1.1 Autism Spectrum Disorder and Asperger’s syndrome

Autism spectrum disorder, also known as ASD, is a developmental disability that can cause significant social, communication, and behavioural challenges. Generally, people diagnosed with ASD have a strong preference for repetition. Also, they communicate, interact, and learn in ways that are different in comparison to their neurotypical peers. (Princeton University, 2011, pp. 29-60)

Nowadays, all people on the spectrum are diagnosed with the same disorder, namely ASD. On the contrary, earlier versions of the DSM (Diagnostic and Statistical Manual), contained several types of disorders on the autism spectrum. One of those types is Asperger’s syndrome. People with Asperger’s Syndrome can speak with others and show a normal stance in their daily life in general. Nevertheless, they have difficulty relating to others and understanding social situations more often than their neurotypical peers. On top of that, body language and sarcasm are often harder to understand. Also, they show more repetitive behaviours than average. In addition, a diagnosis with Asperger’s syndrome is correlated with high intelligence and no delays in speech. One misconception about Asperger’s is that it is only present during childhood. (Princeton University, 2011, pp. 29-60)

1.2 Societal trends and the changing perspectives on disability.

This research is focused on the societal trends and changing perspectives on ASD. Our target group is a male adult with ASD, so this research is specified on this target group. To get a good view of the societal trends and the changing perspective on autism, it is important to understand the history of ASD. After this, the employment of adults with ASD is researched. For adults, employment is the biggest participation and empowerment in their adult life. In the end, the use of technology for people with ASD has been looked at.

1.2.1 Perspective on autism

During the history of ASD, there was a lot of misrepresentation and confusion around autism. Therefore, one can still see a negative social perception of ASD in society today. However, the view on ASD is getting more positive over the years and will only increase. In the past, there was a lot of discussion about ASD. Kanner was the first person who used the term autism, this was in 1943. After this, Bettelheim came up with different theories. There were biological, psychological, and environmental disagreements on the origin and definition of ASD. This caused confusion and ignorance of ASD in society. Recent breakthroughs in research and the increase of autistic voices have improved the view and knowledge of ASD. This shows that the awareness and positivity will only grow in the future. (Martin, 2013)

1.2.2 Participation

Even though the view on ASD is getting more positive, studies show that employment is still an issue for people with ASD. An estimation is made that between 50% to 75% of adults with ASD are unemployed. Even people with high functioning ASD are having a hard time getting a job. People with ASD must switch between jobs frequently, they are getting less paid than their counterparts, and they have difficulties adjusting to new jobs. (Hendricks, 2010)

1.3 Assistive technologies

In the last 10 years, an increase is shown in papers focused on technology and ASD. One of the main focuses of these researches is to support children with ASD. Technologies used for this are virtual reality, sensors, and geolocation. These technologies help mostly with social skills (36,17%) and conceptual skills (25,53%). Another focus of research is user experiences and accessibility of technology for people with ASD. But right now, not a lot of this research is being used. In the future, user experience should be even more researched for people with ASD. The third focus of the research is to use game elements in teaching people with ASD. However, not enough evidence is gathered if these games actually improve educating people with ASD.

Still, a lot of research should be done in connecting ASD and technology. However, studies show that the research is increasing. This makes it possible in the future to have people with ASD getting the support of technology. In the future, it can help them in their daily life. (Valencia, 2019)

1.4 Examples of Assistive Technologies for ASD

To eliminate an overload of external impulses, there are weighted products to make people more aware of their own bodies and give them a safe and secure feeling. Additionally, external impulses have less effect on consciousness. For example, a weighted vest. The vest works preventively. It will make the person become less quickly overstimulated by making their consciousness of themselves. There is also a weighted blanket which is a cooling down option so their body and mind can come to rest.

Lastly, a weighted pillow to eliminate an overload of external impulses. there are weighted products to make people with ASD more aware of their own bodies. the muscles, the skin and the joints which can give a safe and secure feeling, whereby external impulses have less effect on their consciousness. There are three main examples of products with this effect.

