Journal of Autism and Developmental Disorders, Vol. 27, No.

2, 1997

Brief Report: The Effects of Exercise on the Self-Stimulatory Behaviors and Positive Responding of Adolescents with Autism
Andrea Rosenthal-Malek1
Monmouth University

Stella Mitchell
New York City Schools

Persons with autism are often characterized by their self-stimulatory behavior such as body rocking, spinning, hand flapping, head-nodding, object-tapping, gazing at lights, and mouthing (Lovaas, Newson, & Hickman, 1987; Sugai & White, 1986). Research literature has shown that these general behaviors interfere with both the performance of positive social behaviors and learning (Bass, 1985; Kern, Koegel, Dyer, Blew, & Fenton, 1982; Sugai & White, 1986). In addition, these negative behaviors often present a special problem for integration into the mainstream (Van Bourgondien & Mesibov, 1989). One promising area of research for decreasing these negative behaviors without decreasing other positive behaviors has been the use of aerobic exercise. Specifically, the use of aerobic exercise with students in various special populations has been shown to reduce aggressive behavior (Allison, Basile, & MacDonald, 1991; Gabler-Halle, Halle, & Chung, 1993; Yell, 1988), unproductive and disruptive behavior (Bachman & Sluyter, 1988; McKimsey & Favell, 1988), stereotyped and self-injurious behavior (Bachman & Fugua, 1983; Baumeister & MacLean, 1984; Morressey, Franzini, & Karen, 1992), and purposeless wandering (Whitaker & Saleem, 1994). In addition, structured aerobic exercise has been shown to improve attention span (McGimsey & Favell, 1988), work performance (Beasley, 1982), and on-task behavior (Powers, Thibadeau, & Rose, 1992).
1Address

all correspondence to Andrea Rosenthal-Malek, Monmouth University, Education Department, West Long Branch, New Jersey 07764-1898.

193
0162-3257/97/0400-0193$12.50A> 1997 Plenum Publishing Corporation

194

Rosenthal-Malek and Mitchell

Although there are fewer studies reported specifically dealing with people with autism, and more specifically dealing with lowering self-stimulatory behaviors in this population, the few studies dealing specifically with the autistic population have yielded results consistent with the results for other populations. For example, aerobic exercise was shown to reduce selfstimulatory behaviors in both children and older adults with autism without a decrease in academic levels and an increase in appropriate responding (Elliot, Dobbin, Rose, & Soper, 1994; Kern, Koegel, & Dunlap, 1984; Powers et al., 1992; Walters & Watters, 1980). Although aerobic exercise has been shown to be effective in lessening the self-stimulatory behaviors of children and older adults with autism, there is a dearth in the literature regarding studies dealing with attempts to lower the self-stimulatory behaviors in adolescents with autism. Therefore, the purpose of this investigation was to assess the effects of aerobic exercise on the self-stimulatory behaviors and academic performance of adolescents with autism. In addition, since a major purpose of training adolescents with autism is to function in the workplace, an additional purpose of this study was to assess the generalization effects of aerobic exercise on task performance in a community-based workshop situation. METHOD Subjects and Settings Five adolescent males diagnosed as autistic participated in this experiment. The subjects' mean age at the beginning of the experiment was 14.88 years (SD = 0.51). Their mean IQs were 42.2 (SD = 4.9). The specific characteristics of each subject are summarized in Table I. All subjects attended the same special education class located in an urban public school as well as participated in a community-based workshop program. These two locations were used as the experimental settings. Preconditions Two preconditions were used for this experiment: an aerobic exercise and an academic precondition. The aerobic exercise precondition was conducted in the gym and consisted of warm-up stretches and mildly strenuous jogging. To be considered mildly strenuous jogging, the boys needed to show increased breathing rate and mildly flushed faces, but show no observable signs of discomfort such as appearing out of breath. The warm-up stretches were merely used to prevent injuries. Each jogging session lasted for 20 minutes. All of the subjects jogged completely independently. However, Michael needed verbal prompts to begin jogging, but once jogging, he also continued

Effects of Exercise on Adolescents with Autism

195

Table I. Subject Characteristics Subject Jason

Age
15.5

IQ
36

Self-stimulatory behaviors Rotation of eyes Finger distortion Body rocking Mouthing objects Shoe fixation Folding back eyelids Masturbating Picking fingers Biting self Waving hands in air Hand flapping Body rocking Hitting students Constantly touching eyeglasses Finger flapping Inappropriate laughter Constant blinking Kissing objects Body rocking Finger flapping Clucking Jabbing students

