Physical activity and physical fitness of school-aged children and youth with autism spectrum disorders

The concurrent validity and test-retest reliability of a submaximal exercise test in adolescents with autism

PURPOSE

There is a need for valid and reliable clinical assessment tools to assess cardiorespiratory fitness (CRF) levels in adolescents with autism. Therefore, this study aimed to examine the concurrent validity and test-retest reliability of the Astrand-Rhyming Test (ART) in this population.

MATERIALS AND METHODS

45 adolescents with autism aged 12-18 years (n = 32 males, 14.47 ± 1.79 years) performed the ART twice (test-retest reliability) and completed a maximal cardiopulmonary exercise test (CPET) (concurrent validity). Reliability parameters included Pearson correlations, intraclass correlation coefficients (ICCs), standard error of measurements (SEM), minimal detectable changes (MDC), coefficients of variation, paired sample t-tests, linear regressions and Bland-Altman plots. The concurrent validity was evaluated with Pearson correlations, ICCs, paired sample t-tests, linear regressions and Bland-Altman plots.

RESULTS

Strong test-retest reliability (r = 0.84-0.85, ICC = 0.84-0.85) was found for the ART, but the wide limits of agreement intervals suggest the presence of substantial variability. The large SEM (4.73-5.08 mL/kg/min) and MDC (13.20-14.07 mL/kg/min) values suggest lower absolute reliability. Moderate to strong levels of association (r = 0.74-0.75) and agreement (ICC = 0.59-0.66) were found between estimated (ART1) and measured (CPET) VO2 max levels, but significant systematic differences (5.71-8.82 mL/kg/min) were observed.

CONCLUSION

The ART is an accessible and promising method to monitor submaximal CRF levels over time but is less appropriate to estimate maximal CRF levels in this population.

Trajectories of physical activity among autistic children and their caregivers: Outcomes of a virtual 1-year longitudinal intervention

BACKGROUND

Participation in regular physical activity (PA) is a critical component of overall well-being. However, opportunities to engage in health-enhancing PA for families who have an autistic child are relatively obsolete. A virtual PA intervention has the potential to address many participation barriers and represents a timely opportunity to promote positive trajectories of PA among vulnerable populations.

OBJECTIVE

To examine PA trajectories during a one-year virtual intervention for autistic children and their caregiver and to explore relationships in activity participation within child-caregiver dyads.

METHODS

Twenty-nine families, including autistic children and their caregiver participated in the full intervention. Caregivers completed questionnaires to measure PA behavior at baseline and four-month intervals throughout the intervention.

RESULTS

Reported PA significantly increased among autistic children and caregivers during the intervention. No association in PA was observed within dyads at baseline, but moderate relationships were observed during the intervention.

CONCLUSION

Findings demonstrate the initial effectiveness of a virtual PA intervention for autistic children and their caregiver.

Combined Physical Training Strategies Improve Physical Fitness, Behavior, and Social Skills of Autistic Children

The present study aimed to investigate the effects of combined physical training (CPT) on social skills and physical fitness (PF) in children with ASD. Sixteen children with autism (age 6-10 years) were randomly assigned into two groups: CPT and control. The CPT group participated in a program involving ball game, rhythmic movements, and resistance training for eight weeks (three sessions per week). PF and behavior profile were assessed before and after training. CPT program had a significant effect on indicators of social skills such as stereotypic behavior and communication, as well as PF such as handgrip strength, upper and lower body power, flexibility, balance, and agility (P < 0.05). CPT in autistic children can improve indicators of social skills and PF.

Supervised machine learning: A new method to predict the outcomes following exercise intervention in children with autism spectrum disorder

The individual differences among children with autism spectrum disorder (ASD) may make it challenging to achieve comparable benefits from a specific exercise intervention program. A new method for predicting the possible outcomes and maximizing the benefits of exercise intervention for children with ASD needs further exploration. Using the mini-basketball training program (MBTP) studies to improve the symptom performance of children with ASD as an example, we used the supervised machine learning method to predict the possible intervention outcomes based on the individual differences of children with ASD, investigated and validated the efficacy of this method. In a long-term study, we included 41 ASD children who received the MBTP. Before the intervention, we collected their clinical information, behavioral factors, and brain structural indicators as candidate factors. To perform the regression and classification tasks, the random forest algorithm from the supervised machine learning method was selected, and the cross validation method was used to determine the reliability of the prediction results. The regression task was used to predict the social communication impairment outcome following the MBTP in children with ASD, and explainable variance was used to evaluate the predictive performance. The classification task was used to distinguish the core symptom outcome groups of ASD children, and predictive performance was assessed based on accuracy. We discovered that random forest models could predict the outcome of social communication impairment (average explained variance was 30.58%) and core symptom (average accuracy was 66.12%) following the MBTP, confirming that the supervised machine learning method can predict exercise intervention outcomes for children with ASD. Our findings provide a novel and reliable method for identifying ASD children most likely to benefit from a specific exercise intervention program in advance and a solid foundation for establishing a personalized exercise intervention program recommendation system for ASD children.

Racial and ethnic disparities in obesity and contributions of social determinants of health among boys with autism spectrum disorder

Children with autism spectrum disorders (ASD) are at greater obesity risk compared to typically developing peers. Although many potential risk factors for this relationship have been identified, the causal chain must be better understood, particularly modifiable social determinants of obesity risk in ASD, and especially for children with ASD from minoritized racial/ethnic groups. We aimed to: (1) examine racial/ethnic disparities in obesity status in boys with ASD; (2) assess associations between social determinants of health and obesity status; and (3) understand if social determinants of health factors mediate the relationship between race/ethnicity and obesity status for these youth. We used data for 124 boys, aged 9-10 with ASD enrolled in an ongoing longitudinal study. Social determinants of health explored included socioeconomic position, Area Deprivation Index, neighborhood safety, food and housing insecurity, and racial/ethnic discrimination. The racial/ethnic distribution was: 17.1% Black, 14.6% Latino, and 68.3% White; average age was 10 years. Both Black (PR 2.57, 95% CI: 1.26-5.26) and Latino boys (PR 2.08, 95% CI: 1.08-4.03) with ASD were more likely to be obese than their White peers. While there were significant differences in some social determinants of health by race/ethnicity, only food insecurity mediated associations between race/ethnicity (Black vs. White) and obesity. The striking disparities in obesity and differences in social determinants of health between Black and Latino children with ASD compared to White children emphasize the need to identify factors that contribute to healthy weight among these children and to address these factors in practice.

Investigating Strategies Used to Foster Quality Participation in Recreational Sport Programs for Children With Autism Spectrum Disorder and Their Perceived Importance

Quality experiences in sport programming for children with autism spectrum disorder (ASD) can promote physical and psychosocial benefits and long-term quality participation (QP). Unfortunately, children with ASD often experience sport participation barriers and, consequently, participate less in sport compared with children without disabilities. This study investigated QP priorities and strategies that could foster QP for children with ASD. Caregivers (n = 13), volunteers (n = 26), and staff (n = 14) involved in sport programming for children with ASD rated experiential elements of QP using the Measure of Experiential Aspects of Participation. In addition , a two-round Delphi survey with staff (Round 1: n = 11; Round 2: n = 13) generated 22 strategies for promoting QP-each rated highly with regard to importance (5.69-6.85 on a 7-point scale). Strategies were substantiated with published research evidence. Findings informed the development of a QP tool designed to help instructors implement identified strategies in hopes of improving sport experiences for children with ASD.

Associations between meeting 24-hour movement guidelines and quality of life among children and adolescents with autism spectrum disorder

BACKGROUND

The Canadian 24-hour movement behavior (24-HMB) guidelines suggest that a limited amount of screen time use, an adequate level of physical activity (PA), and sufficient sleep duration are beneficial for ensuring and optimizing the health and quality of life (QoL) of children and adolescents. However, this topic has yet to be examined for children and adolescents with autism spectrum disorder (ASD) specifically. The aim of this cross-sectional observational study was to examine the associations between meeting 24-HMB guidelines and several QoL-related indicators among a national sample of American children and adolescents with ASD.