Headphones have a wide list of functions. They can filter out the noise from the environment with noise cancellation; they can focus on voice and filter out background noise, or just simply play music. These are very helpful to reduce the number of stimulations in the environment. (source)

There are a lot of online planning solutions for people with autism. Most of them involve a simple planning board with information online. There are, however, a few innovative solutions that can be used without a phone or computer.

To support planning related issues, several devices have been introduced. For example, the Tic Tac tool offers a visual representation of time intervals, while the quarter-hour clock offers a clear overview of useful units of time. On top of that, there is the Time Rule, the Time Timer and visual calendars that aid some people on the spectrum to have a better grip on time. (Jurek et al., 2019, pp. 7)

The use of visual schedules also yields improvements for difficulties in switching tasks. These types of calendars make use of photos and line drawings to utilise the strength in the visual-learning present in some persons with ASD. One type of visual calendar is the schedule board based on PECS: Picture Exchange Communication System. In addition to visual calendars, PDAs: Personal Digital Assistants are sometimes used. (Sevin et al., 2015, pp. 331-334)

1.5 Designing an assistive technology for ASD

Planning apps could help during a raging stage, where the user benefits from a time-out that was planned before the event. “Note that one of the techniques used to defuse the rumbling stage is promoting the routine. This is one moment in the cycle that planning apps could target. During the rage stage, as the model suggests, the person could benefit from a time-out or the already learned plan of action.” (Mansour, 2014).

This information can be used for designing apps, but also be interpreted for real-life products which can help with planning and organising. “One suggestion that I want to make for a design model during the rumbling stage is a combination of a planning app with a stress detector because stress is hard to monitor in autism.” (Mansour, 2014). In a way, this can also be seen as that the product needs to have some kind of stress detector depending on the user that is using it. This does require detailed research about the person itself to get to know their points of interest.

1.6 Human Centred Design

Human-centered design is a design approach that considers human needs and perspectives first. It focuses on who is going to use it, what their needs are, and the situation of the target group. This results in usable and helpful products or services. The main goal of human-centred design is to understand users’ needs and try to solve the problems they are facing. This design affects not only the way things are designed but also the approach to creating new or customized products and improving the user’s experience. (Nick. B, 2020)

Generally, human-centred design follows several phases.

First is the empathize step which is the most important part of it. Designers should truly understand the situation of users who are struggling with the problem as well as care about the users. Designers need to spend time talking with users who experience hardships face to face, try to observe their environment, and figure out what causes the problem. They need to ask questions to truly understand and define the problem.

The second is the ideation phase. In this step, designers come up with possible solutions from the empathize step. It’s not choosing the best concept, but rather gathering as many concepts as possible. Designers have to be creative with the concept, and brainstorming can be used here.

The third is the making prototype. It can be either a physical or virtual product. This step aims to make sure the products do work for people who are struggling with.

The last step is to implement the part which is testing and improving the prototype. It will be given to the people who have a problem, get feedback on, what aspects should be improved more. This will iterate several times and finally make the product successful.

1.7 Co-design/Participatory Design

Co-design is about designing together with one person or a group of people to create a product or service that is made more specifically for their wants and needs. Participants will work together with researchers, designers and developers throughout the whole process. Cooperative design originally comes from Scandinavia between 1970 and 1980. In Scandinavia, it was initially used for workers to have more influence on the operation of computer programs in their working environment (Natematias, 2011).

Co-design is useful to create the best products for the end-user. Since they will use the product, with co-design it is possible to get the most accurate information about how a product or service will be designed.

There were a few overlapping methods used for co-designing in the research papers we found. Storyboarding, mind mapping and drawing or making collages seemed to be popular. One of the papers (Francis, P. et al, 2009) had a very interesting method. Here they suggested asking co-designers to use photos and video to record their experiences in everyday life. Afterwards storyboarding could be used to investigate the scenarios of interest. Other interesting methods were dot voting, reflection on workshop experiences and thinking out loud to express your feelings in a better manner.

