Physical activity in young adults with autism spectrum disorder: Parental perceptions of barriers and facilitators

App-based meditation habits maintain reductions in depression symptoms among autistic adults

LAY ABSTRACT

Existing research has identified an increased risk of depression among autistic adults, which can negatively impact their adaptive functioning abilities and socioeconomic outcomes. Mobile app-based meditation is a feasible, accessible, and effective self-care solution for depression among neurotypical adults, but there is limited evidence for the long-term benefits of app-based meditation among autistic adults. Habits are a key behavioral strategy for maintaining behavior change, and anchoring is one effective habit formation intervention that has yet to be tested among autistic adults. This study demonstrates that it is both feasible and effective to integrate the anchoring habit formation strategy into an app-based meditation intervention for establishing meditation habits among autistic adults. In addition, the study shows that app-based meditation habits were successful at maintaining reductions in depressive symptoms over 6 months. These results demonstrate the power of anchoring-based habit formation interventions for establishing healthy habits among autistic adults, which offers a promising behavioral intervention technique for establishing other healthy habits among autistic adults. The study also shows that app-based meditation habits are an effective long-term self-care solution for managing depressive symptoms among autistic adults that should be used by mental health providers and policymakers. Future research should test this combined anchoring and app-based meditation intervention technique among larger samples of autistic adults and over longer durations to better understand the mechanisms underlying the success of this intervention.

Motor problems in autism: Co-occurrence or feature?

Motor features of autism have long been acknowledged by clinicians, researchers, and community stakeholders. Current DSM-5 and ICD-11 guidelines allow clinicians to assign a co-occurring diagnosis of developmental [motor] coordination disorder (DCD) for autistic individuals with significant motor problems. DCD is characterized by poor motor proficiency with an onset of symptoms in early development. Studies have shown considerable overlap in the behavioral motor features observed in autism and DCD. However, others indicate that motor problems in autism and DCD may stem from different underlying sensorimotor mechanisms. Regardless of whether autism has a unique motor phenotype or an overlap with DCD, changes need to be made in the clinical pipeline to address motor problems in autism at the stages of recognition, assessment, diagnosis, and intervention. Consensus is needed to address unmet needs in research on the etiology of motor problems in autism and their overlap with DCD, to optimize clinical practice guidelines. The development of screening and assessment tools for motor problems that are valid and reliable for use with autistic individuals is essential, and an evidence-based clinical pipeline for motor problems in autism is urgently needed. WHAT THIS PAPER ADDS: Motor problems in autism are highly prevalent, yet underdiagnosed and poorly managed. An evidence-based clinical pipeline for motor problems in autism is urgently needed.

Aging on the Autism Spectrum: Physical Activity in Individuals Receiving State Services in the United States

This study explores factors associated with participation in moderate physical activity and muscle strengthening activity in adults with autism receiving state services (age: 18-78 years). Researchers analyzed the National Core Indicators-In Person Survey (2017-2018) data using multilevel mixed effects logistic regression. Older adults on the autism spectrum engaged in both moderate physical activity and muscle strengthening activity less often than younger adults on the autism spectrum (OR 0.99; p < 0.05; OR 0.98; p < 0.001). Individuals reportedly in fair/poor health had 50% lower odds of engaging in moderate physical activity and 30% lower odds of engaging in muscle strengthening compared to those in good/ excellent health (OR 0.50; p < 0.001; OR 0.70; p < 0.001). Moderate physical activity/muscle strengthening initiatives may help foster this group's healthy aging.

Facilitators and Barriers to Physical Activity Involvement as Described by Autistic Youth with Mild Intellectual Disability

Objectives

Physical activity involvement among autistic youth and youth with an intellectual disability is significantly lower than the general population. Few studies have included youth with comorbid diagnoses of ASD and intellectual disability. Fewer studies collect information from the youth themselves. This study examined barriers and facilitators to physical activity in autistic youth with mild intellectual disability using semi-structured interviews with youth and through caregiver reports.

Methods

Fourteen caregivers and their children ages 8 to 16 years old participated. Caregivers completed a questionnaire about their thoughts on their child's physical activity while their children completed the semi-structured interview. A descriptive phenomenological approach was followed.

Results

Four themes were inductively identified: intrapersonal barriers (factors that are within the person which impede physical activity involvement, such as exhibiting challenging behaviors that inhibit engagement), interpersonal barriers (factors external to the person, such as lack of community support), intrapersonal facilitators (factors within the person that enhance physical activity involvement, such as being intrinsically motivated to improve skills), and interpersonal facilitators (external factors such as supports from caregivers).