Michael

15.1

42

Sean

14.1

39

Kenny

14.9

46 48

Craig

14.8

independently. Cones were set up during the jogging session to control the direction and area where the boys could run. Tb control for the possibility that any observed effects were simply due to a change in the usual routine, the aerobic jogging classes were established at the beginning of the school year as part of the routine whereas data collection did not begin for a month. The academic precondition consisted of an assortment of academic subjects conducted in the regularly scheduled classrooms. No attempt was made to change the standard procedures the students normally followed. There were a total of 20 preconditions, 10 academic and 10 exercise; 1 to 5 preconditions were scheduled each week and were arranged in randomized order. Each precondition was immediately followed by either the academic or the community-based workshop condition. An assessment of self-stimulatory behaviors as well as academic responding and work performance was conducted.

Dependent Wiriables
The dependent variables were (a) number of elicited self-stimulatory behaviors, (b) number of correct academic responding, and (c) work com-

196

Rosentbal-Malek and Mitchell

pleted during the workshop condition. Specifically, self-stimulation was measured by the number of times a student elicited individualized selfstimulatory behaviors as defined in Table I. Each student was randomly observed for 5 seconds, then a second student was observed, then a third, and so on until all 5 boys were observed 10 times for a total of 50 seconds in each condition. The students received 1 point every time they elicited a self-stimulatory behavior as individually defined in Table I. The total number of points over the 10 sessions were added together to obtain an overall score for each condition for each student. The "correct academic responding" score was obtained by tallying the correct responses for the 10 questions asked of each subject during each academic condition. The "tasks completed" score was obtained by tallying the number of tasks correctly completed during the hands-on workshop condition. Responses in all conditions were tallied individually for each boy.

Procedure The boys participated as a group in both the academic and workshop conditions. Both conditions were conducted by the regular teachers with the assistance of a paraprofessional. Upon completion of both the preconditions, the boys were brought to either the regular classroom or the community-based workshop. During both of these conditions, the teacher conducted the sessions as usual but made no attempt to control the boys' self-stimulatory behaviors. The academic sessions consisted of teacher-directed review lessons in coin values. The format of the lesson consisted of the teacher handing out a worksheet of 10 problems. Each problem was discussed by asking individual subjects to verbally name the coin value. The students were questioned in a random sequence and all responded verbally except for Michael. When Michael responded, he independently utilized a "facilitated" board where the various com values were listed. He merely pointed to the correct answer without any teacher assistance. Correct responses were followed by a verbal reinforcer and were tallied by a second observer. The general format of the hands-on community workshop sessions were individual in nature. Each boy walked to a table where individualized work was waiting for him. The individual jobs, which were part of each boy's normal routine, consisted of the following: Jason placed eggs into an egg carton; Michael twisted off plastic tie clips and placed them into a bin; Sean assembled pens; and Kenny and Craig counted SO beads and placed them into a box. The teacher ensured that the subjects remained in their seats but did not control the amount of work the boys completed.

Effects of Exercise on Adolescents with Autism

197

Fig. 1. Number of self-stimulatory behaviors elicited during the academic condition.

Reliability
Reliability measures were obtained for the self-stimulatory behaviors during both the academic and workshop conditions. Two observers independently recorded occurrences of all self-stimulatory behaviors in both conditions. The average percentage agreement for recording self-stimulatory behaviors across the 20 intervals for the five students in both conditions were 96% (range: 66-100%). RESULTS Results were calculated separately for each dependent variable. Figure 1 and Figure 2 describe the results of the first variable, the amount of self-stimulatory behaviors elicited during the academic and the communityworkshop setting, respectively, for each boy for each session. The graphs indicate that in every instance in both conditions, the boys showed lower

198

Rosenthal-Malek and Mitchell

Fig. 2. Number of self-stimulatory behaviors elicited during the workshop condition. levels of self-stimulatory behaviors after the aerobic exercise precondition versus the academic precondition. It should be noted that in general, all subjects' level of self-stimulatory behaviors were generally higher during the academic condition over the workshop condition regardless of the precondition. To assess whether a statistically significant difference existed between the effects of the exercise precondition and the academic precondition for the occurrence of self-stimulatory behaviors, a t test for paired values (twotailed) was employed for both conditions. The t tests revealed a statistically significant difference between effects of the two preconditions for both the academic and the workshop conditions, t(4) = 4.26, p < .01, and t(4) = 1.46, p < .001, respectively. It also appeared important to determine if decreases were specific to self-stimulatory behavior, or if some sort of fatigue effect was occurring and other positive behaviors would also decrease. Therefore, data regarding the second and third variables, correct academic responding and tasks completed were also collected.

