Hey Readers! This blog post is part 3 of my "Yoga for Individuals with Autism" series. If you haven't read part 1, which discussed what Autism is and the benefits of yoga for Autism, go back and read that one first (here is the link). If you haven't read part 2, which discussed what elements should be included in a yoga practice for Autism, go back and check that post out as well (here is the link) after you read part 1.
Now that we are all caught up, let's talk some yoga! In this post I will review what the recommended duration and frequency is for individuals with Autism (IWA) to receive the benefits of yoga. I will also go over some "pearls of wisdom" that I have learned from experience when implementing a yoga practice for Autism.
How Often, and for How Long, Does Yoga Need to Be Practiced to See the Benefits?
Please keep in mind, individuals with Autism Spectrum Disorder (ASD) may proceed through the following stages when beginning a yoga practice: resistance, to passive tolerance, to active participation, and ultimately to enjoyment of the yoga practice. Thus, be patient and consistent. Research strongly suggests that you will see the benefits of yoga if you give it time. Just like learning a new skill for anything (e.g. riding a bike, learning a musical instrument, etc.), it takes time to acclimate to the demands of the novel task. Some benefits from yoga are seen nearly immediately in IWA, while many other benefits are seen after several weeks, or more. The current scientific research (and my own personal experience) shows that the more often a person practices yoga, the quicker, and more likely, that person is to see the benefits (which again, were outlined in Part 1 of this series - link here). Similar to learning how to play a musical instrument, the more you practice, the faster you get better at it. Yoga is no different. If you want to glean the benefits of yoga, you need to be consistent.
In the best possible scenario, the individual would practice yoga five days, or more, per week, if possible! If that is not possible (because we all know that life happens, right?!), then do what you can. Anything is better than nothing when it comes to physical activity and mind-body practices. Maybe you start with one day a week, and try twice a week the following week, and so on.
The length of each yoga class, or session, honestly depends on the individual. Class lengths for IWA typically range from 30 to 75 minutes. Again, keep in mind that your loved one may only participate for 5 or 10 minutes (or less) in the beginning, so you would work up to 30 minutes (or longer). In my experience, a 30 - 45 minute practice is typically the perfect amount of time for an IWA. Younger children with Autism will likely only stay focused for 30 minutes, or less. Older children and adults may be able to remain engaged for 45 minutes, or even longer.
Yoga is considered a life-long practice where the journey is more important than some arbitrary destination. In the scientific research, most yoga programs span from 8 weeks to 10 months. However, these programs only ended so that the researchers could analyze the data and publish their results. In the real-world, a yoga practice should continue on for the length of the person’s life. The techniques and strategies practiced on the mat can, and should, be taken off the mat into daily life.
Finally, the benefits of yoga are much more pronounced when parents, caregivers, therapists, etc. engage in a regular yoga practice as well (with the IWA or on your own). When you practice yoga, in addition to your loved one with Autism, several things happen: 1) you show the IWA that practicing yoga is worth doing. Why would he/she want to practice yoga if you can’t be bothered to do it as well? 2) You glean the same benefits from yoga as your loved one with Autism, including the physical, mental, emotional, and cognitive benefits. 3) You can better learn what poses are hard for your loved one, possible reasons why, and how to better break it down to make it more accessible to your loved one with Autism.
My "Pearls of Wisdom" When Implementing a Yoga Practice for IWA
Here are some tidbits of wisdom gleaned from my own personal experience with teaching yoga to IWA:
1. Try to make the environment nice and calm, with low lights and calming, or no, music. Reduce distractions, if possible, in the environment. Remember, IWA sometimes have disordered sensory processing, so lighting, music, and even your voice can be alarming or calming. I rarely use music (except during Resting pose) when doing yoga with IWA. Pay attention to the nonverbal cues the IWA communicates to you to determine if the sensory environment needs to be changed. In my personal experience, I have found that IWA typically communicate overstimulation by covering their ears, increasing their stereotypical motor movements (e.g. hand flapping), and/or engaging in more vocal stimulation behaviors (e.g. idiosyncratic sounds, echolalia, etc.). If you observe these communicative attempts from your loved one with Autism, try reducing some of the sensory input in the environment (e.g. reducing the lights, providing a quiet break, etc.). Also, try to make sure preferred toys and materials are out of sight. If it is not possible to remove distractions from your practice environment, you will likely have to provide more cueing to keep the IWA focused, engaged, and on the mat. And that is okay if that is the case for you.