Conclusions

Interviewing youth is important to capture a holistic picture of factors influencing physical activity. Future research may focus on implementing and assessing the efficacy of strategies to address the barriers facing youth diagnosed with ASD and intellectual disability.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41252-022-00310-5.

Examining physical activity and quality of life in adults with autism spectrum disorder and intellectual disability

Adults with autism and co-occurring intellectual disability engage in low levels of physical activity and are at increased risk of developing secondary health conditions attributed to physical inactivity compared to adults in the general population. Few studies have examined the use of objective measures to characterize physical activity levels for adults with autism and intellectual disability. The current study aimed to examine the relationship between physical activity, using an activity tracker, and quality of life in adults with autism and intellectual disability. In the current study, 38 adults with autism and intellectual disability, ages 18-55, wore a Fitbit Flex 2® activity tracker for 1 week, and completed the Quality of Life Questionnaire. The relationship between average daily step count quality of life was examined. Most adults in the sample were overweight and taking fewer daily steps than recommended guidelines. Increased average daily step count was significantly associated with quality of life.

The Effect of Physical Activity on Motor Skills of Children with Autism Spectrum Disorder: A Meta-Analysis

OBJECTIVE

The present study was aimed at analyzing the effect of physical activity on motor coordination in children with ASD.

METHODS

On 28 June 2021, a systematic review with meta-analysis was performed using the following databases: MEDLINE, SciELO, LILACS, PEDro, SPORTDiscus, CINAHL, SCOPUS, Web of Science, Cochrane, and Science Direct. We analyzed the methodological quality and risk of bias using the Jadad scale and Cochrane tool, respectively. Motor coordination results were meta-analyzed using the RevMan program. Two independent researchers used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool to assess the level of evidence from the meta-analysis.

RESULTS

We found four studies in the listed databases and five randomized clinical trials were included in the meta-analysis that included 109 children with ASD. Children with ASD who performed physical activity did not present significantly better motor coordination than control children (p = 0.12).

CONCLUSIONS

Considering the clinical importance of physical activity for children with ASD, this systematic review with meta-analysis showed that physical activity had no statistically significant effects on coordination in individuals with ASD.

Physical activity, Sedentary Behaviour and Their Correlates in Adults with Autism Spectrum Disorder: a Systematic Review

The aim of this systematic review was to investigate what is currently known about autistic adults’ participation in physical activity and sedentary behaviour and explore any associated correlates of these behaviours. The databases EMBASE, MEDLINE, PsycINFO, PubMed, and SPORTDiscus were searched for relevant literature. The review was registered with PROSPERO (No. 189187). The search identified 2834 papers, with 12 meeting the criteria for inclusion. Correlates of physical activity and/or sedentary behaviour were reported in eight included studies. The limited evidence identified suggest that autistic adults are unlikely to meet Australia’s physical activity guidelines. Future research should use device-derived measurement to more accurately quantify activity levels within the autistic adult population.

Community participation in adults with autism: A systematic review

BACKGROUND

This systematic review aimed to explore how adults with autism participate in the community, the impact of community participation on quality of life and mental health, and factors that support and hinder participation.

METHOD

A systematic review was conducted including studies published from inception to 17 January 2021.

RESULTS

Sixty-three reports were included, reporting on 58 studies. Solitary activities, organised group activities, community activities, religious groups and online social participation were identified. The relationship between community participation and quality of life was examined. Barriers and facilitators to increased community participation were identified. Most studies had a moderate to high risk of bias.

CONCLUSION

Adults with autism participate in a range of independent and community activities. The impact of community participation on quality of life and mental health warrants further exploration. Future studies should find effective ways of supporting adults with autism to participate in the community.

Brief Report: Perceived Barriers to Physical Activity Among a National Sample of Autistic Adults

Improving physical activity (PA) levels in autistic adults is an important population health goal. Limiting efforts to achieve this goal is an incomplete understanding of the barriers to PA in this high-risk group. This study utilized cross-sectional data collected via an electronic survey from 253 autistic adults aged 18-50 years to examine their perceived barriers to PA, how PA barriers differed by demographic factors, and the relationship between PA barriers and meeting PA guidelines. The Barriers to Physical Activity scale assessed the independent variable. Lack of motivation to exercise, perceiving exercise as boring, and lack of transportation were the most strongly endorsed barriers to PA. Participants who reported these barriers were significantly less likely (≤ 50%) to meet PA guidelines.

24-h movement behaviors among autistic adults: Differences by sex, age, and level of independence

BACKGROUND

Autistic adults have low levels of physical activity [PA], high levels of sedentary behavior [SB], and insufficient sleep. Not known is the extent to which engagement in these movement behaviors vary by sex, age, and level of independence in activities of daily living (ADLs).

