Recommended practices for virtual nutrition education interventions for adolescents with autism spectrum disorder: A reflection from two pilot interventions during the COVID-19 pandemic.

Youth with autism spectrum disorder (ASD) demonstrate unhealthy eating behaviors and dietary patterns compared to their neurotypical counterparts. Given the increased risk of unhealthy weight gain and the onset of the COVID-19 pandemic, modified nutrition programs in this population are warranted. The authors independently conducted two virtual pilot interventions during COVID-19 that offered feasible and acceptable alternatives to in-person delivery, providing unique opportunities for participant engagement and family involvement. Future virtual nutrition education programs for adolescents with ASD may include visual and verbal aids through Zoom, more parent/family integration, and accommodations for those with varying ASD severity levels.

Effects of an 8-Week Judo Program on Behaviors in Children with Autism Spectrum Disorder: A Mixed-Methods Approach.

Prior studies suggest that a combination of physical activity and mind-body exercises, often seen in martial arts, may attenuate negative behaviors in youth with Autism Spectrum Disorder (ASD). Therefore, the aim of this study was to examine the effects of an 8-week judo program on behavioral factors in children with ASD, using a mixed-methods approach. A total of 25 children (ages 8-17), diagnosed with ASD, participated in an 8-week judo program (1 × week). Parents of participants were given the Aberrant Behavior Checklist (ABC) to compare the severity of ASD-related behavior at baseline and at the end of the program. A subset of parents (n = 9) participated in semi-structured interviews that focused on their child's behaviors during the judo program. Non-parametric paired t-tests were conducted to compare differences in the ABC scores from at baseline and at the end of the program. Interviews were coded independently by two trained researchers and categorized into behavioral themes. Participants attended an average of 7.04 ± 1.06 classes (out of 8 sessions). There were no significant changes in ABC scores, however, parent interviews revealed that 78% of parents observed improvements in both social skills and self-esteem as a result of the judo program. Despite no significant differences in ABC scores pre and post-judo, data from parent interviews indicate improvements in self-esteem and social skills. Future studies should further examine the effects of judo in a larger sample of youth with ASD, and include control conditions (e.g. no-exercise group) for comparison purposes.

The influence of friends and psychosocial factors on physical activity and screen time behavior in adolescents: a mixed-methods analysis.

(1) Determine the association between adolescent moderate-to-vigorous physical activity (MVPA) and screen time with their nominated friends' behaviors and (2) explore potential mechanisms of friends' social influences on MVPA and screen time. Participants consisted of 152 adolescents (mean age: 14.5 years, 53 % female, 50 % high school, 80 % Caucasian). MVPA was measured with an Actigraph GT3X+ accelerometer. Demographic and psychosocial variables were assessed via questionnaires. Participants nominated up to 5 friends who completed MVPA and screen time questionnaires. A subset of adolescents (n = 108) participated in focus groups that examined potential mechanism of friends' influence on MVPA and screen time. Multiple regression analysis examined the association of demographic, psychological, and nominated friend variables with participants' MVPA and screen time. NVivo 10.0 was used to analyze qualitative data. Greater levels of friends' MVPA was associated with greater levels of MVPA in both males (p < .0001) and females (p < .0001). Greater levels of friends' screen time was associated with greater levels of screen time in males (p = .04) while psychosocial variables, such as increased screen time enjoyment, were associated with increased screen time in females (p = .01). School level was not associated with either MVPA or screen time. Focus group data indicated that friends positively influenced participants' MVPA through engaging in activity with participants, verbal encouragement, and modeling of MVPA. All participants preferred to be active with friends rather than alone, however, females preferred activity with a close friend while males preferred to be active with a group. Enjoyment of MVPA was the most cited reason for engaging in MVPA with friends. The majority of participants reported friends not having an influence on screen time. Adolescents with active friends are more likely to be physically active and spend less time engaging in screen-based behaviors. Interventions to increase MVPA in youth could be designed to include the recruitment of friends to increase enjoyment of MVPA.

Comparison of the Effects of Stable and Dynamic Furniture on Physical Activity and Learning in Children.

