Muscle strength and executive function in children and adolescents with autism spectrum disorder

Sport and Autism: What Do We Know so Far? A Review

Autism, or autism spectrum disorders, is a neurodevelopmental condition characterized by limitations in social interaction, communication skills, and repetitive behaviors. Although motor disorders were previously considered marginal in autism, recent research has highlighted their significance. Numerous studies have underscored the positive impact of sports on autistic individuals. This article presents a comprehensive overview of the literature regarding the effects of sport interventions on autistic individuals and aims to extract general and practical recommendations. Initially, the article reviews the various characteristics of autism that are positively impacted by sports, ranging from psycho-social skills to motor behavior. Subsequently, it examines how different configurations of sports practice (individual/collective, indoor/outdoor, etc.) may be suitable for autistic individuals. Literature research was conducted in two databases, resulting in the inclusion of 92 articles meeting longitudinal criteria (i.e., containing full sport/physical activity programs with pre-to-post analyses) out of 1665 initially identified articles. The findings suggest that individuals with autism can benefit from sports across a wide range of physical, psychological, and social factors. Importantly, there is no full contraindication for any activity, although some may require specific step-by-step preparation. Each activity has the potential to provide benefits in specific areas, as discussed in the article. In conclusion, further research is needed to explore the most effective strategies for implementing sports programs and maximizing their benefits for individuals across the autism spectrum.

Getting into the game: evaluation of the reliability, validity and utility of the Ignite Challenge scale for school-aged children with autism spectrum disorder

PURPOSE

Evaluate reliability, concurrent validity and utility of the Ignite Challenge motor skills measure for children with autism spectrum disorder (ASD).

MATERIALS/METHODS

In this measurement study, children completed the Ignite Challenge twice, 1-3 weeks apart. A physiotherapist assessor (one of seven) conducted a child's test-retest assessments and scored administration ease and child engagement (/10 visual analogue scale). A second assessor rated baseline assessment videos. Validity data (parent-report PEDI-CAT) were collected at baseline. Reliability analysis employed ICCs (95% CI) and evaluated minimum detectable change (MDC80). Pearson's correlations (r) estimated validity.

RESULTS

Forty-seven children with ASD (mean 9.34 years [SD = 2.35]; 10 girls; independent social communication) were tested at baseline; 45 were retested. Ignite Challenge baseline and retest mean scores were 69.0% (SD = 17.1) and 69.5% (SD = 16.6) respectively, with excellent inter-rater/test-retest reliability (ICC = 0.96 [95% CI 0.92, 0.97] and ICC = 0.91 [95% CI 0.84, 0.95]) respectively, and MDC80 = 9.28. Administration ease and child engagement were 6.5/10 (SD = 2.4) and 6.7/10 (SD = 2.2). Ignite Challenge and PEDI-CAT Social/Mobility (n = 45) associations were r = 0.54 and 0.57. Minimal suggestions for measure revisions arose from child/assessor feedback.

CONCLUSIONS

Ignite Challenge can reliably identify movement strengths and challenges of children with ASD. Use may permit more appropriate evaluation and goal setting within physical activity-based programs.

Association between muscle strength and executive function in Tibetan adolescents at high altitude in China: Results from a cross-sectional study at 16-18 years of age

BACKGROUND

In recent years, adolescents have shown a trend of decreasing muscle strength, especially in the upper limbs, and it affects the development of executive functions. However, few studies have been conducted on Tibetan adolescents in high-altitude regions of China. To this end, this study investigated upper limb muscle strength and executive function in Tibetan adolescents in Tibetan regions of China and analyzed the association between them.

METHODS

A three-stage stratified whole-group sampling method was used to test and investigate grip strength, executive function, and basic information in 1093 Tibetan adolescents from Tibet, a high-altitude region of China. A chi-square test and one-way ANOVA were used to compare the basic status and executive function of Tibetan adolescents with different muscle strength. Multiple linear regression analysis and logistic regression analysis were used to analyze the correlations that existed between muscle strength and each sub-function of executive function.

RESULTS

The differences between the inconsistently and congruent reaction times of Tibetan adolescents with different grip strength levels (P75 ) at high altitude in China were statistically significant (F-values of 32.596 and 31.580, respectively; P-values <.001). The differences between the 1-back and 2-back response times for the refresh memory function were also statistically significant (F-values of 9.055 and 6.610, respectively; P-values <.01). Linear regression analysis showed that after adjusting for the relevant covariates, the 1-back reaction time of Tibetan adolescents in the grip strength < P25 group increased by 91.72 ms (P < .01); the 2-back reaction time of Tibetan adolescents in the grip strength < P25 group increased by 105.25 ms (P < 0.01), using grip strength > P75 as the reference group. Logistic regression analysis showed that, after adjusting for relevant covariates, Tibetan adolescents in the grip strength < P25 group had a higher risk of developing 2-back dysfunction (OR = 1.89, 95% CI: 1.24,2.88), using grip strength >P75 as the reference group (P < .01). The risk of cognitive flexibility dysfunction (OR = 1.86, 95% CI: 1.16, 2.98) was also increased (P < .05).

