Exercise improves the social and behavioral skills of children and adolescent with autism spectrum disorders

The neurobiological mechanisms underlying the effects of exercise interventions in autistic individuals

Autism spectrum disorder is a pervasive and heterogeneous neurodevelopmental condition characterized by social communication difficulties and rigid, repetitive behaviors. Owing to the complex pathogenesis of autism, effective drugs for treating its core features are lacking. Nonpharmacological approaches, including education, social-communication, behavioral and psychological methods, and exercise interventions, play important roles in supporting the needs of autistic individuals. The advantages of exercise intervention, such as its low cost, easy implementation, and high acceptance, have garnered increasing attention. Exercise interventions can effectively improve the core features and co-occurring conditions of autism, but the underlying neurobiological mechanisms are unclear. Abnormal changes in the gut microbiome, neuroinflammation, neurogenesis, and synaptic plasticity may individually or interactively be responsible for atypical brain structure and connectivity, leading to specific autistic experiences and characteristics. Interestingly, exercise can affect these biological processes and reshape brain network connections, which may explain how exercise alleviates core features and co-occurring conditions in autistic individuals. In this review, we describe the definition, diagnostic approach, epidemiology, and current support strategies for autism; highlight the benefits of exercise interventions; and call for individualized programs for different subtypes of autistic individuals. Finally, the possible neurobiological mechanisms by which exercise improves autistic features are comprehensively summarized to inform the development of optimal exercise interventions and specific targets to meet the needs of autistic individuals.

Self-perceived physical fitness and occurrences of individual levels of autistic traits in adolescents: a cluster association study

BACKGROUND

The association between physical fitness and autistic traits in adolescents remains under explored, especially in adolescents. Understanding this relationship can provide strategies to improve the quality of life of these people.

OBJECTIVE

To identify the association between cluster characteristics derived from levels of self-perceived physical fitness and the occurrences of individual levels of autistic traits in Brazilian adolescents.

METHOD

This descriptive study employed an analytical, quantitative approach involving 515 adolescents aged 11 to 18 (245 boys and 270 girls). Autistic traits were assessed using the Autism Quotient (AQ50), while physical fitness was measured with the Self-Reported Physical Fitness Questionnaire (QAPA). Cluster analysis using descriptive statistics with bootstrapping and generalized estimating equations was performed.

RESULTS

Boys reported higher physical fitness levels than girls, with significant differences in General Power Strength (QAPA 4) and Physical Fitness in Sports (QAPA 7). Girls scored slightly higher on social skills. AQ50 scores indicated that girls had higher aggregated difficulties in imagination, attention, communication, and social skills compared to boys. Higher self-perceived physical fitness was associated with lower levels of autistic traits in both genders. Girls with higher QAPA scores showed significant decreases in autistic traits related to social skills and overall AQ50 scores. Boys with higher physical fitness demonstrated reduced autistic traits in the domains of imagination and communication. Age-adjusted analyses confirmed these findings.

CONCLUSION

There is a significant association between self-perceived physical fitness and autistic traits in adolescents. Higher physical fitness levels are linked to fewer autistic traits, highlighting the importance of promoting physical fitness to mitigate challenges associated with autistic traits and improve adolescents' well-being.

Characteristics of Individuals Losing Autism Diagnosis: A Comparative Study With Typically Developing and Autism Spectrum Disorder Individuals

AIM

This study aims to reveal the characteristics of individuals who have lost an autism spectrum disorder (ASD) diagnosis and to evaluate their current psychiatric diagnoses. Additionally, the study aims to compare individuals who have lost ASD with typically developing (TD) individuals and those with ASD in terms of current psychopathology, functionality and sociodemographic and clinical variables.

METHODS

The study included a total of 85 participants aged between 5 and 18, comprising 30 individuals who no longer meet the criteria for ASD (loss of autism diagnosis or LAD), 32 individuals with ASD and 23 TD individuals. While the sociodemographic data form and Childhood Autism Rating Scale (CARS) were completed by the clinician, the Autism Behavior Checklist (ABC) and Social Responsiveness Scale (SRS) were completed by the parents.

RESULTS

It was found that the LAD group acquired speaking skills earlier, started special education sooner, received preschool education and physical exercise support for a longer duration and exhibited higher mental capacity and lower symptom severity compared to the ASD group. Moreover, 80% of the LAD group had at least one DSM-5 diagnosis. Scores on the ABC and SRS indicated a significant difference, with ASD > LAD > TD.

CONCLUSIONS

Even if ASD regresses, individuals may still experience residual difficulties and remain at risk for other psychopathologies. Therefore, it is crucial to maintain monitoring and support processes.

Benefits of exercise for children and adolescents with autism spectrum disorder: a systematic review and meta-analysis

Background

Numerous experimental studies have shown that exercise can serve as an intervention with beneficial effects on children and adolescents with autism. However, a systematic review on the specific areas affected has not been conducted.

