Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The purpose of this study was to determine the extent to which a specialized swim program for children with autism spectrum disorder (ASD) improved child and parent functioning and body composition (body mass index). Researchers used a crossover design and convenience sampling to recruit 24 children, mostly young (75% < age 9 years), male (83%), and Caucasian (58.3%). Results showed 8 weeks of twice-weekly swimming improved self-esteem and emotional behaviors of children with ASD but did not positively effect body composition.
Primary Author and Speaker: Lisa Mische Lawson
Contributing Authors: Jordan Carlson
PURPOSE: Children with Autism Spectrum Disorders (ASD) are at a heightened risk of obesity and experience limited access to physical activity opportunities (Lawson & Foster, 2016). Studies have shown that obesity can decrease children’s quality of life (Toscano et al., 2018). Additionally, caring for a child with ASD can contribute to a decrease in quality of life for parents. The purpose of this study was to determine the extent to which a specialized swim program for children with ASD, Sensory Enhances Aquatics (SEA), improved child and parent functioning and body composition (BMI).
DESIGN: This study used a crossover design which is useful for determining power calculations with a limited sample size and evaluation of short-term intervention effects (Wyman, Henry, Knoblauch, & Brown, 2015).
METHODS: Researchers recruited a convenience sample of children with ASD ages 4-17 from the SEA distribution list. Children were included if 1) they had an autism spectrum disorder diagnosis, 2) a Social Responsiveness Scale-2 (SRS-2) score indicating probable autism, 3) a BMI > the 85th percentile. Participants were assigned to the immediate intervention or waitlist group. Two weeks before SEA, the research team met with all families to 1) obtain informed consent/assent, 2) collect baseline measures (demographic form, SRS-2, Children’s Health Questionnaire-CHQ, height, weight). Researchers collected measures (CHQ, height, & weight) at two additional time points: 1) when the immediate treatment group completed SEA (week 10), and 2) when the waitlist group completed SEA (week 18). The SEA intervention is fully described in previously published studies (Lawson & Lisk, 2019). Researchers used descriptive statistics to summarize the sample, ANOVA to compare differences between groups and t-tests to explore significant differences. Because this study was exploratory, researchers calculated mean differences and effect sizes of CHQ domain and subscale change scores, height, weight and BMI to better understand changes between groups at each time point.
RESULTS: Our sample of 24 children with ASD was mostly young (75% < age 9), male (83%), and Caucasian (58.3%). At least 25% reported use of medication, and 33% had comorbid diagnoses (e.g., ADHD, ODD, Global Apraxia etc.). ANOVA revealed a significant difference in CHQ psychosocial subscale scores from T2 to T3 (F = 3.35, p = .094) and two CHQ domain scores, family cohesion from T1-T2 (F = 4.80, p = .04) and emotional parent impact from T1-T3 (F = 4.85, p = .04). There were no significant differences in children’s BMI between the immediate treatment (SEA) and waitlist group at any time point (T1 F = .015, p = .9; T2 F = .003, p = 96; T3 F = .031, p = .86). Moderate to large effect sizes existed for behavior, mental health, self-esteem and parent impact-time, but not for height weight or BMI.
CONCLUSIONS: This study showed 8 weeks of twice weekly swimming improved self-esteem and emotional behaviors of children with ASD but did not positively effect body composition. Therapists should include measures of self-esteem and emotional behaviors in addition to physical measures in future physical activity research. This study also informs design and measures for conducting rigorous occupational therapy research.
IMPACT: This proposal is important to occupational therapy practice showing physical activity should be considered as an intervention to improve self-esteem and behavior.
References
Lawson, L.M., & Foster, L. (2016). Sensory patterns, obesity, and physical activity participation of children with autism spectrum disorder. American Journal of Occupational Therapy, 70(5), 7005180070. https://doi.org/10.5014/ajot.2016.021535
Lawson, L. M., & Lisk, C. (2019). Feasibility study of perceived exertion and heart rate of children with ASD during swimming. American Journal of Recreation Therapy, 18(2), 29-37. https://doi.org/01.5055/ajrt.2019.0187
Toscano, C.V., Carvalho, H.M., & Ferreira, J.P. (2018). Exercise effects for children with autism spectrum disorder: Metabolic health, autistic traits, and quality of life. Perceptual and Motor Skills, 125(1), 126–146. https://doi.org/10.1177/0031512517743823
Wyman, P.A., Henry, D., Knoblauch, S., & Brown, C.H. (2015). Designs for testing group-based interventions with limited numbers of social units: The dynamic wait-listed and regression point displacement designs. Prevention Science, 16(7), 956-966. https://doi.org/10.1007/s11121-014-0535-6
