This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

A Wayne State University (WSU) community-based program for kids on the autism spectrum is taking off. PLANE, short for Physical Literacy and Nutrition Education, offers adaptive strategies to get kids moving, as well as a nutrition curriculum that shares ways to introduce kids to healthier foods. 

Dr. Leah Ketcheson, assistant professor and program coordinator of WSU's Health and Physical Education Teaching program, proposed the idea for PLANE through her 2016 doctoral thesis after teaching adaptive physical education in the Detroit Public School Community School District from 2007 to 2010. Ketcheson saw a need for extracurricular health programming among students with autism. 
Dr. Leah Ketcheson.
"The classrooms of children with autism were the most intriguing but also the most challenging," she says. "I saw that the children with autism were exhibiting significant health disparities when compared to neurotypical children."

While autism is commonly recognized as impacting social engagement, communication, and behavior, it affects health in many other ways. According to the National Institutes of Health, children with autism spectrum disorder (ASD) have a 41.1% greater risk of developing obesity. They are also at a higher risk for gastrointestinal issues, diabetes, heart disease, allergies, asthma, and eating disorders. All of these risks can be addressed with physical activity and a healthy diet.

"It's often challenging for families to access activity with their child with autism in ways that are welcoming, consistent, supportive, and promote building healthy habits around keeping physically active," says Heather Eckner, director of state education and outreach for the Autism Alliance of Michigan.

Eckner, who developed a webinar series on educational advocacy for parents and caregivers involved in PLANE, has two children on the autism spectrum. She says nutrition-related challenges, which may include extreme selectivity or sensory-related aversions, are also significant for children on the spectrum. 

"Some kids only eat five different food options," Eckner says. "That can be really challenging and it can impact their health."

Based on her research into motor and physical activity interventions for youth with disabilities, Ketcheson designed one of the first early, intensive movement skill interventions for children with ASD. In 2017 she launched “Jump Up to Play,” her first iteration of adapted physical activity programming for children on the spectrum. With funding from the Michigan Health Endowment Fund and in-kind support from WSU, what started as an eight-week summer intensive focused on children's physical activity and sports has grown into the two-year, year-round PLANE program incorporating physical activity and nutrition programming.
A PLANE exercise session.
"Changing behavior can be very complex for individuals on the autism spectrum. I think it's impossible to talk about promoting health without tackling multiple components of health," Ketcheson says. "This population of children are so susceptible to weight gain because of their food selectivity, and also some medications [prescribed for symptoms of autism] make them predisposed to weight gain. It is particularly important that we target these health behaviors in multiple dimensions, not just physical activity or nutrition. It really has to be both."

Children on the autism spectrum and their families now meet weekly to learn how to successfully integrate physical activity and healthy foods into their lives, moving through PLANE's two-year curriculum of weekly lessons. They are grouped by age into three cohorts: Gliders, ages two to five; Propellers, ages six through 10; and Boeings, ages 11 to 15. A new recipe and physical activity is introduced each week. For example, in week one of year two, Propellers will learn how to do an overhand throw and then snack on watermelon salad. 

"We insert that element of fun while giving attentive care to each one of these families," Ketcheson says. "The parents have maybe realized that their child is so focused on making gains in therapy, which are so necessary, but this is an opportunity for them to focus on another very important domain in a very well-supported and well-loved environment."

Along with Ketcheson, PLANE's staff includes board-certified behavioral analysts who mentor the coaches who work one-on-one with the children. The coaches are WSU health and physical education, or exercise sports science, majors. These students may require a practicum to fulfill graduation requirements, or they may simply want to learn to be better service providers when they enter careers as physical therapists, occupational therapists, or physician assistants.

"We've got all the support systems at Wayne State to make this happen," Ketcheson says. "I think part of being an effective program is really identifying what your target audience needs. I know that our target audience, our primary stakeholders, are the parents and the children with autism. They need direct, individualized support. The way that we can provide that is through the awesome work of our undergraduate and graduate degree programs."
A PLANE exercise session.
Because PLANE initially launched during the height of the COVID-19 pandemic in 2020, its first iterations were virtual. Weekly lessons and informational resources for caregivers, educators, athletes, and families remain accessible on the PLANE website. PLANE participants now meet face to face in WSU's athletic facilities one evening per week.

"It's just an amazing group of families from a variety of backgrounds. They all have one thing in common — a desire to improve the health of their family unit," Ketcheson says. "These families have focused so heavily on meeting the needs of their child's core deficits that health has been put to the wayside, despite the fact that they are exhibiting significant health disparities."

Amanda Paige and her nine-year-old son, Martin Paige-Fowlkes, have been active with PLANE ever since its launch. They first participated in virtual PLANE sessions, which then included pick-ups of grocery items featured in the weekly lesson recipes. Now they attend weekly sessions in person at WSU.

"Martin's got different motor planning issues that PLANE is able to address," Paige says. "A typical sports program does not. So understanding how to break down throwing a ball is just huge. That motor planning takes a little bit more thought and doesn't come necessarily as fluidly for him as for a neurotypical child. He definitely is more aware of how his body works and how to think things through instead of muscling through everything. And it helps him to be more social."
Martin Paige-Fowlkes and Amanda Paige.
While the kids do their PLANE activities, parents are invited to join a coach-led fitness session in another room. Paige notes that she is improving her health and fitness along with her son.

"It helps me to be around other parents who get it. It's a very tiring and somewhat isolating life because you either get the pity stares or friends who just don't understand the ins and outs [of raising a child on the autism spectrum]," she says. "We really enjoy getting together with people at the gym to do sports, as Martin calls it. That's also gotten us more active outside of the program. We've taken up biking and kayaking. We're getting out and moving more."
PLANE parents.
For Martin, PLANE has meant much more than learning how to throw a ball or guard a goal. He's made friends. And he's been quite adventurous in trying the healthy foods offered during PLANE sessions.

"At the end of every session at the gym, they give us a healthy snack with assembly instructions. Martin likes to come home, even if he doesn't try the snack, and make a cooking video, 'Cooking with Martin.' It's actually gotten him to try a lot more foods. He's at least trying it and exposing himself to new foods because it's a safe space to do that," Paige says. "I don't know if I can convey exactly how much this program has been a lifeline."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photos by Doug Coombe.