Increasing Physical Activity for Adults with Autism Spectrum Disorder through Praise and Technology

Background: There are many benefits to engaging in physical activity. However, individuals with autism spectrum disorder (ASD) often do not engage in recommended levels of physical activity. Low motivation, poor motor skills, and behavioral challenges combine to make engaging in regular physical activity challenging. Due to higher level of sedentary behavior, individuals with ASD were identified as a special risk group for health challenges such as obesity and secondary conditions (e.g., depression, diabetes; Hildebrandt, Chorus, and Stubbe, 2010; Rimmer, Yamaki, Lowry, Wang, & Vogel, 2010). In this study, reinforcement and technology were used to engage individuals with ASD in physical activity.

Objectives: (1) To compare the effectiveness of direct praise statements (i.e., praise delivered in-person) and technology-based praise statements (i.e., praise delivered through an iPod) aimed at increasing engagement in physical activity. (2) To determine if levels of engagement in aerobic activity could be maintained when praise statements were systematically faded. (3) To determine if engagement in aerobic activity could be generalized to a new setting. (4) To explore student and teacher perspectives of physical activity, including aerobic activity, as well as the interventions used in the study.

Methods: Three young adults with ASD and intellectual disability participated in this alternating treatment, single-case design study. Three dependent variables were measured including the distance of each session, the duration of each session, and the number of steps participants took in each session. The independent variable was praise statements provided to participants in two conditions: direct praise statements and technology-based praise statements. Study phases included baseline, comparison, best treatment, fading, and generalization phases. Probes were also conducted after baseline to evaluate whether or not the evaluated components had a differential effect on aerobic activity as well as after the best treatment phase that served as an additional component of experimental control. Social validity interviews were conducted before and after intervention for both participants and teachers.

Results: Praise statements were effective in increasing engagement in physical activity in both conditions compared to baseline averages. Two participants performed better and preferred the technology-based condition. The two participants who performed better in the technology-based condition were also able to maintain performance levels during the fading conditions and generalize their performance to a new setting while the participant who performed better in the direct condition was unable to maintain performance levels during fading conditions or generalize performance to a new setting. The strategies used in this study were also well-received by teachers and participants. Inter-observer checks were assessed on over 33% of sessions for each phase with mean agreement of 96.9%. Moreover, procedural fidelity was 99.0% (more than 33% of sessions were assessed). Refer to Figure 1 for results across study phases for distance.

Conclusions: The findings indicate that receiving praise through technology may be effective in increasing levels of physical activity for individuals with ASD and ID. With technology commonly used in schools, it is important to determine its advantages or disadvantages to provide needed support over more traditional (non-technology) forms of support.