Adaptive Behavior Moderates Health-Related Pathways in Children with Autism Spectrum Disorder

Multidimensional motor performance in children with autism mostly remains stable with age and predicts social communication delay, language delay, functional delay, and repetitive behavior severity after accounting for intellectual disability or cognitive delay: A SPARK dataset analysis

When motor difficulties continue into adolescence/adulthood, they could negatively impact an individual with autism spectrum disorder (ASD)'s daily living skills, physical fitness, as well as physical and mental health/well-being. Few studies have examined motor difficulties in children with ASD as a function of sex or age; however, greater cognitive challenges are associated with worse general motor performance. Based on the Developmental Coordination Disorder-Questionnaire (DCD-Q) data from the SPARK study sample, 87%-88% children with ASD were at-risk for a general motor impairment that persisted until 15 years and was related to their core and co-occurring difficulties. Bhat et al. confirmed motor difficulties in children with ASD on multiple motor dimensions that predicted core and co-occurring conditions after accounting for age and sex. However, presence of intellectual disability (ID) or cognitive delay was not controlled in the previous analysis. Additionally, the effects of age, sex, and cognitive ability on multidimensional motor difficulties of the SPARK sample have not been discussed before. Therefore, this analysis examines the effects of age, sex, and cognitive ability (presence of ID or level of cognitive delay) on the motor performance of children from the SPARK sample using the DCD-Q. Except fine motor skills, multiple motor domains did not change with age in children with ASD. Females without ID improved their fine motor scores with age, and performed better compared to males without ID. Children with ASD and ID had greater motor difficulties across multiple motor domains than those without ID. Even after controlling for age, sex, and presence of ID/cognitive delay; motor performance was predictive of social communication skills, repetitive behavior severity, as well as language and functional delays. Gross motor skills contributed more than fine motor and general motor competence skills in predicting social communication delay. However, fine motor and general motor competence skills contributed more than gross motor skills in predicting repetitive behavior severity and language delay. Both, fine and gross motor skills predicted functional delay. In light of consistent findings on motor difficulties in children with ASD, adding motor issues as a specifier within the ASD definition could provide a clear clinical route for movement clinicians to address motor difficulties of individuals with ASD.

Adaptive behavior, sleep, and physical activity in adolescents with fetal alcohol spectrum disorder

BACKGROUND

Fetal alcohol spectrum disorder (FASD) is broadly associated with impairments to adaptive behavior and dysfunctional sleep. Associations between sleep, adaptive behavior, and physical activity are frequently drawn in discussions of typical development and other clinical conditions.

AIMS

In this study, we sought to characterize patterns of sleep, adaptive behavior, and physical activity in adolescents with FASD. We also investigated the associations between sleep, adaptive behavior, and physical activity within this population.

METHODS AND PROCEDURES

Twenty-seven adolescents aged 11- to 17-years with a diagnosis of FASD and their caregivers participated in this study. All participants completed parent and youth questionnaires on adaptive behavior, sleep, and physical activity.

OUTCOMES AND RESULTS

Adolescents with FASD displayed significant impairments to all domains of adaptive behavior and considerable sleep disturbance. Worse sleep was associated with older age and sleep-related breathing disturbances were associated with poorer social adaptive behavior. Participation in physical activity, particularly organized sport, was strongly associated with better adaptive behavior.

CONCLUSIONS AND IMPLICATIONS

Adolescents with FASD experience considerable challenges with regards to sleep and adaptive behavior. Physical activity, particularly organized sport, may provide opportunities for the improvement of adaptive behavior in this population.

Physical activity correlates in children and adolescents with autism spectrum disorder: a systematic review

PURPOSE

This systematic review examined correlates of physical activity (PA) at all levels of the socio-ecological model (i.e., intrapersonal, interpersonal, environmental and policy level) in children and adolescents with autism spectrum disorder (ASD).

MATERIALS AND METHODS

Major electronic databases were searched from inception until March 23^rd, 2021. A summary coding was used to analyze the data for children (3-12 years) and adolescents (13-18 years) with ASD separately.

RESULTS

Out of the 79 potential PA correlates, retrieved from 32 studies (991 657 children; 3857 adolescents), only five correlates were consistently examined as a PA correlate (i.e., examined in four or more studies) in children and adolescents with ASD. Only age was inversely associated with PA in children and adolescents with ASD. Data on gender, body mass index, autism severity level and day of the week being physically active in children with ASD were mixed.