OBJECTIVE

To characterize movement behaviors in a national sample of autistic adults by sex, age, and level of independence in ADLs.

METHODS

A national sample of autistic adults and caregivers of autistic adults self-reported PA, SB and sleep behaviors as well as demographic variables using an electronic survey. Levels of engagement in movement behaviors were described, and compared by sex, age (young-adult versus middle-age), and level of independence in ADLs.

RESULTS

Data were collected on 361 autistic adults (60.3% male, n = 217, mage = 30.82 years, SD = 10.24). Overall, 44% did not meet the PA guideline; PA guideline adherence was lowest among males and those who were dependent on others in ADLs. Overall, the SB guideline was not met by 43% of the sample at weekdays and 48% at weekends. SB guideline adherence was lowest among adults who were middle-aged, and those who were fully independent in ADLs. Overall, 35.2% did not meet the total sleep time (TST) guideline. Middle-aged autistic adults had the lowest adherence to the TST guideline.

CONCLUSIONS

These finding should prompt researchers to consider these demographic differences, and tailor research and programmatic efforts to account for the unique movement behavior profiles of different segments of this heterogenous population.

The intersection of gross motor abilities and participation in children with autism spectrum disorder

Many children with autism spectrum disorder (ASD) demonstrate movement difficulties in addition to problems with social communication and interactions, and repetitive or restrictive behaviors. The goal of early intervention for children with disabilities is to promote participation in routines and activities, but little is known about the role gross motor abilities contribute to participation for young children with ASD. The purpose of this study was to examine relationships between gross motor abilities and participation in preschool-aged children with ASD. Twenty-two children with ASD participated in the study. Gross motor skills were measured using the Peabody Developmental Motor Scales, Second Edition. Participation was measured using the Preschool Activity Card Sort. Children who had greater gross motor skills also demonstrated greater participation in self-care, high demand leisure, and social interaction activities. Results also identified activities that may be difficult for preschoolers with ASD. Findings suggest that early childhood intervention providers consider the impact of gross motor deficits within the context of participation in daily routines and activities.

Male autistic youth experiences of belonging in integrated physical education

LAY ABSTRACT

Recent years have seen calls to amplify the voices of autistic people in research about their subjective experiences. Despite this, we know little about how autistic youth experience integrated physical education, particularly in the United States. The term integrated is used to describe a setting in which all students, regardless of educational needs, are educated in the same physical space. In this study, we sought to explore the perspectives of autistic youth toward their experiences in integrated physical education, and the roles of social interactions and relationships with peers in those experiences. Findings noted that several factors influenced the ways and extent to which our participants interacted with their peers during physical education. Unfortunately, most of our participants recalled experiencing bullying, and that physical education offered an environment where bullying was most frequent and comparatively unique compared to other contexts throughout the school day. The locker room, a space linked to physical education, was of particular concern because of a lack of teacher presence. Despite the negative views of and experiences in physical education, there was evidence of participants actively pursuing to connect with peers in this context. However, most instances where participants recalled pursuing friendship were not welcomed from others, which stunted their sense of belonging in this space. Given the role that belonging plays in what it means "to be included," our research supports emerging ideas that even though autistic students were educated in the same physical spaces as their non-autistic peers, feelings of inclusion were largely absent.

"Just Invite Us": Autistic Adults' Recommendations for Developing More Accessible Physical Activity Opportunities

Background

Autistic adults engage in lower levels of physical activity (PA) than their nonautistic peers, and over 60% do not meet national guidelines for PA. In addition, autistic adults face myriad barriers to PA participation that can make accessing activities challenging. To support the inclusion of autistic adults in PA, this study sought to explore first-hand recommendations for PA participation from autistic adults' perspective.

Methods

We interviewed 23 autistic adults aged 18 to 75 years about their PA experiences across their lifespan, including querying the participants' recommendations for supporting autistic adults in PA. A qualitative descriptive design with a constructivist lens guided the thematic analysis.

Results

The analysis resulted in two overarching themes: (1) It's helpful to have someone there to support; and (2) It's that sensory thing, it always is. Each theme includes participant-provided recommendations to guide professionals in the field of PA.

Conclusions

The autistic adult voice, long absent from conversations about PA, is a valuable and needed addition to understand how to improve PA experiences for this population. Recommendations from this study include (1) listening to the perspectives and insight of autistic adults, (2) consideration of sensory stimulus when planning for PA participation, and (3) encouraging and providing social supports for PA participation.

