Practices Supporting Walking Programs for People with I/DD
Fresh Air Self Care FOR ALL: Part I - General Background
What current standards can we reference to help us to plan our walks and set goals? How do we identify the specific programs and practices that are most likely to help us to walk more?
For two decades, my work (see above) centered on systematically searching for and evaluating the evidence for specific practices and programs that are claimed to benefit children with ASD. I have also described how these practices and programs can guide local, state, and national policy to benefit everyone, and how to help people integrate these practices and programs into everyday education and treatment. So we can use this framework to assemble and evaluate the different kinds of evidence for different approaches to helping children with I/DD or ASD to walk more.
How much should we walk? 24 hour Movement Guidelines
When developing a plan and setting goals, we should look first for any relevant guidelines established by recognized government or professional bodies that might reference what we want to accomplish. In this case, our goal is to become healthier and happier through walking specifically, or movement and exercise more generally. Such guidelines are considered to offer high quality evidence, involving systematic reviews of the available research conducted by experts in the field.
Consider the United States guidelines for physical activity referenced earlier. A 45-60 minute walk 3 to 4 times a week would help to meet the guideline recommendations for adults with I/DD or ASD.
A 45-60 minute walk 3 to 4 times a week would also help to meet the guideline recommendations for children and youths with I/DD or ASD.
Walks might also help people to meet other recommendations related to physical health. For example, the Move Your Way campaign in the US also recognizes that increased physical activity can improve your sleep. Guidelines adopted elsewhere - like those in Canada - recommend "7 to 9 hours of good-quality sleep on a regular basis, with consistent bed and wake-up times" for adults.
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And these guidelines recommend "uninterrupted 9 to 11 hours of sleep per night for those aged 5–13 years and 8 to 10 hours per night for those aged 14–17 years". So adding regular walks in nature might be especially important to those not meeting recommended guidelines for sleep.
And physical activities like walking can help to reach another goal recognized as important to overall health: reducing the amount of time spent sitting, especially without a break. The Canadian Guidelines for adults are listed to the left. For children, they recommend "no more than 2 hours per day of recreational screen time ; limited sitting for extended periods." So adding regular walks in nature might be especially important to those exceeding recommended guidelines for extended sitting.
Where should we walk? Understanding trail difficulty
When developing a plan to walk, it is also important to choose a trail that is a right fit for your hiker's fitness and skills. How do we identify the easiest paths for those just starting out? And how do identify trails that offer just the right challenge for those looking to slowly build their fitness and skills?
Our review suggests that there is no clear trail rating standard that can be easily used by people with disabilities. For example, they do not take into account the fact that hikers struggle with different types of trails depending on the type and extent of their disabilities.
At Kennett Outdoors, we have drawn on other standards and research to suggest that trail ratings for people with disabilities must plan for both Trail Effort and Trail Stress . With respect to Trail Effort, we are proposing a Flat Equivalent Length rating that takes into account both the length and the slope of a trail, using a formula adopted informally by hikers worldwide.
Kennett Outdoors is also exploring the concept of Trail Stress. Many people without limitations to their mobility will not experience hiking as stressful until they find themselves on long trail that is steep or rocky. But for people whose I/DD is complicated by problems with balance and coordination, walking anything but a smooth paved or gravel path might require building strength and skills. For example, Margot's mild Cerebral Palsy means that she would be extremely uncomfortable trying to walk on a trail like this without A LOT of practice and support.
While there are no standards for evaluating Trail Stress as distinct from Trail Effort, there are national standards for universal access paths and trails (you can learn more here ). These standards specify the characteristics that make paths and trails impossible for people with disabilities to navigate. These standards are invaluable for identifying the best paths for those just beginning to try walks in nature.
At Kennett Outdoors, we are exploring how to use these Universal Access Standards as a framework for evaluating Trail Stress (you can read more here ). Instead of simply designating a path or trail as accessible or inaccessible, we are using specific standards to identify a continuum of difficulty. This can help our hikers interested in trying more natural trails identify those that offer just the right amount of challenge based on their abilities and experience. Viewing accessibility as a continuum will also help parks and preserves to create more options for hikers with mobility challenges.
How can we walk more? Specific Evidence-Based Practices
In addition to relevant national standards, we can look for reviews that identify evidence-based programs and practices related to walks in nature. A practice is identified as evidence-based when multiple, well-controlled research studies show that a specific program or practice yields the specific outcome (e.g., regular walking in nature) in the specific group of people we walk to help (e.g., people with I/DD or ASD).
Unfortunately, very little well-controlled research has been conducted on how we can help people with I/DD or ASD to walk (except for some studies on how to reduce problems like toe-walking). And so we broaden our search to includes other sources of evidence.
For example, we can broaden our search to include evidence for programs and practices that help people without disabilities to walk longer and more often. A series of posts in the New York Times over the past year summarizes some of these findings, and offers links to other sources for those who want to read more. Scroll through the Kennett Outdoors blog to find links to these and other posts. Practices like setting specific goals, tracking your progress, and walking with others can help people to walk further and more often.