METHODS

Data were taken from the 2020 U.S. National Survey of Children's Health dataset. Participants (n = 956) aged 6-17 years and currently diagnosed with ASD were included. The exposure of interest was adherence to the 24-HMB guidelines. Outcomes were QoL indicators, including learning interest/curiosity, repeating grades, adaptive ability, victimization by bullying, and behavioral problems. Categorical variables were described with unweighted sample counts and weighted percentages. Age, sex, race, preterm birth status, medication, behavioral treatment, household poverty level, and the educational level of the primary caregivers were included as covariates. Odds ratio (OR) and 95% confidence interval (95%CI) were used to present the strength of association between adherence to 24-HMB guidelines and QoL-related indicators.

RESULTS

Overall, 452 participants (45.34%) met 1 of the 3 recommendations, 216 (22.65%) met 2 recommendations, whereas only 39 participants (5.04%) met all 3 recommendations. Compared with meeting none of the recommendations, meeting both sleep duration and PA recommendations (OR = 3.92, 95%CI: 1.63-9.48, p < 0.001) or all 3 recommendations (OR = 2.11, 95%CI: 1.03-4.35, p = 0.04) was associated with higher odds of showing learning interest/curiosity. Meeting both screen time and PA recommendations (OR = 0.15, 95%CI: 0.04-0.61, p < 0.05) or both sleep duration and PA recommendations (OR = 0.24, 95%CI: 0.07-0.87, p < 0.05) was associated with lower odds of repeating any grades. With respect to adaptive ability, participants who met only the PA recommendation of the 24-HMB were less likely to have difficulties dressing or bathing (OR = 0.11, 95%CI: 0.02-0.66, p < 0.05) than those who did not. For participants who met all 3 recommendations (OR = 0.38, 95%CI: 0.15-0.99, p = 0.05), the odds of being victimized by bullying was lower. Participants who adhered to both sleep duration and PA recommendations were less likely to present with severe behavioral problems (OR = 0.17, 95%CI: 0.04-0.71, p < 0.05) than those who did not meet those guidelines.

CONCLUSION

Significant associations were found between adhering to 24-HMB guidelines and selected QoL indicators. These findings highlight the importance of maintaining a healthy lifestyle as a key factor in promoting and preserving the QoL of children with ASD.

Environmental and social determinants of leisure-time physical activity in children with autism spectrum disorder

BACKGROUND

It is increasingly recognized that children's physical activity behaviors are shaped by neighborhood environment factors and their parent's support. However, these factors have been scarcely studied among children with autism spectrum disorder (ASD), a population at risk of inactivity.

OBJECTIVE

This cross-sectional survey study was designed to examine how neighborhood environmental factors and parental support are related to physical activity levels of children with ASD. Also, this study examined if the relationship between the environment and physical activity is modified by demographic factors and COVID-19 related concerns.

METHODS

An online survey was completed by parents of children with ASD aged 10-17 years. The questionnaire included items related to environmental factors (i.e., distance to school, distance to park, existence of sidewalks, walkability), parent support for physical activity (i.e., encouraging, watching, and providing transportation), child's physical activity, and demographic characteristics. The instrument also queried parental concerns about COVID-19 and their child's physical activity participation.

RESULTS

The results indicate that proximity to a local park and to school is positively associated with physical activity. Parent's encouraging behavior correlated with and predicted children's physical activity levels. Also, higher levels of COVID-19 related concerns among parents were related to decreased physical activity supporting behaviors.

CONCLUSIONS

This study demonstrated that the neighborhood environment, in particular the distance between home and parks and schools, and parent support behavior are influential factors that may shape physical activity behaviors for children with ASD.

Global Trends in Physical-Activity Research of Autism: Bibliometric Analysis Based on the Web of Science Database (1980-2021)

The World Health Organization has identified nervous system diseases as one of the biggest public health problems, including autism spectrum disorder (ASD). Considering the extensive benefits of physical activity (PA), the literature on the PA research of ASD has increased each year, but there is a lack of bibliometric analyses in this field. To investigate the research achievements worldwide, this paper adopts bibliometrics to analyze the trend in the academic literature on the PA research of ASD published from 1980 to 2021. The documents were retrieved from the Web of Science database, and the search strategy was to combine the keywords related to “physical activity” and “autism spectrum disorder” by using the Boolean operator tools “OR” and “AND” in the title. A total of 359 English documents were retrieved. Microsoft Excel, Data Wrapper, VOSviewer, and Biblioshiny were used for the visual analysis. We found that the number of published documents increased the fastest from 2017 to 2021, which may be due to the promulgation of the Global Action Plan for Physical Activity 2018–2030 and the influence of COVID-19 on the world. The United States and the University of California systems are in the leading position in this field. Cooperation among countries with different levels of development will help to jointly promote the PA research progress on ASD. The focus themes include “individual effect”, “social support” and “activity dose”. The analysis of the frontier topic points out that researchers are paying increasing attention to how to improve the health and physical fitness of this group through PA. This research clearly puts forward a comprehensive overview, theme focus, and future trends in this field, which may be helpful to guide future research.

Comparison of Physical Activity Between Children With and Without Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Lower levels of physical activity (PA) are often observed among children with autism spectrum disorder (ASD) compared to children without ASD; however, some studies have demonstrated few to no PA differences between the two groups. The purpose of this systematic review with meta-analysis was to compare the differences in PA between children (2-18 years) with and without ASD. An exhaustive search of five online databases was completed, and 31 studies met the inclusion criteria. A pooled random-effects Hedges's g model was used to determine differences in PA between children with and without ASD. Children with ASD were found to be significantly less physically active than children without ASD (Δ = -0.62, p < .001). Subgroup analyses revealed significant moderate to large differences in PA by intensity level, age, setting, and measurement methods. Future studies are needed to further explore the underlying mechanisms associated with lower levels of PA among children with ASD.

Motor skills predict adaptive behavior in autistic children and adolescents

It is well-documented that intelligence quotient (IQ) is a poor predictor of adaptive behavior scores in autism, with autistic children having lower adaptive behavior scores than would be predicted based on their IQ scores. Differences in motor skills may explain the variability in their adaptive behavior scores. The current study examined how motor skills might explain autistic individuals' low adaptive behavior scores and which individual components of IQ (i.e., verbal comprehension and perceptual reasoning) and motor skills (i.e., manual dexterity, aiming and catching, and balance) may drive this effect. We examined the associations between IQ, motor skills, calibrated severity, and adaptive behavior scores in 45 autistic children and adolescents. Using a t-test, we found a significant difference (p <0.001) between full-scale IQ and adaptive behavior scores, indicating that our participants' adaptive behavior scores were lower than would be expected given their full-scale IQ. Using a linear regression, we investigated whether motor skills predicted adaptive behavior in autistic children and adolescents and found that motor skills scores were associated with adaptive behavior scores (p = 0.022). To further investigate these associations, we used another linear regression to examine how individual components of IQ and motor skills predicted adaptive behavior scores in autistic children and adolescents. Our results indicated that manual dexterity scores were associated with adaptive behavior scores (p = 0.036). These findings clearly illustrate the need for further understanding of autistic individuals' difficulties with adaptive behavior and the potential role of motor skill difficulties that may underlie these difficulties. LAY SUMMARY: Autistic children have lower adaptive behavior scores (e.g., daily living skills, social skills, communication) than intelligence scores (e.g., verbal and perceptual skills) along with difficulties with motor skills. Motor skills may explain the gap between adaptive behavior and intelligence. We found motor skills were associated with adaptive behavior in autistic children and adolescents. In particular, hand coordination was associated with adaptive behavior. We need to better understand how autistic individuals' motor skills impact their adaptive behavior to provide effective supports.

