By Nikhil Ramburn and Sat Bir Singh Khalsa, Ph.D.
The term autism has gone from a relatively obscure medical diagnosis to a household word. The autism spectrum disorder (ASD) now includes disorders that were previously considered separate such as Asperger’s syndrome and childhood disintegrative disorder. ASD is a neurodevelopmental disorder that impairs a child’s ability to communicate and interact with others. Symptoms vary widely between patients and include restricted repetitive behaviors, interests, and activities. In addition, speech delays are common in children with ASD. Although, the specific causes of ASD have yet to be identified, several risk factors have been identified in the literature research, such as genetics, prenatal and perinatal factors, neuroanatomical abnormalities, and environmental factors. In recent years, the number of children identified with ASD has increased and doctors are better trained to identify ASD even in adulthood. The prevalence of this disorder is global, with approximately 1-3% of all children diagnosed with ASD. Its social impact is devastating.
Treatment options for ASD have increased but most interventions are outcome-driven and remain heavily dependent upon meeting insurance standards, often at the detriment of meeting the patient’s multiple overlapping needs. In addition, conventional pharmacological treatments only address the external symptoms such as irritability, depression, and hyperactivity. Pharmacological interventions show no clear benefit in treating core symptoms and have known adverse effects. The non-medical treatment options for comorbid depression and anxiety in ASD primarily includes cognitive behavioral therapy (CBT) and while studies have described positive effects of this intervention, researchers have also highlighted several limitations. Notably, the gains from CBT may be relatively short-lasting and generalization of CBT to real-life situations appears to be limited. Therefore, holistic therapies that address the varying needs of patients, and facilitate the learning of long-lasting skills such as self-management and social awareness are required.
Yoga and meditation may prove to be one such holistic intervention. Indeed, meditation positively affects core executive functions such as self-control and cognitive flexibility and this can help patients better handle situations of high executive demand. Meditation has been shown to strengthen inter-hemispheric brain connectivity by increasing activation of the Corpus Callosum, a white matter structure which connects the left and right brain hemisphere. Since ASD patients often suffer from sensory integration dysfunction, they could benefit from more efficient interhemispheric information transfer and the resulting increase in integration of complementary experiences. Furthermore, meditation improves breathing patterns and studies showing changes in hormone levels demonstrate the potential of meditation to change physiological parameters and rhythms. Other traditional forms of yogic meditation employ the use of mantras that act as psychophysical modulators of health. Since language, music, and singing share the same functional networks, singing mantra with music may compensate for deficiencies in language acquisition. In addition, chanting of mantra accompanied by mudras or hand gestures facilitates interhemispheric synchronicity, which is set into motion by rhythmic vocal sounds and breathing patterns. These traditional forms of meditation, which have become known in the west through disciplines such as Kundalini Yoga, are easier to adhere to and to monitor.
Apart from the benefits of the breath, mantra, and mudra, yoga also includes body movement and awareness. Physical activity allows children with ASD to learn concepts related to impulse control, the ability to calm the body after activity, and overall self-regulation. In fact, children with ASD often lack coordination and body awareness and yoga movement has been shown to increase vestibular and proprioceptive awareness that can support sustained attention, behavioral regulation, and general body awareness. The repetition and routine of movement sequences such as sun salutations may increase a child’s capacity to carry out motor plans and has the benefit of capitalizing on the patient’s inherent need for structure and repetition. Furthermore, parents who practice alongside their children may also benefit from reduced parenting stress, keeping them from rejecting and becoming over-reactive to their children.
A 2015 review of the research on the efficacy of yoga for patients with ASD by Gwynette et al. reveals that so far only two studies published in peer-reviewed journals have implemented a standardized protocol, assessed clinical outcomes, and utilized either a control group or the subjects as their own control. Nevertheless, these studies together with other published trials suggest that yoga interventions may indeed improve core symptoms of ASD and several case studies support this finding despite inherent weaknesses in statistical power, risk of bias in the experimental design, and inconsistent outcome measures.
One of the studies in the Gwynette et al. review is a 2011 pilot study from the Saint Francis Hospital and Medical Center in Hartford, Connecticut. The researchers looked at the efficacy of an 8-week yoga, dance, and music therapy program using a group of 24 ASD-diagnosed children aged 3-16 years. While the study reported statistically significant improvements for all subjects in psychological and behavioral characteristics, the multimodal nature of the treatment prevents us from knowing how much the yoga component contributed to efficacy.
Another small study in Bengaluru India, applied vigorous warm-ups and loosening practices followed by traditional yoga postures (asana), yogic breathing, and mantra in 12 children with ASD over a period of two academic years. The results confirmed previous reports of qualitative behavior changes including increased tolerance of sitting and adult proximity, and subsequent socialization. Quantitative results showed regularization of aberrant immune activity.
In another study, Koenig et al. compared students undergoing a daily 16-week yoga intervention with students who engaged in their standard morning routine. They found that the intervention group showed a reduction of maladaptive behaviors, including irritability, lethargy, social withdrawal, hyperactivity, and noncompliance. Since this was a manualized yoga curriculum, it may serve as a viable behavioral intervention for school-based therapists. Although the study demonstrates the significant impact of yoga interventions on key classroom behaviors among children with ASD, the lack of randomization and absence of blind raters may have contributed to bias in the study.
As ASD awareness increases and is more commonly diagnosed, application and testing of holistic therapeutic interventions are important, such as yoga, that address the various needs of the patient. Despite the significant limitations in the research in this new field, the potential efficacy of yoga appears promising. It is a potentially cost-effective therapeutic approach that seems to be well received by ASD patients and their parents and so future research of increasing quantity and quality is warranted.