Yoga for Individuals with Autism - What Should Be Included In a Yoga Practice?

Hey Readers! This blog post is part 2 of my "Yoga for Individuals with Autism" series. Part 1 discussed what Autism is and the benefits of yoga for individuals with Autism (IWA), based on current scientific research. If you have not read that blog post yet, I recommend that you read that post before delving any deeper into this article (here is the link). In this blog post, I will provide an overview of what a typical yoga session should include for IWA. Stay tuned for part 3 of this series that will discuss the recommended duration and frequency and many "tricks of the trade" when implementing a yoga practice for IWA. The information in these blog posts are appropriate for parents/caregivers of Autism, therapists who work with Autism, individuals with Autism, coaches, classroom teachers, special needs yoga teachers, or anyone else who finds this topic interesting. Get comfy and settled, as this article is a little lengthy, BUT, all of this information is super important.

Similar to a typical yoga class, yoga for autism should include (in this order): breathing techniques, tuning in with breath and voice, warming postures, more challenging yoga postures and physical movement, cool down postures, and rest/relaxation. Let's chat about each one of these in more detail.

Breathing techniques

The value of breath work cannot be overstated. Breath work is so, so, so important, especially for those with Autism. Never skip breath work! IWA often present with shallow, rapid breathing. This type of breathing increases stress, anxiety, and fear because rapid, shallow breathing triggers the sympathetic nervous system (i.e. your "fight, flight, or freeze" response). As discussed in part 1 of this series, IWA often have increased activity in their sympathetic nervous system (SNS) potentially causing them to chronically feel stressed, anxious or scared. Obviously humans need the SNS to help them escape real danger. But, chronic activation of the SNS is not healthy for the human body or mind due to the physiological effects of SNS activation (e.g. increased cortisol release; elevated blood pressure; etc.). Breathing practices help to reestablish slower, deeper breathing through increased activation of the diaphragm muscle. Slow, deep breathing triggers the parasympathetic nervous system (i.e. your "rest and digest" response), which results in decreased anxiety, stress, and fear and increased feelings of safety and calmness. In the beginning, I recommend trying simple breath awareness (BAW), extended exhalation (EE), and/or belly breathing (BB). You do not need to do all of these techniques in each yoga session. I always do BAW and one other breathing strategy listed below.

Breath awareness (BAW). BAW simply means noticing, experiencing, and feeling your breath, without trying to purposefully change it. I usually have students sit in Sukhasana (aka criss cross easy pose; criss cross applesauce) with eyes closed (if that feels safe to the individual), and we just sit and breathe for a few seconds (or longer, if attention allows). I cue them by saying something like, "notice your breath. Follow it in. Follow it out."

Extended exhalation (EE). EE means making the exhale longer than the inhale, which can be very calming for the body and mind. I recommend using tools such as pinwheels, bubbles, or feathers to help the individual experience his/her exhale with immediate feedback from the tool. This also helps IWA to learn the difference between "breathing in" and "breathing out." When teaching inhalation, I use a cue such as "breathe in like you are smelling a yummy cake, pretty flower, etc."

Belly breathing (BB). BB means using the diaphragm muscle with a greater range of motion (ROM) than typically used for that person. I typically do 5 rounds of belly breathing. Once this become easy for the yogi with Autism, I add another set, or two, of 5 breath cycles. In my experience, BB is often very challenging for IWA, but that is not a reason to skip practicing it. The diaphragm muscle CAN be trained to move with greater range of motion. Just like everything in yoga, you have to keep at it consistently. There are three ways I practice belly breathing with IWA (I usually try one, or two, of these examples):

1) Hands on the belly (either seated or lying on back), feeling the belly rise/get bigger with the breath in and feeling the belly sink or get smaller with the breath out (see picture below - seated version).

2) Lying prone on a yoga ball (see picture below), where the ball gives tactile feedback to the person each time the belly moves in and out. Yoga balls come in different sizes with a variety of different diameters. Try to use a yoga ball appropriate for the size of the individual. Encourage the individual to hold still so they can focus their attention primarily on their breath. You might have to help steady the individual on the ball.

3) Touch each fingertip on one hand to the same fingertip on the opposite hand, for all fingers. Move fingers outward to represent the inhale and inward to represent the exhale.

Inhalation.

Exhalation.

Tuning In

The tuning in section of yoga helps to focus and ready the mind for the rest of the class. I like tune ins that require the use of the voice, especially since this is one of the main areas that is difficult for IWA. Many IWA have difficulty coordinating their breath flow with the muscles that produce speech. Tuning in with a mantra or chant helps to reestablish balance among airflow and voice production. I recommend using one of the following tune ins:

"I am ready." This mantra is from the Grounded Kids Yoga curriculum, and it is one of my absolute favorites for IWA who have more verbal skills. This tune in uses both the voice AND the fingers. Touch the index finger to the thumb on each hand and say, "I am ready." Then, touch the middle finger to the thumb on each hand and say, "I am steady." Next, touch the ring finger to the thumb on each hand and say, "I am clear." Last, touch the pinky finger to the thumb on each hand and say, "I am here." I usually repeat this several times. You could play with saying it loudly, softly, and in the mind to practice vocal intensity control and concentration.