We compared the effects of traditional (stable) and non-traditional (dynamic) school furniture on children's physical activity (PA), energy expenditure (EE), information retention, and math skills. Participants were 12 students (8.3 years, 58 % boys) in grades 1-5. Participants wore an Actigraph GT3X+ accelerometer (to assess PA), and an Oxycon Mobile indirect calorimetry device (to assess EE) for 40 min (20 min for each session). Each session consisted of a nutrition lecture, multiple choice questions related to the lecture, and grade-appropriate math problems. We used paired t tests to examine differences between the stable and dynamic furniture conditions. Average activity counts were significantly greater in the dynamic than the stable furniture condition (40.82 vs. 9.81, p < 0.05). We found no significant differences between conditions for average oxygen uptake (p = 0.34), percentage of nutrition questions (p = 0.5), or math problems (p = 0.93) answered correctly. Movement was significantly greater in the dynamic than the stable furniture condition, and did not impede information acquisition or concentration. Future studies should compare the long-term effects of traditional and dynamic furniture on health and academic outcomes in schools and other settings.

Sitting Less for Success: Reducing Sedentary Behaviors to Increase Kindergarten Achievement.

BACKGROUND: Physical activity (PA) improves outcomes, but disadvantaged children typically experience more sedentary behavior (SB). This study explored movement, executive function (EF) health, and academic achievement (AA) for economically disadvantaged kindergarteners. METHODS: Children in 2 classrooms (n = 16; n = 7) wore wrist-based accelerometers to assess PA/SB during the school day. Independent t-tests and analysis of variance analyzed mean group differences in PA/SB and EF/AA, and correlations explored AA and EF associations. RESULTS: The movement-based class spent significantly less time in SB compared to the contemporary class (t = 2.552, g = 1.115), made greater reading (t = -2.611) and math (t = .967) gains, and had better EF (t = .012). There were significant negative correlations between SB and math (r = -.534) and reading (r = -.592), but no significant relationships with EF. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Schools should consider methods to decrease time spent in SB at lower-SES schools, which is financially feasible and less time-consuming than programs to increase PA. CONCLUSION: Decreased SB time was associated with better AA. More research is needed to determine whether interventions to decrease time spent in SB at school improve academic outcomes in disadvantaged children.

Effects of a family judo program on sleep quality in youth with Autism Spectrum Disorder.

OBJECTIVE: The purpose of this study was to examine the effects of a family-based judo program on sleep quality in youth diagnosed with Autism Spectrum Disorder (ASD). METHODS: Eighteen youth (13.17 years ± 3.76, 78% male) diagnosed with ASD participated in a 14-week family judo program. Sleep quality was assessed using the Actigraph GT9X accelerometer pre- and post-judo intervention. Non-parametric paired t-tests were conducted to examine changes in sleep quality variables. RESULTS: There was a significant increase in sleep efficiency (p = .05), and a significant decrease in both sleep latency (p = .001) and wake after sleep onset (p = .02) following participation in the judo program. There were no changes in sleep duration observed in this sample (p = .83). CONCLUSION: Participation in a family judo program may improve sleep quality in youth with ASD. More research is necessary to understand the mechanisms by which judo may improve sleep quality in youth with ASD.

The physical and psychosocial benefits of a family judo program for parents of children with Autism Spectrum Disorder: A pilot study.

BACKGROUND: Parents of children with Autism Spectrum Disorder (ASD) tend to have high levels of stress and poor health habits. There is a lack of interventions that focus on improving health outcomes in parents of children with ASD. OBJECTIVE: To examine the physical and psychosocial effects of a family-based judo program on parents of children diagnosed with ASD. METHODS: This study utilized a pre-post single group design. Eighteen parent-child dyads participated in a 14-week judo program for families of children with ASD. Judo sessions were held once a week for 45 min. Parents wore wrist accelerometers to assess physical activity/sleep quality, and completed surveys regarding self-reported stress levels pre- and post-judo. Parents also completed open-ended questions regarding their experience in the program. Paired sample t-tests were conducted to examine changes in stress, physical activity, and sleep quality from pre-to post-program. RESULTS: Both a decrease in parental stress (47.77 vs. 41.61, p < 0.01) and an increase in minutes per day of physical activity (35.49 vs 45.94, p = 0.002) were observed from baseline to post-program. Fourteen of the 18 parents (78 %) reported at least one psychosocial benefit (e.g. increased self-confidence) or physical health benefit (e.g. increased physical activity) from participation in the program. CONCLUSIONS: A family judo program may provide health benefits, such as reducing stress levels and increasing physical activity in parents of children with ASD. Further research involving larger sample sizes is necessary to better determine the effects of judo on both parents and their children with ASD.

The role of psychosocial factors in the decision to enroll in physical education courses at the state college level.

