150. https://doi.org/10.1016/S0891-4222(96)00032-7

13.

Centers for Disease Control and Prevention. Department of Health and Human Services . (2021). Community report on autism 2021. https://www.cdc.gov/autism/media/pdfs/addm-community-autism-report-12-2-021_final-h.pdf

14.

Chazin

K. T.

Ledford

J. R.

Barton

E. E.

Osborne

K. C.

(2018). The effects of antecedent exercise on engagement during large group activities for young children. Remedial and Special Education, 39(3), 158–170. https://doi.org/10.1177/0741932517716899

15.

Chazin

K. T.

Velez

M. S.

Ledford

J. R.

(2020). Reducing escape without escape extinction: A systematic review and meta-analysis of escape-based interventions. Journal of Behavioral Education, 31, 186–215. https://doi.org/10.1007/s10864-021-09453-2

16.

Chen

Pustejovsky

J. E.

(2024). Multilevel meta-analysis of single-case experimental designs using robust variance estimation. Psychological Methods, 29(3), 537–560. https://doi.org/10.1037/met0000510

17.

Currier

T. D. R.

(2012). Untangling the effects of scheduled exercise on child engagement, stereotypy and challenging behavior [Unpublished master's thesis]. University of North Texas.

18.

Dishman

R. K.

Berthoud

H. R.

Booth

F. W.

Cotman

C. W.

Edgerton

V. R.

Fleshner

M. R.

Kramer

A. F.

Gomez-Pinilla

Greenwood

B. N.

Hillman

C. H.

Kramer

A. F.

Levin

B. E.

Moran

T. H.

Russo-Neustadt

A. A.

Salamone

J. D.

Van Hoomissen

J. D.

Wade

C. E.

York

D. A.

Zigmond

M. J.

(2006). Neurobiology of exercise. Obesity, 14(3), 345–356. https://doi.org/10.1038/oby.2006.46

19.

Dowdy

Peltier

Tincani

Schneider

W. J.

Hantula

D. A.

Travers

J. C.

(2021). Meta-analyses and effect sizes in applied behavior analysis: A review and discussion. Journal of Applied Behavior Analysis, 54(4), 1317–1340. https://doi.org/10.1002/jaba.862

20.

Dowdy

Tincani

Schneider

W. J.

(2020). Evaluation of publication bias in response interruption and redirection: A meta-analysis. Journal of Applied Behavior Analysis, 53(4), 2151–2171. https://doi.org/10.1002/jaba.724

21.

Drevon

Fursa

S. R.

Malcolm

A. L.

(2017). Intercoder reliability and validity of WebPlotDigitizer in extracting graphed data. Behavior Modification, 41(2), 323–339. https://doi.org/10.1177/0145445516673998

22.

Edelson

S. M.

(2022). Understanding challenging behaviors in autism spectrum disorder: A multi-component, interdisciplinary model. Journal of Personalized Medicine, 12(7), Article 1127. https://doi.org/10.3390/jpm12071127

23.

Ellis

(1989). A behavioral approach to information retrieval system design. Journal of Documentation, 45(3), 171–212. https://doi.org/10.1108/eb026843

24.

Fearnbach

S. N.

Martin

C. K.

Heymsfield

S. B.

Staiano

A. E.

Newton

R. L.

Jr. Garn

A. C.

Johannsen

N. M.

Hsia

D. S.

Carmichael

O. T.

Ramakrishnapillai

Murray

K. B.

Blundell

J. E.

Finlayson

(2020). Validation of the Activity Preference Assessment: A tool for quantifying children’s implicit preferences for sedentary and physical activities. The International Journal of Behavioral Nutrition and Physical Activity, 17, 1–13. https://doi.org/10.1186/s12966-020-01014-6

25.

Folino

Ducharme

J. M.

Greenwald

(2014). Temporal effects of antecedent exercise on students' disruptive behaviors: An exploratory study. Journal of School Psychology, 52(5), 447–462. https://doi.org/10.1016/j.jsp.2014.07.002

26.

Fox

C. K.

Barr-Anderson

Neumark-Sztainer

Wall

(2010). Physical activity and sports team participation: Associations with academic outcomes in middle school and high school students. The Journal of School Health, 80(1), 31–37. https://doi.org/10.1111/j.1746-1561.2009.00454.x

27.

Goldman

K. J.

DeLeon

I. G.

(2022). Increasing selection of and engagement in physical activity in children with autism spectrum disorder. Journal of Applied Behavior Analysis, 55(4), 1083–1108. https://doi.org/10.1002/jaba.929

28.

Goldman

K. J.

DeLeon

I. G.

Schieber

Weinsztok

S. C.

Nicolini

(2021). Increasing physical activity and analyzing parametrically the effects on stereotypy in children with autism spectrum disorder. Behavioral Interventions, 36(4), 867–891. https://doi.org/10.1002/bin.v36.4

29.