We have already started with some co-designing activities in the first meetings with our co-designer. Together with Marcel we made some mind maps and got to know each other using some short games. Furthermore, we have reflected on a persona and storyboards together with Marcel. In future meetings with our co-designer, some of the methods used in the research papers can help us with our project. Additionally mind mapping, sketching, making collages and using pictures are also great techniques to make his visions tangible. When we are in his house we will make a video together as described in (Francis, P. at al, 2009)

Repetitive and Restricting Behaviours in ASD

Repetitive and restricting behaviours (or RRBs) also occur as a symptom of other disorders, but if a child displays RRBs they are more likely to have an ASD than another disorder. RRBs include repetitive seemingly random physical, verbal acts but in some cases even self-harm by for instance banging their head against a wall (Lam, K. S. L, Bodfish, J. W. & Piven, J. (2008)). Scientists think there might be a correlation between RRBs and sensory problems such as unusual responses to noise, light, touch, smell or movement. (Boyd, B. A., McDonough, S. G. & Bodfish, J. W. (2012)).

One of the key symptoms of ASD is repetitive interests and activities (American Psychiatric Association (2004)). Most people with ASD have a special topic, object, or activity. Often, they use these topics to build a career or build their personalities around (Grandin, T. (2006)).

Many autistic people have obsessions, routines, or rituals. This can be a sign to recognise who is autistic among a group of people. There are several habits for these signs, first, they have linguistic oddities. This usually occurs in children, and they struggle with speaking vocabulary and holding a conversation with others. They have a lack of verbal rhythm, monotone pitch, and an odd intonation of certain words. Adults with ASD may look different compared to children they might seem eccentric during a conversation because of frequent interruptions and focusing on particular topics which is the second habit. They might discuss the same topic while having to communicate with others or do certain motions repeatedly. These negative signs will lead to social difficulties which is the third ritual. It is hard to communicate with others because they make others think that they do not participate in conversation anymore.

Additionally, people with autism mostly focus on themselves. This is related to the above rituals, a person with autism speaks and discusses themselves, not allowing others to interrupt. They spend a large amount of time focusing on themselves which can be main reason for having difficulty in conversation.

Next people with autism have a strong dislike of change. They need to have meals every day in the same quantity with the same foods. The reason for this is that a changed routine can lead to outbursts in the individual. For instance, if they use other product instead of using what they used, they might be angry and shows aggressive behaviour.

Devotion to routines can be related to the above habit. People with autism are devoted to routines, meaning that they stick to a specific routine that is developed by others. For example, washing their hands when arrived at home. If the routine does not work as they thought, they might be frustrated. Also, a large amount of time is used for self-care, exercise, or learning. On the other hand, there are positive aspects of this habit.

The average person might struggle to handle certain routines, people with Asperger’s will typically take quite well to those patterns and make significant results.

Repetitive habits are also a sign of autism which could interrupt others to do what they need to do, and this can impact their health. An individual who refuses to wear jackets but insists on wearing a T-shirt in winter can be an example. And there is another ritual called unusual movement patterns, toe walking is a common movement disorder.

Finally, which is the most well-known habit and ritual, people with autism have strong sensitivity. Many of them have difficulties with sensory, which lead to emotional distress. As it is well known many theories and studies are actively being conducted. (Hyman, S. L. et al. (2020))

Aggression and self-injury in ASD

Also, aggression and self-injury is relatively common in ASD. Half the people that are diagnosed with ASD have displayed aggressive or destructive behaviour and/or self-injurious behaviour (SIB) at some point in their lives (Duerden E.G., Oatley H.K., Mak-Fan K.M., McGrath P.A., Taylor M.J., Szatmari P., Roberts S.W. (2012)) These behaviours are not a symptom of ASD, but the likelihood of having this behaviour increases with more severe cases of ASD. This behaviour is seen in children starting from as young as 12 months old, but most children grow out of this behaviour. Important to note is that these episodes places the individual with ASD or others in jeopardy and or significantly impact factors like living placement, their education, or the level at which they can be involved in a community. (Fodstad, J.C., Rojahn, J. & Matson, J.L. (2012)). Social and communication problems are discussed next. What is really behind the challenging behaviour in autism? In contrast to popular belief, severe behaviours in people with ASD are not majorly affected by a person’s ability to speak, but by a person’s ability to cope and adept (Williams, D. L., Siegel, M., Mazefsky, C. A., & Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC). (2017)). A person that has ASD has great difficulty understanding the complex dance that is our social world. This is because the social sense, a person’s ability to successfully interact with others, is the sense most affected by ASD (American Psychiatric Association. (2000)) Most people with ASD have difficulty showing interest in others and try to avoid looking people in the face. Because of this, it is very hard for them to acquire the body language, verbal and nonverbal feedback and facial expressions needed for successful social interactions. (American Psychiatric Association. (2004))

