Becerra, L. A., Higbee, T. S., Vieira, M. C., Pellegrino, A. J., & Hobson, K. (2021). The effect of photographic activity schedules on moderate‐to‐vigorous physical activity in children with autism spectrum disorder. Journal of Applied Behavior Analysis, 54(2), 744-759.
Reviewed by: Tia Horn, PsyM and Robert H. LaRue, PhD, BCBA-D
Rutgers University
Why research this topic?
Physical activity is essential for good health. Moderate-to-vigorous physical activity (MVPA) has been linked to several health benefits and reduced risk of obesity (U.S. Department of Health and Human Services [HHS], 2018). Unfortunately, most children do not engage in enough vigorous activity. These concerns are amplified for individuals diagnosed with ASD as they tend to engage in less physical activity than their typically developing peers (Sandt & Frey, 2005). In addition, the incidence of obesity in individuals diagnosed with ASD is higher than in their neurotypical peers (Ho, et al., 1997). While some behavioral analytic studies have targeted physical activity in children (e.g., see Lang et al., 2010 for a review), most have focused on typically developing populations. Less is known about increasing physical activity for children with developmental disabilities/ASD. The use of photographic activity schedules (i.e., a sequence of pictures depicting exercises/physical activity within a folder) may represent a useful strategy to increase engagement in physical activity for autistic children.
What did the researchers do?
The purpose of the current investigation was to increase levels of physical activity in three 4-year-old children diagnosed with autism. All of the children attended a university-based preschool program. All participants had generalized imitation and matching skills and had the ability to follow two-step instructions. None of the children had previous exposure to video modeling. Prior to inclusion in the study, all three participants had mastered the use of activity schedules in the classroom using leisure and academic activities. The participants had all been referred due to a lack of engagement in outdoor physical activity.
The researchers used the Observational System for Recording Physical Activity in Children (OSRAC) to measure the level of physical activity of the children throughout the investigation. The authors started by conducting the Physical Activity Context Assessment to guide the intervention process. They used this assessment to identify which contexts the children were least likely to engage in MVPA. During the Physical Activity Context Assessment, the researchers measured physical activity in five different conditions/contexts: fixed equipment (outdoor jungle gym), empty field (no leisure items), outdoors with toys, indoors with toys (both consisting of school items such as basketball and gymnastic ribbons), and a control condition (activities requiring no physical activity). These five conditions were alternated in a multielement design and MVPA was measured. The researchers used interval data to calculate MVPA across the different conditions (i.e., they noted if MVPA occurred at any point during five-second intervals throughout the observation). The conditions with the least MVPA observed were targeted for subsequent intervention.
The primary intervention component consisted of an activity schedule to guide the participants to complete the assigned exercises. These exercises were taught and coordinated by the researchers, who delivered the intervention directly to the participants. The photographic activity schedule consisted of a small three-ring binder containing pictures of physical activities. The last page of the activity schedule depicted a picture of the terminal reinforcer. For this study, a beverage was chosen as the terminal reinforcer, as it was a naturally occurring reinforcer after physical activity. They evaluated the effectiveness of the photographic activity schedule to increase MVPA using a nonconcurrent multiple baseline design across all three participants. That is, the intervention delivery was staggered over time across the participants to ensure that the intervention was effective. Baseline and intervention components were individualized for each participant. Researchers ran the sessions up to four times per day, and at least three days a week. The intervention lasted between 15 and 20 sessions for all three participants.
What did the researchers find?
During the physical activity context assessment, the highest levels of MVPA for all participants were observed during the indoor toys condition. None of the participants engaged in MVPA during the control condition (no physical activity required). The two conditions with the lowest levels of MVPA were then used as baseline conditions for intervention. MVPA remained low during baseline sessions for all participants. After implementing the intervention (photographic activity schedules), immediate increases in MVPA were observed. To assess for generalization of the intervention effects, the researchers guided participants to one of the conditions they had engaged in little MVPA previously. The activity schedule and juice bottle were present, but the researcher did not physically prompt engagement/correct responses. They found that the trained skills generalized to these untrained environments and sustained for two weeks after the final generalization sessions.
What are the strengths and limitations of the study?
The results indicate that the implementation of activity schedules represents an effective way to increase MVPA for young children diagnosed with ASD. One limitation of the current investigation was the brief session length. Session length in the current study was typically less than five minutes, which is considerably less than the recommended amount of MVPA for school-aged kids, which is 60 minutes each day (HHS, 2018; WHO, 2020). Brief exercise sessions are unlikely to produce comparable health benefits to extended exercise, this limited the generality of the findings. In addition, the participants in the current investigation all possessed prerequisite skills (i.e., the ability to follow an activity schedule) that children with ASD often lack, which may limit the generality of the findings. In addition, the authors only implemented a single maintenance probe at the end of the study, so it is difficult to determine the extent to which the intervention produced lasting effects.
What do the results mean?
The current study is important for a couple of reasons. The study demonstrates the usefulness of the Physical Activity Context Assessment to help guide practitioners to identify the settings/situations where intervention is necessary. The results of the study are also important in that they indicate that a relatively simple intervention (i.e., a photographic activity schedule) was useful for increasing MVPA across teaching, generalization, and maintenance phases in the absence of researcher prompting for all participants. All three participants demonstrated increases in activity variability and MVPA in three different contexts (i.e., empty field condition, and the outdoor toys and fixed-equipment conditions). It is notable that these intervention effects were obtained using “low-tech” materials readily available to parents and teachers. These findings are of particular importance as individuals diagnosed with ASD tend to engage in less vigorous physical activity, which places them at risk for a number of deleterious health conditions. The current investigation represents a strategy to improve these outcomes.
References
Ho, H. H., Eaves, L. C., & Peabody, D. (1997). Nutrient intake and obesity in children with autism. Focus on Autism and Other Developmental Disabilities, 12(3), 187-192. https://doi.org/10.1177/1088357697 01200308
Lang, R., Kern Koegel, L., Ashbaugh, K., Regester, A., Ence, W., & Smith, W. (2010). Physical exercise and individuals with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 4, 565–576.
Sandt, D. D. R., & Frey, G. C. (2005). Comparison of physical activity levels between children with and without autistic spectrum disorders. Adapted Physical Activity Quarterly, 22(2), 146-159.
U.S. Department of Health and Human Services (2018). Physical activity guidelines for Americans, 2nd Ed. https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf
World Health Organization (2020). Global recommendations on physical activity for health. https://iris.who.int/bitstream/handle/10665/44399/9789241599979_eng.pdf
Citation for this article:
Horn, T., & LaRue, R.H. (2023). Research synopsis: The effect of photographic activity schedules on moderate-to-vigorous physical activity in children with autism spectrum disorder. Science in Autism Treatment, 20(10).
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