CONCLUSIONS

We only found consistent evidence for age being inversely related to PA. Our review indicates that more research is needed to explore intrapersonal, interpersonal, environmental and policy-related correlates of PA in children and adolescents with ASD.IMPLICATIONS FOR REHABILITATIONRehabilitation programs should take into account that in particular older children and adolescents with autism spectrum disorder are at risk for physical inactivity.Boys and girls with autism spectrum disorder need the same care when motivating them to be more physically active.

MYTime: A Mindfulness and Yoga Program to Promote Health Outcomes in Parents of Children With Autism Spectrum Disorder

Background

Parenting a child with Autism Spectrum Disorder can be stressful and result in health consequences for the caregivers, a population that is often overlooked and underserved. While mind-body interventions such as mindfulness yoga can help promote positive health outcomes, limited research has explored the impact of such a program on caregivers of children on the autism spectrum.

Objective

The primary objective of this pilot study was to evaluate the effects of a 12-week mindfulness yoga program (MYtime) on perceived stress, anxiety, and depression among urban caregivers of children on the autism spectrum.

Methods

Twenty-seven parents were randomized into either MYTime (n = 13) or the control group (n = 14). Perceived Stress Scale (PSS) and Depression, Anxiety, and Stress Scale (DASS) were administered.

Results

The MYTime group reported lower stress, depression and anxiety while the control group maintained similar scores across pre- and post-assessment. Following 12 weeks of participation the PSS and DASS scores improved by 25% and 49% respectively for parents in the MYTime group. In comparison, PSS scores worsened by 5% and DASS scores improved by 17% for the Control group. Differences in pre-and post-assessment scores were not significant for either group (P > .05).

Conclusion

The results from this pilot study indicate that a mindfulness yoga program could be considered among feasible interventions aimed at improving the health of parents of children on the autism spectrum.

A comparison of the physical fitness of individuals with intellectually disabilities autism spectrum disorders and Down syndrome diagnosis

Introduction: This article reports the physical abilities and physical wellness of three groups of children with different neurodevelopmental disabilities: Autism, Down Syndrome and Intellectual Disability. Methods: The causal-comparative research method was implemented in this study. The participants comprised 32 students with moderate intellectual disabilities, 18 with autism spectrum disorder, and 22 with down syndrome. The body mass index (BMI), flexibility, standing long jump, sitting height, stroke length, and medicine ball throwing levels were measured for physical fitness, and the groups were compared afterward. The Kruskal Wallis-H Test and Mann-Whitney U Test were applied to determine the differences between the groups' physical fitness averages for the statistical analysis. Results: Statistically significant differences were obtained in BMI, standing long jump, stroke length, and medicine ball throwing variables (p < 0.05). However, no statistically significant difference was discovered for the flexibility and sitting height variables (p > 0.05). The BMI, sitting height, and stroke length levels for the group with autism spectrum disorder were higher than the other groups, as the flexibility levels of the group with down syndrome were higher than the other groups. Students with intellectual disabilities were demonstrated to have better values than other groups regarding standing long jump and medicine ball throwing performances. Conclusions: Objective information about the physical fitness of individuals with children with different neurodevelopmental disabilities was obtained. In addition, the data obtained with these children will contribute to future plans for movement training as well as the content and frequency of the interventions, and will guide the development of new strategies to develop physical abilities and physical wellness.

Does Symptom Severity Moderate the Relationship Between Body Mass Index and Motor Competence in Children With Autism Spectrum Disorders? An Exploratory Study

To date, there has been little research considering both autism spectrum disorder (ASD) symptom severity and motor impairment simultaneously when investigating their associations with obesity. This study was designed to identify the moderating role of symptom severity in the relationship between motor competence and overweight/obesity for children with ASD. Seventy-eight children with a clinical diagnosis were recruited from a large autism rehabilitation center in Wuhan, China. Chi-square, partial correlation, and moderation regression analyses revealed that the prevalence of overweight and obesity was similar regardless of symptom severity. Balance was the only motor skill that correlated with body mass index. Furthermore, symptom severity significantly moderated the correlation. Children with low autism severity might be more likely to demonstrate the relationship between balance and body mass index than those with high autism severity. Combating obesity by enhancing motor competence should cautiously consider personal and environment factors such as individual severity of ASD.

