Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 54  |  Issue : 2  |  Page : 83-91

Yoga for children with autism spectrum disorder: A descriptive review


Division of Yoga and Humanities, S-VYASA Yoga University, Bengaluru, Karnataka, India

Date of Submission25-May-2022
Date of Decision22-Jul-2022
Date of Acceptance25-Jul-2022
Date of Web Publication15-Dec-2022

Correspondence Address:
Dr. Balaram Pradhan
SVYASA (Deemed-to-be University, Division of Yoga and Humanities, Prashanthi Kutiram, Vivekananda Road, Kalluballu Post, Jigani, Anekal, Bengaluru-560105, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ym.ym_62_22

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  Abstract 


Autism spectrum disorder (ASD) indicates a multifactorial neurodevelopmental disorder exhibiting distinct core characteristics of lifelong deficits in social communication and interaction along with restricted, repetitive behaviors. This developmental disorder impacts the achievement of developing milestones during childhood. Apart from the core features of autism, children with ASD display a range of behavioral disorders and physiological dysfunctions, creating a unique heterogeneity in their symptomatology. Conventional therapies are adopted to address such issues with specific treatments suited to the individual needs of children with ASD. As a therapeutic modality, yoga is also recognized as an alternative therapy that can help manage various symptoms of autism. A mind-body intervention yoga applies movement, breathing, and relaxation to nurture holistic well-being in children. This review describes the various studies on yoga as an effective intervention for children with ASD in managing the several aspects of autism. They were searched through Google Scholar and PubMed, and a total of 16 empirical studies were identified on yoga intervention on various behavioral and physiological aspects of autism in children. The current literature on the efficacy of yoga on children with ASD is limited. There is a need for further research for evidence-based studies to highlight yoga as a holistic modality in the management of ASD.

Keywords: Autism spectrum disorder, research, yoga


How to cite this article:
Shanker S, Pradhan B. Yoga for children with autism spectrum disorder: A descriptive review. Yoga Mimamsa 2022;54:83-91

How to cite this URL:
Shanker S, Pradhan B. Yoga for children with autism spectrum disorder: A descriptive review. Yoga Mimamsa [serial online] 2022 [cited 2023 Feb 6];54:83-91. Available from: https://www.ym-kdham.in/text.asp?2022/54/2/83/363811




  Introduction Top


Autism spectrum disorder (ASD) is identified as India's most common neurodevelopmental disorder.[1] Children with ASD display specific core deficits in social communication and interaction and restricted, repetitive behaviors.[2]. Such impairments are further exacerbated by concurrent psychiatric, cognitive, and physiological comorbidities, adversely affecting the optimal quality of life.[3] ASD exhibits a marked singularity in the heterogeneity of its maladaptive behavioral symptomology and is one of the most challenging, yet common neurodevelopmental disorders seen in India's developing children.[4] The unique disparity in ASD symptomatology is expressed as a host of deficits in behavioral and physiological functionalities manifesting varying severity across a continuum. These include social skills deficits, problem behaviors, poor motor proficiency, gastrointestinal disorders, sleep disorders, and immune system dysfunctions.[5],[6],[7]

The hindrances in normal childhood development can cause language and social skills deficits, with verbal and nonverbal communication challenges spilling over as impaired social communication and interaction.[8] This developmental disorder can impact the children's perception of the world around them, affecting their learning through daily experiences.[9] Children can often have difficulties understanding and communicating what they hear and struggle to interpret body language, facial expression, vocal tones, gestures, emotional recognition, and maintaining eye contact cascading to an inability to communicate their needs.[10] These can give rise to compensatory externalizing and internalizing problem behaviors.

Consistent research across decades has contributed to better awareness and understanding of ASD with the rise of many interventions formulated specifically to aid and improve the quality of life of children with ASD. The diverse challenges in the daily functionality of children with ASD are conventionally addressed through various psychosocial to educational interventions.[11],[12] Apart from goal-specific conventional therapies, there is a rising interest in managing autism symptoms through complementary therapies. Complementary and Alternative Medicine (CAM) is a group of discrete therapeutic health practices distinct from conventional medicine as complementary adjunct therapies given along with conventional treatments and is most widely used in children with ASD.[13] Yoga as a holistic intervention is increasingly recognized as a complementary therapy for children with ASD for comprehensive management of the core symptoms and other associated challenges in autism.[14],[15] Yoga is now considered a promising CAM therapy showing several positive outcomes in children with ASD.[16],[17] Yoga is a mind-body intervention that applies movement, breathing, and relaxation to nurture holistic well-being in children.[18] The yogic philosophy propounds the “Pancha Kosha” concept as our identification, where yoga works as a mind-body interaction and brings integration of all the koshas for optimal health and well-being.[19] It is regarded as an experiential science (Anubhuti Shastra), an ancient practice with various therapeutic benefits.[15] Yoga for children with ASD is a therapeutic process that aids in reducing and managing multiple autism symptoms and aids in moving toward an improved quality of life and well-being.[20]