Noise and smell sensitivity

Noise sensitivity is another symptom of ASD. People with autism either ignore or overreact to ordinary sounds. It is difficult and sometimes impossible to filter out irrelevant noises (S. Rogers, pp. 1255-1256). This is somewhat due to perceiving certain sounds as more intense and overwhelming. The lower auditory detection thresholds ensure that sounds are sooner heard (J Autism Dev Disord, pp. 3)

Some ASD adults are not able to get used to certain sensory stimuli. For people without ASD a repeated stimulus will trigger a physiological response to slowly decrease the stimulus or make it go extinct. This is called habituation, where the body learns not to respond to stimuli that are predictable, familiar or overall, not relevant. Some people with autism might not or slowly habituate to sensory stimuli causing a sensory overload and hyper-reactions. (J Autism Dev Disord, pp. 3)

Sensory problems, like noise sensitivity, can also be triggers for other behavioural issues such as extremely picky eating habits (S. Rogers, pp. 1255-1256).

People with autism might experience both hyper and hyposensitivity. Not only sound but they also might have sensitivities to smell. When scents are exposed to humans, the postcentral and postmedial cortex is used to distinguish the smell. Typical people normally use the postcentral cortex to distinguish the smell, whereas people with autism use the postmedial cortex. Some people with autism can detect the smells from a long distance, others will not react at all. Oversensitive people would complain about smells that they do not like, however under sensitive people might sniff everything. Also, some people might actively search for the smell they like. When they smell a certain scent, it reminds them of past memories so they feel like they are actually smelling the scent from the past. If it is a good memory, they recognize it as a good smell and vice versa (H. Furfaro (May 9, 2018)).

The reason for this sensory difficulty is weakened of the neurological process that organizes the sensory information. Many people with ASD have trouble processing and incorporating sensory information and therefore react differently than expected to information in the background.

When typical people smell a scent, an odour-sensing region called the piriform cortex increases brain activity, but scents do not cause any increase in people with autism. (Gomot M, Giard MH, Adrien JL, Barthemely C (2002))

Reducing autism symptoms

As Lisa describes in: “Treatment of High-Functioning Autism Spectrum Disorder in Adults” there are cases of people with high functioning autism spectrum disorder that have such light symptoms that help is not necessary. However, if the symptoms effect a person in their daily life, there are “treatments” available. Where it must be stated that there is no cure for autism but there are ways to reduce the symptoms or improve other things, such as building self-control, controlling emotions or reducing anxiety. (Rudy, 2021)

One of the options to control symptoms of autism is getting medication. Antidepressants can help manage emotions, stimulants improve focus and attention and anti-anxiety drugs can help with anxiety. Like these, there are for every person different options for medication. Besides medication, behaviour therapy like social skills groups or cognitive therapy can help people with ASD. For most ASD cases, highly structured and specialized programs help best to reduce symptoms and help with daily activities.

Besides medicine and therapies, there are also things that can be done at home, alone or in a social context. Adaptive skills are a collection of practical skills that help people to live a normal life, like communications, social skills, activities of daily living (ADL) and behaviours (Anderson, 2012). When diagnosed with ASD these skills often are harder to accomplish. Sometimes it is important for individuals with ASD to have strong rituals and routines, while for others that works oppositely.