2. Use simple and concrete language. IWA often have difficulty with processing auditory information, so keep your cues simple and direct. For example, instead of saying, “go ahead and lie flat on your back on your mat,” you could say, “lie down on your back.” Also, use “breathe in, breathe out” instead of “inhale, exhale,” particularly with younger kiddos. It truly takes time and experience to get better at using simplified instructions in yoga. Sometimes I audio record myself teaching, so I can go back and listen to how I provide my cues during a class. Yes, this can be super uncomfortable to hear yourself on camera, but it is also really helpful to hear yourself teach.
3. Provide increased time to allow the IWA to process information AND to motor plan a response. This is SUPER important. After you give a cue (e.g. "Lift your right leg"), WAIT (at least 5-10 seconds, maybe longer depending on the individual’s processing speed) before you offer help or cue again. I'll be honest, giving wait time can be hard to do, but it is super necessary. Some IWA need a few extra seconds to process language and/or to execute a motor response. One of the goals in yoga is to improve body awareness and motor planning. Thus, it is super important for the IWA to get in/out of each pose as independently as possible. If you are constantly cueing, or helping, the individual, he/she may become dependent on those prompts. And that defeats the purpose of practicing yoga. To help ensure I provide adequate wait time to the individual, I often use one of the following techniques – 1) I take a few slow, deep breaths while waiting (this has the added benefit of increasing my inner calm and peace); 2) I subvocally repeat my cue in my head a few times (this helps me to become more aware of HOW I am cueing during a yoga session); or 3) I count to 10, slowly, in my head. Remember, it is OKAY to have some silent intervals in yoga. In fact, it is essential for there to be moments of quiet during yoga, so the student yogi has an opportunity to experience his/her own sensations and emotions.
4. Use visual picture cards for poses to support language processing. IWA often process language visually, so picture cards really help the individual to understand what you are asking of him/her. I highly recommend the picture cards (see below) from the Grounded Kids Yoga curriculum. I use these cards in my personalized yoga sessions AND in my speech therapy sessions. The drawings are colorful, yet simple, and instructions are on the back of each card that detail how to get into the pose (along with modifications to make the pose easier or more challening). I place the cards for our yoga sequence on the floor in front of the person's yoga mat. Sometimes I place the cards down one at a time, and other times, I place all cards at once, pointing to each pose as we move through the sequence. Keep the sequence of yoga poses consistent for a few sessions (or more, depending on the individual), and then, as tolerance permits, slowly change up a few poses or the order of poses. This will challenge the muscles in new ways but also help the individual to practice cognitive flexibility, adapting, and coping amidst change (which can be hard for IWA). In one session, I typically go through our yoga sequence 2 - 3x (or more depending on the individual). This repetition helps them to build motor memory for the movements in the sequence, allowing them to more deeply explore novel parts of a pose each time we come in, and out of, that pose. And all of that further helps to build body awareness. The sequence of poses totally depends on the student yogi and the teacher.
5. Use of some type of visual schedule to help create predictability, familiarity, and to reduce anxiety. In fact, if you interact with IWA in any capacity, you should use visual schedules, as this is an evidence-based strategy that reduces anxiety in IWA. The visual schedule should list yoga as one of the first tasks, with a preferred task (e.g. iPad, toys, ball, play-doh, snack, etc.) listed after yoga. The preferred task is on the schedule to help motivate the individual to participate in the yoga session. You may even try using “first-then” language (e.g. “first yoga, then ball”), especially if the individual is resistant to participate in the yoga practice. Some options for visual schedules include:
Picture cards (I really like LessonPix, which offers a yearly membership that is relatively inexpensive, where you have access to thousands of picture cards)
A mini dry erase board with the tasks listed in order (see picture below)
A piece of paper with the task names listed in order
An iPad app that creates schedules (I sometimes use Choiceworks app, and a lot of occupational therapists I work with use this app as well).