A further study of relations between motor impairment and social communication, cognitive, language, functional impairments, and repetitive behavior severity in children with ASD using the SPARK study dataset

Motor impairments are pervasive and persistent in children with autism spectrum disorder (ASD) throughout childhood and adolescence. Based on recent studies examining motor impairments in children with ASD between 5 and 15 years (i.e., SPARK study sample), 87-88% of this population is at-risk for a motor impairment, these problems persisted until 15 years, and related to their core (social communication skills and repetitive behaviors [RBs]) and comorbid (language, cognitive, and functional) impairments. Persistent motor impairments extending into adolescence/adulthood could negatively impact their independent daily living skills, physical fitness/activity levels, and physical/mental health. While multiple studies have examined relations between motor dimensions and core/comorbid impairments in young children with ASD, few studies have examined such relations in school-age children/adolescents with ASD. This paper conducts a further multidimensional study of which motor domains (i.e., gross-motor including visuo-motor or multilimb coordination/planning, fine motor [FM] or general coordination [GC] skills) best distinguish subgroups of school-age children/adolescents with ASD and help predict core and comorbid impairments after accounting for age and sex. Visuomotor, FM and certain GC skills were better at explaining variations in/predicting social communication impairments whereas FM skills were slightly better at explaining variations in/predicting RB severity. Multilimb coordination/planning and FM skills explained variations in/predicted cognitive delays whereas visuomotor and FM skills explained variations in and better predicted language delays. All three motor dimensions explained variations in/predicted functional delays. This study provides further evidence for inclusion of motor impairments within the ASD definition (criteria or specifiers). LAY SUMMARY: Gross-motor skills were related to social communication and functional delays of children with ASD (visuomotor skills related to language delays and multilimb coordination/planning skills related to cognitive delays). Fine-motor skills were related to repetitive behavior severity, language, cognitive, and functional delays in ASD. Diagnosticians should recommend systematic motor screening, further evaluations, and treatments for children at-risk for and diagnosed with ASD. Motor advocacy and enhanced public/clinical community awareness is needed to fulfill the unmet motor needs of children with ASD.

Baseline behaviour moderates movement skill intervention outcomes among young children with autism spectrum disorder

LAY ABSTRACT

It is common for children with autism spectrum disorder to experience delays in their movement skills. These skills are important for participation in play and physical activity. Previous research has found that movement skills can be improved with movement skill interventions. This study explored the behavioural factors of young children with autism spectrum disorder that make them most likely to improve their movement skills following a 12-week intervention. The study found that children with higher levels of adaptive behaviour and lower levels of emotional and behavioural challenges at the start of the intervention were more likely to have greater improvements in their movement skills following the intervention. These findings may help clinicians and caregivers plan which types of interventions are best suited for individual children with autism spectrum disorder.

Longitudinal Association Between Participation in Organized Sport and Psychosocial Development in Early Childhood

OBJECTIVE

To explore whether the associations between developmental delays in the first year of life and psychosocial outcomes in preschool children are affected by participation in organized sport.

STUDY DESIGN

Data were obtained from the infant cohort of the Growing Up in Ireland project. Parents reported on child development (Ages and Stages Questionnaire) at age 1 year, psychosocial characteristics (Strengths and Difficulties Questionnaire) at ages 3 and 5 years, and engagement in organized sport at age 5 years. Data were analyzed using mixed models.

RESULTS

At age 1 year, 15% of the cohort was classified as having developmental delays. These children exhibited more behavioral difficulties (0.55, ±0.27; mean difference, ±95% confidence limits [CL]) (P < .0001) and fewer prosocial behaviors (-0.54, ±0.11) (P < .0001) at age 3 years. For boys in this group, engagement in sport was associated with a significant decrease in behavioral difficulties between ages 3 and 5 years (-0.44, ±0.39) (P = .03). Compared with those classified as lacking regular engagement (ie, never engaging, or engaging <1 hour/week), the relative effect of sport on changes in behavioral difficulties for boys with developmental delays was statistically significant (0.70, ±0.59) (P = .02). Participation in sport was not associated with significant changes in behavioral difficulties for girls, or a significant change in prosocial behaviors for boys or girls.

CONCLUSIONS

Regular participation in sport by boys could attenuate some of the behavioral difficulties associated with early development. Lack of opportunities for engaging in sport could negatively affect boys' behavioral regulation in the preschool period.

Experiences of stakeholder collaboration when promoting participation in physical activity among adolescents with autism spectrum disorder

PURPOSE

Various stakeholders contribute to the development of healthy physical activity habits in adolescents with autism spectrum disorder (ASD). Parents and stakeholders seek collaborative actions but little is still known about such efforts. The purpose of this study was thus to explore how professionals from different services experience stakeholder collaboration when promoting participation in physical activity for these adolescents.