For most individuals with ASD, it is important to have rituals and routines, which will differ considerably per person.

ASD in adulthood

Diagnosing adults with ASD and especially with high-functioning ASD can be a challenge. This is because, during the diagnosing of the examinee, the experience of the examinee is researched as well as those of the parents. Sometimes a gap can occur between these experiences when the examinee looks different at his/her behaviour than their parents.

When diagnosing adults with ASD, it is common that the examinee shows normative behaviour in the beginning. After more focused testing it can be discovered that the examinee has ASD. This happens because some people learn social codes and how to behave in different situations during their life. Some people also learn to hide their ‘unacceptable’ behavioural traits, they learn how to mask them. This makes it difficult to diagnose someone with ASD. It can also occur that the symptoms of someone with ASD are the same as symptoms of other disorders or anxieties.

During diagnosis, the Theory of Mind (ToM) can be tested on the examinee. ToM are the abilities a person has to understand their own and others’ emotions and mental states. The outcome of this test shows significant differences for people with ASD. However, a small group of people with high-functioning ASD pass the ToM test by compensatory reasoning. From this can be concluded that there is a lack of diagnostic tools to diagnose people with high-functioning ASD. (Rubinstein K. (2019)).

Late diagnosis of ASD

The education system has a positive influence on children with ASD. They learn to socially interact with other people, how to communicate and they reduce their repetitive behaviours. It is shown that after children leave the education system, this improvement reduces. This makes it uncomfortable for people who are diagnosed with ASD as an adult. Less research and treatment exists for adults with ASD.

A survey by the UK National Autistic Society conducted that 71% of people over the age of 55 with ASD received the ASD diagnosis within the last decade. They are called ‘the lost generation of autism’. This group might become smaller when there is more awareness and accessibility to receiving a diagnosis. It is also possible that this group will not become smaller, because they are at the end of the spectrum. This makes it harder to recognize the symptoms in those people.

There are multiple reasons for non-diagnosis in childhood. These can be separated into environmental and individual factors.

Environmental factors:

· Lack of awareness: the first time ASD was mentioned in the DSM (Diagnostic and Statistical Manual of Mental Disorders) was in DSM-3 in 1980. Asperger’s syndrome appeared for the first time in DSM-4 in 1994. Incorrect diagnoses were given to people in the past, because of the lack of awareness of ASD.

· Social environment: in some social environments it is harder to recognise the symptoms of ASD in children. One of these environments is the education system. This system is highly structured, which makes it easier for a child with ASD to well function. School schedules are worked out in detail and the information asked on an exam has been given beforehand. After school hours this schedule is less structured, but if a child continues studying after school, it will stay in the ‘school structure’. This behaviour will only be rewarded by parents and teachers. When a child with ASD can fit into the system, it will most likely not be diagnosed with ASD. These are children who are silent, have good grades and do their own thing. Children who disrupt the system are easier diagnosed with ASD.

Individual factors:

· Intensity of symptoms: the bigger and more obvious the symptoms are, the easier it is to diagnose a child with ASD. ‘

· Temperament: when a child accepts authority or has a positive attitude towards people, it puts less attention on this child. But when a child has rebellious traits or has resistance towards people, it will get more attention. This makes it again easier to diagnose a child with ASD.

· Compensation strategies: because of compensation strategies, ASD symptoms are hidden from people. This mostly occurs among females, who have a bigger span of social roles.

· Comorbidities: it is harder to diagnose people when they also have another mental illness at the same time. The symptoms of this other mental illness can hide or mask the symptoms of ASD.

· Family members: family members play an important role in the diagnosis. When they do not notice the symptoms or do not want to get labelled, they can keep a diagnosis from happening.

· Age: symptoms of ASD can change over time. The reason why this happens is not clear yet, but most of the time the symptoms improve with age. This makes it more difficult over time to diagnose someone with ASD. But symptoms can also get worse over time when a person does not get a proper diagnosis. It can cause frustration or disappointment in themselves and others.