Review the schedule with the individual 1-2 times BEFORE going through each task to prep the individual for what is to come. Review the schedule 1-2 times AFTER going through each task to help the individual process what he/she just did.
Here is an example of a visual schedule on a mini dry erase board. Help encourage sequencing by having the individual cross out activities as you complete them. Encourage communication by having them say something like, "yoga is all done."
6. Use a Tibetan singing bowl as an audible cue to refocus the student yogi. I recommend gently striking the bowl with the stick a few times until the individual refocuses his/her attention. Depending on the individual, you may even let the individual strike the bowl with the stick. Tibetan singing bowls (see picture below) are very calming to the nervous system. Be careful not to strike it too hard or it may make a loud sound that can be dysregulating to the IWA. You can find knock-off Tibetan singing bowls on Amazon that are relatively inexpensive (about $30 - 40). However, I recommend you purchase a real one, if your finances allow, through websites such as The Om Shoppe.
7. Provide encouragement based on what the individual can do on a given day. The first few sessions may simply involving praising the individual for staying in the room, on the mat, or standing nearby watching you. Or, maybe all you accomplish on the first few sessions is getting the individual to sit cross-legged and take a few breaths. That is fine! Move on and try again the next time. A yoga practice should be a positive experience. Thus, give tons of praise for victories, no matter how small, displayed during a yoga session.
8. You might have to provide some manual manipulations (aka hands-on assist) to help individuals get in/out of a pose. However, these tactile cues need to be faded ASAP, so the individual does not become dependent on these cues. The goal is for the individual to motor plan how to get in, and out, of each pose on his/her own. Additionally, cues (verbal, visual, and/or tactile) might be required to keep a person on the mat and participating in the practice. Typically, these cues can be faded once the individual understands what yoga is all about and increases his/her concentration/focus.
9. Progressively increase the time spent on the mat and in various poses. For example, an IWA may only be able to hold Downward facing dog 1-2 seconds in the beginning of a yoga practice. Or, a child might do best with only 3 poses at the start of a yoga practice, such as sitting and breathing, table with cat and cow, and downward facing dog. One of the tenets of yoga itself is that the practitioner lets go of expectation and judgment. Thus, let go of any preconceived ideas about how a yoga practice should proceed on a given day, and just simply accept what it is.
10. Allow the individual to watch you as you slowly go through some poses. Do not force the IWA to participate motorically, especially during the first few sessions (unless of course, that individual wants to try the poses). Give the person time to process what yoga is all about. Once the individual realizes that the demands you are placing are small and safe, he/she will typically begin to join you.
11. Provide choices of poses, if needed, to the student yogi. This can help the person to feel like he/she has some control and ownership over the practice and might help increase engagement/participation. Providing choices often helps resistant individuals to participate in nonpreferred tasks. For example, you might say, “Would you rather start sitting or standing today?” Or, you might say, “Do you want more movement or more rest in your practice today?” When providing choices, offer options for things that do not matter either way. For example, if you really want to work on building anterior (i.e. front of the body) strength, make sure all of your choices include anterior work (e.g. Down dog, Table, Sphinx, etc.). Providing choices also helps the student yogi learn to listen to what his/her body wants/needs on a given day.
12. Use mantras in different poses. A mantra is a word, or phrase, that is repeated several times (aloud or in the mind). Mantras can be used to focus the mind (e.g. “I am grounded”) or motivate the practitioner (e.g. “Yes, I can”). Mantras are great because they help provide a verbal monologue in the mind of the student that can help keep the individual grounded and committed. Many IWA have difficulty with using language to represent their thoughts and ideas. By providing the IWA a mantra, you are giving him/her the language that directly maps to the sensations or feelings in a given pose. My favorite mantras for IWA include:
“I am safe” (I use this one often during resting pose or any other poses where the student yogi looks nervous or worried)
“I am calm” (I use this mantra when the student yogi is moving too quickly or impulsively)
“I am strong” (I use this one during challenging poses)
“I can do this” (I also use this one during challenging poses)
“I have a right to be here” (I often use this one during our breath work or tune in – see part 2 of this series for more information on these components of the class).