  Materials and Methods Top


The keywords included mainly were yoga and ASD, apart from “autism severity,” “behavior,” social skills,” “cognitive skills,” “motor skills,” “sleep disorders,” and “gastrointestinal disorders.” An extensive search was made using search engines such as Google Scholar and PubMed to retrieve 16 empirical studies on yoga intervention on the various aspects of autism in children. All studies, such as pilot, randomized, nonrandomized trials, and case reports, were included in the review. The summary of the studies is shown in [Table 1].
Table 1: Yoga interventional studies on children with autism spectrum disorder

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Yoga intervention studies on children with autism spectrum disorder

Evidence-based studies on yoga for children with ASD are limited. However, yoga interventions for children with ASD have garnered much interest in the last decade. Yoga has shown several promising beneficial effects in mitigating the various features of autism

Yoga for autism symptom severity

Autism severity is considered of the various aspects of autism apart from the core diagnostic symptoms that include deficits in different functional measures. These include adaptive functioning, communication ability, intelligence, cognitive impairments, language acquisition, behavior, psychopathology, and other health conditions.[21] Few studies have demonstrated that yoga can positively impact autism severity in children with ASD. Archoudane et al. stated that yoga had therapeutic effects on children with ASD and reduced the severity in autism symptoms. A block randomized controlled trial was conducted on children with ASD, where the yoga group underwent yoga therapy sessions for two weeks. The parents reported a significant reduction in the autism severity in the yoga group compared to the control group, who followed regular school activities.[22] An earlier study by Sotoodeh et al. reported that yoga practices could have a holistic effect on children with ASD by alleviating autism severity across the various domains of sociability, sensory and cognitive awareness, behavior, and health.[23] Similar findings were suggested in a study that showed yoga aided in decreasing autism-related symptoms across a twelve-week yoga intervention. The children with ASD were given one hour of yoga that included chanting, postures (asanas), pranayama, and relaxation. Results showed an improvement in the various symptoms of autism, leading to a reduction in autism severity in children.[24]

Yoga for cognitive skills deficits

Children with ASD are commonly associated with many cognitive skills deficits due to dysfunctions of the central and peripheral nervous system that manifest as impairments in cognition.[25] As an adjunct mind-body practice, yoga regulates the nervous system and beneficially complements other conventional therapies for children with ASD.[26] A randomized controlled pilot study by Tanksale et al. stated that yoga, along with third-wave cognitive behavioral therapy, was effective in improving executive functioning in children with ASD.[27] Executive functions as a set of cognitive skills can be described as the mental processes that aid in controlling one's behavior, emotions, attention, and cognitive impulses within a specific context extending to assist an individual's adaptation to the environment.[28] Children with ASD were randomized into two groups, where the yoga group underwent six weekly sessions of the combined yoga program. The significant primary outcomes included parent-reported improvements in the children's executive functioning.

Ramanathan et al. supported that yoga can effectively increase auditory reaction time (ART) and visual reaction time (VRT) in children with ASD. Reaction time (RT) as a cognitive test is considered the fundamental contributor to information processing with reference to speed through various central and peripheral pathways, including cognitive, perceptive, and motor processing, bringing about the activation of muscles. RT is considered a part of cognitive functions and involves the time between the onset of a stimulus and the beginning of any response to such stimulus. Yoga practices could shorten ART and VRT for faster information processing, with isometric muscular contractions improving brain speed and central processing ability. An improvement in focus, concentration, and relaxation was observed in children with ASD, positively impacting their problem behaviors.[29]

Yoga for problem behaviors

Most yoga studies conducted have addressed problem behaviors in children with ASD. Problem behaviors are considered one of the most significant challenges associated with children with ASD. Koenig et al. demonstrated that yoga as a classroom program in an inclusive school environment for children with ASD significantly reduced maladaptive behaviors. Maladaptive behaviors were regarded as problem behaviors frequently observed in the classrooms, including irritability, social withdrawal, hyperactivity, temper tantrums, and self-stimulatory behaviors. In this study, the teachers of children with ASD reported a positive impact of yoga on the key behaviors necessary for effective classroom functioning, with a reduction in irritability and other maladaptive behaviors. Children in the yoga group showed an improvement in their behavior compared to the control group, who just followed the daily school routine.[30]