We can also broaden our search to include evidence supporting specific practices useful in teaching skills related to walking in people with I/DD or ASD. An excellent starting point is the 2021 comprehensive national review of ASD outcome research led by Odom and his colleagues as part of the National Clearinghouse on Autism Evidence and Practice (NCAEP). They identified a wide variety of evidence-based practices for addressing the full range of skills among school age children and youth with ASD. The NCAEP also developed AFIRM modules available free online for those interested in learning a specific evidence-based practice.
For example, we can also consider practices that build Motor Skills. The 2021 NCAEP review found that programs to improve Motor Skills in children and youths with ASD can benefit from a wide range of practices. For 15 to 22 year-olds, this includes Augmentative and Alternative Communication (AAC) and Visual Modelling (VM).
And other evidence-based practices that have proven to be more generally effective for building a wide range of skills can also contribute to a successful walking routine. This includes Modelling (MD), Prompting (PP), Reinforcement (R), Self-management (SM), and Visual Supports (VS).
With the right training, caregivers and other professionals can learn to implement these practices effectively.
For example, we have used practices like Prompting to draw Margot's attention to spots where she needs to step more carefully, and Reinforcement to encourage these efforts. If we choose a trail that matches her abilities and interests, we can create real opportunities to build her comfort and skills.
How do we address problem behaviors that might emerge while walking?
Sometimes children with I/DD or ASD struggle with activities that are difficult or unfamiliar, leading to increases in challenging behaviors. Maybe they become aggressive towards others or towards themselves or simply refuse to cooperate. Professionals then try to work out how to respond or - better yet - how to prevent these behaviors, by understanding what purpose they serve or what the person is trying to communicate. Maybe they are reacting to being too tired or too hot or too cold, or simply because they do not understand what is expected.
The good news is that the NCAEP review referenced earlier also identified many evidence-based practices for preventing and responding to many problem behaviors that might arise. These include practices like Antecedent Behavioral Interventions (ABI), Behavioral Momentum (BMI), Differential Reinforcement (DR), Extinction (EXT), and Functional Communication Training (FCT). These are all techniques that are often integrated into the kinds of behavior plans that special educators use every day, and that can be easily extended into any walk. With the right training, caregivers and other professionals can also learn to implement these practices effectively (NCAEP offers AFIRM modules for those interested in learning more about any of these practices).
These guide some of the choices we make with Margot. For example, Margot sometimes pinches us to get attention or when she is unhappy with something. If she is pinching us more often than is typical on a walk, we might take a shorter or easier route. Preventing a behavior by making modifications to demands is one type of Antecedent Behavioral Intervention.
When she tries to pinch us we make sure to use Differential Reinforcement - we ignore this behavior and instead give her attention regularly for walking independently.
Part of our clinical work and research reviews have focused on practices to improve the health and well-being of people with ASD and/or I/DD who also have extremely challenging behaviors. We have found that regular walks offer other benefits in these cases. Walking may be
- Their favorite thing to do
- Their only physical exercise
- One of the few community outings they can enjoy
- An antecedent intervention to increase their readiness to work.
Other potential triggers of problem behaviors more specific to a walk in nature might require more individualized planning. For example, Margot does not mind being cold but quickly becomes uncomfortable when she is hot, so we have to adjust expectations in the summer. We have also seen hikers who become very worried about encountering dogs or bugs on the trail, or just getting their shoes dirty. If there are any triggers you believe might lead to major behavior problems, you might need to develop a plan to prevent or respond to these before your first walk.
Children and youths with I/DD or ASD who run away from people to get attention present a special challenge, however. They may require additional planning and practice before trying any walks in more natural settings.
There are other general practices common to special education settings that might not have been specifically researched but that just make sense and can really help to prevent or reduce problem behaviors that might emerge while walking.
For example, many children and adults with I/DD respond really well to predicable routines. We would expect that behaviors would decrease with a predictable walking routine, especially involving a familiar path. A new hiking partner can more easily complete a first walk on a trail that your hiker is familiar with. And your hiker will be more comfortable with less than ideal weather (as seen here) if they are familiar with the trail.
Hikers may eventually become comfortable enough with this routine that they experience a walk on an unfamiliar path as an adventure rather than a source of stress. This helped us to plan a successful 2 mile walk on a trip through upstate New York (Chenango Valley State Park), on a trail that Margot had never walked before. This was key to breaking up a 6 hour drive.
In our experience, walking is so successful because many of the typical "triggers" of problem behavior are absent, especially once a routine is established and your hiker is more independent. Your hiker might dread demands or feel crowded in a classroom, but not in a park. Natural environments are neither over- nor under-stimulating but calm and peaceful. You can see this during a break on our walk around Chenango lake.
Want us to help you to develop a personalized plan for someone with I/DD or ASD you want to walk or hike with? Build their profile by completing a short survey about your hiker here .
We would like to be able to learn more about the opportunities available -and barriers faced - by our hikers, so that we can communicate more detailed findings to decision makers. Please help us by completing a short supplemental survey by clicking here .
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