Effects of Exercise on Adolescents with Autism

199

With regards to academic responding, the subjects' total number of correct responses were greater after the exercise precondition than after the academic precondition (M = 33.60, SD = 16.15; M = 29.60, SD = 15.57, respectively). In fact, the t test for paired values (two-tailed) revealed a significant difference in the two sessions and showed that after aerobic exercise, the subjects' correct responding increased significantly, t(4) = 2.83, p < .05. With regards to the number of tasks completed during the workshop condition, the boys completed a greater number of task after the exercise precondition than after the academic precondition (M = 24.20, SD = 6.42; M = 21.80, SD = 6.98, respectively). Again, the t test for paired values (two-tailed) revealed a significant difference in the two sessions and indicated that after aerobic exercise, the subjects' number of completed tasks increased significantly, t(4) = 4.71, p < .01.

DISCUSSION To summarize, the results of the data indicate that (a) there is a significant decrease in self-stimulatory behavior following the physical exercise precondition as compared to the self-stimulatory behaviors following the regular academic precondition, (b) the level of correct responding; significantly increased following the aerobic exercise precondition as compared to the academic precondition, and (c) the number of tasks completed during the community-based workshop situation significantly increased following the aerobic exercise as compared to the academic precondition. The findings of the investigation confirm Watters and Watters (1980), Kern et al. (1984), Powers et al. (1992), and Elliot et al's (1994) studies regarding the effects of exercise on the reduction of self-stimulatory behaviors of persons with autism, thus expanding their results to adolescents with autism. Further, although researchers have shown that using aerobic exercise reduces the level of self-stimulatory behavior in persons with autism, a major concern regarding exercise has been the issue of the fatigue effect. In fact, this study again confirms Watters and Watters (1980) and Kern et al.'s (1982) observations that mildly strenuous aerobic exercise (jogging) decreases the self-stimulatory behavior of persons with autism while increasing the level of academic performance. In addition, this study showed an increase in work-related performance, confirming Elliot et al.'s (1994) study. Thus, while aerobic exercise directly decreases the self-stimulatory behaviors of persons with autism, it does not appear to lower other positive behaviors in this population.

200

Rosenthal-Malek and Mitchell

Another benefit of aerobic exercise, besides the obvious health benefits, is that unlike the use of behavior management techniques that are implemented during the training sessions, the exercise intervention takes place before the training sessions. Thus, exercise has the advantage of not interrupting the classroom teaching. In addition, since the exercise procedure is relatively easy to administer, the teacher does not need to be as extensively trained as the teacher who uses sophisticated behavior management techniques. An additional issue involves the amount of time and the level of intensity that is needed to produce these results. A number of researchers (e.g., Kern et al., 1984) have studied the differential effects of level of intensity and length of aerobic exercise sessions on self-stimulatory behaviors, and in fact found differing effects depending on both these variables. Watters and Watters (1980), Kern et al. (1984) as well as this study all used mildly strenuous jogging exercise for a period ranging from 8 to 20 minutes, whereas Elliot et al. (1994) used strenuous aerobic exercise. It is plausible that the exact duration of the exercise as well as the level of intensity may be important variables for the level of improvement. To find the most profitable aerobic exercise program, further research is warranted. Another issue is the durability of the behavior change. Unfortunately, little evidence is available regarding long-term effects of aerobic exercise on maladaptive behaviors. Those studies which did look at duration of effects found the greatest degree of change immediately following the exercise (Gabler-Halle et al., 1993). In fact, Jansma and Combs (1987) found that within 2 weeks after exercise, maladaptive behaviors returned to original levels for adults with developmental disabilities. No other study has looked at the long-term effects of aerobic exercise on students with autism (Gabler-Halle et al., 1993). In addition, in all cases the subjects elicited more self-stimulatory behaviors regardless of the precondition during the academic setting rather than the community-based setting. The second author, who was familiar with the students also noted this finding anecdotally, claiming that this appears to be the case on a regular basis. One possible explanation for these results is that the work-related sessions may be inherently less challenging or stress-inducing than the academic sessions since the former require no verbal or social interaction. Thus, this decreased level of stress may indirectly decrease self-stimulatory behaviors during the workshop sessions. Finally, with regard to the applicability of these findings to the classroom, although many programs for persons with autism include minor levels of physical exercise, few teachers include systematic physical exercise of the amount and type of this study. In light of the results of this and other applied studies, the systematic programming of aerobic activities into

Effects of Exercise on Adolescents with Autism

201

the student's day may be an easy, cost-effective way to help improve the student's positive functioning in the classroom.