A study by Narasingharao et al. in a special school found that implementing a structured yoga program for children with ASD effectively decreased various problem behaviors such as aggressiveness and self-injurious behavior.[31] Yoga can reduce problem behaviors by eliciting a relaxation response in children with ASD. A relaxation response-based yoga program was conducted as a part of a multimodal intervention for children with ASD between the ages of 3–16 years to treat behavioral issues and core symptoms of autism. The core symptoms included attention, anxiety, atypicality, conduct problems, somatization, and withdrawal. The multimodal program spread across 8 weeks consisted of yoga practices, music, dance, and relaxation with one weekly treatment session. A significant reduction was observed in the behavioral symptoms across the entire cohort participating in the intervention. The latency-aged group (children between 5–12 years) also exhibited positive posttreatment changes across other internalizing and externalizing behavioral outcomes. Children with ASD were receptive to yoga and music that addressed their various sensory needs. The higher response seen in the latency age group was attributed to younger children in their developmental stage, making them more responsive to a combination of yoga and music.[32]

Two single-case studies on the efficacy of yoga for children with ASD demonstrated significant changes in disruptive behaviors with notable improvements in attention, emotional expressivity, self-regulation, and social interaction.[33],[34] Both studies reported a positive change in focus on tasks and the need for lesser prompts on the assigned academic tasks in children.

Yoga for social skills deficits

The social skills deficits commonly observed in children with ASD include a lack of non-verbal and gestural communication, imitation skills, eye contact, empathy, reciprocal conversation, peer interaction, and different speech patterns, affecting their social responsiveness.[35] Such children face difficulties cultivating social relationships and struggle to establish appropriate social communication, emotional responsiveness, and sharing mutual interests. A study conducted on children with ASD over two academic years as eighty weeks school yoga program based on an integrated approach to yoga therapy showed that yoga nurtured imitation skills and gestural communication. Postintervention showed increased receptivity to verbal commands and social communication.[36] Imitation skills are crucial for fostering many social skills in developing children where lack of such skills is highly prevalent in children with ASD leading to social skills deficits.[37]

An exploratory study further suggested that yoga contributed to enhancing social and emotional skills in children with ASD.

A multimodal multimodal yoga program was implemented across 4 weeks, with children participating in two weekly yoga sessions. The multimodal part of the yoga program included kinesthetic touch with partners to alleviate sensory defensiveness, rhythmic gestures during chanting, positive affirmations, mandala artwork, songs, and deep pressure relaxation. These were integrated along with yoga postures and breathing techniques. A thematic analysis identified three key factors in children after the yoga intervention: improved mood and emotional expression, increased empathy towards others, and better teamwork skills. The multimodal yoga program effectively improved various aspects of social skills such as children's emotional expression, recognition of others' emotions, spatial awareness, positive mood, recognition of facial expression, body language, and better social interaction.[38]

Yoga for motor proficiency

One of the significant challenges for children with ASD is the lack of motor proficiency, affecting various gross and fine motor skills deficits, manifesting as difficulties in imitation, eye-hand coordination, postural control, and gait with poor body and fine motor coordination.[39] Rhythmic movements of yoga can improve motor imitation skills, flexibility, posture, and strengthening of muscles in children with ASD. Limited studies are available on the effect of yoga on motor proficiency in children with ASD. Artchoudane et al. proposed that yoga effectively improved hand grip strength in children with ASD.[22] A recent study found that a consistent, structured yoga program in special school environments contributed to developing motor proficiency in children with ASD. The randomized controlled trial involved children with ASD across four special schools with a school group yoga program. Significant changes were noted in the children's gross motor skills and total motor proficiency.[40] A similar study on children with ASD observed that yoga positively affected the motor performance of children with ASD who showed generalized improvements in bilateral coordination compared to the control group of children who participated only in academic activities. Both studies reported no difference in the children's fine motor skills.[41]