Getting diagnosed in adulthood can be a challenge for developmental reasons. Over time, an undiagnosed individual can learn compensatory mechanisms so that he/she can function in social environments. Also, a specific interest can be made into a job or hobby, this hides the extreme interest in an area.

Psychologists say that knowledge is better than ignorance when talking about diagnosing. A diagnosis has a positive impact on the quality of someone’s life. The person can get access to proper medication and psychological treatment. When a person always felt different from other people, it can be helpful to know what the cause for that is. It can help with accepting and understanding yourself.

However, diagnosis in adulthood can also have negative consequences. For example, an individual can internalize the stigma associated with ASD, which can lead to low self-esteem or social isolation. It can cause self-efficacy and depression. They might not see the need for treatment and do not want to cooperate with mental health professionals. This shows that it is important to realize the consequences of late diagnosis. For some patients, extra care should be taken when diagnosing them. (Epstein T. (2019))

ASD and planning

When talking about time, one can differentiate between several magnitudes. Firstly, there is circadian timing, which covers a time span of 24 hours and is concerned with our sleep-wake rhythm, which is regulated by the suprachiasmatic nucleus in the human brain. Secondly, there is interval timing, which is about intervals of less than a second up to several minutes. It is used in conscious time estimations and of great importance in decision-making. There is no certainty which part of the human brain is responsible for interval timing, but likely the cortico-striatal networks and dopamine neurons factor in. On top of the previously mentioned intervals, millisecond timing concerns moments of less than a second, as the name suggests. It is of importance for motor control and speech, where the part of the human brain which is involved, depends on different cerebral structures. For motor control and speech processing, the cerebellum and respectively the auditory cortex are of importance. (Jurek et al., 2019, pp. 1-2)

Apart from the different magnitudes, one can distinguish between time perception, time orientation and time management. Time perception is the experience of the duration of an interval, time orientation is the awareness of what day or month it currently is and time management includes planning, prioritising and allocating a certain amount of time for a task. (Jurek et al., 2019, pp. 2)

There are indications that ASD is affiliated with lesser performances in all aforementioned aspects of time and timing. Common complications include difficulty in determining the chronology of memories, lack of sense of time, difficulty understanding the continuity of time and difficulty making associations between certain hours and related activities. Also thinking in a diachronic fashion is often more challenging, which means imagining past and future stages of a certain current situation. Managing the allotted time for an activity and considering successive discrete events as being part of one cohesive event is often more difficult as well. (Jurek et al., 2019, pp. 2)

Although time-related issues have not been directly linked but rather associated with the ASD diagnoses (Jurek et al., 2019, pp. 2), one symptom greatly related to planning has been documented since the development of the clinical picture of ASD: difficulty switching tasks (Sevin et al., 2015, pp. 329). Often, these difficulties with transitioning can obstruct treatment, care and learning, as well as causing serious distress in the person with ASD (Sevin et al., 2015, pp. 329).

To support planning related issues, several devices have been introduced. For example, the Tic Tac tool offers a visual representation of time intervals, while the quarter-hour clock offers a clear overview of useful units of time. On top of that, there is the Time Rule, the Time Timer and visual calendars that aid some people on the spectrum to have a better grip on time. (Jurek et al., 2019, pp. 7)

The use of visual schedules also yields improvements for difficulties in switching tasks. These types of calendars make use of photos and line drawings to utilise the strength in the visual-learning present in some persons with ASD. One type of visual calendar is the schedule board based on PECS: Picture Exchange Communication System. Steps for constructing a visual calendar include identifying and defining desired transition behaviours, collecting data behaviour and choosing a between-activity or within-activity schedule. After, a mode of presentation, medium and location for the schedule should be chosen. The person should be trained to use the calendar, after which intervention data is collected and new pictures or words are added to the calendar. Then, prompts should be phased out and the schedule should be adjusted to fit the user well. Lastly, generalisation of for example certain activities should be promoted. In addition to visual calendars, PDAs: Personal Digital Assistants are sometimes used. (Sevin et al., 2015, pp. 331-334)

