Clinicians deal with clients and patients with a range of abilities. This author provides expert guidance on meeting patients and clients where they are to succeed in communicating.
By Eric Chessen, M.S.
Photos provided by Eric Chessen.
“Okay, now let’s see a squat, I’m gonna go first and then you try.”
The above is a standard sentence during our initial session; what we call our PAC Profile® Assessment. PAC stands for Physical, Adaptive and Cognitive and that first sentence carries with it a powerful proactivity. When we teach movement, it makes sense to demonstrate first. Explaining an exercise, opposed to demonstrating, is far less conducive to success. This is regardless of whether discussing the autism or neurotypical population. With particular respect to those with autism and related developmental disabilities, how we coach and cue exercise is critically important. Certain practices give us and our athletes better opportunities to succeed and reduce breakdown.
In our Autism Fitness® programming, we’ve found the most efficient use of initial instruction time (the first time we are teaching an exercise) follows this format:
- Do and Cue
This structure has become one of our training mantras. For those with Autism Spectrum Disorder (ASD), labeling in particular can have immediate and long-term benefit for language (productive and receptive), memory, and independence. Labeling refers to naming the exercise. Upon introducing squats, our labeling protocol would be:
“Let’s try squats. I’ll go first and then you go.”
By giving the exercise a name, and with consistent repetition, 2 highly important attributes emerge:
- The athlete learns the name of the exercise
- The athlete begins to associate the name of the exercise with the expectation for performance
If the athlete is familiar with the word “squat” and can equate it to the movement pattern that constitutes a squat (whatever their current ability level), the coach does not have to repeat and demonstrate and repeat and repeat and repeat – because the athlete already knows. The word “squat” and the movement/physical performance have been paired in a way that makes sense, and is memorable, for the athlete. Extraneous language use by the coach/instructor can kill momentum by causing confusion. Extraneous language typically goes something like this:
“Okay, it’s time to do squats. Remember to bend your knees and keep your head forward. You remember how to do squats, right? They’re really fun! Keep your feet on the floor. No, not like that, remember how to do it correctly…”
And the athlete is lost, and likely frustrated.
Labeling adds to the lexicon, and building receptive language is important.
It’s remarkable just how much functional language we can build through fitness programs. Not only exercise names “squat, press, pull-down, push throw, rope swings…” but objects “Sandbell, rope, cones, Dynamax ball, sandbag…” and abstract concepts including prepositions “in, on, under, right, left, up, down….” When our athletes are actively engaged in fitness activities, teaching these terms/concepts is easily presented in a natural manner.
By labeling, we are also avoiding using abstract language that is often lost on our athletes with ASD, who tend toward very literal thinking. Labeling also leads to autonomy. When an athlete can choose one exercise over another and demonstrate preference, we can infer an understanding of what the name of the exercise represents. Choice is dependent on understanding the distinction between, for example, a medicine ball “push” throw, or an “overhead” throw.
Demonstrating is crucial because it circumvents us and our athlete standing there and staring at one another (or off into the distance for those of our less-eye-contact-inclined friends). We always demonstrate a new exercise; this provides context for our athlete’s interpretation of what we just did. Demonstrating provides our athlete visual representation of what they are about to do.
Now, performance will vary, and demonstrating a movement once is no guarantee that the athlete will have the physical capability to complete the exercise to full independent mastery. But that is where we provide a regression. But we cannot regress an exercise until we’ve observed the individual perform it first. So, we demonstrate and allow them to follow our lead.
Do they get right down to squatting (pun somewhat intended)? Are they hesitating? Do they just bend their knees a little bit? Do they squat below parallel but with significant compensatory patterns present? What we get here is a baseline. A baseline is what level of ability the skill is at right now so that we can program accordingly.
We may provide a physical or guided prompt early on with an exercise to ensure safe and effective technical performance. With the squat, this may mean having the athlete use a box or elevated surface to ensure healthy hip flexion and neutral spine position. The quality of performance makes the exercise.
Depending on physical, adaptive, and/or cognitive ability, we may be able to fade this support in the first session or it could take months. I’ve had some highly motivated athletes who, because of their physical needs, require longer practice with a given level of an exercise. The athlete is held to the expectation of his/her best current level of performance.
Do and Cue. Effective assessing enables us to determine how best the athlete will learn a particular exercise. While it’s tempting to classify our athletes as “more visual” or “more kinesthetic” learners, I’ve found that it is far better to approach this from an exercise-by-exercise basis. Some of my athletes need physical prompting through the end range of an overhead press but will independently perform a band row when I demonstrate pulling my arms back while standing parallel to them.
“Doesn’t know how” is a misinterpretation of breakdown in effective coaching communication. We need to be instructing with less words, more action. We need to have a hierarchy of cues and strategies depending on what is observed. More show than tell. Label. Demo. Do and cue.
When our athletes, or any of us, don’t understand the direction, the contingency, or the expectation, we freeze, get off-task, get frustrated, or a Lucky Charms marshmallow cornucopia concoction of all three. Being proactive in coaching means giving our athletes the information they require delivered in a way that is useful to them. It means having a structure that is reliable for assessing, addressing, and meeting goals in all three areas of ability (physical, adaptive, and cognitive).
It is easy to take for granted the neurotypical ability to interpret nuance, abstraction, and implied information; the untold stuff between the clearly marked things. Giving our athletes the context and environment to succeed, especially in the first few sessions or when teaching new exercises becomes our bridge to success in coaching and performance.
Eric Chessen, MS, is the founder of Autism Fitness®. An exercise physiologist with an extensive background in Applied Behavior Analysis, Eric has spent nearly 20 years developing successful fitness and adapted PE programs for the autism and special needs populations. Eric is the creator of the PAC Profile® Method and the Lead Instructor for the Autism Fitness Certification (Levels 1, 2, and Master). His work has been featured on Yahoo News, VICE Media, and he has Presented at TEDx. He resides in Charlotte, NC. For more information visit AutismFitness.com
This article expands a blog post that originally appeared on MedFit Network, a professional organization for medical fitness (fitness and allied healthcare) professionals, one of LER’s partners. Their work can be found at