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Autism is the fastest-growing developmental disorder in the United States, with about 1% of the population having received a diagnosis. Although the incidence is increasing, there has, fortunately, been an increase in acceptability, accommodations and specializations for people in all areas of life, including the fitness community.
As such, many gym owners and health and exercise professionals are working to find ways to provide programming and an environment that best meet the needs of people on the autism spectrum. Because autism is diagnosed on a spectrum, however, it can be difficult to accommodate the specific needs of each client, because no two people experience the same symptoms. Even so, there are effective ways to provide training sessions for clients with autism.
This article examines some of the common challenges specific to training clients who have autism, and offers recommendations based on my years of experience working with this very special clientele. I can tell you that the work is not easy, but is never lacking in its rewards.
An estimated 5.4 million American adults (2.2%) live with an autism spectrum disorder, and the prevalence of autism among children in the U.S. increased dramatically from the year 2000 to the year 2016, from 1 in 150 in 2000 to 1 in 54 in 2016, according to the Centers for Disease Control and Prevention. This means that more health- and fitness-focused programs will be needed to accommodate the growing number of people with autism, and providing accommodations to best suit their needs is key. While there are specific ways to facilitate quality training programs for people with autism, to best understand how to meet the needs of this group of people, it is crucial to understand how their brains work.
In addition to often being highly intelligent and observant of certain interests, individuals with autism may exhibit the following behaviors and challenges:
Exercise can be highly effective for addressing anxiety, impulsiveness, low muscle tone and coordination. Physical activity has also been shown to improve cognition. According to Michelle Ploughman, an associate professor of physical medicine and rehabilitation at Memorial University of Newfoundland, Canada, and author of the journal article “Exercise Is Brain Food,” exercise engages the parts of the brain associated with social, physical and intellectual performance, reduces stress hormones and increases the neurotransmitters responsible for accelerating information processing and reducing anxiety.
While exercise is beneficial for people with autism, implementing a program is where most health and exercise professionals struggle. Because people on the spectrum all have different tendencies and needs, you need to exercise your creativity, flexibility and perception to be successful when training this population. The ability to change plans, adapt the program and think on the fly are key. From minute to minute, a person with autism can become overstimulated, irritated or non-compliant for various reasons—some of which they can communicate and some of which they cannot. As a health and exercise professional, you need to be able to read the client, recognize their behaviors, read a change in body language or observe rising irritability to best interpret how a training session should proceed.
Safety—for both you and the client—is paramount. On days when a client has noticeable irritability, frustration or non-compliance, you will need to scale back any overstimulating activity or high-energy movements that will serve to exacerbate a behavior to anger or outbursts. Overstimulating activities may include dancing, boxing, jumping, throwing, swinging or high-intensity interval training (HIIT). It also is essential to avoid any type of equipment that could be dangerous for you or the client should an outburst occur. Dumbbells, kettlebells, plates, heavy medicine balls and bands can become dangerous during a moment of anger or frustration expressed by a client with autism. Activities that are better suited for days like these include yoga, foam rolling, stretching, breathing activities, swimming, weighted vest walking and heavy sled pushing and pulling. These activities are generally more calming and have been shown to have calming effects on people with developmental delays.
Although maintaining flexibility within a session is important, you also need to be consistent in terms of scheduling, the location of your sessions and the order of your clients' workout routines. Scheduling workout sessions for a consistent length of time and in the same low-stimulating environment, while also going through the workout in the same order and pace, helps a person with autism focus, comply and avoid anxiousness.
When Gretchen Adams, the mother of a son with autism spectrum disorder, was first signing him up for personal training and group exercise sessions, she told me her main goals was “to [have him] be connected to a physically healthy lifestyle—to strengthen his core and develop his coordination.” She said he was never interested in working out when she asked him, but if she would ask him to go play with his friends, his motivation changed. To ensure success, aligning the motivations of the person with autism with the goals of fitness and health is essential. Adams also mentioned that having a shorter workout session—fewer than 40 minutes—and utilizing games and “play time” helped her son stay focused and complete his workout sessions.
For another client, Logan Paterson, 21, workout motivations come from celebrities he aspires to look like. His current motivation is Chris Hemsworth. Paterson lifts weights five times a week and does cardio four times a week, following a program similar to the actor he wishes to emulate.
“I like how [exercise] makes me feel, and how I look, and it keeps me healthy,” Paterson has told me. He went on to explain that he mostly likes working out by himself because it helps to calm him down.
A person with autism typically follows a strict schedule and routine; therefore, try to maintain the same training times from week to week with each client’s sessions. The personal-training session should follow a plan that is written out for the client to see and follow. In addition, the reasons for the exercises and reps and sets should be explained. Take the time to communicate regularly with the client, particularly when you first start working together. Ask them about goals and dreams, or even about the celebrities they want to train and look like. This information will give you a clearer idea of how to motivate the client and devise a plan. Because people with autism generally lack social understanding and cues, they are more likely to be honest with you about what they want and why, which should come as a great help to you when designing their programs.
Consider incorporating the following three elements when designing programs for clients with autism: play, breath and core control, and brain-challenging exercises.
When creating a program for a client with autism, keep in mind that autism spectrum disorder is a group of developmental brain disorders. It affects how information processing in the brain occurs by altering how nerve cells collect and use information. Play therapy has been shown to help encourage brain development in people with autism, as it can help improve social and emotional skills, as well as challenge the client to think in different ways. One easy way a trainer can introduce play therapy into a training session is to get on the floor and play a game. In this case, however, the game rules are slightly changed to encourage exercise and physical activity.
The video below shows how a game of Candy Land can be adapted for use with children who have developmental disabilities such as autism and Down Syndrome. The rules were changed to apply exercises and reps to each colored square. The clients had to work their way through the squares to Candy Land by doing each of the designated exercises they landed on.
Research suggests that diaphragmatic breathing can be an effective tool in reducing anxiety and should be used as a therapeutic protocol. Additionally, research has shown that diaphragmatic breathing paired with Dynamic Neuromuscular Stability exercises involving aligning the head, neck, spine and pelvis help improve respiration and core function even further. Adding breathing and core-aligning positions into the client’s warm-up can be a great way to reduce anxiety before a workout session, while also improving core strength.
Finally, you may consider incorporating brain-challenging exercises for your clients, depending on their level of function on the autism spectrum. We know that for developmental disorders such as autism, left-right brain communication and optimal balance between hemispheres is vital. Contralateral exercises, such as crawling, bird dog, alternating supermans, marching in place with arm swings and dead bug variations, are a great way to implement use of both hemispheres of the brain. Incorporating these movements into a dynamic warm-up, applying load with bands or a weighted vest or using them to create a circuit at the end of a workout are creative ways to help enhance a client’s brain health during a workout session.
Training a client on the autism spectrum may seem overwhelming at first. However, with time, effort, enthusiasm and clear communication, these clients will become your hardest-working and most dedicated clients. The functional and life-giving rewards far outweigh the initial preparation and work.
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