Apart from using a visual calendar, there are several other approaches to reduce the difficulties in switching tasks. Firstly, there is altering the time of request to switch the task, to make it occur in a more natural way. For example, quitting watching tv is easier after a program ended rather than in the midst of an episode. Also, a cue a few minutes before the next task is coming is rather helpful, especially visual cues. Besides these cues, priming could prepare a person for a change in tasks, which could mean the person performs a walk-through of a future task without already performing it, or watching a video of the task. This way, the person is already exposed to some aspects of the task, which could make the transition more smoothly. During modelling, videos could also be used, where the emphasis of this approach is to demonstrate to the person in question how to do the tasks instead. The last mention is that of behavioural momentum, where a high-probability command is given before a low-probability command, where the momentum of the first command is used to make performing the second command easier. This means that when a person stuck in one task has to move on to the next, it could help to do a small task in between, like giving a high five, to distract from the previous task. Since the focus is then off the previous task, it is easier to move on. (Sevin et al., 2015, pp. 330-336)

ASD and physical activities

Doing physical activities has been proven to improve the physical condition of people with ASD and reduce their impaired behavioural patterns of them. Especially in children with ASD, an improvement is shown in the physiological and psychological factors while participating in physical activities. Also, studies show that physical activities improve the intellectual and social outcomes of people with ASD, as well as their self-esteem, and happiness. Besides that, physical activities require fundamental motor skills, like running, catching, throwing etcetera (Bauer, C., Guldager, E. K., Brunner, K., & Stilner, R. (2020, February)). These skills can be significantly improved.

Especially aerobic exercises help individuals with ASD with task behaviour, work performance, and their attention span. It also reduces self-injurious, aggressive, unproductive, and disruptive behaviour. Aerobic exercising also improves the sleeping behaviour and attention span of people with ASD.

Additionally, fitness exercises improve muscular strength and endurance, which people with autism tend to have in a lesser extent. These skills are important not only for physical health but also for social opportunities that involve physical activity. (Bauer, C., Guldager, E. K., Brunner, K., & Stilner, R. (2020, February))

From different studies can be concluded that no matter the type of physical activity, it improves the physical condition of an individual with ASD, but it also improves their behaviour. Often people with ASD have a sedentary lifestyle, it is important to encourage them to be more active.

Participating in group activities can be difficult for someone with ASD. They prefer to do physical activities on their own. There are several reasons for this. It can be caused by their social communication impairments and playing with team players requires communication. Another reason is that people with ASD often have very specific interests, which can be difficult to share with other people. A third reason is people with ASD often prefer to have their own personal schedule or routine. Participating in group activities can disturb this schedule and there is a great deal of unpredictability.

Participating in physical activities can also be a challenge for people with ASD because they do not perform as well in sports like other people in general. This can be discouraging to keep doing these activities. To improve this, people with ASD should constantly be encouraged to be active. And also, the individual should be more focused on participation and joy, than on the outcome.

Nevertheless, people with ASD should still participate in group activities and should be encouraged to do so. It can improve their social and communication skills and could build confidence, which would reduce anxiety (elemy. (2022, January 13)).

Oversensitivity to stimuli such as contact with others can off-put autists to play contact sports like rugby. However, autistic people can have strong visual skills and academic abilities so with the right support, they can be helped to reach their full potential. To achieve this, coaches and fellow players need to be mindful of sensory issues and adapt to the situation if required. (Carmen B.Pingree. (2021))

Autistic people may also display some other strengths during physical activities, such as logical thinking ability, a drive for perfection, and strong adherence to rules (Mansour, I. (2014, March 25)). While exercising or competing these can contribute to a successful result.

It is important that being active is done in a safe environment and in an efficient manner. Multiple factors should be considered when implementing an exercise program in the daily life of a person with ASD:

1. Enough time should be given for the person to do a warm-up and cool down. Enough breaks should be added to the exercise, so the person does not get overwhelmed.

2. Keep track of the individual outcomes and make exercises more enjoyable or difficult when needed.

3. Use equipment that is safe and user-friendly. If the individual has sensory or motor impairments, these should be considered when choosing the right equipment.