Motor Functional Characteristics in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorders: A Systematic Review

BACKGROUND

The development of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) has various influences on physical abilities. Identification of specific physical abilities of people with ADHD/ASDs as biomarkers for diagnosing these conditions is necessary. Therefore, in the present review, we aimed firstly to extract the difference in physical abilities of people with ADHD or ASDs compared to those of normal individuals. Secondly, we aimed to extract the specific physical ability characteristics for identifying potential diagnostic biomarkers in people with ADHD/ASDs.

METHODS

A systematic literature review was performed. The databases were searched for relevant articles on motor function deficits and characteristics of ADHD or ASD.

RESULTS

Forty-one cross-sectional studies and three randomized controlled trials were identified, comprising 33 studies of ADHD, 10 studies of ASDs, and 1 study of both ADHD and ASDs. The quality of studies varied. Three types of physical activities/exercises were identified, including coordinated movement, resistance-type sports, and aerobic-type sports. People with ADHD/ASDs generally exhibited poorer physical abilities for all types of activities, possibly because of low levels of physical activity. Specifically, we found temporal discoordination of movement in ADHD and integration or synchronization of separate movements in ASDs.

CONCLUSION

Specific deficits in physical ability may be attributed to ADHD/ASDs. However, there is not enough research on the physical abilities of people with ADHD and ASDs to clarify the specific deficits. Investigation of specific motor functions that characterize ADHD/ASDs should be facilitated.

Behavioural Improvements in Children with Autism Spectrum Disorder after Participation in an Adapted Judo Programme Followed by Deleterious Effects during the COVID-19 Lockdown

The public health lockdown prompted by the novel coronavirus (COVID-19) pandemic, which included school closures that may have potentially serious consequences for people with disabilities or special educational needs, disrupted an ongoing adapted judo training intervention in children with Autism Spectrum Disorder (ASD). The purpose of this study was to compare repetitive behaviours, social interaction, social communication, emotional responses, cognitive style and maladaptive speech scores across four time-points: baseline, after an eight-week control period, after an eight-week judo intervention and after an eight-week lockdown period due to COVID-19. The sample consisted of 11 children diagnosed with ASD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V), with an intelligence quotient (IQ) range between 60 and 70. Significant improvements were shown following the judo intervention period compared to the baseline and control periods. However, the same values significantly declined during the COVID-19 lockdown period resulting in values lower than those recorded at baseline, and following the control period and the judo intervention. The decline in psychosocial and behavioural scores are likely due to the stress caused by the sudden halt in activity and the increase in sedentary practices associated with the lockdown.

How Do Physical Activity and Sedentary Behaviour Affect Motor Competence in Children with Autism Spectrum Disorder Compared to Typically Developing Children: A Pilot Study

Older children with Autism Spectrum Disorder (ASD) have high levels of motor impairment, however we are unsure if similar patterns exist in young children. This study aimed to investigate motor competence in four-to-seven-year-old children with (n = 17) and without (n = 17) ASD. A series of ANOVAS indicated children with ASD performed significantly poorer on all measures of motor competence, except MABC-2 manual dexterity and ball skills subscales. Results indicate that moderate-to-vigorous physical activity (PA) and sedentary behaviour (SB) may influence motor competence, regardless of diagnosis. Establishing appropriate levels of engagement in moderate-to-vigorous PA and SB during early school years is important for the development of all children and may be an important early intervention avenue for motor impairment in children with ASD.

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

The development of effective (non‐pharmacological) treatment approaches for executive dysfunction in autism spectrum disorder (ASD) requires evidence that factors influencing this domain can be modified by behavioral interventions. The present cross‐sectional study investigated the relative associations of ASD, muscle strength and body mass index with executive function and information processing among the Healthy Brain Network cohort. Patients with ASD (N = 174) and healthy peers (N = 202) aged 5 to 18 years completed cognitive tasks of the NIH toolbox (Pattern Comparison, Flanker, List Sorting, Card Sorting) to assess core components of executive function and information processing. Additionally, anthropometrics and muscle strength were collected from selected items (push‐ups, curl‐ups, trunk lift, and grip strength) of the Fitnessgram battery. Based on structural equation modeling, ASD was related to impaired muscle strength and executive function, when confounders (age, sex, pubertal status, and socioeconomic status) were accounted for. Muscle strength further showed independent contributions to information processing and executive function. This association was moderated by ASD, so that higher muscle strength was related to higher executive function in ASD patients only. The present findings provide a first indication that the promotion of muscle strength may have the potential to generally enhance information processing and to reduce ASD‐related executive dysfunction in children and adolescents.

Children with Autism Spectrum Disorder Spent 30 Min Less Daily Time in Moderate-to-Vigorous Physical Activity than Typically Developing Peers: a Meta-Analysis of Cross-sectional Data

It remains unclear if participation in moderate-to-vigorous physical activity (MVPA) differs between children with ASD and typically developing children (TDC). We compared daily MVPA, time spent in MVPA during physical education (PE) and recess, and odds of not meeting MVPA recommendation (60 min/day) between children with ASD and TDC. Nine studies reporting accelerometer-measured MVPA were included in the meta-analyses. MVPA was 30 min lower/day, 12% and 8% lower during PE and recess, respectively, in children with ASD, and they had 4 times higher odds of not meeting MVPA recommendation when compared to TDC. Children with ASD engage in daily MVPA less than TDC and below the guidelines. Tailored interventions to increase MVPA in children with ASD are warranted.

Effect of Daily Physical Activity on Sleep Characteristics in Children with Autism Spectrum Disorder

Background. Sleep problems have been reported in children with autism spectrum disorder (ASD). One of the methods proposed to improve sleep characteristics is based on physical activity (PA). Objective. To assess characteristics of sleep and the effect of PA level on sleep quality in children with ASD compared to controls. Methods. Fifty boys with ASD (ASD; 10.8 ± 2.6 years) and 18 controls (CONT, 10.1 ± 2.2 years) wore an accelerometer device for five consecutive days to obtain measures of activity and sleep characteristics. Results. Some significant differences were reported between ASD and CONT groups. Wake-up time resistance was significantly higher (p < 0.05) in ASD. Total time for PA, and daily steps number were significantly lower in the ASD group (p < 0.05). Time for sedentary behavior was significantly higher (p < 0.01) in the ASD group. Using a principal component analysis and an agglomerative hierarchical analysis, we observed three clusters. Two showed the same poor-quality indices of sleep but two opposing profiles of PA, either an insufficient PA volume (cluster 1, Total time PA = 75.1 min; Daily steps: 7704) or an important PA volume (cluster 3, Total time PA = 222.1 min; Daily steps: 17,164). Cluster 2 was characterized by moderate participation in PA and children with the best sleep indices (Total time PA = 166.8 min; Daily steps: 12,718). Conclusion. The dose–response effect of exercise on sleep may indicate large individual differences but the present findings are important to prevent sedentary behaviors or to correct over-activity that could be detrimental to the sleep quality in children with ASD.

Comparison of fitness levels between elementary school children with autism spectrum disorder and age-matched neurotypically developing children

Low physical fitness is associated with reduced physical activity and increased cardiovascular diseases. To date, limited research has compared physical fitness levels between children with and without autism spectrum disorder (ASD). Therefore, the primary aim was to investigate if differences in fitness levels exist between children with ASD and age-matched neurotypically developing children (ND). The second aim was to examine if age, sex, height and weight could be used to predict potential fitness levels. The third aim was to examine if the developmental trajectory of fitness is comparable between children with ASD and ND children. The modified Eurofit test battery was used to compare fitness levels between 244 children aged 4-13 years old (n = 152 ND and n = 92 ASD). Independent samples t tests and regression analyses were used to investigate differences in fitness levels between the two groups. The results indicated that statistically significant differences exist in fitness levels between children with ASD when compared to ND children across all ages, favoring the ND children, with small to large effect sizes noted (p < 0.05, d = 0.36-1.13). Regression analysis could not accurately predict fitness measurements in children with ASD but could for ND children. The developmental trajectories were significantly delayed on the 20 m sprint and standing broad jump for children with ASD when compared to ND children. Future studies should seek to address the disparities in physical fitness experienced by children with ASD by using relevant neuromuscular interventions.