"Sa ta na ma." This mantra is also used in the Grounded Kids Yoga curriculum, and it is derived from "Sat nam" (meaning "true identify" or "true name") in the Kundalini yoga lineage. This tune in is one of my favorites for IWA who have less verbal skills. This tune in uses both the voice AND the fingers. Touch the index finger to the thumb on each hand and say, "Sa." Then, touch the middle finger to the thumb on each hand and say, "Ta." Next, touch the ring finger to the thumb on each hand and say, "Na." Last, touch the pinky finger to the thumb on each hand and say, "Ma." I usually repeat this several times. You could play with saying it loudly, softly, and in the mind to practice vocal intensity control and concentration.

Warming Postures

Warming postures are gentle movements that help to prepare the body for more challenging movement later in the practice. My favorite warming postures for IWA include (I typically do all of the poses listed below for my clients with Autism):

Seated twist. From Sukhasana, place your right hand on your lower, right ribs and your left hand on your lower, left ribs. Breathe in. Then, twist side to side, exhaling to twist, inhaling to come back to center. Repeat this a few times. Keeping the hands on the ribs gives immediate tactile feedback to the individual. Twists help to build balanced strength in the core muscles.

Seated side bend. From Sukhasana, place one hand on the ground beside the same side legs. Inhale to press into that hand and reach the other arm up overhead. Exhale to side bend to the other side. Switch sides. Repeat a few times. Side bends help to increase flexibility on one side of the core while simultaneously building strength on the opposite side of the core.

Cat-Cow. This is a very common yoga warm-up for most yoga classes (autism or not). From tabletop position (i.e. hands and knees), breathe in as you drop the belly, lift your seat, and look up at the sky (I cue with "eyes to the sky"). Breathe out as your round through the spine, bring chin to chest, tuck the tail, and look at your thighs (I cue with "eyes to the thighs"). Repeat several times, and then rest in child's pose. Cat-cow helps to build core strength and mobility.

Child's pose. This is also super common in all yoga classes. Child's pose (aka "Balasana") is a gentle pose that most IWA love. Child's pose is a great opportunity to take a break with reduced sensory input (since the head is downwards, facing the mat). It also stretches parts of the hips and low back, helping to further warm the body for more physically challenging postures.

More Challenging Physical Postures

Pretty much any of the traditional yoga postures can be used with IWA. For some IWA, these postures may be very challenging in the beginning. That is okay. Allow the individual to express the pose however he/she needs to (as long as the individual is safe from injury). There are several poses listed below; however, I would not recommend doing all of these poses each and every yoga session, and definitely not in the beginning of a yoga journey. Rather, I would pick 1-3 poses to focus on for a few sessions, and then slowly add one more pose at a time, based on how the individual responds. My favorites, from a motor planning and strength-building perspective, are (again choose 1 - 3 in the beginning):

Spinal balance (aka bird dog; balancing table pose). From table top, extend one leg straight back behind you and extend the opposite arm in front of you. Hold. Then, switch sides. This is excellent for building core strength and increasing communication between the left and right hemispheres of the brain.

Downward facing dog. From table top, tuck the toes under, lift the knees, and press the hips up and back. Work on holding this posture. In the beginning, the individual may only be able to hold this pose for 1 second. That is okay! Incrementally work your way up to holding this posture for several seconds to one minute. This posture helps to build strength in the front of the body and helps to build flexibility in the back of the body.

3-legged Dog. From downward facing dog, lift one leg. Put that leg down and switch sides. Repeat PRN (i.e. as-needed). This pose helps to build strength in the glute muscles of the lifted leg in addition to building strength in the front of the body.

Forward fold. From downward dog, exhale and hop or step your feet to your hands, or from standing position, exhale and hinge from the hips and bring your hands to the earth (you can bend your knees as much as you need to in order to touch the ground). This posture helps to build flexibility in the back of the legs.

Half lift. From forward fold, inhale and lift your upper body halfway. I usually cue by saying, "breathe in, hold your knees." This pose helps to build strength in the upper body (front and back).

Tall mountain. This one is pretty simple. From standing, breathe in and reach your arms up overhead. I sometimes cue by saying, "reach for the sky." This pose gives a good stretch to the core and works on stability in the legs and feet.

Mountain. This one is also pretty simple. Standing posture with hands together at the heart center or arms alongside the body. This pose helps to build stability in the legs and feet.

Warrior II. From standing position, step the feet wider than the hips, facing the long edge of the mat. Pick up your toes of one foot, coming on to the heel of that foot. Pivot on that foot's heel until the toes are parallel with the long edge of the mat. Bend the knee of the foot you just moved. Extend the arms out from the shoulder like the letter "T." Return that foot back to its starting position. Switch sides. This pose helps to build strength in the core, shoulders, hips, and legs. This pose also helps to build confidence and focus. This pose is definitely more complex from a motor planning perspective. Thus, you may need to work on one piece of this pose at a time (and the same goes for any other pose), and that is totes okay! For example, maybe you only work on stepping the feet wide apart, or pivoting on the heel of the foot.