13. Remember – yoga poses do NOT have to look a certain way. While there are some basic alignment cues for joint and muscle safety, most yoga poses are highly variable in how they appear from person-person. Also, keep in mind that while a pose may seem very simple for you to execute motorically speaking, it might be very challenging for an IWA to motor plan into that pose. That being said, you might have to break a pose apart into several steps to get into the pose. For example, moving from table top pose (i.e. hands and knees) to downward facing dog can be tricky for some IWA. So, break it apart clearly and concisely into each step along the way – e.g. “tuck toes, lift knees, hips go up and back, hold.” You might even have to work on each step for some time before cueing the next step. In the Down Dog example, you might need to spend a few sessions working on the concept of “tucking the toes.” Once this is mastered, you can work on lifting the knees. Thus, be aware that you might have to progressively work up to the full pose you are targeting.
14. Use social stories to promote a general schema for what yoga is and what can be expected in a yoga session. Social stories, first developed by Carol Gray (check out her website here for more information), are evidence-based learning tools that support the meaningful exchange of information between IWA and their caregivers/professionals. A Social Story accurately describes a context (e.g. going to the dentist), skill (e.g. chewing food), or concept (e.g. making friends). You can search the internet for pre-made Social Stories. Some Social Stories are available for free and some charge you to download them. You can also make your own Social Story (which is what I typically do) so you can tailor it to fit the needs of your loved one. I attached a Social Story I created about breathing below- you can enjoy this Social Story for free. The images in this story I created are from LessonPix (mentioned in #5).
Summary
There are many many many benefits of practicing yoga regularly for IWA. Consistency is the key when beginning a yoga practice (or any other new activity for that matter). Do not give up hope if your loved one with Autism is not at all interested in yoga the first several times. Keep trying. Be willing to modify your plan for an IWA. As one of my amazing trainers, Sedef Dion, always says, “Who is in front of you today?” This quote means that you need to meet your students where they are on a given day, adding, or removing, challenge as needed. Remember, yoga is about the journey, not the destination. Let go of expectations of what you think should happen and simply accept what is on that day. Praise the efforts, no matter how small, from your loved one with Autism. And keep in mind that just because a pose is easy for you, it does not mean that it will be easy for an IWA. I highly recommend that you seek the help of a registered yoga teacher and/or a registered children’s yoga teacher. You can search for providers in your area on the Yoga Alliance website (click here). You could also search specific yoga programs for certified providers. For example, I am a certified Grounded Kids yoga teacher. If you are interested in Grounded Kids Yoga (which I highly recommend), you can search their website for trained, and certified, providers (click here).
Keep in mind that Autism Spectrum Disorder is indeed a spectrum with widely varying presentations and characteristics. Each IWA is different and unique, as we all are. Thus, some of this information may apply and some may not. Stay attuned to the communication attempts (verbal or nonverbal) from your loved one with Autism. If he/she appears to be dysregulated or feeling pain, stop, or ease off, the pose, and try again some other time. If you have specific questions about Autism itself or yoga for Autism, please consult with your loved one's physician, therapists, or yoga teacher. If you are interested in yoga sessions with me, Jackie, you can book services on my website ("Book Online" from the menu at the top of the page), or you can email me at info@lotusyogisbyjackie.com for more information about my services. A special thank you to my wonderful partner, Matt Allen, for doing the artwork in the sketch at the beginning of the post. Also, please subscribe to my website so you can receive my weekly newsletters (scroll to the bottom of the page where you can submit your email address). This will help keep you "in-the-know" about my latest blog releases and other helpful yoga and wellness information.
Finally, if you are a yoga teacher and you have gleaned some wisdom from implementing yoga for Autism in your own classes/sessions, please comment on this post with what works, or doesn't, for you (you will need to create a login first). This allows all of us readers to learn from each other. Thanks for reading!
~Namaste, Jackie Allen, M.S., M.Ed., CCC-SLP, RYT-200, RCYT