Effects of Mini-Basketball Training Program on Social Communication Impairment and Executive Control Network in Preschool Children with Autism Spectrum Disorder

This study evaluated the effect of a 12-week mini-basketball training program (MBTP) on social communication (SC) and the executive control network (ECN) in preschool children with autism spectrum disorders (ASD). We finally assigned 30 preschool children with ASD to an experiment group (n = 15, 12 males, 3 females) or a control group (n = 15, 13 males, 2 females). The experiment group participated in a 12-week MBTP (40-min sessions per day, 5 days a week), while the control group only received the institutional routine behavioral rehabilitation intervention. The SC of preschool children with ASD was measured using the Social Responsiveness Scale, Second Edition (SRS-2), whereas functional connectivity (FC) of the ECN was assessed using resting-state functional magnetic resonance imaging (rs-fMRI) at pre-and post-test. Our results showed that SC exhibited significant improvement in the intervention group, especially in SRS-2 total score, social cognition, and social communication. We found significantly enhanced functional connectivity between the right cerebellum and left inferior frontal gyrus in the experimental group, while functional connectivity between the left middle temporal gyrus and right cerebellum were decreased in the control group. Furthermore, there were no significant correlations between the change in SC scores and FC of the ECN. Altogether, this study provides valuable insights that a 12-week MBTP improves SC and functional connectivity of the ECN in preschool children with ASD. We further inferred that neural mechanisms might be associated with changing the ECN of preschool ASD children caused by the 12-week MBTP.

Instruments to Assess Physical Activity in Primary Education Students with Autism Spectrum Disorder: A Systematic Review

The scientific evidence supports that physical inactivity in childhood is a reality throughout the world which generates important consequences in the global development of children. Young people with Autism Spectrum Disorder (ASD), due to the characteristics of the disorder they suffer, constitute a group at risk. Therefore, assessing the levels of physical activity (PA) in this group is fundamental for subsequent decision making and implementation of PA promotion programmes. Consequently, the aim of this systematic review was to identify, summarise and analyse the main instruments used to assess the levels of PA (in terms of time and/or intensity) in primary school children diagnosed with ASD. Scientific articles in English and Spanish published in five databases were reviewed: PsycINFO, WOS, SPORTDiscus, Scopus and PubMed, following the guidelines of the PRISMA statement. Out of the 605 articles identified, 12 met the previously established inclusion criteria. The instruments used by the studies analysed were divided into two main groups: accelerometers and questionnaires. Both showed different strengths and limitations but agreed on the low levels registered of PA in children with ASD. For this reason, it is considered necessary that further research be carried out in this field, as well as the development and implementation of sports programmes adjusted and adapted to the needs and characteristics of the ASD group.

How Technology Applied to Music-Therapy and Sound-Based Activities Addresses Motor and Social Skills in Autistic Children

Autism affects how people perceive and make sense of the world around them. Autism is a spectrum condition which impacts people in different ways. Also referred to as Autism Spectrum Disorder (ASD), it is characterized by challenges in the domains of social, cognitive and motor functioning, which differ in severity. Previous research suggests that music can have cognitive, psychosocial, behavioural, and motor benefits in this population. We systematically review the use of technology in Music-therapy and related sound-based activities to improve the motor and social skills of children. In May 2020 we conducted a systematic search on Music-therapy and musical activities for autistic children in research databases including Science Direct, APA PsycNet, Cochrane, IEE and Web of Science, to collect relevant studies. We initially collected 5179 papers of which only 27 studies were identified as suitable for the scope of this review. In the paper, we analyse and describe key characteristics of each project. We then highlight the commonalities, strengths and limitations of existing work, and identify implications for future interaction design.

Physical and Sedentary Activity Patterns in Youths with Autism Spectrum Disorder

Little is known about the patterns of sedentary behavior and physical activity (PA) within different school levels (i.e., primary school and secondary school) and on different day types (i.e., weekdays and weekend days) among youths with autism spectrum disorder (ASD). The sample was recruited from one city in Taiwan. A total of 68 male youths with ASD, aged 6–17 years, participated in the study. PA was assessed using an ActiGraph accelerometer, and sedentary behaviors (i.e., TV viewing, computer use, and reading time) were determined using a self-report log. The main findings were that (a) primary school youths with ASD were more active than secondary school youths with ASD on both weekdays and weekend days, but primary school youths with ASD also had more sedentary time than did secondary school youths with ASD on both weekdays and weekend days; (b) secondary school youths with ASD were more active but also more sedentary on weekdays compared with weekend days, but they had more screen use on weekend days compared with on weekdays. Future interventions are required to decrease sedentary behavior and increase PA to improve the health of these youths according to school level and day of the week.

Physical Activity and Motor Performance: A Comparison Between Young Children With and Without Autism Spectrum Disorder

PURPOSE

This study aims to examine the differences in physical activity and motor performance between young children with autism spectrum disorder (ASD) and children with typical development (TD) and to investigate the relationships between the levels of physical activity and motor performance.

PATIENTS AND METHODS

Twenty-five children with ASD (mean age = 59.3 ± 8.1 months) and 28 children with TD (mean age = 63.1 ± 8.6 months) were recruited. The Actigraph accelerometer, Movement Assessment Battery for Children-second edition, and Assessment of Preschool Children's Participation were used.

RESULTS

Young children with ASD spent significantly less time in moderate and light physical activity and exhibited more sedentary behavior than did children with TD. Those children with ASD also had greater motor difficulties and engaged less frequently in physical recreation activities compared to their TD peers. Motor performance was significantly correlated with physical activity in all children.

CONCLUSION

This study highlighted the specificity of the levels of physical activity, motor difficulties, and participation diversity in children with ASD comparing performances on children with TD. Additional research is needed to provide valuable information for early interventions.

Brief Report: Preliminary Efficacy of a Judo Program to Promote Participation in Physical Activity in Youth with Autism Spectrum Disorder

To examine the preliminary efficacy of an 8-week judo program to promote moderate-to-vigorous physical activity (MVPA) and reduce sedentary behavior (SB) in youth with Autism Spectrum Disorder (ASD). Fourteen children diagnosed with ASD participated in a weekly judo program over a period of 8 weeks. Participants wore an Actigraph accelerometer to measure activity levels at baseline and post-judo. All 14 children attended at least 75% of the 8 judo classes. Percentage of time spent in daily MVPA (8% vs 4%, p = .05) increased following the intervention. A high rate of participation and an increase in time spent in MVPA was observed following the 8-week program. Further research to examine causal mechanisms is warranted.

Mini-Basketball Training Program Improves Physical Fitness and Social Communication in Preschool Children with Autism Spectrum Disorders

This investigation examined the effects of a 12-week mini-basketball training program (MBTP) on physical fitness and social communication in preschool children with autism spectrum disorders (ASD). The study applied a quasi-experimental design. Fifty-nine preschool children aged 3-6 years with ASD were assigned to either a MBTP group (n = 30) or a control group (n = 29). Participants in the MBTP group received a scheduled mini-basketball training program (5 sessions per week, forty minutes per session) for twelve consecutive weeks, while the control group was instructed to maintain their daily activities. The physical fitness test and the parent-reported Social Responsiveness Scale Second Edition (SRS-2) test were performed before and after the intervention. Results indicated that the 12-week MBTP facilitated performance in the physical fitness test, particularly in speed-agility and muscular strength abilities. Additionally, children in the MBTP group demonstrated improvement in SRS-2 performance in social awareness, social cognition, social communication, and autistic mannerisms, whereas no such changes were found in the control group. It may be concluded that the 12-week MBTP could improve physical fitness and social communication in preschool children with ASD, and thus the use of physical exercise intervention as a therapeutic tool for preschoolers with ASD is recommended.