Lunge (with back knee up or down). From mountain pose, pick up one foot off the ground. Extend that same leg behind you and step your foot onto the mat. For more challenge, keep the chest and back knee lifted. For less challenge, lower the back knee to the mat and bring the hands to the mat. Step the back leg up to meet the front leg. Rise into mountain. Switch sides. This pose is great for building strength in the core and legs.

Tree pose. From mountain pose, pick up one foot off the ground. Turn that same-side knee outward (away from your body) to externally rotate through the hip. Place that foot on the opposite leg's ankle, calf, or upper thigh (theoretically you should not place the foot on the opposite leg's knee). Replace that foot back to the ground. Switch sides. This pose is great for improving balance, concentration, and hip range of motion.

Chair pose. From mountain pose, bend the knees, lowering the seat (aka bottom) back and down a few inches. You could lift your arms overhead, reach them back behind you, or bring palms to touch at heart center. Stay strong in the core and legs. Release back to mountain pose. This pose is great for building resilience and core/leg strength. Sometimes I play with flowing in and out of this pose and mountain pose.

Sphinx pose. From a prone position (i.e. on the belly), bring the elbows under the shoulders. Press into the forearms and lift the chest off the mat. Hold as long as the individual can. This pose sounds simple, but some IWA have difficulty with lying in the prone position (possibly from motor planning issues getting into the position, sensory issues with lying on their belly, and/or gravitational insecurity issues - thanks to my occupational therapy friends for teaching me this!). Thus, that is why I listed this pose as a "more challenging posture." There are several options once the IWA gets into, and can successfully hold, this pose. For example, you could play with lifting one foot off the ground at a time or engaging some mild spinal rotation by looking over each shoulder.

Cooling Postures

Cooling postures help to steady the breath and prepare the body for the final resting pose. My favorite cooling postures for IWA are (I typically do both of these):

Legs up in the air. From a supine position (i.e. on your back), lift the legs up into the air. If possible, straighten through the knees. Keep the core and head flat against the mat. Bend and straighten through the knees a few times. This pose helps to calm the body and prepare it for resting pose.

Windshield wiper knees. From a supine position, put a bend into the knees and place the soles of the feet on the mat. Windshield wiper (or rock) the knees from side to side a few times. This pose helps to release any build up tension in the muscles from the more challenging postures.

Resting Pose

Always, always, always, end any yoga practice with resting pose (aka “savasana” pronounced “shuh-VAHS-uh-nuh”). This is actually a cardinal rule in yoga because resting pose helps to calm the nervous system and assimilate the movement practice into the person’s tissues. The goal of savasana is to simply relax. There is no work or effort in this pose. It is okay if an IWA engages in vocal stimulation behaviors or echolalia during resting pose. I like to play a song (like the "Namaste" song by Kira Willey - this is one of my favs) so kids have something to listen to while lying still. You might only be able to get your loved to stay still for savasana for 10 seconds, or less, the first session. That is okay. Progressively work your way up to 5 minutes over time and slowly. Theoretically, you lie on your back in resting pose, but be aware- some IWA have gravitational insecurity and feel unsafe when lying supine (on their back). If the person is small enough, he/she could lie on your belly. If not, he/she could lie supine on furniture, as sometimes that helps the person to feel safer. If that is not an option or that does not work, you could simply lie next to the person, holding his/her hand, reminding him/her that he/she is safe (e.g. “you are safe”). Or, you could put some gentle, deep pressure on the person’s thorax to help him/her feel more grounded. Or, you could put a pillow, weighted blanket, or sandbag on the front of their body, again to help them feel grounded. If none of those options help, allow the individual to lie in whatever position feels safest (e.g. on their side, on their belly, etc.).

Summary

The general structure of a yoga practice is very similar to the structure of a yoga class for "neurotypical" individuals. Breath work and resting pose are arguably the most important postures to complete. Ideally, you would include at least one pose or breathing technique from each category listed above. However, if you are short on time, I recommend that you ALWAYS do breath work, 1 - 2 warming postures, 1 - 2 cooling postures, and resting pose. If there was any posture discussed above that you are unsure of, search Google images to help you get a better idea of what the posture looks like. Also, please keep in mind that Autism Spectrum Disorder is indeed a wide spectrum, where each IWA is unique with his/her own strengths and limitations. Thus, some of the information in this blog series may apply to your loved one with Autism, and some information may not apply.

The information presented in this blog post is derived from my own personal study and practice of yoga and human movement in IWA. Pay close attention to the nonverbal cues that your loved one with Autism is giving you during a yoga practice. If your loved one communicates (verbally or nonverbally) that he/she is distressed or in pain during a yoga pose, simply discontinue the posture and try again another day. 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 registered providers in your area on the Yoga Alliance website (website link 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 (website link here). If you have specific questions about Autism itself or implementing a yoga practice for a loved one with Autism, please consult with your child‘s physician, therapists (e.g. physical therapist, occupational therapist, etc), and/or yoga teacher.

A special thank you to my husband, Matt Allen, for doing the artwork in all of the sketches in this post.

~Namaste, Jackie Allen, M.S., M.Ed., CCC-SLP, RYT-200, RCYT