CONCLUSION

There was a significant correlation between grip strength and executive function of refresh memory function and cognitive flexibility in Tibetan adolescents in high altitude areas of China. Those with higher upper limb muscle strength had shorter reaction time, that is, better executive function. In the future, we should focus on improving the upper limb muscle strength of Tibetan adolescents at high altitude in China to better promote the development of executive function.

Protocol for a randomized clinical trial comparing the efficacy of Structured Diet (SD) and Regular Therapy (RT) for adolescents with malnutrition having Autism Spectrum Disorder (ASD)

BACKGROUND

Autism spectrum disorders (ASD) have a lifelong impact on behavior, communication, cognitive function, education, physical functioning, and personal, or social life. Separate studies suggest, Therapeutic and dietary interventions are effective to some extent in managing these issues. No study integrated the nutrition and therapeutic approaches and examined the outcome on disease severity, overall health, and behavioral status in ASD. The proposed study is designed to evaluate the combined effect of regular therapy (RT) and structured diet (SD) compared to the usual diet (UD) for Adolescents with ASD.

METHODS

The proposed study will be a randomized clinical trial (RCT) with the assessor, therapist, and participants blinded to group allocation. Seventy ASD children with malnutrition will be enrolled in two different facilities of the Centre for the Rehabilitation of the Paralysed (CRP) between January 2023 and June 2023. Participants will be enrolled through a hospital-based randomization process from a population-based screening dataset, and with a concealed group allocation to either RT+ SD or RT+ UD group with a 1:1 ratio. The outcome measures are the Childhood Autism Rating Scale as per DSM-5 to determine the severity of ASD, Mid-upper arm circumference (MUAC), and BMI for nutritional status, and Gilliam Autism Rating Scale (GARS-2) to assess the behavioral status. Post-test will be performed after 12 weeks of intervention, and Follow-up will be taken after 6 months of post-test.

PERSPECTIVES

The result of the study will contribute to the provision of a comprehensive approach to malnourished Adolescents with ASD, and manage the issues related to the severity of ASD, stereotypical behavior, and anticipated health hazards.

CLINICAL TRIAL IDENTIFIER

CTRI/2022/11/047653.

Touch may reduce cognitive load during assisted typing by individuals with developmental disabilities

Many techniques have attempted to provide physical support to ease the execution of a typing task by individuals with developmental disabilities (DD). These techniques have been controversial due to concerns that the support provider's touch can influence the typed content. The most common interpretation of assisted typing as an ideomotor phenomenon has been qualified recently by studies showing that users with DD make identifiable contributions to the process. This paper suggests a neurophysiological pathway by which touch could lower the cognitive load of seated typing by people with DD. The required sensorimotor processes (stabilizing posture and planning and executing manual reaching movements) and cognitive operations (generating and transcribing linguistic material) place concurrent demands on cognitive resources, particularly executive function (EF). A range of developmental disabilities are characterized by deficits in sensorimotor and EF capacity. As light touch has been shown to facilitate postural coordination, it is proposed that a facilitator's touch could assist the seated typist with sensorimotor and EF deficits by reducing their sensorimotor workload and thereby freeing up shared cognitive resources for the linguistic elements of the task. This is the first theoretical framework for understanding how a facilitator's touch may assist individuals with DD to contribute linguistic content during touch-assisted typing.

The association between muscle strength and executive function in children and adolescents: Based on survey evidence in rural areas of China

Background

In recent years, muscle strength in children and adolescents has continued to decline, especially in rural areas. Executive function as a higher function of the brain, is closely related to the future achievement of children and adolescents. For this reason, this study analyzed the correlation between muscle strength and executive function in children and adolescents in rural areas of China to better promote the development of muscle strength and executive function.

Methods

Demographic factors, muscle strength, and executive function were tested in 1,335 children and adolescents in rural China using a three-stage stratified whole-group sampling method. One-way ANOVA and chi-square test were used to compare the differences in executive function among children and adolescents with different muscle strengths. Multiple linear regression analysis and logistic regression analysis were used to analyze the association that exists between muscle strength and executive function.