Lay summary

Why was this study done?: Autistic adults have many health concerns such as anxiety, depression, and obesity. Physical activity can improve these health concerns. Yet, professionals lack knowledge about how to provide optimal physical activity experiences for autistic individuals. Very little research has engaged autistic adults to directly ask their recommendations about their own physical activity needs.What was the purpose of this study?: This study wanted recommendations from autistic adults on how to make physical activity more accessible and enjoyable. By doing this, the authors hope to increase the voices of autistic adults in physical activity research.What did the researchers do?: The researchers asked 23 autistic adults for their recommendations on how to improve physical activity experiences.What were the results of the study?: Participants' responses were grouped into two categories: (1) It's helpful to have someone there to support and (2) It's that sensory thing, it always is. The first theme highlights the social supports that many autistic adults feel they need to be successful. Supports include individuals within the close social circles of the autistic adults, such as parents, friends, and other close people. They can also include professionals, such as teachers or exercise trainers. The second theme highlights the need to address the sensory sensitivities of the individual before activity can take place; if an environment or activity is not "sensory friendly" or is not accommodating, then autistic adults are less likely to engage.What do these findings add to what was already known?: Autistic adults face many barriers to physical activity participation. These findings offer first-hand accounts by autistic adults about how to improve their physical activity experiences. These results also offer ideas on how to increase physical activity engagement for autistic individuals. Other research has focused on improving physical activity in those who are autistic, but this research is rarely from the perspective of the autistic individual. This study is one of a very small number of studies that has done this and is the first to ask autistic adults to give recommendations for physical activity participation.What are potential weaknesses in the study?: This study only interviewed autistic adults who prefer to communicate verbally, and so the study sample is not representative of all autistic adults. Many participants in the sample were from the United States, and autistic adults in other countries may have different opinions about physical activity participation. Finally, the researchers may have recruited individuals with an interest in physical activity-autistic adults who are not interested or dislike physical activity may have different recommendations.How will these findings help autistic adults now or in the future?: This study will help professionals provide more appropriate physical activity experiences to autistic adults. Also, this research could help practitioners and researcher make physical activity spaces more welcoming and enjoyable for autistic adults.

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.

The experiences of Hispanic families of children with autism spectrum disorder regarding physical activity

BACKGROUND

Researchers seldom focus on the services needed for Hispanic children with ASD, especially in regard to physical activity (PA).

PURPOSE

The purpose of this study was: (a) to explore why Hispanic families with children with ASD seek out and participate in PA, and (b) to describe the strategies and supports needed by Hispanic families of children with ASD to improve PA participation.

METHODS

Participants in this descriptive-qualitative study were Hispanic parents of children with ASD (n = 9) who participated in one-on-one semi-structured telephone interviews. Interviews were transcribed and then analyzed using thematic line-by-line analysis.

RESULTS

Two major themes emerged from the data: 1) Personal Responsibility and 2) "Every Day is a Different Challenge". Parents were motivated to engage in PA because of perceived health benefits for themselves and their children. Parents faced famililal and external barriers that impacted their participation. Participants commented on the role of culture (e.g., customs, lack of family support after immigration) in the context of these barriers.

IMPLICATIONS

Further research is needed regarding culturally responsive PA interventions for Hispanic families with children with ASD.

"Physical activity is beneficial to anyone, including those with ASD": Antecedents of nurses recommending physical activity for people with autism spectrum disorder

LAY ABSTRACT

Participation in regular physical activity is linked with physical, psychological, and social improvements. Nevertheless, persons with autism spectrum disorder participate at lower levels than do their peers. Nurses can play a key role in helping to promote such behaviors, but do so sparingly. The purpose of this study is to examine the degree to which nurses recommend physical activity to people with autism spectrum disorder. Even though a number of scholars have examined the role of health professionals in promoting physical activity, comparatively little research has examined nurses. Further, previous scholars have largely focused on the promotion of physical activity to patients in general. However, people with disabilities and people with autism spectrum disorder, specifically, are frequently overlooked when it comes to physical activity promotion. Data were collected from a representative sample of nurses (n = 180) working in the United States. Results indicate that nurses were only moderately likely to recommend physical activity. When perceived barriers were low, perceived benefits held a positive, significant association with recommendations. However, when perceived barriers were high, the relationship between perceived benefits and recommendations was no longer significant. Analysis of qualitative data showed the value nurses place on physical activity, how they interpret barriers and benefits, and strategies for making physical activity inclusive for people with autism spectrum disorder. In conclusion, nurses have an opportunity to more frequently promote physical activity to their patients with autism spectrum disorder and, in doing so, help mitigate some of the poor health outcomes people with autism spectrum disorder experience. The authors identified implications for nursing education and professional development, as well as for sport and recreation managers charged with delivering physical activity to people with autism spectrum disorder.