Methods

Preliminary research sources were obtained by searching four databases, and two researchers independently screened the literature that met the study criteria. The study was conducted under the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions.

Results

37 studies were included in the final analysis, of which 9 studies were quantitatively synthesized and 28 studies were qualitatively analyzed. Exercise interventions have positive effects on motor performance, cognitive function, individual and social relationships, behavioral problems, physical health, and brain function in children and adolescents with autism. The results of the meta-analysis indicate that exercise can effectively improve social skills [SMD=-0.53, 95%CI (-0.76, -0.3), P=0.000].

Conclusions

Long-term, regular, chronic exercise is beneficial for children and adolescents with autism, particularly in the area of social skills.

Systematic review registration

https://www.crd.york.ac.uk/prospero PROSPERO, identifier CRD42024554530.

The impact of exercise intervention on social interaction in children with autism: a network meta-analysis

Background

Extensive research has documented the positive impacts of physical activity on children and adolescents with Autism Spectrum Disorders (ASD). However, the specific benefits of various sports on the social functioning of children with ASD remain ambiguous. This study aims to employ a network meta-analysis to investigate the effects of different sports on the social functioning of children and adolescents with ASD and to establish a ranking of their effectiveness.

Methods

This study conducted a comprehensive online search across Web of Science, PubMed, Cochrane, and Embase databases for randomized controlled trials and quasi-experimental studies focusing on social functioning outcomes. Data were synthesized using a Bayesian framework.

Results

Sixteen relevant studies encompassing 560 participants were included. According to Cohen's classification, mini-basketball (SMD = 0.84, 95% CI: 0.46, 1.20), SPARK (SMD = 0.88, 95% CI: 0.06, 1.70), and Karate (SMD = 1.10, 95% CI: 0.27, 2.00) demonstrated high effect sizes, with Karate identified as the most effective intervention. Conversely, Combined Exercise and Nei Yang Gong interventions exhibited the least significant effects, falling below small effect sizes.

Conclusion

Physical activity interventions have been shown to enhance social functioning in children and adolescents with ASD to varying extents, with Karate emerging as the most efficacious.

The impact of the physical activity intervention on sleep in children and adolescents with neurodevelopmental disorders: a systematic review and meta-analysis

Objective

The purpose of this review was to synthesize the current literature on the relationship between sleep and physical activity in children and adolescents with neurodevelopmental disorders.

Methods

Articles were searched in PubMed, Web of Science, EBSCO, Cochrane, and Embase until April 2024. The meta-analysis was performed using Review Manager 5.3.

Results

Our results show that measuring sleep parameters by means of different measuring tools yields different results. Most studies have found no association between sleep and physical activity in children with neurodevelopmental disorders, especially when measured subjectively, such as parent reports and sleep logs. Physical activity interventions had a significant effect on sleep efficiency, wake after sleep onset, and sleep duration when measured objectively using instruments such as wrist actigraphy. Meta-analysis showed that children and adolescents with neurodevelopmental disorders who participated in mind-body activities (SMD = -3.01, 95%CI = -4.15~-1.87, p < 0.001, I2 = 99%) showed significant improvements in sleep, which were sessions lasting more than 12 weeks (SMD = -1.01, p < 0.01, I2 = 97%), performed at least 3 times per week (SMD = -0.81, 95%CI = -1.53~-0.10, p = 0.03, I2 = 95%), and lasted for more than 60 min per session (SMD = -1.55, 95%CI = -2.67~-0.43, p = 0.007, I2 = 97%). However, the results of these subgroup analyses must be interpreted with caution because of the small number of studies included.

Conclusion

Our results show that measuring sleep parameters by means of different measuring tools yields different results. There was difficulty in interpreting many of the studies included in this meta-analysis, in view of the non-standardization of protocol, especially the ability range of the cohort, duration of the study, recommended exercises, whether the caregivers or researchers supervised the exercise regime/activity, and the practicality of continuing the exercise long-term by caregivers.

Systematic review registration

Identifier, CRD42024541300.

The impact of the physical activity intervention on sleep in children and adolescents with autism spectrum disorder: A systematic review and meta-analysis

Pharmacological treatments (i.e., melatonin) and non-pharmacological therapies (e.g., parent-based sleep education programs and behavioural interventions) have been found to result in improved sleep in children and adolescents with autism spectrum disorder (ASD). However, there are several limitations to these treatment approaches, including concerns about the possible side-effects and safety, high-cost and uncertainties of long-term effects. Physical activity (PA) intervention is a promising behavioural intervention that has received increasing attention. However, the effects of PA intervention on sleep are still unclear in this clinical group. This study aimed to synthesize available empirical studies concerning the effects of PA interventions on sleep in children and adolescents with ASD. Following PRISMA guidelines, seven electronic databases: APA PsychInfo, CINAHL Ultimate, ERIC, MEDLINE, PubMed, SPORTDiscus, and Web of Science, were searched from inception to March 2023. Randomized controlled trials/quasi-experimental designs with comparison groups were included. Initially, 444 articles were identified, 13 articles underwent systematic review, and 8 studies with control groups and sufficient statistical data were selected for meta-analysis. Compared to no-treatment control groups, PA interventions had a large positive effect on parent-reported general sleep problems, night awakenings, sleep resistance, sleep duration and actigraphy-assessed sleep efficiency in children and adolescents with ASD.

