Evaluating the effects of a yoga-based program integrated with third-wave cognitive behavioral therapy components on self-regulation in children on the autism spectrum: A pilot randomized controlled trial

Abstract

Research using mind–body practices in autism is limited but suggests a trend for ruminative reduction and improved behavioral–emotional outcomes. Following random assignment ( N = 67), effects of a weekly six-session pilot yoga-based group program combined with third-wave cognitive behavioral therapy elements on self-regulation for children on the autism spectrum (aged 8–12 years) was assessed. The primary outcome was executive functions. Secondary outcomes were sleep, anxiety, and emotion awareness. After attrition, assessment results from participants in the intervention ( n = 31) and the waitlist conditions ( n = 30) completed at baseline, post-intervention, and 6-week follow-up were evaluated. For the intervention group, the between-group mean score differences suggest a decrease in parent-reported global executive difficulties from baseline to post-intervention (−2.61; 95% confidence interval −5.13 to −0.09, p = 0.047, d = −0.39) and baseline to follow-up (−4.17; 95% confidence interval −6.72 to −1.62, p = 0.017, d = −0.59) with small-to-medium effect sizes. Small-to-medium effects were found for a few parent-reported children’s sleep issues, child-reported aspects of emotion awareness, and performance anxiety. Non-significant findings are discussed in this article. Preliminary findings suggest mixed results and should be interpreted cautiously. The yoga-informed program may complement existing treatments and will benefit from ongoing evaluation. Lay abstract Children on the autism spectrum may experience difficulties with the regulation of attention, thoughts, emotions, and behavior, understanding, and expressing their emotions appropriately, as well as anxiety, and sleep. In autism research, contemplative practices that work through both body and mind have shown tentatively promising results. However, there are limited studies on this topic, and the use of yoga to facilitate executive control has not been researched yet. The Incredible Explorers (6-week program), a yoga-informed intervention program for children (8–12 years), was developed to understand whether, for children on the autism spectrum, the training could improve the ability to self-regulate, reduce anxiety and sleep problems, and increase awareness of emotions. In our sample, 61 children with one of their parents completed the program. Half of the group received the intervention, and the other half had to wait until the yoga group completed their trial. The participants were asked to give their feedback immediately after program completion and at 6-week follow-up. Compared to the group that was waiting to receive the intervention, parents in the yoga group reported significant gains for their children in regulating their overall executive control immediately after the session and again at follow-up. The parents reported a reduction in some of the sleep problems post-treatment. Children indicated an improved ability to communicate their feelings and willingness to analyze their emotions post-intervention. However, the study had several shortcomings and given that this was the first trial of the program, the results need to be interpreted with caution. Further research is recommended.

Effects of Creative Movement Therapies on Social Communication, Behavioral-Affective, Sensorimotor, Cognitive, and Functional Participation Skills of Individuals With Autism Spectrum Disorder: A Systematic Review

“…On the other hand, 8 studies (3 music, 1 yoga, 1, martial arts, 1 theater, 2 dance) found that the immediate beneficial effects of CMT were not sustained at FU ( 87 , 134 , 136 , 137 , 146 , 172 , 173 ). Overall, although 9 of the 17 papers claimed sustained beneficial effects of CMT in individuals with ASD, our calculations suggested that only 4 out of the 22 calculated ES (ES: −0.79–0.71) from a Level II yoga and a Level III theater-based intervention study ( 152 , 170 ) were statistically significant (i.e., CI did not include 0). Thus, there is currently insufficient evidence for short-to-long-term sustained benefits following CMT in individuals with ASD.…”

“…There was great variability in sample sizes across individual studies. The largest sample size studies for different CMT approaches included 364 participants for music therapies ( 116 ), 61 participants for yoga therapy ( 147 , 152 ), 57 participants for dance therapy ( 173 ), 48 participants for martial arts ( 155 ), 77 participants for theater–based interventions ( 125 ), and 56 participants for dance and other combined therapies ( 173 ).…”

“…The 6 Level I studies (2 yoga, 4 martial arts) that assessed cognition used EEG measures to record neural activity, computerized tests such as the Go-No-Go and the Hearts and flowers test, as well as questionnaires such as the ATEC to report medium to large ES for improvements in executive functioning, visual memory, cognitive awareness, and brain activation patterns following CMT ( 104 , 148 , 152 , 154 , 155 , 161 ) (see Tables 3A,B , 6 ). For instance, Chan et al reported large improvements in self-control (ES: 0.84), indicated by a reduction in the # of rule violations during a Tower of London task following a Nei Yang Gong martial arts intervention compared to a control group that received progressive muscle relaxation ( 154 ).…”

“…However, the study only reported outcomes at the final FU visit and suggested sustained improvements in autism severity and emotion recognition at 12 months post-intervention compared to baseline values ( 170 ). Lastly, 1 yoga-based intervention study found sustained improvements in executive functioning at 1.5 months post intervention compared to the posttest and baseline measures ( 152 ). On the other hand, 8 studies (3 music, 1 yoga, 1, martial arts, 1 theater, 2 dance) found that the immediate beneficial effects of CMT were not sustained at FU ( 87 , 134 , 136 , 137 , 146 , 172 , 173 ).…”

“…Moreover, the practice of static and dynamic postures that focus on improving balance, core muscle strength, flexibility, and body awareness may impact the sensorimotor systems ( 150 ) and also have physiological effects on digestion, sleep, and HR variability ( 88 , 145 , 148 ); see Table 5 for components). Yoga and mindful awareness have also been found to help with attention regulation, memory, and executive control ( 152 , 154 , 155 ). Additionally, the only study that provided mindfulness training to adolescents with ASD and their caregivers found improved quality of parent-child interactions as evidenced by decreased parental stress and improved behavioral regulation ( 146 ).…”