Parent Perception of the Effect of Integrative Movement Therapy on Social Participation in Children with an Autism Spectrum Disorder

The purpose of this descriptive study was to examine parent perspectives of the effect of Integrative Movement Therapy (IMT), a yoga-based therapy, on social interaction in school age children with an autism spectrum disorder (ASD). A survey was completed by 7 parents of children ages 6-12 diagnosed with an ASD who participated in IMT for an average of once a week for at least 3 months. Data collection included demographic information, history of participation in IMT, social skills, and parent perceived outcomes. Four areas of social development were addressed including (1) Maintaining Interactions (2) Responding to Initiations, (3) Initiating Interaction, and (4) Affective Understanding/ Perspective Taking. Parents retrospectively rated their child’s social skills before and after participation in IMT. A two-tailed paired t-test for all social skills questions combined suggested that participation in IMT had a significant positive effect on social skills of the children in this study. Other areas of behavior reported to be affected by participation in IMT included increased ability to self-calm, increased body awareness, and ability to maintain appropriate personal space, and ability to modify self stimulating behavior. One must take into consideration the small sample size (n = 7) when attempting to generalize these findings to a larger population. IMT AND CHILDREN WITH AN ASD 4 Children with autism have difficulty initiating social interactions and often exhibit repetitive motor behavior (Loftin, Odom, & Lantz, 2008), leading some to consider social dysfunction as the most defining characteristic of autism spectrum disorders (ASD) (Rogers, 2000). Promoting social participation is a vital part of occupational therapy intervention (Hilton, 2010). According to the American Occupational Therapy Association (AOTA) (2008), “the defining contribution of occupational therapy is the application of core values, knowledge, and skills to assist clients to engage in every day activities or occupations that they want and need to do. “ (p. 626). As a child gains social skills, he or she can participate in meaningful occupations of childhood. Through social interactions, children can achieve specific developmental milestones and occupational goals. Thus, poor social skills may limit individuals in all aspects of their lives as they mature (Hilton, 2010). Therefore improving social function is one of the most important goals of intervention outcomes for professionals working with children with an ASD (Rogers, 2000). The ability to engage in effective social interactions involves the integration of verbal and nonverbal components of language and communication (Audet, 2010). The verbal aspects include both expressive and receptive language (Audet, 2010). The nonverbal aspects include, but are not limited to, eye-gaze, gestures and facial expressions (Audet, 2010). Audet identifies the four fundamental aspects of communication as being receptive language, comprehension of nonlanguage aspects of communication, use of nonlanguage aspects of communication, and development of internalized language (Audet, 2010). IMT AND CHILDREN WITH AN ASD 5 Socialization and social interaction are linked to language and communication (Audet, 2010). In several studies, social initiation and social interaction are used as dependent variable measures to examine social ability in children with autism (Rogers, 2000). Social behaviors such as proximity to other children, time spent looking at peers during play, and time engaged socially have also been used to measure social communication abilities (Rogers, 2000). Children with an ASD have been found to be responsive to a wide variety of interventions aimed at increasing their social engagement (Rogers, 2000). Such interventions include those utilizing peer-mediated and adult administered interventions such as modeling, prompting, sensory based, developmental, and cognitive-behaviorally based methods (Rogers, 2000). A less studied intervention is that of yoga-based therapy. Yoga-based therapy is a promising approach for children with an ASD. Yoga helps children with autism achieve a calm state internally, rather than relying on an external source for calming. One specific type of yoga-based therapy is Integrative Movement Therapy (IMT). IMT encourages increased body awareness and thus provides a method for a child to explore their ability to have control over their body (Kenny, 2002). The relative safety of yoga allows children to explore their bodies and gain a sense of physical self-confidence (Kenny, 2002). According to Kenny (2002), increasing body awareness is crucial to developing social skills. Increased proprioceptive and tactile awareness, through yoga, can ultimately increase social skills by helping the children to recognize and respect