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Living Well

Health and wellness tips from Indiana University

Living Well for March addresses disability issues. More disability-related tips can be found at The following topics are discussed in this issue:

A family approach to movement can benefit the whole family, not just children with disabilities
Early temperament and autism
Accessibility -- a shift away from fear and resistance

When the whole family participates in physical activity, it can benefit each member in different ways.

What's good for one is good for all -- physical activity, family and disabilities. The activity levels of children with visual impairments, such as low vision or blindness, decrease as they age despite the importance of physical fitness to not only their health but also to their ability to be independent. Francis Kozub, an assistant professor in Indiana University's Department of Kinesiology, said these youth and their families could benefit from a "family systems approach" to physical activity. His research also has found low levels of activity for the parents of children with disabilities.

"Parents are trying hard to make sure their kids are safe and active at the expense of their own physical activity," said Kozub, who discusses this in research published in Exceptional Children in an article titled, "Explaining physical activity in children with visual impairments: A family systems approach." Co-authors are Nalan Ayvazoglu, a doctoral student in the Department of Kinesiology, and Hyun-Kyoung Oh, assistant professor in the Department of Kinesiology, California State University San Bernadino.

The idea behind family systems theory is that what affects one member of the family affects all. Kozub gives the following examples of how physical activity behavior by all in the family can benefit everyone:

  • Productive use of family leisure time, such as swimming, can provide an outlet for the family and increase fitness in a child with a visual impairment. The family time is good for all because it gets everyone out in the community where other relationships can be built outside of the family. Often, families who have children with disabilities feel isolated from the larger community.
  • Physical activity can be used as a means to independence for children with mental retardation. This can occur, for example, when a family lifts weights together. The child with mental retardation may develop physical skills that make jobs requiring more physical skills, rather than cognitive ability, possible. The family members who work out with the child benefit by engaging in a healthy behavior. A family is enhanced when each member becomes a productive, working member of society.

Children typically see their activity levels decrease as they age, but for children with disabilities this decline is steeper. In Kozub's study, efforts to get children with visual impairments moving were hampered by the following: transportation arrangements to facilities and programs that were far away, hectic family schedules, lack of extended family members living nearby and parents' fear of safety issues.

Kozub can be reached at 812-855-7719 and Top

Early temperament may predict later social skill deficits and social anxiety in children with autism. Hyper-sensitivity to stimuli such as light, sounds and interpersonal interactions may be the first step in the development of social anxiety among children with autism, according to a recent study by Scott Bellini, assistant director of the Indiana Resource Center for Autism at Indiana University. The study, published in the journal Focus on Autism and Other Developmental Disabilities, demonstrates a developmental pathway toward social skill deficits and social anxiety that begins as early as infancy. "Many children with autism are born with a temperament that is high in physiological arousal. They are easily overwhelmed by stimulation," Bellini said. Early signs of hyper-arousal include increased heart rate and psychomotor agitation, such as flailing arms and legs. Children who experience high physiological arousal begin to withdraw, Bellini said, leading to deficiencies in social skills, and for many children with autism, to high levels of anxiety regarding social situations. Below, Bellini describes strategies for effective intervention. These techniques are best delivered via a team approach, which includes parents, pediatricians, speech therapists, mental health providers and educators, he said.

  • Infancy: Recognize triggers for withdrawal. "Parents may unwittingly overwhelm their kids with interaction. They will need to learn to detect signs of discomfort like looking away, increased motor activity and changes in facial expression. Then they can learn techniques for interacting without overwhelming the child."
  • Preschool: Social skills groups. "At this age, we are interested in getting kids to participate in social interaction with others, but the introduction should be gradual and systematic and with support from a skilled therapist."
  • Primary school: Social skills training and peer training. "One of the things this research demonstrated is a direct link between social skills deficits and social anxiety. Using systematic social skills training, we can reduce those deficits so kids are more comfortable interacting with their peers. To complement that effort, we introduce peer training programs that teach children without disabilities how to accommodate and be accepting of children with autism."
  • Grade school through adolescence: Relaxation techniques. "Once children are a little older, they can learn ways to regulate their arousal and emotions. One of the things I'll do in my practice is use a heart rate monitor to help them observe how their heart rate increases when they become anxious. Then we work on breathing exercises and other techniques to regulate that response. The use of the heart monitor provides a visual representation of how effective breathing can help regulate their arousal level."

Bellini can be reached at 812-855-6508 or The Indiana Resource Center for Autism is part of the Indiana Institute on Disability and Community at Indiana University. Bellini is also a faculty member in the Indiana University School of Education. Top

Accessibility: A shift away from fear and resistance. When the National Center on Accessibility at Indiana University began presenting training courses in the early 1990s, instructors were met with much resistance. Common reactions to topics such as access to trails brought on heated questions starting with, "You want me to do what?" said Gary Robb, NCA director and associate professor in IU Bloomington's Department of Recreation, Park and Tourism Studies. "Most resistance was embedded in fear and lack of understanding on what accessibility meant," Robb said. "Over time, we have seen a positive and encouraging shift in attitudes amongst practitioners in the field. More common than not, professionals are heard saying they want to make accessibility improvements for their park visitors with disabilities, not because it's the law, but because it's the right thing to do."

This year marks the 15th anniversary of NCA, which is widely recognized for its research, training and information centers on the inclusion of people with disabilities in parks, recreation and tourism. Robb and Jennifer Skulski, a senior training instructor for NCA, share some organizational tips for successfully including people with disabilities:

  • Commitment from the top. Accessibility for people with disabilities and universal design for the widest spectrum of users are values that should be accepted as part of the organizational culture, Skulski said. "When our values regarding inclusion of people with disabilities are clear, our decisions about accommodations, policy modifications and barrier removal are so much easier," she said. While "equal opportunity to participate and benefit" is a core mandate of both Section 504 of the Rehabilitation Act and the Americans with Disabilities Act, it should be a core value for each and every public park and recreation agency -- federal, state or local.
  • Involvement in the process. Implementation of a successful, effective and efficient accessibility management program requires involving everyone in the process. And this does mean everyone -- from the CEO to the frontline staff.
  • Planning for action. The organization must assess its current level of accessibility to determine where physical, programmatic, communication and policy barriers still exist. "Then," Robb said, "the organization can better plan and prioritize barrier removal."
  • Evaluating for action. "Ongoing evaluation is essential to determine, 'are we doing the right things right?'" Skulski said.

Skulski can be reached at 812-856-4428, 812-856-4421 (tty) and Top

For further assistance with these tips, contact Tracy James at 812-855-0084 and, or Elisabeth Andrews at 812-855-2153 and

EDITORS: This monthly tip sheet is based on Indiana University faculty research, teaching and service. "Living Well Through Healthy Lifestyles" is the guiding philosophy of IU Bloomington's School of Health, Physical Education and Recreation. In keeping with that philosophy, this tip sheet offers information related to both physical and mental well-being. Faculty in other IU schools and departments also contribute their expertise in this area.