OBJECTIVE: Physical education (PE) courses may provide young adults with opportunities to become active, however, enrollment in college PE courses remains low. PARTICIPANTS: This study examined psychosocial factors related to PE enrollment in a sample of 177 college students (29.4% completed a PE course). METHODS: Participants completed an online survey that inquired about demographic information, college PE enrollment, exercise self-efficacy, and several open-ended questions regarding their enrollment decisions. RESULTS: There were no differences in self-efficacy scores between PE completers and non-completers. PE completers had more positive previous experiences with PE (43.7% vs 19.3%, p < .01) while non-completers had more negative PE experiences (33% vs 12.5%, p = .03). PE completers felt that self-improvement (51.5% vs 21.3%, p < .01) was most important regarding decisions to enroll in a PE course, while non-completers were concerned with PE courses counting toward their degree (29.2% vs 9.1%, p = .02). CONCLUSIONS: These findings can help inform those involved in teaching and administration of PE courses at the state college level. Future research should further investigate how past PE experiences shape students' feelings toward PE.

An urban versus rural comparison of obesity between youth with and without autism spectrum disorder.

To examine obesity prevalence in youth with autism spectrum disorder (ASD) and neurotypical (NT) youth living in rural and urban areas. Data is from the 2019 National Survey of Children's Health, a national dataset that collected information on child health and well-being. Overweight/obesity status was based on parent/caregiver report of child height and weight. Urban and rural status was determined by whether children lived in/near a city. Chi-square tests were conducted to examine differences in obesity prevalence in youth with ASD and NT youth living in rural and urban areas. Overall, 43.9% of youth with ASD were overweight/obese compared to 30.6% of NT youth (p < 0.001). There was a significantly higher proportion of NT youth living in rural areas (36.44%) who were overweight/obese compared to urban NT youth (30.35%, p = 0.002). There were no significant differences in the proportion of overweight/obese youth with ASD living in rural areas (44.02%) compared to urban areas (44.44%, p = 0.96). Urban residence reduced the odds of overweight/obese compared to rural residence among NT youth (aOR = 0.77, 95%CI = 0.66-0.90) but urban/rural residence was not a significant factor in models for ASD youth (aOR = 1.25, 95%CI = 0.63-2.48). In contrast to NT youth, there were no differences in levels of overweight/obesity in youth with ASD living in rural areas compared to urban areas. Further research on how sociodemographic factors and geographic location affect obesity in youth with ASD is warranted.

The impact of health education on physical activity correlates in college students.

Objective To examine the effects of a 15-week, conceptually based university health/wellness course on moderate-to-vigorous physical activity (MVPA) levels, psychosocial factors, and health-related fitness knowledge (HRFK). Participants: 125 undergraduates enrolled during spring 2016 semester. Methods: Participants completed pre- and post-course surveys with questions on MVPA levels, exercise self-efficacy (SE), exercise motivation, and HRFK. Wilcoxon rank sum tests examined changes in SE, motivation, and HFRK. A multiple regression analysis examined associations among HRFK, psychosocial factors, and MVPA. Results: HRFK and MVPA increased from baseline to post-course assessment (p<.01). An increase in SE was associated with an increase in MVPA (p < 0.0001). Conclusions: Enrollment in a conceptually based health/wellness course may increase MVPA and HRFK in college students. Although the increase in SE post-course was not significant, it was associated with an increase in MVPA. These results support adoption of health/wellness programming to attenuate decreases in MVPA typically observed in college students.

Health behaviors, psychosocial factors, and academic engagement in youth with autism spectrum disorder: A latent class analysis.

The purpose of this study was to identify behavioral and health-related profiles of children with autism spectrum disorder (ASD), based on the 2016 National Survey of Children's Health. A sample of 894 children with ASD (weighted sample N = 768,181) were included in the analysis. All data were parent-reported and included measures on current diagnosis of ASD, general child health, weight status, physical activity (PA), screen time (ST), sleep duration, academic engagement, and social engagement. Latent class analysis, estimated with Mplus v. 8.4, was used to identify latent profiles of children with ASD. A three-profile solution was the best fitting model, per model fit criteria. Children in profile 1 had overall more positive attributes (better health and weight, PA, more engaged in school, little difficulty in making friends, and modest ST) relative to children in either profiles 2 or 3. Children in profile 2 had distinctly increased ST and more difficulty in making friends when compared with children in either other profile. A greater proportion of children in profiles 2 and 3 were receiving behavioral treatment compared to profile 1; however, no differences were observed among profiles according to ASD severity, medication status, or additional health conditions. Studies should examine causal mechanisms among health behaviors, academic achievement, and social engagement in youth with ASD.

