Training Youth with Neurodivergent Disorders
When training youth with neurodivergent disorders, it’s essential to approach these clients with genuine empathy and unconditional positive regard. You, as a personal trainer, can have an immense impact on their health and well–being. While the definitions and descriptions of the conditions may vary across the literature, neurodivergent disorders include attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, Down syndrome, aphasia and brain injury. Some individuals with these conditions may display difficulties in speech, attention or focus compared to peers, a lack of understanding of rules and consequences, and difficulties with motor skills.
It is not uncommon for a person with a neurodivergent condition to find it difficult to transition from one activity to the next, causing them to feel overwhelmed and perhaps experience frustration and sensory overload. As a result, they may display unexpected behaviors that are most often prompted by emotions of anxiety, panic, discouragement and/or fear.
As a health and exercise professional, it is essential that you take the time to thoroughly understand the antecedents, behaviors and a client’s specific challenges before beginning their training sessions (antecedents are events, conditions or actions that may incite a response from a client). Potential antecedents and behaviors should be understood through the initial interview with both the client and, if appropriate, their caretaker or guardian. It is important to set the client at ease by expressing your desire to support their needs in the gym environment, and then be thorough in asking questions about fears and anxieties relating to a wide range of factors, such as sounds, crowds or environmental changes (e.g., new staff, changes to schedule, or a new floor plan).
Medication effects should be discussed up front and its important you let the client and their parent or caregiver know that you should be alerted to any changes to medication, as the client may be more easily incited during the adjustment period. Next, you should ask about their preferred coping methods. This could range from repetitive behaviors, to retreating to darkened quiet rooms, or even wearing a weighted vest.
In addition to being well-prepared, it’s important to also become highly observant of changes in a young client’s demeanor that may signal that they may be getting frustrated or overwhelmed. Understanding a client’s body language and common mannerisms, which can often signal distress, can be helpful in anticipating and possibly diverting behaviors or struggles that can disrupt a training session. When youth are overwhelmed, they may not be able to verbally communicate their frustrations as they are coming on, so you need to be able to recognize and sense this ahead of time and revise your training plans, as needed.
Here are three common scenarios you might encounter when working with youth with neurodivergent conditions and how to best respond to reduce frustrations and anxiety to keep your sessions on track.
Scenario 1: AVOIDANCE
People with neurodivergent conditions sometimes struggle with sensory processing disorder. Sensory processing is defined as the organization of sensory information from the body and the external world that will allow a person to interact with their physical and social environments. When a person has disorganization of the sensory information in their brain, it leads to a cacophony of incoming data with no purpose or order, which can lead to overwhelming feelings of irritability, anger and/or frustration; this may result in unexpected outbursts, aggression, hiding or non-compliance.
A client may begin employing their own coping mechanisms or require your support, so it is crucial you understand them. Occasionally, an outburst is unavoidable, and you’ll want to have learned how to negotiate or redirect behavior to something more positive.
Example: Imagine you walk into a training space for a workout session with a young client. Instead of being ready to train, they have locked themselves in the bathroom and are refusing to come out.
At this point, you might ask the caretaker or parent more questions to better understand the situation and how to respond. If a caretaker is not available, you can also review your previous knowledge of this client’s antecedents and make an intuitive decision about how to help them participate in the session. Start by taking a few deep breaths to help you remain calm—and repeat that practice frequently.
Your first goal should be to understand the client’s antecedent and help them feel safe from whatever they are avoiding, and that starts with maintaining a calm demeanor. Ask simple open–ended questions and allow long pauses during the conversation. This will allow the client ample time to consider your question and develop a response without further overwhelming them.
It can be helpful to tell the client about one or two aspects of the workout you have planned that you know they will enjoy and feel successful doing. Then, ask the client to come up with two things they want to do that can be completed at the end of the session. “If–then” statements work well. For example, “If we do this ________________, then we will do this __________.” Then, allow the client time to process the deal. When they come out of the bathroom, keep the workout short, to the point, and exactly as agreed upon with the “if-then” statement.
Scenario 2: OVERSTIMULATION
Learning to recognize body language prior to a workout session in a child with hypersensitivity will help you to know how to adapt that day’s programming to their specific needs on any given day. Typical overstimulating behaviors include:
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Speaking loudly or quickly
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Being aggressive or angry
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Acting or running around for no reason, or being restless
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More frequent tics or hand movements than usual
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Looking sleepy or worn out
Example: You have a training session with a young client on a Friday. They have a new companion staff and are scheduled to attend a family birthday party the next day. They come in with their head down, shuffling their feet, waving their hands and talking loudly. They then sit down on a piece of equipment and start spinning out of control on the chair, forgetting the normal routine of the workout session.
You intuitively pick up on the excitement, anxiety and overstimulation of the senses the client is experiencing inside their body. A weekend, a birthday party to look forward to and a change in staff can lead to behaviors like the ones your client is exhibiting. You will need to adjust the plans for the workout session and likely shorten the designated training time.
Remind the client of the normal routine of a workout session by writing it out on a board or a piece of paper to help them return their focus to the task at hand. Ask them to mark off each item as it is completed. It is also helpful to limit all other sensory input information as much as possible. For example, keep the lights dim, and the variety of equipment textures and number of distractions (such as other people, sounds and smells) to a minimum.
Regardless of your original plans, the primary goal of the workout session is now to help your young client cope with their feelings of overstimulation while safely and effectively being physically active.
Scenario 3: AN INABILITY TO FOCUS
Understanding when a client with ADHD is hyperactive, impulsive and unable to focus, and not merely being disrespectful or careless, will save you many hours of frustration.
Example: You are leading a small-group training session. While you are explaining the workout plan, one participant continuously moves around on the equipment behind the group, takes jabs and stabs at the kid standing in front of them, and keeps interrupting your instructions with comments. They also repeatedly ask you what they are supposed to be doing next.
In this situation, you might provide the client a role to play within the class. For example, the client could become the rep counter, leader, clock timer, person who writes the workout on the whiteboard, or anything else that would provide them with a purpose and reason to focus. This title or role should become the norm at every workout session to create normalcy and routine. These roles should be assigned with the expectation of boundaries, which should be written out, clarified and understood.
Final Thoughts
There are times when a workout session with a child or group of children needs to stop for the safety and well-being of everyone involved. Often, however, understanding the client’s needs, behaviors and antecedents to behavior and how to address and manage these incidents can lead to a long-lasting relationship with great results for both you and your clients.
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To learn more from author Anna Woods, check out these two ACE continuing education courses:
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Adaptive Fitness Exercise Programming (worth 0.4 ACE CECs): In this course, you’ll learn how to effectively work with clients with Down syndrome and autism spectrum disorder, as well as non-ambulatory individuals. The focus is on communication, individualized programs and motivating both clients and caregivers.
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Adaptive Fitness for Clients with Special Needs (worth 0.1 ACE CECs): In this course, you’ll learn how to modify exercises and programs for clients with various diagnoses, behaviors and physical limitations, as well as communication strategies that encourage client compliance and motivation to learn.
