A study was conduced on autistic individuals who commonly face challenges with sleep due to difficulties in relaxation &amp; irregular melatonin levels, impacting the child &amp; their families. The feet reflexology has demonstrated benefits in addressing sleep problems, this study aimed to assess the effect of feet reflexology on sleep quality among autistic children. A quantitative research approach with a quasi-experimental pretest-posttest control group design was used, convened sampling was used for the study. The study findings reveled foot reflexology intervention led a significant improvement in sleep quality in the experimental group, with notable decrease in moderate sleep problems (P&lt;0.0001) thereby the study suggest the effectiveness of foot reflexology

Dr Agnes Arun Swamy

Dr Sreelekha Rajesh

Ms. Amruta Gade

English

The Bioscan

 365         20(1): 365-367, 2025                                                                       www.thebioscan.com                     Effect of Foot Reflexology on sleep quality among Autistic children in selected special schools. 1Ms. Amruta Gade, 2Dr Sreelekha Rajesh and 3Dr Agnes Arun Swamy 1Student, Tehmi Grant Institute of Nursing Education, Pune -01, Maharashtra University of Health Sciences Nashik, Maharashtra, India. 2Vice Principal, Tehmi Grant Institute of Nursing Education Pune – 01, Dean Faculty Nursing Maharashtra University of Health Sciences Nashik, Maharashtra, India. 3Professor, Tehmi Grant Institute of Nursing Education Pune – 01, Maharashtra, India.    DOI:  https://doi.org/10.63001/tbs.2025.v20.i01.pp365-367      Individuals diagnosed with autism spectrum disorder commonly demonstrate challenegs in social interaction & communication, coupled with repetitive or stereotypical behaviors. These children require ongoing support and supervision due to intellectual disabilities. These children also suffer from disturbed sleep. Sleep plays a crucial role in human development and maturation. Throughout sleep numerous vital functions of the human body, including cellar growth, memory consolidation and restoration of cellular function. Foot reflexology aims to induce the physiological relaxation, enhance blood circulation, maintain bodily equilibrium, and facilitate the efficient exchange of energy, within the body’s organs and cell associated with these pressure points.  Need of the Study: ASD is a complex developmental disorder characterized by a wide range and severity of intellectual and behavioral deficit. The American Psychiatric Association (2013) has outlined various types of ASD, including atypical autism, childhood disintegrative disorder pervasive developmental disorder. Preeti A Devani & Hegde A.U. (2015) conducted a study to assess the prevalence of sleep disorders in individual with autism spectrum disorder the findings revealed that the prevalence of sleep problems, particularly insomnia, was found to be higher in children with ASD compared to typically developing children, ranging from 40% to 80%. Based on researcher’s personal experience with a one of family member diagnosed with autism spectrum disorder (SD), the researcher observed that sleep disturbances are very common among autistic children. Objective: • To assess the sleep quality among autistic children in experimental and control group. • To evaluate the effect of foot reflexology on the sleep quality among autistic children in experimental group. • To determine the association between pre-intervention level of sleep quality with selected demographic variables. Hypothesis: H0 - there is no significant difference in the effect of foot reflexology on sleep quality among autistic children at 0.05 level of significance. H1 – there is significant difference in the effect of foot reflexology on sleep quality among autistic children at 0.05 level of significance. Ethical Consideration: • The study proposal was sanctioned by the institutional ethical committee. • The prerequisite was fulfilled, and the permission will be obtained from the concerned competent authorities of selected special school. • Study was explained to the subjects and informed consent was taken from them prior to the study. • Various strategies were adopted to meet the ethical principles of beneficence, non-maleficence, veracity, autonomy and justice. INTRODUCTION   KEYWORDS ASD (Autistic Spectrum Disorder)    Received on: 12-12-2024 Accepted on: 13-01-2025 Published on: 11-02-2025 ABSTRACT  A study was conduced on autistic individuals who commonly face challenges with sleep due to difficulties in relaxation & irregular melatonin levels, impacting the child & their families. The feet reflexology has demonstrated benefits in addressing sleep problems, this study aimed to assess the effect of feet reflexology on sleep quality among autistic children. A quantitative research approach with a quasi-experimental pretest-posttest control group design was used, convened sampling was used for the study. The study findings reveled foot reflexology intervention led a significant improvement in sleep quality in the experimental group, with notable decrease in moderate sleep problems (P<0.0001) thereby the study suggest the effectiveness of foot reflexology.   366 • Confidentiality of the information maintained by utilizing code number of subjects. Conceptual Framework: The conceptual framework adopted in this study was based on modified Imogene King’s Goal Attainment Theory. Review of Literature: Review of literature is one of the most important steps in the research process. It refers to an extensive and systematic examination of publications relevant to the research projects. The researcher did extrinsic work in the review of literature in order to support the study the researcher gathered various studies related to the topic. Studies related to autistic children, studies related to prevalence of sleep disturbance among autistic children, studies related to effect of foot reflexology among autistic children and studies related to effect of foot reflexology. Research Methodology: Research Approach: Quantitative Research approach Research Design: Quasi Experimental non-randomized control group research design Sample: School-age children (6-12 years) Sample technique: convenient sampling technique Sample