appropriate personal spatial boundaries (Kenny, 2002). Specific improvements in social communication as a result of IMT may include verbal IMT AND CHILDREN WITH AN ASD 6 identification of poses from picture cards and the initiation of and engagement in social interactive play routines involving turn taking and direct eye contact (Kenny, 2002). Background and Significance Autism spectrum disorders. Autism is a developmental disorder that originates prior to birth or early in infancy and is defined on the basis of observed or described behaviors (Lord & Risi, 2000). The term autism spectrum disorder is used to refer to a wide spectrum of neurodevelopmental disorders characterized by “the presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests. ” (APA, 2000, p. 70). Impairment in reciprocal social interaction is marked by difficulty with the use of nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (APA, 2000). Failure to develop age appropriate peer relationships as well as lack of spontaneous seeking to share enjoyment, interests, or achievements with other people are also indicators of impaired development in social interaction (APA, 2000). Behaviors such as preferring solitary activities or not actively participating in social play games may be present (APA, 2000). Impairment in communication involves both verbal and nonverbal skills. Such impairments are marked by a delay in or lack of the development of spoken language, impairment in the ability to initiate or sustain a conversation with others, stereotyped or repetitive use of language, and lack of developmentally appropriate social imitative or make-believe play (APA, 2000). When speech does develop in children with an ASD, the pitch, intonation, rate, rhythm, or stress maybe abnormal (APA, 2000). Language comprehension also is often delayed (APA, 2000). IMT AND CHILDREN WITH AN ASD 7 Individuals with an ASD also “have restricted, repetitive, and stereotyped patterns of behavior, interests and activities” (APA, 2000, p. 71). According to the diagnostic criteria for autism, such behaviors include one of the following “a) abnormal preoccupation with one or more patterns of interest, b) inflexible adherence to specific routines or rituals, c) stereotyped and repetitive motor mannerisms, or d) persistent preoccupation with parts of objects” (APA, 2000, p. 75). Associated features often present with an ASD include a diagnosis of mental retardation ranging from mild to severe as well as a range of behavioral symptoms (APA, 2000). Such behavioral symptoms include odd responses to sensory stimuli, hyperactivity, short attention span, aggressiveness, impulsivity, and self-injurious behavior (APA, 2000). Abnormalities of mood or affect including an absence of emotional reactions, or giggling or weeping for no apparent reason may be present (APA, 2000). In addition, there may be a lack of fear in response to real dangers, and excessive fear in response to harmless objects (APA, 2000). The number of children diagnosed with an ASD has increased in the past 10 years (Case-Smith & Arbesman, 2008). According to the most current Centers for Disease Control and Prevention (CDC) data, approximately 1 in 110 children in the U.S. are diagnosed as having an ASD. The overall identified prevalence increased 60% among males and 48% among females between 2002 and 2006 (CDC, 2010). Children with an ASD have a continuum of occupational and performance problems that interfere with their ability to engage in school, home, and community activities (Case-Smith & Arbesman, 2008). Due to the increase in children diagnosed with an ASD, a need for IMT AND CHILDREN WITH AN ASD 8 services and programs that facilitate participation in everyday activities, such as social interaction and communication, are gaining importance. Occupational therapy Occupational therapy and ASD. The Occupational Therapy Practice Framework, 2 nd Edition: Framework-II (AOTA, 2008) identifies the role of occupational therapy as “promoting health and participation through engagement in occupation” (p. 625). Occupational therapists evaluate and provide intervention for individuals with an ASD in order to enable the individual to engage in desired occupations or activities that support health and participation in the home, school, and community environments (AOTA, 2008; Watling, Tomchek, & LaVesser, 2005). “For an individual with an ASD, the domain of occupational therapy services is defined according to that individual’s goals and priorities for participation” (Watling et al., 2005, p. 680). Some examples of such priorities include self-care, education, leisure and play, social participation, and work (Watling et al., 2005). Occupational therapy and social participation. One of the occupations addressed by occupational therapy practitioners is social participation. The Framework-II (AOTA, 2008) defines social participation as “organized patterns of behavior that are characteristic and expected o