Feasibility of a Remote-based Nutrition Education and Culinary Skills Program for Young Adults With Autism Spectrum Disorder.

OBJECTIVE: To evaluate the feasibility of a remote-based nutrition education and culinary skills program for young adults with autism spectrum disorder (ASD). METHODS: Thirteen young adults with ASD (26.6 ± 4.4 years; 77% male) participated in a remote-based nutrition program twice a week over 12 weeks. Principles of Social Cognitive Theory were used to develop the curriculum, which focused on nutrition education and meal preparation. Feasibility was assessed through attendance records, retention rates, duration/frequency of participant engagement, session notes, and participant interviews. RESULTS: The program had a 13% refusal rate and a 7% attrition rate. Participants had a session attendance rate of 83%. Session notes revealed that the remote format offered several methods of participant communication and captured evidence of family support. Interview themes included increased nutrition-related knowledge, self-efficacy, and behavioral capability. CONCLUSIONS AND IMPLICATIONS: The remote-based nutrition program met feasibility benchmarks for adherence and retention and was well-accepted by participants. A remote-based format for nutrition interventions can reach a wider range of young adults with ASD; however, input from the target population should be considered in the development of the program.

Brief Report: Feasibility and Acceptability of a Remote-Based Nutrition Education Program for Adolescents with Autism Spectrum Disorder: A COVID-19 Pilot Study.

To examine the feasibility and acceptability of a remote-based nutrition education program during COVID-19 for adolescents with autism spectrum disorder (ASD). Ten adolescents with ASD participated in a 4-week nutrition education program utilizing Zoom software during COVID-19. Topics included shopping for healthy food, and food preparation safety measures. Attendance was collected for each session. Participants, parents, and the classroom teacher completed post-program surveys and interviews. The course attendance rate was 97%. Every adolescent reported they would participate in similar future programs, and the teacher/parents felt the program was a positive experience for the participants. The remote-based nutrition education program appeared to be feasible and acceptable to participants. Future research should focus on program efficacy.

Health Factors, Sociability, and Academic Outcomes of Typically Developing Youth and Youth with Autism Spectrum Disorder: A Latent Class Analysis Approach.

To identify profiles of both typically developing (TD) children and children with autism spectrum disorder (ASD) based on health indicators, and academic/social engagement. Latent class analysis was conducted to identify profiles of children from the 2016 National Survey of Children's Health, based on physical activity, screen time, sleep, and academic/social engagement. A three-profile solution was the best fitting model, with children in profile 3 characterized as having excellent health, and academic/social outcomes, compared to profiles 1 and 2. Compared to TD youth, a greater percentage of youth with ASD fit into the poorer health profiles. Studies should examine whether health interventions for youth with ASD can improve factors, such as academic engagement and social interaction.

Brief report: The impact of the COVID-19 pandemic on health behaviors in adolescents with Autism Spectrum Disorder.

BACKGROUND: There is concern that the COVID-19 pandemic may negatively affect health behaviors in youth, especially youth diagnosed with Autism Spectrum Disorder (ASD). OBJECTIVE: The purpose of this paper was to examine changes in physical activity, screen-time, and sleep in adolescents with ASD due to the COVID-19 pandemic. METHODS: Nine adolescents with ASD completed surveys measuring physical activity, screen-time, and sleep duration prior to and during the pandemic. RESULTS: A significant decrease in days of physical activity (4.17 vs 2.27; p = 0.0006), and a significant increase in hours of both weekday (3.69 vs 6.25; p = 0.007) and weekend screen-time (5.94 vs. 7.39; p = 0.004) was observed during the pandemic. No changes regarding sleep duration was observed. CONCLUSIONS: Although preliminary, results suggest that physical activity and screen-time may be negatively affected by the COVID-19 outbreak in youth with ASD. The development of interventions to promote health behaviors in ASD populations during long periods of less-structured time (quarantine) should be considered.

Implementation of a school-based Fitbit program for youth with Autism Spectrum Disorder: A feasibility study.

