Aquatic Exercise on Stereotypic Behaviors and Sleep Habits in Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that occurs in early childhood and is characterized by two main cores of impairment in communication and social interaction, as well as repeated and limited behaviors, called stereotypical behaviors. Stereotypic behaviors refer to behaviors that are repetitive, rigid, invariant, maladaptive, and self–stimulatory. Furthermore, sleep problems are one of the most common clinical difficulty associated with autism. Sleep problems in children with ASD are much more common than other developmental disorders, and the percentage of outbreak is reported to be between 50 to 80%. Sleep disturbances can have detrimental effects on children’s cognitive development and daily functioning in areas such as attention, learning, memory, mood regulation, and behavior. According to past research, there was a direct and positive relationship between the severity of sleep problems and the severity of the symptoms of autism. Aquatics programs have clear benefits for children with ASD. Previous studies have shown that aquatic exercise can be used to improve the behavioral, physical and cognitive problems of children with ASD; but there is some shortage about its effect on sleep habits in ASD. This study aimed to investigate the effect of aquatic exercise on stereotypic behaviors and sleep habits in children with ASD.

This study was an experimental research with a pretest–posttest randomized design with control group. The population consisted of children with ASD, being a member of Guilan Autism Association in Rasht (Guilan province, North of Iran). A total of twenty children with ASD (mean aged 10.9±2.91 years) were selected according to convenience sampling. Inclusion criteria included; male gender (8–14 years), parental satisfaction, and having behavioral and sleep problems, according to parents’ reports. Exclusion criteria also involved having severe autism, being absence more than two times in aquatic exercise sessions and receiving specialized treatment in addition to the usual treatment receiving at their association. The participants were randomly divided into two groups, namely, experimental (N=10) and control (N=10). Experimental group received aquatic training program 60 min, 2 sessions per week/for ten week, including 5 minutes of warm–up, 20 minutes of aerobic exercise, 20 minutes of strengthening training using water resistance, 10 minutes of free swimming and 5 minutes cool–down. The research instruments were the stereotypic behaviors subscale of Gilliam autism rating scale (GARS 2) and Owens children’s sleep habits questionnaire. Parents of both groups completed the stereotypical behavior and sleep habits questionnaire before and after 10 weeks of intervention. Shapiro–Wilk test was used for normality and analysis of covariance (ANCOVA) was utilized to determine if differences existed between pretest–posttest in two groups.

Mean and SD of the age of experimental and control group were 11.30 ± 3.36 and 10.50 ± 2.50, respectively. Results revealed that ten weeks aquatic exercise had a significant effect on stereotypic behaviors and total score of sleep habits in children with ASD (p<0.001). Furthermore, the results of the analysis of covariance showed that aquatic exercise had a positive effect on bedtime resistance, sleep onset delay, sleep duration and sleep anxiety, but there was no effect on night wakening, parasomnias, sleep disorder breathing and daytime sleepiness in children with ASD.

The results of presnt study showed that aquatic exercise had a positive effect on stereotypic behaviors and sleep habits in children with ASD. Water provides relatively constant somatosensory input, which is an important feature for sensory integration (SI) techniques often used in treating children with ASD. At the same time, because there is less physical stress on specific body parts, the water allows for freer, independent movement. Therefore, it could be concluded that aquatic activities can be a valuable option added to the educational programs to reduce repetitive Behaviors and to improve sleep pattern in ASD.