Results

When comparing the inconsistently, congruent, 1back, 2back, conversion, size parity, and cognitive flexibility response times of children and adolescents with different muscle strength indexes in rural China, the differences were statistically significant (F = 46.592, 45.610, 10.809, 32.068, 24.095, 19.260, 11.501, p < 0.001). Logistic regression analysis was performed using children and adolescents with muscle strength index >P80 as the control group. The results showed that the risk of 1back dysfunction was higher (OR = 1.764, 95% CI:1.094, 2.843) in children and adolescents with muscle strength index <P20 (p < 0.05). The risk of 2back dysfunction was higher in children and adolescents with a muscle strength index <P20 (OR = 2.129, 95% CI:1.329, 3.410) (p < 0.01). Compared with children and adolescents with muscle strength index >P80. The muscle strength index <P20 group had a higher risk of cognitive flexibility dysfunction (OR = 1.820, 95% CI:1.111, 2.982) (p < 0.05).

Conclusion

There is a association between muscle strength and executive function in children and adolescents in rural areas of China. Those with higher muscle strength have shorter executive function reaction times and are at lower risk of developing executive dysfunction. Future measures should be taken to improve muscle strength and executive function levels in children and adolescents in rural areas to promote healthy physical and mental development.

Correlations between muscle strength and psychological health in Chinese adolescents: a cross-sectional analysis

Background

Studies indicate that muscle strength is associated with good mental health. However, it remains unclear whether muscle strength is directly correlated with psychological symptoms in Chinese adolescents. Given the declining muscle strength and worrying mental health status of Chinese adolescents, the present study aimed to estimate the correlation between muscle strength and psychological symptoms as well as explore the gender differences in those correlations in Chinese adolescents.

Method

From April to July 2018, a total of 14,344 Chinese adolescents from eight provinces were selected using a stratified clustered sampling method. Psychological symptoms were evaluated using the Multidimensional Sub-health Questionnaire of Adolescents (MSQA), a verified and validated questionnaire that assesses three psychological areas: emotional symptoms, behavioral symptoms, and social adaptation difficulties. Muscle strength was assessed using grip strength, sit-ups, and standing long jump. The Chi-square test was used to compare the detection rates of the different categories of psychological symptoms. A logistic regression analysis was used to analyze the correlations between muscle strength and psychological symptoms and explore the gender differences in those correlations in Chinese adolescents.

Results

In general, the detection rate of psychological symptoms for Chinese adolescents was 21.39%. Males had a higher detection rate of psychological symptoms (22.12%) than females (20.66%, p < 0.05). Psychological symptoms were present in significantly fewer Chinese adolescents with a muscle strength index >P75 (19.26%) than among Chinese adolescents with a muscle strength index ≤P25 (23.00%) (χ² = 23.417, p < 0.01). Compared with females, the OR values for males in most groups were over one (OR = 1.04-1.43), indicating that males have a higher risk of psychological symptoms than females.

Conclusions

The psychological symptom detection rate of Chinese adolescents is correlated with muscle strength. Psychological symptoms were more correlated to muscle strength in males than in females. The significance of the present study lies in the important insights for integrated mental and physical fitness intervention strategies that promote muscle strength and psychological symptoms simultaneously.

The Management of Toe Walking in Children with Autism Spectrum Disorder: "Cast and Go"

Background: Toe walking is associated with autism spectrum disorders (ASD). Correction of this “behavior” is a health challenge. The toe walker is affected by the contact refusal with the outside world: touching the ground as little as possible, trying to avoid any contact. A structured equines foot is a possible consequence. Method: We present the “Cast and Go” protocol, used in 22 idiopathic toe walker children with ASD treated from 2015 to 2020. The treatment was performed by a single senior experienced doctor with botulinum injection, ankle casts and rehabilitative therapies. All patients underwent pre- and post-treatment clinical evaluation using ankle dorsiflexion angle and casting number as treatment. We aimed to identify the intervention with the shortest acquisition time for the management of toe walking. Results: Our findings demonstrated the baseline ankle dorsiflexion angle influenced the casting number (p < 0.01) and male patients had a higher baseline ankle dorsiflexion angle than female patients (p < 0.01). No adverse events were observed. Conclusions: These findings suggested that the “Cast and Go” protocol could be a promising, dynamic and effective practice for toe walking disease in ASD patients.