BACKGROUND: School settings may be optimal for physical activity interventions for youth with Autism Spectrum Disorder (ASD). Additionally, consumer-based fitness trackers may encourage youth with ASD to increase their physical activity levels, however, no studies have examined whether a fitness tracker program would be feasible in youth with ASD. OBJECTIVE: To examine the feasibility of a 12-week school-based Fitbit© program for youth with ASD. METHODS: Six classroom teachers and their students (n = 45) were provided with Fitbit fitness trackers to wear over 12-weeks. Classroom teachers monitored student tracker use and completed open-ended surveys to describe both their experience and their students' experience with the fitness trackers. RESULTS: Out of the 45 eligible students, 42 (94%) opted to participate in the study. All six teachers and 32 (76%) of the 42 students wore the fitness tracker daily over 12 weeks. Teachers reported that students were most interested in tracking their daily steps, and the short batter life, and account set-up were the biggest challenges to students. All six teachers felt that this program could have long-term sustainability, especially if tracker use could be incorporated into school curriculum and classroom activities. CONCLUSIONS: A school-based Fitbit program appears to be both feasible, and well-accepted by students with ASD. Future work should evaluate the preliminary efficacy of this type of program.

The time course of neuromuscular impairment during short-term disuse in young women.

Skeletal muscle disuse results in rapid functional declines. Previous studies have typically been at least 1 week in duration and focused on the responsiveness of men. Herein, we report the timeline of initial impairments in strength, voluntary activation (VA), and motor unit control during 2 weeks of knee joint immobilization. Thirteen women (mean age =21 years) underwent 2 weeks of left knee joint immobilization via ambulation on crutches and use of a brace. Participants visited the laboratory for testing on seven occasions (two familiarization visits, pretest, 48 and 72 h, 1 and 2 weeks). Knee extensor isometric and concentric isokinetic strength at two velocities (180 and 360 degrees⋅s-1 ), VA, and submaximal vastus lateralis motor unit activity were evaluated. Moderate-to-large decreases in isometric and concentric strength at 180 degrees⋅s-1 and VA were observed within 48 hours. Isometric strength continued to decline beyond 72 h, whereas other variables plateaued. The B-term of the motor unit mean firing rate versus action potential amplitude relationship demonstrated a moderate increase 1 week into immobilization, suggesting that greater firing rates were necessary to maintain pretest torque levels. Concentric strength at a velocity of 360 degrees s-1 was not affected. Decreases in knee extensor strength occur within a matter of days after immobilization, although the time course and magnitude vary among assessment methods. These changes are mediated by the nervous system's capacity to activate skeletal muscle. Clinically appropriate interventions which target nervous system plasticity should be implemented early to minimize the rapid functional impairments associated with disuse.

Brief Report: Obesogenic Behaviors of Children with Developmental Disabilities During Summer.

The 'Structured Days Hypothesis' suggests that children's obesogenic behaviors (e.g., activity, diet, sleep, and screen time) are less favorable during times when there is less-structure to a child's day (e.g., summer). To compare obesogenic behaviors of children with developmental disabilities (DD) during summer on days with differing amounts of 'structure'. Seventeen children with DD (mean age 9.8 years) attending a day camp wore a Fitbit© activity monitor on the non-dominant wrist during summer, and parents completed a survey packet, to capture obesogenic behaviors. Participants displayed improved physical activity levels, diets, and sleep timing on camp days versus other days. Providing children with DD 'structure' over summer is a potential intervention approach requiring further investigation.

Transition of a Judo Program from In-Person to Remote Delivery During COVID-19 for Youth with Autism Spectrum Disorder.

OBJECTIVES: To examine the feasibility of a remote judo program for high school students with autism spectrum disorder (ASD) during the COVID-19 pandemic. METHODS: Nine high school students with ASD had been participating in an in-person judo program that transitioned to a livestream format once the stay-at-home orders were mandated. The students completed surveys regarding their experience with the remote sessions. Their classroom teacher completed a semi-structured interview regarding the advantages and disadvantages of the remote format. RESULTS: Eight out of the nine students attended 92% of the remote classes. All nine students reported feeling satisfied with the remote judo sessions. Reported benefits of the remote format included the structured routine during the pandemic and the opportunity for physical activity. Disadvantages included a lack of space and lack of one-on-one instruction. CONCLUSIONS: The remote judo program appeared to be both feasible and acceptable for youth with ASD.

Environmental Factors Associated with Physical Activity and Screen Time Among Children With and Without Autism Spectrum Disorder.

This study aimed to examine how environmental factors are associated with physical activity (PA) and screen-time (ST) among children with and without ASD (n = 1380 and 1411, respectively). For TD children, the absence of a bedroom television and neighborhood support were associated with PA. For children with ASD, no environmental factors were associated with PA. Regarding ST, the presence of a bedroom television, absence of limits on ST, lack of neighborhood amenities and support, and adverse neighborhood factors were all associated with ST among TD children. For children with ASD, the presence of a bedroom television and the absence of limits on ST were associated with ST. Potential explanations for this dichotomy and suggestions for future research are discussed.