Hogan

Knez

Kahng

(2015). Evaluating the use of behavioral skills training to improve school staffs’ implementation of behavior intervention plans. Journal of Behavioral Education, 24(2), 242–254. https://doi.org/10.1007/s10864-014-9213-9

30.

Hus

Segal

(2021). Challenges surrounding the diagnosis of autism in children. Neuropsychiatric Disease and Treatment, 17, 3509–3529. https://doi.org/10.2147/NDT.S282569

31.

Jang

Reeve

Deci

E. L.

(2010). Engaging students in learning activities: It is not autonomy support or structure but autonomy support and structure. Journal of Educational Psychology, 102(3), 588–600. https://doi.org/10.1037/a0019682

32.

Kern

Koegel

R. L.

Dunlap

(1984). The influence of vigorous versus mild exercise on autistic stereotyped behaviors. Journal of Autism and Developmental Disorders, 14(1), 57–67. https://doi.org/10.1007/BF02408555

33.

Kirkpatrick

Akers

Rivera

(2019). Use of behavioral skills training with teachers: A systematic review. Journal of Behavioral Education, 28(3), 344–361. https://doi.org/10.1007/s10864-019-09322-z

34.

Kozlowski

A. M.

Matson

J. L.

Rieske

R. D.

(2012). Gender effects on challenging behaviors in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6(2), 958–964. https://doi.org/10.1016/j.rasd.2011.12.011

35.

Laraway

Snycerski

Michael

Poling

(2003). Motivating operations and terms to describe them: Some further refinements. Journal of Applied Behavior Analysis, 36(3), 407–414. https://doi.org/10.1901/jaba.2003.36-407

36.

Ledford

J. R.

Chazin

K. T.

Gagnon

Lord

Turner

V. R.

Zimmerman

K. N.

(2020). A systematic review of instructional comparisons in single case research. Remedial and Special Education, 42(3), 155–168. https://doi.org/10.1177/0741932519855059

37.

Ledford

J. R.

Eyler

P. B.

Windsor

S. A.

Chow

J. C.

(2024). Single-case design effect-size distributions: Association with procedural parameters. School Psychology, 39(6), 589–600. https://doi.org/10.1037/spq0000636

38.

Ledford

J. R.

Gast

D. L.

(2024). Single case research methodology: Applications in special education and Behavioral sciences (4th ed.). Routledge. https://doi.org/10.4324/9781003294726

39.

Ledford

J. R.

Windsor

S. A.

(2022). Systematic review of interventions designed to teach imitation to young children with disabilities. Topics in Early Childhood Special Education, 42(2), 202–214. https://doi.org/10.1177/02711214211007190

40.

Lee

(2013). The effects of physical activities on stereotypic behaviors and task engagement in preschool children with autism spectrum disorder [Doctoral dissertation]. The Ohio State University. ProQuest Dissertation Publishing.

41.

Lewis

M. H.

Bodfish

J. W.

(1998). Repetitive behavior disorders in autism. Developmental Disabilities Research Reviews, 4(2), 80–89. https://doi.org/10.1002/(SICI)1098-2779

42.

Losinski

Cook

Hirsch

Sanders

(2017). The effects of deep pressure therapies and antecedent exercise on stereotypical behaviors of students with autism spectrum disorders. Behavioral Disorders, 42(4), 196–208. https://doi.org/10.1177/0198742917715873

43.

Luke

Vail

C. O.

Ayres

K. M.

(2014). Using antecedent physical activity to increase on-task behavior in young children. Exceptional Children, 80(4), 489–503. https://doi.org/10.1177/0014402914527241

44.

Matson

J. L.

Kozlowski

A. M.

(2011). The increasing prevalence of autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 418–425. https://doi.org/10.1016/j.rasd.2010.06.004

45.

Matson

J. L.

Mahan

Hess

J. A.

Fodstad

J. C.

Neal

(2010). Progression of challenging behaviors in children and adolescents with autism spectrum disorders as measured by the autism spectrum disorders-problem behaviors for children (ASD-PBC). Research in Autism Spectrum Disorders, 4(3), 400–404. https://doi.org/10.1016/j.rasd.2009.10.010

46.

McCoy

S. M.

Jakicic

J. M.

Gibbs

B. B.

(2016). Comparison of obesity, physical activity, and sedentary behaviors between adolescents with autism spectrum disorders and without. Journal of Autism and Developmental Disorders, 46(7), 2317–2326. https://doi.org/10.1007/s10803-016-2762-0

47.

McGimsey

J. F.

Favell

J. E.

(1988). The effects of increased physical exercise on disruptive behavior in retarded persons. Journal of Autism and Developmental Disorders, 18(2), 167–179. https://doi.org/10.1007/BF02211944

48.