Accelerometer-measured physical activity levels in children and adolescents with autism spectrum disorder: A systematic review

Associations between physical activity (PA) and health benefits are well documented. Evidence indicates that children and adolescents with autism spectrum disorder (ASD) are less physically active than their typically developing peers. The purpose of this systematic review is to provide a comprehensive summary of the PA levels of children and adolescents with ASD and the associated factors that affect their PA levels by applying a socio-ecological model (SEM). Seven databases (PubMed, CINAHL, SPORTDiscus with Full Text, MEDLINE, EMBASE, ERIC, and PsychINFO) were searched in June 2019 to identify studies examining accelerometer-measured PA and factors affecting the PA levels of children and adolescents with ASD, aged 6-17 years. Two researchers independently screened studies, assessed methodological quality, and summarized relevant data. Twenty-one studies were included in the detailed review. Only 42% of the participants met the PA guidelines (i.e., children and adolescents aged 5-17 years should do at least 60 min of moderate to vigorous PA daily). By applying the SEM, multi-level factors ranging from intrapersonal to community levels that positively or negatively influenced PA levels in children and adolescents with ASD were identified. This review indicates that children and adolescents with ASD have low PA levels, and that there are multi-level factors that affect their PA. There is a pressing need to design effective PA interventions that promote activity accrual in the school, family, and community settings for children and adolescents with ASD.

Physical activity and motor skill outcomes of a 10-week intervention for children with intellectual and developmental disabilities ages 4-13: A pilot study

BACKGROUND

Children with intellectual and developmental disabilities (IDD) often experience increased barriers to engaging in physical activity (PA) which can stem from lack of gross motor function (GMF) development. Intervening on GMF at an early age can create better opportunities for children with IDD to engage in regular PA. In turn, increased PA can improve health outcomes and increase social skills.

OBJECTIVE

The primary objective of this pilot study was to explore the effectiveness of a community-based GMF-focused PA intervention for improving overall motor skills and PA for children with IDD.

METHODS

All study participants (n = 24) engaged in 10 weeks of programming for 1 h each week. A convenience sample was utilized.

RESULTS

Results indicated no statistically significant changes pre to post for motor skill scores. However, a visual analysis of mean changes showed a consistent pattern of increased scores from pre to post on most skills. Additionally, we found that a change in participant locomotor skills significantly predicted change in Moderate to Vigorous Physical Activity (MVPA), F (1,11) = 5.16, Adj R² = .26, p = .04.

CONCLUSIONS

These results suggest individualized attention on GMF may help to increase motor skills for children with IDD. This study adds to the small but growing amount of research examining the efficacy of community based adapted PA interventions. Further, study results should support continued exploration of effective approaches to address the motor delays experienced by children with IDD.

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

The purpose of this study was to examine the moderating role of adaptive behavior on the pathways connecting motor competence, physical activity, and health-related fitness in 7-12 year old children with ASD (N = 27). Results demonstrate that motor competence and health-related fitness were positively related (r = .42, p < .05), and this relationship was moderated by adaptive behavior. Specifically, we found that motor competence and health-related fitness were significantly related for those participants scoring approximately one or more standard deviations below the mean on adaptive behavior. No other significant pathways were present. Implications of these associations and directions for future research are discussed.

Examining the relationship between parent physical activity support behaviour and physical activity among children and youth with autism spectrum disorder

LAY ABSTRACT

Children and youth with autism spectrum disorder engage in less physical activity than neurotypically developing peers. This may be due to factors associated with autism spectrum disorder at the individual and environmental level that can make physical activity participation more challenging. Parent support is a known determinant of physical activity among children and youth; however, limited research has explored the relationship between parent physical activity support behaviour and child physical activity behaviour within the autism spectrum disorder population. The purpose of this study was to examine the relationship between parent physical activity support behaviour and physical activity levels of children and youth with autism spectrum disorder. Parents (n = 201) of school-aged children and youth with autism spectrum disorder completed measures of parent physical activity support (intentions, behavioural regulation, support behaviour), as well as their child's physical activity behaviour. The results showed that parent's intentions to provide physical activity support were associated with their support behaviour for their child's physical activity (e.g. encouragement, being active together). Parents who followed through with their intentions to provide support reported using behavioural regulation strategies such as goal setting and planning more often. Finally, the results showed parent physical activity support behaviour was positively associated with child physical activity behaviour. Findings suggest parents play an instrumental role in the physical activity behaviour of children and youth with autism spectrum disorder. Family-level interventions targeting parents' behavioural regulation strategies to provide physical activity support may be an effective strategy to increase physical activity in children and youth with autism spectrum disorder.

Effect of a Service-Learning Program on the Active Lifestyle of Children with Autism Spectrum Disorder: A Pilot Study

Background: active lifestyles and Physical Activity (PA) are closely related to health. Healthy habits such as being physically active should be consolidated during childhood. Children with Autism Spectrum Disorders (ASD) present fewer opportunities to be involved in PA. For this reason, we conducted a Service-Learning (SL) program to enhance the possibility of participating ASD children enjoying PA sessions. The aim of this study was to analyze and describe the evolution in terms of the frequency and intensity of PA performed by ASD children who participated in the SL program. Methods: we used a quasi-experimental design. The sample was formed by 26 children with ASD (Experimental group: n = 16; 4 girls, 12 boys) (Control group: n = 10; 1 girl, 9 boys) with ASD level 1. Results: after the intervention program, moderate PA during the week increased significantly (Pre-Median: 92.04, Range: 35.71–126.47 min; Post-Median: 212.67, Range: 99.75, 271.04 min) (p ≤ 0.001). When comparing both groups, the tendency to do PA in the Experimental group remained more stable. Also, the improvements in moderate intensities were higher in the Experimental group after the intervention. Conclusion: a six-month SL program improved the moderate PA routines of ASD children. However, longer programs and longitudinal studies are required.

Incidence Rate of Advanced Chronic Kidney Disease Among Privately Insured Adults with Neurodevelopmental Disabilities

Purpose

Due to complex medical profiles, adults with neurodevelopmental disabilities (NDDs) may have a heightened risk for early development of chronic kidney disease (CKD) and accelerated CKD progression to advanced stages and kidney failure. The purpose of this study was to estimate the incidence rate of advanced CKD for adults with NDDs and compare the incidence rate to adults without NDDs.

Patients and Methods

Data were used from the Optum Clinformatics^® Data Mart to conduct this retrospective cohort study. The calendar year 2013 was used to identify eligible participants: individuals ≥18 years of age and without advanced CKD. Participants were followed from 01/01/2014 to advanced CKD, loss to follow-up, death, or end of the study period (12/31/2017), whichever came first. Diagnostic, procedure, and diagnosis-related group codes identified NDDs (intellectual disabilities, cerebral palsy, autism spectrum disorders), incident cases of advanced CKD (CKD stages 4+), diabetes, cardiovascular diseases, and hypertension present in the year 2013. Crude incidence rates (IR) of advanced CKD and IR ratios (IRR), comparing adults with vs without NDDs (with 95% CI) were estimated. Then, Cox regression estimated the hazard ratio (HR and 95% CI) for advanced CKD, comparing adults with NDDs to adults without NDDs while adjusting for covariates.

Results

Adults with NDDs (n=33,561) had greater crude IR of advanced CKD (IRR=1.32; 95% CI=1.24–1.42) compared to adults without NDDs (n=6.5M). The elevated rate of advanced CKD among adults with NDDs increased after adjusting for demographics (HR=2.19; 95% CI=2.04–2.34) and remained elevated with further adjustment for hypertension and diabetes (HR=2.01; 95% CI=1.87–2.15) plus cardiovascular disease (HR=1.84; 95% CI=1.72–1.97). Stratified analyses showed that the risk of advanced CKD was greater for all NDD subgroups.

Conclusion

Study findings suggest that adults with NDDs have a greater risk of advanced CKD than do adults without NDDs, and that difference is not explained by covariates used in our analysis.