Yoga on other physiological parameters in autism spectrum disorder

Children with ASD often exhibit multiple physiological dysfunctions along with other behavioral deficits. These include a range of gastrointestinal disorders, sleep disorders, inflammation, oxidative stress, and immune system abnormalities.[6] Vidyashree et al. suggested that yoga as a noninvasive intervention can effectively bring about parasympathetic dominance in children with ASD who often exhibit a tendency for chronic stress with various autonomic dysfunctions. The study measured the short-term heart rate variability (HRV) of children with ASD, with the yoga group showing a significant increase in time domain parameters of mean RR intervals (interbeat intervals between successive heartbeats), standard deviations of NN intervals, root mean square of successive interval differences. The frequency-domain parameters also showed an increase in high frequency (HF) and a decrease in low frequency (LF) and LF/HF ratio, correlated to sympathovagal balance. A reduction in the mean heart rate was seen in the yoga group. Yoga increased parasympathetic dominance, creating better balance in autonomic functions and promoting a physiological and psychological balance in children with ASD.[42] Yoga also fostered relaxation, significantly decreasing diastolic blood pressure and breath-holding rate in children with ASD. Such physiological changes can cause a decrease in autism severity and behavioral issues with an improvement in social-communicative skills in children with ASD.[43] Gastrointestinal disorders and sleep disorders are highly prevalent in children with ASD compared to children with other developmental disorders and typically developing children.[44],[45] Two studies were identified that showed yoga for children with ASD could bring significant improvements in various gastrointestinal and sleep disorders.[31],[27]


  Discussion Top


This review aims to summarize the yoga interventional studies and their impact on various aspects of autism in children. A total of 16 yoga interventional studies were identified that implemented yoga as an intervention for children with ASD. The increasing prevalence of ASD in developing children has garnered interest in yoga as a holistic and non-invasive therapeutic intervention for children. Yoga is perceived as a holistic movement therapy that teaches children with ASD to quieten their minds, foster focus, and build balance, flexibility, and strength. Interventional studies on yoga have shown effectiveness across different environments, such as schools and therapy centers. It works well for children with ASD with or without the support of parents. Yoga catered to inclusion by incorporating various learning styles with visual, auditory, tactile, and kinesthetic reinforcements providing multiple sensory inputs and meeting the diverse needs of the children. As a systematic approach, yoga practices aid children toward effective self-regulation through its postures, breathing, and relaxation bringing forth mental, emotional, and physical harmony in children with special needs.[20] The probable mechanism showing the effect of yoga is represented in [Figure 1].
Figure 1: Mechanism of effect of yoga on children with ASD. ASD: Autism spectrum disorder

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The current literature on yoga for children with ASD has selected specific aspects of autism. The studies highlighted the holistic mechanism of yoga that was found to have a significant positive far-reaching effect on various other autism-related symptoms. ASD is characterized by heterogeneity in its symptomatology that manifests as a unique disparity in the strengths and needs of children. Given the vast heterogeneity displayed by children with ASD, there is a need for future studies with better methodologies. Children with ASD often find it challenging to follow instructions, appropriately respond and participate in interventions due to various behavioral and physiological issues. They need longer intervention durations, structured schedules, and consistent reinforcements for exhibiting appropriate responses and performance.[20] Few studies have mentioned their adherence to a yoga intervention with a lack of information on children's participation and performance responses. Furthermore, there is less description of the implementation of yoga intervention conducive to children with ASD and limited intervention durations. Many studies have provided insufficient details regarding the basis of randomizing children with ASD into matched groups. Small sample sizes further limited the generalizability of such studies across the autism population. Such challenges and constraints create a need for future studies to implement a more rigorous methodology to improve the acceptability of the therapeutic effects of yoga on various behavioral and physiological aspects of autism.

Nevertheless, there is a growing emergence of yoga as a promising intervention for alleviating various symptoms in children with ASD. Several studies have shown that yoga can be integrated as an adjunct mind-body intervention along with other conventional therapies usually recommended for children with ASD. As a therapeutic process, yoga aided in managing various autism symptoms while fostering a feeling of health and well-being and improving the quality of life in children with ASD.[14]

Yoga as a mind-body intervention has a beneficial impact on brain health and cognition, having a positive cascading effect at the psychological, physiological, and physical levels. The structured movements in yoga with coordinated breathing cause activation of the parasympathetic nervous system, cognitive skills enhancement, relaxation of mind and body, and nurturing holistic well-being.


  Conclusion Top


Yoga can be considered a therapeutic tool, having several beneficial effects on the management of various aspects of autism.[23],[26] Many studies have evaluated the effect of yoga on the multiple aspects of autism, either as a stand-alone intervention or as an adjunct therapy. Yoga appears to have positive implications on children's cognitive skills deficits, problem behaviors, social skills deficits, motor proficiency, and overall autism severity. The awareness of yoga as a holistic intervention is increasingly recognized for addressing the unique heterogeneous needs of children with ASD. However, the lack of extensive literature creates a need for more evidence-based studies to establish its efficacy as an alternative intervention for children with ASD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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