REFERENCES
Allison, D. B., Basile, V C, & MacDonald, R. B. (1991). Brief report: Comparative effects of antecedent exercise and lorazepam on the aggressive behavior of an autistic man. Journal of Autism and Developmental Disorders, 21, 89-94. Bachman, J. E., & Fugua, R. W (1983). Management of inappropriate behaviors of trainable mentally impaired students using antecedent exercise. Journal of Applied Behavior Analysis, 16, 477-484. Bachman, J. E., & Sluyter, D. (1988). Reducing inappropriate behaviors of developmentally disabled adults using antecedent aerobic dance exercises. Research in Developmental Disabilities, 9, 73-83. Bass, C. K. (1985). Running can modify classroom behavior. Journal of Learning Disabilities, 18, 160-161. Baumeister, A., & MacLean, W (1984). Deceleration of self-injurious and stereotypic responding by exercise. Applied Research in Mental Retardation, 5, 385-393. Beasley, C. R. (1982). Effects of a jogging program on cardiovascular fitness and work performance of mentally retarded adults. American Journal of Mental Deficiency, 86, 609-613. Elliot, Jr., R. O., Dobbin, A. R., Rose, G. D., & Soper, H. V (1994). Vigorous, aerobic exercise versus general motor training activities: Effects on maladaptive and stereotypic behaviors of adults with both autism and mental retardation. Journal of Autism and Developmental Disorders, 24, 565-576. Gabler-Halle, D., Halle, J. W., & Chung, Y. B. (1993). The effects of aerobic exercise on psychological and behavioral variables of individuals with developmental disabilities: A critical review. Research in Developmental Disabilities, 14, 359-386. Jansma, P, & Combs, C. S. (1987). The effects of fitness training and reinforcement on maladaptive behaviors of institutionalized adults classified as mentally retarded/emotionally disturbed. Education and Training of the Mentally Retarded, 22, 268-279. Kern, L., Koegel, R. L., & Dunlap, G. (1984). The influence of vigorous versus mild exercise on autistic stereotyped behaviors. Journal of Autism and Developmental Disorders, 14, 5767. Kern, L., Koegel, R. L., Dyer, K., Blew, P A., & Fenton, L. R. (1982). The effects of physical exercise on self-stimulation and appropriate responding in autistic children. Journal of Autism and Developmental Disorders, 12, 399-419. Lovaas, L, Newsom, C., & Hickman, C. (1987). Self-stimulatory behavior and perceptual reinforcement. Journal of Applied Behavior Analysis, 20, 45-68. McKimsey, J. F., & Favell, J. E. (1988). The effects of increased physical exercise on disruptive behavior in retarded persons. Journal of Autism and Developmental Disorder, 18, 167-179. Morressey, P. A., Franzini, L. R., & Karen, R. L. (1992). The salutary effects of light calisthenics and relaxation training on self-stimulation in the developmentally disabled. Behavioral Residential Treatment, 7, 373-389. Powers, S., Thibadeau, S., & Rose, K. (1992). Antecedent exercise and its effects on selfstimulation. Behavioral Residential Treatment, 7, 15-22. Sugai, G., & White, W. J. (1986). Effects of using object self-stimulation as a reinforcer on the prevocational work rates of an autistic child. Journal of Autism and Developmental Disorders, 16, 459-471. Van Bourgondien, M., & Mesibov, G. (1989). Diagnosis and treatment of adolescents and adults with autism. In G. Dawson (Ed.), Autism: Nature, diagnosis, and treatment (pp. 367-385). New York: Guilford.

202

Rosenthal-Malek and Mitchell

Watters, A. M., & Watters, W E. (1980). Decreasing self-stimulatory behavior with physical exercise in a group of autistic boys. Journal of Autism and Developmental Disorders, 10, 379-387. Whitaker, S., & Saleem, A. (1994). The effect of non-contingent exercise on purposeless wandering and self-injury in a man with a profound learning difficulty. Behavioral and Cognitive Psychotherapy, 22, 99-102. Yell, M. L. (1988). The effects of jogging on the rates of selected target behaviors of behaviorally disordered students. Behavioral Disorders, 13, 273-279.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.