IMPACT OF ADAPTIVE YOGĀSANA ON PSYCHOLOGICAL HEALTH OF CHILDREN HAVING AUTISM SPECTRUM DISORDER AND WITH INTELLECTUAL DISABILITY (MULTIPLE DISABILITIES): A SINGLE-CASE EXPERIMENTAL DESIGN

Abstract

BACKGROUND Children with multiple disabilities and developmental disorders face significant challenges across physiological, physical, learning, and socio-emotional domains. Psychological issues, including cognitive, emotional, and behavioural difficulties, are particularly common among children with autism spectrum disorder (ASD) and intellectual disabilities (ID). Parents and caregivers are eager for holistic interventions, such as yoga, which has shown promise in physical, physiological, and psychological therapies. However, limited scientific evidence exist on yoga's psychological benefits for children with multiple developmental disabilities.

This study addresses the need to empirically validate the impact of yoga through a comprehensive approach that resonates with psychologists, disability specialists, and caregivers alike. Traditional yoga methods are not feasible for children with special needs, requiring instead personalized, one-on-one interventions that engage caregivers, adapt to each child’s abilities, and involve long-term, continuous assessment. A multiple stakeholder study involving parents (or caregiver), practicing psychologists, and yoga interventionist was the premise for this study.

Due to the unique and varied needs of these children, a group design like RCT may be inappropriate. Thus, a single-case experimental design (SCED) was chosen, allowing each child to serve as their own control. This rigorous approach statistically assesses the impact of yoga with continuous data collection, establishing a significant relationship between yoga intervention and psychological improvement.

AIMS AND OBJECTIVES This research work aims to prove existence of a functional relationship and efficacy of tailored made yoga intervention for children with ASD and with ID on improving their psychological health in cognitive, behavioural, and emotional domains by employing a rigorous scientific framework, a well-crafted adaptive course plan and teaching methodology. The purpose is also to involve caregivers that ensures continuity of the practice if there are carry forward benefits in home condition.

METHODS Participants Six children, having Autism Spectrum Disorder (ASD) and with Intellectual Disability (ID) certified as multiple disabled by NIEPMD (D) — National Institute for Empowerment of Persons with Multiple Disabilities (Divyangjan), Chennai, Tamil Nadu, India along with their caregivers recruited for this study. The chronological age of children was between 7 to 12 years having mild to moderate severity level of the disorder. The respective caregivers agreed to participate throughout the study.

Design A multiple baseline single case experimental design (AB1B2) was implemented for this study. Each participant went through three phases: (A) baseline phase without intervention for 4 months (eight assessments), (B1) intervention phase in institute setting with yoga teacher and caregiver for 6 months (twelve assessments), and (B2) intervention phase in home setting with only caregiver for 3 months (six assessments). Continuous assessments were planned and administered for each participant at a frequency of every two weeks.

Assessment Indian Scale for Assessment of Autism (ISAA) and Behavioural Assessment Scales for Indian Children with Mental Retardation (BASIC-MR) instruments were used to assess the desired cognitive, behavioural, and emotional parameters objectively.

Intervention The yoga sessions were administered for the participants as one-to-one intervention along with yoga teacher and caregiver. The intervention sessions started in institute setting along with yoga teacher and caregiver for 120 days, followed by 60 days in home setting along with only caregiver. Each intervention session duration was between 45 to 60 minutes administered every working day of the week excluding weekends and holidays. Before moving from institute setting to home setting, the ownership of intervention was handed over to the caregiver with documented course plan for continuity and smooth execution.

RESULT The internal validity of effectiveness of adaptive yoga intervention is established based on visual analysis, the effectiveness is supplemented by non-overlap method NAP and statistical significance using Cohen’s d. Effect size using non overlap method shows for the 120 observable parameters across baseline vs. intervention phases (institute and home settings) having 18% as less significant, 24% as moderately significant, 44% as significant and 14% as insignificant effect. Similarly, effect size using Cohen’s d shows 34% of data has significant effect, 8% of data shows moderately significant and 13% of data shows less significant, 32% of data shows the intervention impact is positive, however, insignificant and 13% of data shows opposite effect. The impact of intervention shows effectiveness across all cognitive, behavioural, and emotional domains; and across participant replications. This establishes external validity of the impact.

CONCLUSION The long term, consistent one-to-one adaptive yoga intervention can effectively improve the cognitive, behavioural, and emotional conditions of children having ASD and with ID. This study establishes the potential of yoga interventions in the field of multiple disabilities and psychology. This gives confidence to the caregivers in assessing the feasibility and acceptability of yoga practices in the context of their daily routines and overall care strategies.