Effect of yoga on children with autism spectrum disorder in special schools

ABSTRACT

Introduction:

Yoga as a holistic mind-body intervention is increasingly evaluated for the management of various autism symptoms in children with autism spectrum disorder (ASD).

Methodology:

Forty-three children with ASD from 4 special schools were randomized into two groups, yoga group: 23 children and control group: 20 children. The yoga group received 12 weeks of yoga intervention in special schools.

Results:

Significant improvement in the yoga group was noted in the overall autism severity (P < 0.001) as reported by the parents in comparison to the control group.

Conclusion:

The findings of the study show that yoga can have a positive impact on the symptomatology of autism.

INTRODUCTION

Autism spectrum disorder (ASD) indicates a group of neurodevelopmental disorders with distinct core deficits in social communication and restricted, repetitive behaviors.[1] Children with ASD often face challenges in the form of various comorbidities affecting typical childhood development with deficits in speech, sensory dysfunctions, problem behaviors, along with other physiological distress. An awareness of an increasing prevalence of ASD in India among the developing children showed various functional challenges needing considerable support with multiple therapies.[2] Diversity in interventions for children creates a need to implement a holistic strategy that can meet their unique needs in day-to-day life. As an alternative therapy, yoga is emerging as one of the holistic therapies increasingly explored for children with ASD.

Yoga integrating body postures and breathing balances the autonomic nervous system bringing forth a sense of well-being with significant mental and physical health benefits.[3] Few evidence-based studies have shown yoga to have a positive impact on problem behaviors in children.[4,5] Yoga can develop social skills such as imitation and communication skills, eye contact, tolerance, and emotional regulation in children with ASD.[6] Different body movements and breathing in yoga regulated the high levels of stress response in children with ASD influencing their mind and body into a state of calmness and relaxation.[7]

Many children with ASD attend special schools where they receive different academic and functional skills according to their specific needs. A structured yoga program can be implemented in special schools with yoga practices conducive to the learning styles of children with ASD.[4] The objective of the current study was to explore the effect of the inclusion of a yoga program in special schools on the severity of autism in children with ASD.

METHODOLOGY

Study design

The study used a randomized control trial design where children from 4 special schools participated in the study (n = 43). Inclusion criteria were children with ASD between the age of 5–15 years and a formal diagnosis of autism. Children with any physical impairments were excluded.

Procedure

The parents of the children completed the Autism Treatment Evaluation Checklist (ATEC). Based on the total ATEC scores taken as the severity measure in autism, the children were randomly assigned to two groups: yoga group (n = 23) and control group (n = 20). Parents provided their approval through written informed consent. The study was approved by the Institutional Ethics Committee (IEC).

Intervention

The children participated in a daily 45-minute yoga session for 12 weeks. The control group did not participate in yoga and continued with other school activities. The intervention consisted of various loosening and dynamic practices, breathing exercises, asanas (postures), pranayama (breathing techniques), relaxation, and chanting.[4,6] Two trained yoga teachers in each special school conducted yoga for children with ASD.

Assessment

The Autism Treatment Evaluation Checklist (ATEC) was completed by the parents of the children pre- and post-the yoga intervention in the special schools. The ATEC consisted of various autism symptoms and was taken as a measure of the autism severity in children with 77 items under four subtests: (i) speech/language/communication, (ii) sociability, (iii) sensory/cognitive awareness, (iv) health/physical/behavior.[8] The internal consistency of ATEC was high (r = 0.94 for the total score). Lower scores indicate less severity in autism.

Statistical analysis

The baseline data were analyzed with independent sample t-tests at the pre-intervention level. A linear mixed-effects model was used for intervention effects on the outcome measures with effects estimate given by the marginal R2 values and statistical significance level set at P < 0.05.

RESULTS

The baseline characteristics of participants showed no significant differences between groups: autism severity (P = 0.96) and age (P = 0.82). There was a significant reduction in the total ATEC scores overtime in the yoga group with a large effect size (t = −3.66, P < 0.001 <0.001, R² = 0.333). The total ATEC scores were driven by a significant improvement in subscale (speech/language/communication), (t = −2.56, P = 0.011, R² = 0.113) and subscale (health/physical/behavior), (t = −1.97, P = 0.049, R² = 0.159).

DISCUSSION

The current study showed a significant reduction in the autism severity as reported by the parents for the yoga group. Our findings on the ATEC scores were comparable to a previous study conducted by Sotoodeh et al.[9] who found that yoga significantly reduced autism severity as reported by the parents across an 8-week intervention. Interestingly, a significant improvement was noted in the ATEC subscale I. Such responses could be attributed to different chanting in the yoga sessions. Children with ASD can imitate sounds like OM and recite a few words when given a daily stimulus of chanting.[6] Rhythmic bee's breath humming also strengthened oral-motor movements. Porter[10] proposed that yoga created effective opportunities for improving verbal and non-verbal communication through various forms of verbal and motor imitation of speech.

Yoga practices can contribute significantly to maintaining optimal health outcomes while improving the quality of life in children with ASD.[9] Regular yoga for children can ameliorate gastrointestinal distress and sleep disorders[4] while reducing hyperactivity and aggression.[5] Teaching yoga to children with ASD catered to inclusion in learning by integrating multisensory learning styles encouraging better responses. They are more receptive to the rhythmic movements of yoga, regulating their stress levels to a more parasympathetic shift. Goldberg[7] proposed that regular yoga practices can lead children with ASD into a state of calmness, resilience, and self-regulation. Yoga can thus favorably impact children with ASD inducing a relaxation response fostering a sense of health and well-being.

Limitations of the study

A longer intervention duration could have shown more significant results considering the sample size limitation and the diverse responses of children with ASD.

CONCLUSION

Yoga in special schools can contribute toward an improvement in the autism severity of children with ASD.

Ethical considerations

This manuscript does not contain clinical studies and patient data. This study includes data collected from the parents of children with autism spectrum disorder in four special schools. However, all the procedures performed in the present study were in accordance with the 1964 Helsinki Declaration and its later amendments. The study was approved by the ethical committee of S-VYASA Yoga University (RES/IEC-SVYASA/126/2018).

Informed consent

Written informed consent was signed by the parents of children participating in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.