Association between Physical Fitness Index and Psychological Symptoms in Chinese Children and Adolescents

The aim of this study was to determine the relationship between different physical fitness indices (PFIs) and psychological symptoms and each dimension (emotional symptoms, behavioral symptoms, social adaptation difficulties) of Chinese children and adolescents. Methods: A total of 7199 children and adolescents aged 13−18 in Jiangxi Province, China, were tested for grip strength, standing long jump, sit-ups, sit and reach, repeated straddling, 50 m run, 20 m shuttle run test (20 m SRT) items. The physical fitness indicators were standardized, converted to Z score and added up to obtain the PFI, and the self-assessment of the psychological section of the multidimensional sub-health questionnaire of adolescents (MSQA) to test the psychological symptoms, using the chi-square test to determine the psychological symptoms of different types of children and adolescents and binary logistic regression analysis to determine the association between psychological symptoms and different PFI grades. Results: The higher the PFI of Chinese children and adolescents, the lower the detection rate of psychological symptoms, emotional symptoms and social adaptation difficulties, from 25.0% to 18.4%, 31.3% to 25.7% and 20.1% to 14.4%, respectively. These results were statistically significant (χ2 = 14.073, 9.332, 12.183, p < 0.05). Taking the high-grade PFI as a reference, binary logistic regression analysis was performed. Generally, compared with the high-grade PFI, children and adolescents with a low-grade PFI (OR = 1.476, 95% CI: 1.200−1.814) or medium-grade PFI (OR = 1.195, 95% CI: 1.010−1.413) had a higher risk of psychological symptoms (p < 0.05). Conclusions: The lower the PFI of Chinese children and adolescents, the higher the detection rate of psychological symptoms, showing a negative correlation. In the future, measures should be taken to improve the physical fitness level of children and adolescents in order to reduce the incidence of psychological symptoms and promote the healthy development of children and adolescents.

Associations between Physical Fitness Index and Body Mass Index in Tibetan Children and Adolescents in Different High-Altitude Areas: Based on a Study in Tibet, China

Objective: To investigate the relationship between physical fitness index (PFI) and body mass index (BMI) of Tibetan children and adolescents in different high-altitude areas in Tibet, China. Methods: Using the stratified cluster sampling method, 3819 Tibetan children and adolescents from three different high-altitude areas including Nyingchi, Lhasa and Nagqu in the Tibet area of China were given grip strength, standing long jump, sitting forward bend, 50 m running and endurance running tests. One-way analysis of variance was used to compare the physical fitness index in different high-altitude areas. In addition, the method of curve regression analysis was used to analyze the relationship between PFI and BMI. Results: In general, the level of PFI in Nagqu, Tibet, China was lower than that in Nyingchi and Lhasa, and the levels of girls were generally lower than those of boys. The proportions of malnourished, normal, overweight and obese Tibetan boys in high-altitude areas were 11.8%, 79.7%, and 8.5%; those of girls were 3.3%, 82.3%, and 14.4%, respectively. The curve regression analysis showed that the model fitting of male Nyingchi, Lhasa, Nagqu and female Nyingchi, Lhasa, Nagqu were all significant (F values were 29.697, 34.709, 37.500, 9.123, 9.785, 6.939, p < 0.01). The relationship between BMI and PFI generally showed an inverted “U” curve relationship. Conclusion: The negative impact of overweight and obesity on physical fitness of Tibetan boys in high-altitude areas is significantly higher than that of girls, and the negative impact of overweight and obesity on physical fitness of boys in Lhasa and Nyingchi area is more significant than that in the Nagqu area. In the future, attention should be paid to Lhasa and the occurrence of overweight and obesity among Tibetan boys in Nyingchi area in order to prevent the sharp decline of physical fitness and promote the physical and mental development of Tibetan children and adolescents in high-altitude areas.

Effects of Square-Stepping Exercise on Motor and Cognitive Skills in Autism Spectrum Disorder Children and Adolescents: A Study Protocol

Individuals with autism spectrum disorder (ASD) diagnoses present not only cognitive, emotional, communicative, and social challenges but also movement issues that affect their everyday activities, learning, and leisure. The use of the square-stepping exercise (SSE), a motor program initially created to strengthen the lower limbs of older adults, is spreading because of its advantages (e.g., balance and lower limb strength improvements). A study protocol to assess the SSE effects on motor, sensory, and cognitive skills in Spanish children and adolescents between 6 and 12 years old with ASD diagnoses is presented. A randomised clinical will be performed, recruiting 52 children and adolescents with ASD who will be distributed into two groups: an experimental (n = 26) and a control (n = 26) group. The SSE sessions will be held for 9 weeks (two times per week). The main variable will be balance, which will be measured with the Movement Assessment Battery for Children 2 (MABC2), and secondary outcomes will include sensory processing, attention, and executive functions. Assessments will be carried out before and at the end of the program implementation, including an additional follow up one month later. If this program obtains positive results, it should be implemented in different settings (schools, clinics, associations, etc.) to improve the quality of movement and development in children and adolescents with ASD, as it is an easy-to-use and structured tool.