Elevated fracture risk for adults with neurodevelopmental disabilities

BACKGROUND

Fracture is a high-burden condition that accelerates unhealthful aging and represents a considerable economic burden. Adults with neurodevelopmental disabilities (NDDs) may be susceptible for fracture at younger ages compared to adults without NDDs; and yet, very little is known about the burden of fracture for these underserved populations. The purpose of this study was to determine the sex-stratified prevalence of all-cause fracture among adults with NDDs, as compared to adults without NDDs, and if comorbidity of NDDs is associated with greater risk of fracture.

METHODS

Data from 2016 were extracted from Optum Clinformatics® Data Mart (private insurance) and a random 20% sample from Medicare fee-for-service (public insurance). ICD-10-CM diagnosis codes were used to identify adults with NDDs, including intellectual disabilities, autism spectrum disorders, and cerebral palsy. Age-standardized prevalence of any fracture and fracture by anatomical location was compared between adults with and without NDDs, and then for adults with 1 NDD vs. 2 and 3 NDDs.

RESULTS

Adults with intellectual disabilities (n=69,456), autism spectrum disorders (n=21,844), and cerebral palsy (n=29,255) had a higher prevalence of any fracture compared to adults without NDDs (n=8.7 million). For women, it was 8.3%, 8.1%, and 8.5% vs. 3.5%, respectively. For men, it was 6.6%, 5.9%, and 6.7% vs. 3.0%, respectively. Women with NDDs had a higher prevalence of fracture of the head/neck, thoracic, lumbar/pelvis, upper extremities, and lower extremities compared to women without NDDs. A similar pattern was observed for men, except for no difference for lumbar/pelvis for all NDDs and thoracic for autism spectrum disorders. For women and men, increasing comorbidity of NDDs was associated with a higher prevalence of any fracture: 1 NDD (women, 7.7%; men, 5.7%); 2 NDDs (women, 9.4%; men, 7.2%); all 3 NDDs (women, 11.3%; men, 13.7%).

CONCLUSIONS

Study findings suggest that adults with NDDs have an elevated prevalence of fracture compared to adults without NDDs, with the fracture risk being higher with greater numbers of comorbid NDD conditions for most anatomical locations. Our study findings indicate a need for earlier screening and preventive services for musculoskeletal frailty for adults with NDDs.

Reliable and Feasible Fitness Testing for Children on the Autism Spectrum

Purpose: This study examined the test-retest reliability and feasibility of select fitness assessments in 7-12 year old children on the autism spectrum. Method: Participants (N = 14; n = 1 female; Mage = 9.5 ± 1.7 years) completed 7 fitness assessments, administered in a random order, on two occasions: Bruce protocol; Modified 6-minute walk test (M6MWT); Wingate anaerobic cycling test; muscle power sprint test (MPST); sit & reach; standing long jump; and grip strength. Intraclass correlations (two-way mixed with absolute agreement) were computed to examine test-retest reliability. Feasibility was assessed by questionnaire following the first administration of each test. Results: The Wingate (ICC = .956), standing long jump (ICC = .925), grip strength (ICC = .913), and sit and reach (ICC = .829) tests demonstrated good- to- excellent reliability, while the Bruce protocol (ICC = .811), M6MWT (ICC = .510), and MPST (ICC = .703) demonstrated moderate- to- good reliability based on the 95% confidence intervals of the ICC. All tests demonstrated assessor-rated feasibility scores of 70/100 or higher and child-rated feasibility scores of 66/100 or higher. Conclusion: The results demonstrate moderate- to excellent test-retest reliability for select fitness tests. Short, single-instruction (e.g., standing long jump) tests may be more reliable than lengthier assessments (e.g., M6MWT) in this population. Implications of this work include the ability of practitioners and researchers to feasibly and reliably measure the fitness of school-aged children on the autism spectrum for ongoing health and behavioural monitoring and intervention purposes.

The effect of low-trauma fracture on one-year mortality rate among privately insured adults with and without neurodevelopmental disabilities

BACKGROUND

Individuals with neurodevelopmental disabilities (NDDs) have poor development and preservation of skeletal health throughout the lifespan, and are especially vulnerable to low-trauma fracture and post-fracture health complications. However, no studies have examined if adults with NDDs have greater post-fracture mortality risk compared to adults without NDDs. The purpose of this study was to determine whether adults with NDDs have greater 12-month mortality rates following a low-trauma fracture compared to adults without NDDs.

METHODS

Data from 2011 to 2017 was leveraged from Optum Clinformatics® Data Mart; a nationwide claims database from a single private payer in the U.S. Data were extracted from adults (18+ years) with and without NDDs that sustained a low-trauma fracture between 01/01/2012-12/31/2016, as well as pre-fracture chronic diseases (i.e., cardiovascular diseases, cerebrovascular diseases, diabetes, chronic obstructive pulmonary diseases, cancer). Mortality rate was estimated for adults with and without NDDs, and the mortality rate ratio (RR) and 95% confidence interval (CI) was calculated. Cox regression was used to estimate hazard ratio (HR) and 95% CI for 1-, 3-, 6-, and 12-month post-fracture mortality rates between adults with and without NDDs after adjusting for age, sex, race, U.S. region, and pre-fracture chronic diseases.

RESULTS

Mean age (SD) at baseline was 56.7 (20.6) for adults with NDDs (n = 3749; 45.2% men) and 63.9 (19.2) for adults without NDDs (n = 585,910; 34.4% men). During the 12-month follow-up period, 182 adults with NDDs (mean age [SD] = 69.8 [14.7]; 46.2% men) and 25,456 adults without NDDs (mean age [SD] = 78.9 [9.8]; 38.3% men) died. Crude mortality rate was not different between adults with and without NDDs for any time points (e.g., 12-months: 5.40 vs. 4.96 per 100 person years; RR = 1.09; 95% CI = 0.94-1.26); however, it was greater for adults with intellectual disabilities compared to adults without NDDs (RR = 1.46; 95% CI = 1.23-1.79). After adjustments, adults with NDDs had greater post-fracture mortality rates for 3-, 6-, and 12-month time points (e.g., 12-months: HR = 1.46; 95% CI = 1.27-1.69). When stratified by the type of NDD, adults with intellectual disabilities and adults with autism spectrum disorders, but not adults with cerebral palsy, had greater 12-month post-fracture mortality risk. When stratified by fracture location, lower extremities were associated with greater crude mortality rate (RR = 1.69; 95% CI = 1.22-2.35) and adjusted mortality risk (HR = 2.41; 95% CI = 1.73-3.35), while upper extremities were associated with greater adjusted mortality risk (HR = 1.76; 95% CI = 1.23-2.50) for adults with vs. without NDDs.

CONCLUSIONS

Among privately insured adults with NDDs, low-trauma fracture is associated with greater mortality risk within 1 year of the fracture event, even after adjusting for pre-fracture chronic diseases. Study findings suggest the need for earlier fracture prevention strategies and improved post-fracture healthcare management.

Motor Capacities in Boys with High Functioning Autism: Which Evaluations to Choose?

The difficulties with motor skills in children with autism spectrum disorders (ASD) has become a major focus of interest. Our objectives were to provide an overall profile of motor capacities in children with ASD compared to neurotypically developed children through specific tests, and to identify which motor tests best discriminate children with or without ASD. Twenty-two male children with ASD (ASD—10.7 ± 1.3 years) and twenty controls (CONT—10.0 ± 1.6 years) completed an evaluation with 42 motor tests from European Physical Fitness Test Battery (EUROFIT), the Physical and Neurological Exam for Subtle Signs (PANESS) and the Movement Assessment Battery for Children ( M-ABC). However, it was challenging to design a single global classifier to integrate all these features for effective classification due to the issue of small sample size. To this end, we proposed a hierarchical ensemble classification method to combine multilevel classifiers by gradually integrating a large number of features from different motor assessments. In the ASD group, flexibility, explosive power and strength scores (p < 0.01) were significantly lower compared to the control group. Our results also showed significant difficulties in children with ASD for dexterity and ball skills (p < 0.001). The principal component analysis and agglomerative hierarchical cluster analysis allowed for the classification of children based on motor tests, correctly distinguishing clusters between children with and without motor impairments.