size: total number of 50 school-age children Validity: to ensure the content validity, the developed tools were given to seven experts for validation. Reliability: The tool reliability was assessed using Cronbach’s alpha test, 12 samples were selected, reliability of the child sleep habits questionnaire on Likert scale was 0.7782 which is >0.70 indicating the tool was reliable. Inclusion Criteria: • Children diagnosed with mild to moderate autism by a psychiatrist • Children aged between 6 – 12 years. • Children experiencing sleep disturbances. Exclusion Criteria: • Children with foot injuries such as wounds, burns, skin or fungal problems, and foot fractures • Children with severe autism • Children with pathological disease condition. • Children who have experienced any stressful events (e.g. parents’ divorce, death of the first-degree family member, parental disputes, or the presence of stepparents) within the last 3 months. Results: To assess the effectiveness of foot reflexology on quality of sleep among autistic children in the experimental and control group: The findings of the study suggested, In the pre-test, the data indicates that most children, specifically 23 out of 25 (92%), demonstrated moderate sleep quality, while only 2 out of 25 (8%) exhibited good sleep quality. However, in the post-test results, a noteworthy change is observed, it is evident that 19 out of 25 (76%) children maintained a moderate sleep quality, while 6 out of 25 (24%) children good sleep quality. Therefore, this suggests a positive impact of the intervention on improving sleep quality among the participants, as reflected in the shift towards a higher proportion of children experiencing good sleep quality in the post0test phase compared to pre-test. Table 1: Distribution of pre-test and post-test sleep quality among children with autism in the experimental group Sleep quality Score Pre-test percentage Post test Percentage Frequency Percentage Frequency Percentage 0 – 30 (Good) 2  8% 6 24% 31 – 60 (Moderate) 23 92% 19 76% 61 – 90 (Poor) 0 0 0 0  In the experimental group all children in the pretest that is 100% demonstrated moderate sleep quality, with none of the children exhibiting poor or good sleep quality, and in the post test 96% children maintained moderate sleep quality while 4% achieved good sleep quality. This suggest that in the control group there is no noticeable changes seen. Table 2: Distribution of pre-test and post-test sleep quality among children with autism in the experimental group Sleep quality Score Pre-test percentage Post test Percentage Frequency Percentage Frequency Percentage 0 – 30 (Good) 0 0 1 4% 31 – 60 (Moderate) 25 100% 24 96% 61 – 90 (Poor) 0 0 0 0  To assess the significant difference in the pretest post test mean score regarding foot reflexology on quality of sleep among the autistic children in the experimental and control group In the experimental group after providing the foot reflexology there was improvement in the sleep quality which was identified in the posttest. The p-value was <0.0001 the Z value was 4.24. therefore, the null hypothesis was rejected, and the alternate hypothesis was accepted. Table 3 Effectiveness of foot reflexology on sleep quality among autistic children in the experimental group Parameter Pre-test Post-test Wilcoxon  Z Value P Value Sleep quality score Mean SD Mean SD 41.84 6.768 26.60 7.890 4.24 <0.0001  H0 – There is no significant difference in the quality of sleep after the foot reflexology among autistic children at 0.05 level of significance. H1 - There is significant difference in the quality of sleep after the foot reflexology among autistic children at 0.05 level of significance. In the present study the H0 is rejected and H1 is accepted therefore the intervention of foot reflexology on children between 6 – 12 years of autistic children has been effective to improve the quality of sleep. Whereas in the control group the p value was 0.007 and here the H0 was accepted and H1 was rejected. Association of selected demographic variables on effectiveness of foot reflexology on quality of sleep among the autistic children in the experimental and control group. Demographic variables like age, gender, educational qualification were taken for the association between pretest mean score, to assess the effectiveness of foot reflexology on quality of sleep among autistic children in experimental and control group, there was no association found at 0.05 level of significance.   Foot reflexology shows promise as an effective intervention for improving sleep quality in autistic children. Both parents and caregivers can use foot reflexology as an alternative therapy to alleviate sleep problems and improve the wellbeing of autistic children. CONCLUSION  367    • Nancy T. Hatfield, Pediatric Nursing. 7 edition New Delhi: Wolters Kluwer (India) Pvt. Ltd; 2009. P 184-185 • Terri Kyle, Susan Carman, Essentials of Pediatric Nursing, 2nd edition, New Delhi: Wolters Kluwer (India) Pvt. Ltd; 2013.p. 468-470 • Devnani P. A. & Hegde, A.U (2015). Autism and sleep disorders. Journal of pediatric neurosciences, 10(4), 304-307. Available from https://doi.org/10.4103/1817-1745.174438 • Moore M. Evans. V. Hanvey G & Johnson C(2017). Assessment of sleep in children with autism spectrum disorder. Children (Basel Switzerland), 4(8), 72 available from https://doi.org/10.3390/children4080072  • The National Autistic Society (Inetrnet) available from https://www.autism.org.uk/advice-and-guidance/topics/physical-health/sleep  • foot reflexologist, Farlex Partner Medical Dictionary (2012) available from https://medical-dictionary.thefreedictionary.com/foot+reflexologist  • palmer M. Tarver. J. Carter Leno V. Paris Perez J. Frayne M etal (2023) Parent, Teacher and observational reports of emotional and behavioral problems in young autistic children. Journal of autism and development disorders, 53 (1), 296-309 available from https://doi.org/10.1007/s10803-021-05421-x  REFERENCES 

Effect of Foot Reflexology on sleep quality among Autistic children in selected special schools

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Effect of Foot Reflexology on sleep quality among Autistic children in selected special schools

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