4. Make use of a heart rate monitor, these should be checked by an appropriate scale. The heart rate and blood pressure can be different for individuals with ASD because of their medication.

5. Watch out for negative-type behaviour of ASD, like tantrums, nonadherence, or self-injurious behaviour. These are signs that physical activity should be stopped.

6. Find out where on the autism spectrum the participant lies. For lower functioning ASD different exercises are better than for high functioning ASD.

Doing physical activities has been proven to improve the physical condition of people with ASD and reduce their impaired behavioural patterns. Also, studies show that physical activities improve the intellectual and social outcomes of people with ASD, as well as their self-esteem, and happiness. Besides that, physical activities require fundamental motor skills, like running, catching, throwing etcetera (Sean Healy, 2018). These skills can be significantly improved. Additionally, fitness exercises improve muscular strength and endurance, which people with autism tend to have to a lesser extent. These skills are important not only for physical health but also for social opportunities that involve physical activity. (Sean Healy, 2018) Often people with ASD have a sedentary lifestyle, so it is important to encourage them to be more active.

Participating in group activities can be difficult for someone with ASD. They prefer to do physical activities on their own. There are several reasons for this. It can be caused by their social communication impairments. But also, they often have very specific interests, which can be difficult to share with others. A third reason is people with ASD often prefer to have their own personal schedule or routine. Moreover, it can be a challenge because people with ASD do not perform as well in sports like other people in general. It can be discouraging to keep doing these activities. Nevertheless, people with ASD should still participate in group activities and should be encouraged to do so. It can improve their social and communication skills and could build confidence, which would reduce anxiety (J. Wertheim & S. Apstein).

Oversensitivity to stimuli such as contact with others can off-put autists from playing contact sports. However, autistic people can have strong visual skills and academic abilities so with the right support, they can be helped to reach their full potential. To achieve this, coaches and fellow players need to be mindful of sensory issues and adapt to the situation if required. (Amy Webster, pp. 13-16)

Autistic people may also display some other strengths, such as logical thinking ability, a drive for perfection, and strong adherence to rules. While exercising or competing, these can contribute to a successful result.

Comorbid disorders

Adults with ASD have a higher occurrence of 80% of getting diagnosed with other associated psychiatric disorders so people with ASD might have multiple disorders (S. Portuguese (2019)).

ADHD, OCD, depression and anxiety disorder are all disorders that often go under-recognised in individuals with ASD, as it is difficult to diagnose them with the right disorder or disorders (Oshi, G., Petty, C., Wozniak, J., Henin, A., Fried, R., Galdo, M., Kotarski, M., Walls, S. & Biederman, J. (2010) pp. 1361-70). However, depressive disorders are the most common psychiatric disorder among people with high functioning ASD. 57% of adults with high functioning ASD are also in a depression somewhere in their adulthood. The risk of depression is for women higher than for men, not only for people with ASD but also for the general population (S. Portuguese (2019)).

It has been suggested that there is some overlap between ADHD and ASD and that they might be similar in their genetic alteration. This is because both tend to over-focus on something while shutting out or ignoring other people. (Smalley, S.L., Kustanovich, V., Minassian, S., Stone, J.L., Ogdie, M.N., McGough, J.J., McCracken, J.T., MacPhie, I.L., Francks, C., Fisher, S.E., Cantor, R.M., Monaco, A.P., & Nelson, S.F. (2002) pp. 959-963).

Existing foundations

Nederlandse Vereniging voor autisme (NVA)

The NVA focuses on building a society in which people with autism are fully integrated, accepted and self-sufficient. The NVA is involved in advocacy, reliable information provision and contact with others with autism in the neighbourhood. This is the biggest foundation in The Netherlands with over 10.000 members.

Stichting De As

This foundation is focused on personal guidance and treatment for people with autism. They want to personally connect with them and are striving for stability so that every individual can come to their right, can use his/her talents and can develop themselves.

Stichting Droomkinderen

Stichting Droomkinderen guides and supports the youth with related disorders. They come into their own the best in a small-scale setting.