A Peer Mentored Physical Activity Intervention: An Emerging Practice for Autistic College Students

Many autistic individuals are less fit and have more health problems than their nonautistic peers. These findings suggest a need to develop effective physical activity interventions. Motor skill deficits, lack of motivation, and limited opportunities for physical activity may restrict exercise participation. Peer mentors can help autistic college students increase their physical activity level and fitness. We developed a 10-week peer mentored physical activity program that affords autistic college students the opportunity to act in a self-determined manner in which students are encouraged to engage in preferred activities and self-directed instruction (autonomy), gain skills through access to expert instruction (competence), and engage socially with peers (relatedness). The ability to act with self-determination may increase students' motivation to participate in physical activity. From our pilot study, we learned that autistic college students could improve their cardiorespiratory fitness, flexibility, and upper body muscular endurance as a result of participating in Into Fitness Together. We also learned of three shared themes: students felt that they gained motor competence, improved their health, and felt a sense of belonging. The autistic students spent time with both autistic and nonautistic peers, which fostered this belongingness. Access to movement experts and peer mentors in an individualized program that affords choice in physical activity is a step in the right direction to eliminate the health disparities of autistic young adults.

Lay Summary

Why was this program developed?We developed a physical activity program because we saw the need for autistic individuals to benefit from regular physical activity. Motor skill challenges may keep autistic adults from engaging in regular physical activity and from reaping the benefits of improved fitness. Since participating in regular physical activity is important for the health of all individuals, it is important to design programs that address barriers so all people can benefit.What new program was developed?We developed a 10-week physical activity program called Into Fitness Together (IFiT) for autistic college students. The program is unique because it is individualized, tailored to autistic adults, fun, and has a built-in one-to-one peer support system.What did the researchers do?We wanted to learn whether the program had the potential to increase health-related fitness and how autistic college students experienced IFiT. Sixteen autistic college students participated in IFiT. They were paired one-on-one with another college student (known as a peer mentor) who was an expert in exercise science. The pairs worked out together 2.5 hours a week for 10 consecutive weeks. We examined change in participants' fitness levels at the start and end of IFiT. We also interviewed the autistic peers to understand their IFiT experience.What was the result of participating in the program?With regular participation in physical activity, the autistic peers improved their cardiorespiratory fitness levels, muscular endurance, and flexibility by the end of IFiT. There were three main themes that emerged from the interviews. At the end of the program, participants reported (1) greater competence in motor skills and a greater understanding of exercise, (2) improved overall health, and (3) a sense of belonging. Participants said they learned new ways to exercise, how to exercise correctly, and stated that they felt healthy and fit. They also expressed a sense of belonging. Participants stated that they valued their time with their peer mentor not only because the peer mentor shared their expertise in physical activity and exercise, but also because the peers talked about school, hobbies, and life in general. Having ongoing opportunities for regular social interaction was a positive experience for IFiT participants.What are the next steps for program development?This emerging practice article describes a small pilot study performed at one university, thus results cannot be generalized. Also, we did not have data from a comparison group of autistic students who did not participate in the program. Future studies should use a control and comparison group and gather data at multiple institutions.How will these findings help autistic adults now or in the future?There is limited information on interventions focused on physical activity for autistic college students; therefore, our work provides insight into a promising program. Regular physical activity can lead to positive health outcomes, skill acquisation, and participating in IFiT can potentially set the stage for lifelong physical activity.

Perceptions of Physical Activity Participation Among Adolescents with Autism Spectrum Disorders: A Conceptual Model of Conditional Participation

Adolescents with an autism spectrum disorder (ASD) are less physically active compared to typically developing peers. The reasons for not being physically active are complex and depend on several factors, which have not been comprehensively described from the adolescent’s perspective. Therefore, the aim was to describe how adolescents with an ASD perceive, experience and reflect on their participation in physical activity. Interviews with 24 adolescents diagnosed with high-functioning ASD, aged 12–16 years, were analysed with qualitative content analysis with an inductive approach. They expressed a variety of reasons determining their willingness to participate, which were conceptualized as: Conditional participation in physical activities. The present study presents an alternative perspective on participation in physical activity, with impact on intervention design.

Brief Report: Physical Activity, Body Mass Index and Arterial Stiffness in Children with Autism Spectrum Disorder: Preliminary Findings

We examined the association between physical activity (PA), body mass index (BMI) and novel measures of subclinical cardiovascular disease (CVD) in 15 children with autism spectrum disorder (ASD) (mean age 7 ± 2 years, 2 girls). PA was objectively assessed using accelerometry as time spent in moderate-vigorous physical activity (MVPA). Arterial stiffness was measured via aortic pulse wave velocity (PWV) and taken as a marker of subclinical CVD risk. MVPA was inversely associated with aortic PWV (r = - 0.46, p < 0.05). BMI percentile was positively associated with aortic PWV (r = 0.61, p < 0.05). Overall findings suggest that reduced PA and higher body mass in children with ASD are associated with increased arterial stiffness which may have a detrimental impact on overall cardiovascular health.

Meeting the 24-hr movement guidelines: An update on US youth with autism spectrum disorder from the 2016 National Survey of Children's Health

The purpose of this study was to examine how adherence to the physical activity (PA), screen-time (ST), and sleep duration guidelines differ between youth with autism spectrum disorder (ASD) and youth with typical development (TD). A secondary objective was to assess how PA, ST, and sleep duration varied among youth with ASD by age and ASD severity. Utilizing the 2016 National Survey of Children's Health data, parental reports of time spent by youth in PA, ST, and sleep were used to determine adherence to the 24-hr movement guidelines for 1008 youth with ASD and 34 489 youth with TD. Multivariate logistic regression analyses determined that children with ASD were less likely to meet the guidelines for PA, ST, and sleep duration, and adolescents with ASD were less likely to meet the guidelines for PA and ST than participants with TD. Furthermore, logistic regression analyses determined adolescents with severe ASD to be less likely to meet the sleep guideline compared to adolescents with mild ASD. Overall, youth with ASD were significantly less likely to adhere to all three guidelines. The findings highlight the breadth of health behaviors that require intervention to counteract the poorer health status among youth with ASD. Autism Res 2019, 12: 941-951. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: New health recommendations suggest children and adolescents should have at least 1 hr of physical activity, no more than 2 hr of screen-time (e.g., television), and 9-11 hr of sleep (or 8-10 hr for children aged 14 or older) every day. This article looked at how children and adolescents with autism meet these new guidelines. The two main results were that: (a) children with autism were less likely to meet all three guidelines compared to children without autism, and (b) adolescents with autism were less likely to meet the guidelines for physical activity and screen-time.

Scoping Review: Physical Activity and Social Functioning in Young People With Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) affects ~1 in 59 people in North America and diagnoses continue to rise (Center for Disease Control and Prevention, 2018). Unfortunately, the exact cause of ASD is unknown and therapy remains the primary means of intervention. People with ASD experience social and behavioral deficits associated with the disorder, which affect all aspects of life such as academics, relationships, and physical activity. Research has shown a relationship between physical activity and social skills in typically developing individuals; however, this relationship is less understood in people with ASD. The purpose of this scoping review was to uncover what is known about ASD, physical activity, and social functioning. The authors searched four databases and included 40 primary research articles in the review, most of which demonstrated a relationship between physical activity and social functioning for people with ASD. The relationship appears bidirectional: social functioning influences physical activity (to a lesser extent) and physical activity influences social functioning (to a greater extent). Regrettably, there were many limitations in these articles, such as small sample sizes and the under-representation of females and adults. Therefore, the review highlights several directions for future research.