Beneficial Use and Potential Effectiveness of Physical Activity in Managing Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by poor social and communication skills. Therapeutic interventions are behavioral and educational—normally delivered as structured programs. Several well-established programs exist and most of them do not incorporate physical activity and exercise as core elements. Deficiencies in motor skills are associated with ASD and physical activity has been shown to reduce maladaptive behaviors with autistics. However, the notion of exercise being employed to manage autism is controversial. Meta-analysis and systematic reviews have concluded that physical activity has positive effects on social skills and behavior in young children and adolescents with autism. Activities such as martial arts have been singled out as being particularly beneficial. Established programs such as TEACCH have been successfully modified, as research trials, to be more physical activity-based and have shown positive results. Studies have also reinforced the importance of the role of parental involvement in delivering programs based on physical activity. There is a paucity of research evidence about the long-term effects of physical activity-based interventions. There is also disparity over the detailed nature of the activities and exercises that compose an effective program. Each person with autism has a highly individualized set of symptoms and characteristics for which highly individualized programs are warranted. This is especially true for physical activity programs.

Comparison of Physical Activity, TV/Video Watching/Gaming, and Usage of a Portable Electronic Devices by Children With and Without Autism Spectrum Disorder

OBJECTIVE

Individuals with autism spectrum disorder (ASD) participate in less physical activity (PA) and more sedentary behavior than their peers without ASD.

METHODS

The study employed Chi-square analyses of the NSCH 2016-2017 data to compare PA, TV/video watching/gaming, and usage of portable electronic devices by children with and without ASD by age and ASD severity.

RESULTS

Results suggest more than two and a half times as many children 6-11 and 12-17 years old with ASD failed to engage in 60 min of PA during the past week compared to peers without ASD. As children aged, their PA time decreased, with a larger percentage drop for children with ASD. For children ages 6-11 years, an inverse relationship was found between PA and ASD severity that was not found for older children. As the children got older, children with ASD spent more time watching TV/video watching/gaming than peers without ASD, with differing results by ASD severity. More children Birth to 5 years ASD used portable electronic devices than their peers without ASD and more young children with ASD used devices for 3 or more hours a day. Roughly the same proportions of children 12-17 years old used devices for more than 3 h a day but differential results were found between children with and without ASD for less than 1 h of device use.

CONCLUSIONS FOR PRACTICE

These data can be used to advocate for individualized PA interventions and services to increase PA and decrease sedentary behaviors of children with ASD.

Parents' perceptions and concerns about physical activity participation among adolescents with autism spectrum disorder

The parents of adolescents with autism spectrum disorder have a vital and proactive role in encouraging healthy physical activity habits, and they possess important knowledge about the adolescents’ needs when it comes to enhancing participation in physical activity. But promoting healthy physical activity habits in adolescents can be difficult. The purpose of this study was thus to describe parents’ perceptions of their adolescent child’s participation in physical activity and to describe the parental role in promoting such participation. Twenty-eight parents of adolescents aged 12–16 years with autism spectrum disorder were interviewed. The interviews were analyzed using an inductive content analysis approach. The parents described how challenging participation in physical activities could be for their adolescents. Despite this, they wanted to see their children participate more in physical activity but found the promotion of physical activity to be an overwhelming task that was difficult to cope with on their own. The results reveal a need for support and collaborative efforts among different actors to give these issues increased priority in order to promote the adolescents’ physical activity participation.

Physical Activity Among Adults With Autism: Participation, Attitudes, and Barriers

Children and adolescents with autism spectrum disorder (ASD) have shown have low levels of physical fitness, increasing risks for health-related problems associated with inactivity, such as being overweight, when compared with typically developing children. Few studies have examined physical activity (PA) among adults with ASD. This U.S.-based study examined participation in and attitudes and barriers toward PA among adults with ASD and their peers without ASD. We used standardized existing scales to survey participants for data regarding their frequency of engagement in weekly PA (strenuous, moderate, light), attitudes toward PA, expectations of others, perceived behavioral control, intention toward PA, and perceived PA barriers. Findings indicated that, on average, the ASD group compared with the comparison group reported (a) less frequent strenuous or moderate PA, (b) less positive attitudes toward PA, (c) less perceived behavioral control or ease of performing PA, and (d) more PA barriers. There was also evidence that the ASD group reported less PA intent, but there was no difference between groups regarding beliefs about others' PA expectations for them. These findings suggest a need for more PA for adults with ASD, particularly because PA has potential to attenuate such ASD challenges as anxiety, stress, and sleeping difficulties.