METHOD

Five focus group discussions were held with 17 professionals from education, health care, community, and sports organizations, engaged in the promotion of physical activity in adolescents with ASD. The data were analyzed with qualitative content analysis.

RESULTS

The discussions revolved around a central theme: Collaboration is needed to promote physical literacy among adolescents with ASD. The professionals though experienced that this collaboration was hampered by the low priority given to physical activity issues within different organizations, by limited resources, lack of knowledge, and unclear roles.

CONCLUSIONS

Notwithstanding the professionals' different roles, all agreed that physical activity issues need to be prioritized and that each stakeholder needs to acknowledge the shared responsibility of collaboration. However, more clear routines for collaboration that include joined efforts but also highlight the organization-specific responsibilities might enhance the collaborative efforts.IMPLICATIONS FOR REHABILITATIONIn-depth understanding of both the adolescents' needs and the environments in which physical activity is promoted is required if participation in physical activity among adolescents with ASD is to be enhanced.Families and professionals within different organizations need to be supported to collaborate when mapping and meeting the adolescents' physical activity needs.Issues regarding developing physical activity habits need to be prioritized.Professionals, such as education, health, and community professionals who are important for the promotion of healthy physical activity habits need to be included in multi-stakeholder meetings.

Motor Impairment Increases in Children With Autism Spectrum Disorder as a Function of Social Communication, Cognitive and Functional Impairment, Repetitive Behavior Severity, and Comorbid Diagnoses: A SPARK Study Report

Eighty-seven percent of a large sample of children with autism spectrum disorder (ASD) are at risk for motor impairment (Bhat, Physical Therapy, 2020, 100, 633-644). In spite of the high prevalence for motor impairment in children with ASD, it is not considered among the diagnostic criteria or specifiers within DSM-V. In this article, we analyzed the SPARK study dataset (n = 13,887) to examine associations between risk for motor impairment using the Developmental Coordination Disorder-Questionnaire (DCD-Q), social communication impairment using the Social Communication Questionnaire (SCQ), repetitive behavior severity using the Repetitive Behaviors Scale - Revised (RBS-R), and parent-reported categories of cognitive, functional, and language impairments. Upon including children with ASD with cognitive impairments, 88.2% of the SPARK sample was at risk for motor impairment. The relative risk ratio for motor impairment in children with ASD was 22.2 times greater compared to the general population and that risk further increased up to 6.2 with increasing social communication (5.7), functional (6.2), cognitive (3.8), and language (1.6) impairments as well as repetitive behavior severity (5.0). Additionally, the magnitude of risk for motor impairment (fine- and gross-motor) increased with increasing severity of all impairment types with medium to large effects. These findings highlight the multisystem nature of ASD, the need to recognize motor impairments as one of the diagnostic criteria or specifiers for ASD, and the need for appropriate motor screening and assessment of children with ASD. Interventions must address not only the social communication and cognitive/behavioral challenges of children with ASD but also their motor function and participation. LAY ABSTRACT: Eighty-eight percent of the SPARK sample of children with ASD were at risk for motor impairment. The relative risk for motor impairment was 22.2 times greater in children with ASD compared to the general population and the risk increased with more social communication, repetitive behavior, cognitive, and functional impairment. It is important to recognize motor impairments as one of the diagnostic criteria or specifiers for ASD and there is a need to administer appropriate motor screening, assessment, and interventions in children with ASD.

Playing games can improve physical performance in children with autism

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is characterized by deficits in social communication, interaction, and stereotypical behaviours. Children with ASD have not enough opportunities to participate in physical activity (PA), which lead to increase fitness and health problem. The aim of this study was to compare two programs on motor skills. In the current investigation, 30 high functioning autistic children were diagnosed by a psychiatrist and randomly divided into control and experimental groups. The evaluation tools included the Brininx-Oresetsky Test (BOT) and a program named "I can have physical literacy" (ICPL) and Sport, Play, and Active Recreation for Kids (SPARK). The experimental intervention groups received sixteen sessions of 60 min, while the control group did not receive any treatment. Analysis of covariance was used to determine the difference between the groups. Post-hoc test was used to compare pairs of groups. Results showed that the experimental ICPL and Spark groups had increased motor skills (MS). There were significant differences between groups on gross motor skills. There were significant differences between the control and experimental ICPL groups, and between the experimental Spark and experimental ICPL groups. Both of these programs increased MS. ICPL program that address the characteristics of children with ASD, have a positive effect on their MS.