Prevalence of Overweight and Obesity Among Children and Adolescents With Autism Spectrum Disorder and Associated Risk Factors

Introduction: Prevalence of obesity in Autism Spectrum Disorder (ASD) has been reported to be higher than in the general population. Determining prevalence may help increase awareness of obesity in ASD and potentially lead to initiatives to reduce obesity. In order to understand obesity in ASD children, common risk factors were assessed including physical activity, feeding problems and sleep disturbances. Methods: This is a cross-sectional study performed at the Child Development Center at Universiti Kebangsaan Malaysia Medical Center on 151 ASD children aged 2-18 years. Anthropometric and demographic information were obtained and parents completed three questionnaires; Children Sleep Habits Questionnaire (CSHQ), Physical Activity for Older Children Questionnaire (PAQ-C) and Brief Autism Mealtime Behavior Questionnaire (BAMBI). Results: For ASD children in our sample, the prevalence of overweight (BMI ≥85th to <95th percentiles) was 11.3% and the prevalence of obesity (BMI ≥95th percentile) was 21.9%. The overweight/obese ASD children's median age was higher at 8.5 years (IQR 5.81-10.13) compared to the normal/underweight group of 6.33 years (IQR 4.75-7.7) with a p-value of 0.001. The two groups also differed significantly for maternal BMI and paternal age. The median maternal BMI in the overweight/obese group was 26.05 (IQR 23.35-32.25), statistically significantly higher (p = 0.003) than in the non-overweight/obese group, 24.7 (IQR 21-27.9). The median paternal age of 40 years (IQR 37-44) was statistically significantly higher (p = 0.039) in the overweight/obese group, compared to the median paternal age in the non-overweight/obese group of 38 (IQR 35-42). The male overweight/obese children had median PAQ-C score of 2.44 (IQR 2.00-3.00) vs. 2.89 (IQR 2.35-3.53) in the counterpart group with a p-value of 0.01. Using the multiple linear regression stepwise method, three predictors associated with BMI percentiles reached a statistical level of significance; PAQ-C score in males (p < 0.001), the BAMBI domains of Food Refusal (p = 0.001) and Limited Variety of Food (p = 0.001). Conclusions: The prevalence of obesity and overweight is high among Malaysian ASD children and adolescents. Older child age, high maternal BMI, older paternal age, low physical activity, low likelihood of food refusal and high likelihood of food selectivity were found to be risk factors for high BMI in these children.

Reduced Cardiorespiratory Capacity in Children with Autism Spectrum Disorders

Background—Children with autistic spectrum disorders (ASDs) are frequently hampered by motor impairment. It limits them from regularly practicing physical activities and results in a lower physical fitness even though low cardiorespiratory fitness is one of the most important predictors of all-cause mortality. This study aimed to investigate the cardiorespiratory fitness of boys with ASD compared to typically developed children. Methods—forty male children participated. Twenty were control children (CONT—10.0 ± 1.6 years) and 20 were ASD children (ASD—10.7 ± 1.2 years; intellectual quotient > 70). All participants completed an incremental exercise test on a treadmill. An evaluation of motor characteristics by three tests was conducted (muscular strength; explosive power; flexibility). Assessments of daily physical activity were obtained by questionnaires (PAQ-C) and by actigraphy. Results—in the ASD group, aerobic capacity values (VO_2peak), effort duration and maximal speed were significantly lower compared to CONT (p < 0.05). Flexibility, explosive power and muscular strength were significantly lower in ASD compared to CONT (p < 0.05). Similarities between all children were observed for physical activity evaluation by actigraphy and with the PAQ-C. Conclusions—children with ASD had lower cardiorespiratory fitness than CONT despite similar physical activity levels. Our results suggested that the difference may be due to motor discrepancies.

Nutrition and Bone Density in Boys with Autism Spectrum Disorder

BACKGROUND

Boys with autism spectrum disorder (ASD) have lower bone mineral density (BMD) than typically developing controls. Differences in diet and exercise may contribute to low BMD.

OBJECTIVE

Our aim was to examine macro- and micronutrient intakes and self-reported physical activity in boys with ASD compared to TDC and the relationship of these variables with BMD.

DESIGN/METHODS

We conducted a cross-sectional study of 49 boys (25 ASD, 24 typically developing controls) assessed for 3-day food records and physical activity records, and BMD of the whole body less head, hip, and spine using dual-energy x-ray absorptiometry. Fasting levels of 25(OH) vitamin D and calcium were obtained.

PARTICIPANTS

Participants were adolescent boys, aged 8 to 17 years, recruited from a clinic population (ASD) or community advertisements (ASD and typically developing controls) matched for age.

RESULTS

ASD participants were approximately 9 months younger than typically developing control participants on average. Body mass index and serum vitamin D and calcium levels were similar. Boys with ASD consumed 16% fewer calories, with a larger percentage obtained from carbohydrates, and 37% less animal protein and 20% less fat than typically developing controls. A lower proportion of ASD participants were categorized as "very physically active" (27% vs 79%; P<0.001). BMD z scores were 0.7 to 1.2 standard deviations lower in ASD than typically developing controls at all locations. Higher animal protein, calcium, and phosphorus intakes were associated positively with bone density measures in boys with ASD.

CONCLUSIONS

Compared to typically developing controls, boys with ASD had lower protein, calcium, and phosphorus intakes, activity levels, and BMD z scores at the lumbar spine, femoral neck, total hip, and whole body less head. Protein, calcium, and phosphorus intakes were associated positively with BMD.

Effects of a Physical Exercise Program (PEP-Aut) on Autistic Children's Stereotyped Behavior, Metabolic and Physical Activity Profiles, Physical Fitness, and Health-Related Quality of Life: A Study Protocol

Physical exercise has shown positive effects on symptomatology and on the reduction of comorbidities in population with autism spectrum disorder (ASD). However, there is still no consensus about the most appropriate exercise intervention model for children with ASD. The physical exercise program for children with autism (PEP-Aut) protocol designed allow us to (i) examine the multivariate associations between ASD symptoms, metabolic profile, physical activity level, physical fitness, and health-related quality of life of children with ASD; (ii) assess the effects of a 40-week exercise program on all these aspects of children with ASD. The impact of the exercise program will be assessed based on the sequence of the two phases. Phase 1 is a 12-week cross-sectional study assessing the symptomatology, metabolic profile, physical fitness and physical activity levels, socioeconomic status profile, and health-related quality of life of participants. This phase is the baseline of the following phase. Phase 2 is a 48-week intervention study with a 40-week intervention with exercise that will take place in a specialized center for children with ASD in the city of Maceió-Alagoas, Brazil. The primary outcomes will be change in the symptomatic profile and the level of physical activity of children. Secondary outcomes will be anthropometric and metabolic profiles, aerobic function, grip strength, socioeconomic status, and health-related quality of life. The study will provide critical information on the efficacy of exercise for children with ASD and help guide design and delivery of future programs.

Accelerometer-Assessed Physical Activity and Sedentary Time in Youth With Disabilities

This study compared accelerometer-assessed habitual physical activity (PA), sedentary time, and meeting PA recommendations among 102 youth with disabilities (7-20 years) in four subgroups-physical/visual impairments, intellectual disability, autism spectrum disorders, and hearing impairment-and 800 youth with typical development (8-16 years). Low proportions of youth with disabilities met PA recommendations, and they generally were less physically active and more sedentary than youth with typical development. The hearing impairment and autism spectrum disorder groups were the most and least physically active, respectively. Older age and to some extent female sex were related to less PA and more sedentary time. Considering the suboptimal levels of PA in youth with disabilities, effective interventions directed at factors associated with PA among them are needed.

Implications of Social Groups on Sedentary Behavior of Children with Autism: A Pilot Study

This pilot study compared sedentary behavior (SB) of children with autism (ASD) to typically developing peers (TD), and evaluated the influence of social contexts within free play (FP) and organized activity settings on SB of children with ASD during an inclusive summer camp. Participants with ASD were matched with TD peers by age and gender, and a modified OSRAC-P was utilized to assess SB and social context by setting. SB did not differ by diagnosis (ASD, TD), setting, or social contexts. In FP, children with ASD spent significantly more time in SB within social contexts compared to solitary contexts. ASD-related social deficits may facilitate SB in children with ASD during summer camp FP social contexts, compared to a solitary context.