Diagnosing autism severity associated with physical fitness and gray matter volume in children with autism spectrum disorder: Explainable machine learning method

PURPOSE

This study aimed to investigate the relationship between physical fitness, gray matter volume (GMV), and autism severity in children with autism spectrum disorder (ASD). Besides, we sought to diagnose autism severity associated with physical fitness and GMV using machine learning methods.

METHODS

Ninety children diagnosed with ASD underwent physical fitness tests, magnetic resonance imaging scans, and autism severity assessments. Diagnosis models were established using extreme gradient boosting (XGB), random forest (RF), support vector machine (SVM), and decision tree (DT) algorithms. Hyperparameters were optimized through the grid search cross-validation method. The shapley additive explanation (SHAP) method was employed to explain the diagnosis results.

RESULTS

Our study revealed associations between muscular strength in physical fitness and GMV in specific brain regions (left paracentral lobule, bilateral thalamus, left inferior temporal gyrus, and cerebellar vermis I-II) with autism severity in children with ASD. The accuracy (95 % confidence interval) of the XGB, RF, SVM, and DT models were 77.9 % (77.3, 78.6 %), 72.4 % (71.7, 73.2 %), 71.9 % (71.1, 72.6 %), and 66.9 % (66.2, 67.7 %), respectively. SHAP analysis revealed that muscular strength and thalamic GMV significantly influenced the decision-making process of the XGB model.

CONCLUSION

Machine learning methods can effectively diagnose autism severity associated with physical fitness and GMV in children with ASD. In this respect, the XGB model demonstrated excellent performance across various indicators, suggesting its potential for diagnosing autism severity.

Children with Autism Spectrum Disorder Exhibit Elevated Physical Activity and Reduced Sedentary Behavior

According to previous research, individuals with autism spectrum disorder (ASD) have lower levels of physical activity than their typically developed (TD) counterparts. There have been conflicting reports about physical activity (PA) levels in people with ASD. Given the conflicting evidence, further investigation is required. We believe that evaluating PA in individuals with ASD is critical in order to offer PA intervention plans aiming at increasing their health-related physical fitness on a daily, systematic, and individualized basis. In the current study, an ActiGraph monitor (GT3X+) was used to accurately measure PA and sedentary activity in 21 children with autism aged 6.43 ± 2.29 years and 30 TD children aged 7.2 ± 3.14 years. Our data indicated that while the light and moderate activity counts were not significantly different between the two groups, the vigorous activity was significantly higher in ASD compared to TD. This finding was attributed to ASD characteristic stereotypy and self-stimulating behaviors. The significantly higher vigorous PA is discussed in relation to altered neurochemistry, oxidative stress, and neuroinflammation as etiological mechanisms in ASD. This research provides a better understanding of the status of PA participation in individuals with ASD.

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.

The effect of physical exercise on disordered social communication in individuals with autism Spectrum disorder: a systematic review and meta-analysis of randomized controlled trials

Objective

The aim of this systematic review and meta-analysis was to systematically investigate the intervention effect of physical exercise on disordered social communication in patients with autism spectrum disorders.

Methods

This systematic review and meta-analysis used the PubMed, Web of Science, the Cochrane Library, and Embase electronic databases to conduct a systematic search of literature describing randomized controlled trials (RCTs) on the effect of physical exercise on disordered social communication in autistic patients from the first year of inclusion to 21 January 2023.

Results

A total of 14 RCTs including 460 autistic patients were analyzed. A meta-analysis showed that physical exercise had a positive effect on social communication disorder (SMD = 0.45, 95% CI: 0.15, 0.74, p < 0.05) in autistic patients. Subgroup analysis showed that exercise programs with multiple components (SMD = 0.73, 95% CI: 0.39, 1.06, P < 0.001), a moderate duration (SMD = 0.73, 95% CI: 0.38, 1.08, P < 0.001), a moderate-high frequency (SMD = 0.84, 95% CI: 0.53, 1.14, P < 0.001), and a long duration (SMD = 0.77, 95% CI: 0.36, 1.18, P < 0.001) led to significant improvement.

Conclusion

Physical exercise can improve disordered social communication in patients with autism spectrum disorders. Specifically, early intervention, multi-component exercise, a moderate period, moderate and high frequency, long duration, and multi-participant programs were most effective.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/ RecordID= CRD42023422482.