McLaughlin

C. A. H.

(2010). Decreasing stereotypy in preschoolers with autism spectrum disorder: The role of increased physical activity and function [Doctoral dissertaion]. University of Washington. ProQuest Dissertations and Thesis.

49.

McLaughlin

(2017). Effects of antecedent physical activity on engagement [Unpublished doctoral dissertation]. University of Washington.

50.

Moeyaert

Manolov

Rodabaugh

(2020). Meta-analysis of single-case research via multilevel models: Fundamental concepts and methodological considerations. Behavior Modification, 44(2), 265–295. https://doi.org/10.1177/0145445518806867

51.

Morrison

G. R.

Ross

S. M.

Kalman

H. K.

Kemp

J. E.

(2013). Designing Effective Instruction (7th ed.). John Wiley & Sons, Inc.

52.

Morrison

Roscoe

E. M.

Atwell

(2011). An evaluation of antecedent exercise on behavior maintained by automatic reinforcement using a three-component multiple schedule. Journal of Applied Behavior Analysis, 44(3), 523–541. https://doi.org/10.1901/jaba.2011.44-523

53.

Murphy

Healy

Leader

(2009). Risk factors for challenging behaviors among 157 children with autism spectrum disorder in Ireland. Research in Autism Spectrum Disorders, 3(1), 474–482. https://doi.org/10.1016/j.rasd.2008.09.008

54.

Nakutin

S. N.

Gutierrez

Campbell

(2019). Effect of physical activity on academic engagement and executive functioning in children with ASD. School Psychology Review, 48(2), 177–184. https://doi.org/10.17105/SPR-2017-0124.V48-2

55.

Neely

Rispoli

Gerow

Ninci

(2015). Effects of antecedent exercise on academic engagement and stereotypy during instruction. Behavior Modification, 39(1), 98–116. https://doi.org/10.1177/0145445514552891

56.

Nicholson

Kehle

T. J.

Bray

M. A.

Van Heest

(2011). The effects of antecedent physical activity on the academic engagement of children with autism spectrum disorder. Psychology in the Schools, 48(2), 198–213. https://doi.org/10.1002/pits.v48.2

57.

Nosek

B. A.

Alter

Banks

G. C.

Borsboom

Bowman

S. D.

Breckler

S. J.

Buck

Chambers

C. D.

Chin

Christensen

Contestabile

Dafoe

Eich

Freese

Glennerster

Goroff

Green

D. P.

Hesse

…Yarkoni

(2015). Promoting an open research culture. Science, 348(6242), 1422–1425. https://doi.org/10.1126/science.aab2374

58.

Nuske

H. J.

McGhee Hassrick

Bronstein

Hauptman

Aponte

Levato

Stahmer

Mandell

D. S.

Mundy

Kasari

Smith

(2018). Broken bridges new school transitions for students with autism spectrum disorder: A systematic review on difficulties and strategies for success. Autism, 23(2), 306–325. https://doi.org/10.1177/1362361318754529

59.

Page

M. J.

McKenzie

J. E.

Bossuyt

P. M.

Boutron

Hoffmann

T. C.

Mulrow

C. D.

Shamseer

Tetzlaff

J. M.

Akl

E. A.

Brennan

S. E.

Chou

Glanville

Grimshaw

J. M.

Hróbjartsson

Lalu

M. M.

Loder

E. W.

Mayo-Wilson

McDonald

Moher

(2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372(n71). https://doi.org/10.1136/bmj.n71

60.

Pincus

S. M.

Hausman

N. L.

Borrero

J. C.

Kahng

(2019). Context influences preference for and level of physical activity of adolescents with intellectual and developmental disabilities. Journal of Applied Behavior Analysis, 52(3), 788–795. https://doi.org/10.1002/jaba.582

61.

Pituch

K. A.

Green

V. A.

Didden

Lang

O’Reilly

M. F.

Lancioni

G. E.

Sigafoos

(2011). Parent reported treatment priorities for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 135–143. https://doi.org/10.1016/j.rasd.2010.03.003

62.

Pokorski

E. A.

Barton

E. E.

Ledford

J. R.

Taylor

A. L.

Johnson

Winters

H. K.

(2019). Comparison of antecedent activities for increasing engagement in a preschool child with ASD during a small group activity. Education and Training in Autism and Developmental Disabilities, 54(1), 94–103. https://doi.org/10.1016/j.jsp.2018.02

63.

Powers

Thibadeau

Rose

(1992). Antecedent exercise and its effects on self‐stimulation. Behavioral Interventions, 7(1), 15–22. https://doi.org/10.1002/bin.v7:1

64.

Pustejovsky

(2024). Package ‘clubSandwich’: Cluster-Robust (Sandwich) Variance Estimators with Small-Sample Corrections (Version 0.5.11) [R package]. http://jepusto.github.io/clubSandwich/

65.

Pustejovsky

J. E.

(2018). Using response ratios for meta-analyzing single-case designs with behavioral outcomes. Journal of School Psychology, 68, 99–112. https://doi.org/10.1016/j.jsp.2018.02.003

66.

Pustejovsky

J. E.

Tipton

(2018). Small-sample methods for cluster-robust variance estimation and hypothesis testing in fixed effects models. Journal of Business & Economic Statistics, 36(4), 672–683. https://doi.org/10.1080/07350015.2023.2174123

67.

Rattaz

Michelon

Munir

Baghdadli

(2018). Challenging behaviours at early adulthood in autism spectrum disorders: Topography, risk factors and evolution. Journal of Intellectual Disability Research, 62(7), 637–649. https://doi.org/10.1111/jir.12503

68.

Richards

E. J.

(2019). Skill acquisition and behavior change following an exercise about in children with autism spectrum disorder [Master's thesis]. Brigham Young University.

69.

Riker

A. A.

(2019). Individual exercise intervention training to increase eye contact and verbal initiation in adolescents with high functioning autism spectrum disorder in a school setting [Master's thesis]. Purdue University Global. ProQuest Dissertation Publishing.

70.

Rohatgi

(2015). WebPlotDigitizer (Version 3.9) [Computer software]. Retrieved from http://arohatgi.info/WebPlotDigitizer.

71.

Ruzzano

Borsboom

Geurts

H. M.

(2015). Repetitive behaviors in autism and obsessive-compulsive disorder: New perspectives from a network analysis. Journal of Autism and Developmental Disorders, 45(1), 192. https://doi.org/10.1007/s10803-014-2204-9

72.

Schmitz Olin

McFadden

B. A.

Golem

D. L.

Pellegrino

J. K.

Walker

A. J.

Sanders

D. J.

Arent

S. M.

(2017). The effects of exercise dose on stereotypical behavior in children with autism. Medicine and Science in Sports and Exercise, 49(5), 983–990. https://doi.org/10.1249/MSS.0000000000001197

73.

Shadish

W. R.

Hedges

L. V.

Horner

R. H.

Odom

S. L.

(2015). The role of between-case effect size in conducting, interpreting, and summarizing single-case research. NCER 2015-002. National Center for Education Research. https://files.eric.ed.gov/fulltext/ED562991.pdf

74.

Shadish

W. R.

Hedges

L. V.

Pustejovsky

J. E.

(2014). Analysis and meta-analysis of single-case designs with a standardized mean difference statistic: A primer and applications. Journal of School Psychology, 52(2), 123–147. https://doi.org/10.1016/j.jsp.2013.11.005

75.

Siu

Q. K. Y.

Chan

R. C. H.

Floria

H. N. C.

Chan

D. F. Y.

Mak

W. W. S.

(2019). The role of child problem behaviors in autism Spectrum symptoms and parenting stress: A primary school-based study. Journal of Autism and Developmental Disorders, 49(3), 857–870. https://doi.org/10.1007/s10803-018-3791-7

76.

Swan

D. M.

Pustejovsky

J. E.

(2018). A gradual effects model for single-case designs. Multivariate Behavioral Research, 53(4), 574–593. https://doi.org/10.1080/00273171.2018.1466681

77.

Teh

E. J.

Vijayakumar

Tan

T. X. J.

Yap

M. J.

(2021). Effects of physical exercise interventions on stereotyped motor behaviours in children with ASD: A meta-analysis. Journal of Autism and Developmental Disorders, 52(7), 2934–2957. https://doi.org/10.1007/s10803-021-05152-z

78.

Tincani

Travers

J. C.

(2022). Questionable research practices in single-case experimental designs: Exam-ples and possible solutions. In O’Donohue

Masuda

Lilienfeld

S. O.

(Eds.), Avoiding questionable research practices in applied psychology (pp. 269–285). Springer Publication. https://doi.org/10.1007/978-3-031-04968-2_12

79.

Viechtbauer

(2010). Conducting meta-analyses in R with the metaphor package. Journal of Statistical Software, 36(3), 1–48. https://doi.org/10.18637/jss.v036.i03

80.

Wickham

Çetinkaya-Rundel

Grolemund

(2023). R for data science. O'Reilly Media.

81.

Wong

Falcomata

T. S.

Barnett

(2022). The collateral effects of antecedent exercise on stereotypy and other nonstereotypic behaviors exhibited by individuals with autism spectrum disorder: A systematic review. Behavior Analysis in Practice, 16(2), 407–420. https://doi.org/10.1007/s40617-022-00746-0

82.

Zappella

(2023). Autism: A diagnostic dilemma. Neuroscience and Behavioral Physiology, 53(1), 34–39. https://doi.org/10.1007/s11055-023-01388-7

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.24 MB

0.02 MB

0.16 MB

0.03 MB

0.04 MB

0.00 MB