U.S. Physical Activity Para Report Card for Children and Adolescents With Disabilities.

The U.S. Report Card on Physical Activity for Children and Youth has tracked 10 physical activity (PA) indicators common to the Active Healthy Kids Global Matrix since 2014. This article expands on the U.S. report cards by presenting PA indicator assessments among children and adolescents with disabilities. Grades for indicators were assigned based on a search of peer-reviewed articles presenting nationally representative data. The Global Matrix 3.0 benchmarks and grading framework guided the process. Grades for overall PA, sedentary behaviors, organized sports, and school were F, D+, D+, and D, respectively. Insufficient evidence existed to assign grades to the remaining six indicators. There is a need in the United States for targeted PA promotion strategies that are specific to children and adolescents with disabilities. Without a commitment to this effort across sectors and settings, the low grades identified in this para report card are expected to remain.

Physical Activity, Medical Home, and Health Behavior Counseling Among Adolescents with Special Health Care Needs: NSCH 2016-2017.

OBJECTIVES: Aim 1 was to establish updated prevalence estimates for meeting national physical activity (PA) guidelines among adolescents with and without special healthcare needs (SHCN), 12-17 years old. To identify at-risk subgroups, our sub-aim was to compare the distribution of prevalence estimates across PA levels by SHCN subtypes, and in reference to peers without SHCN. Aim 2 was to examine the association between meeting PA guidelines, having a medical home, and receiving positive health behavior counseling in this population. METHODS: Weighted prevalence estimates for meeting the 2018 National PA Guidelines (inactive, insufficiently active, sufficiently active: guidelines met) were calculated from a secondary analysis of the National Survey of Children's Health 2016-2017 ( n = 16,171, 27% SHCN). Adjusted odds ratios and 95% CIs were estimated from logistic regression models to measure the association between PA, medical home, and postive health behavior counseling. RESULTS: Of adolescents with SHCN, 15% were reported to be meeting PA guidelines compared to 19% of peers without SHCN peers. Among adolescents with a medical home, regardless of SHCN status, those receiving positive health behavior counseling had 1.70 times the adjusted odds of meeting PA guidelines compared to peers without counseling. CONCLUSIONS FOR PRACTICE: Adolescents with and without SHCN were more likely to meet PA guidelines if they had a medical home and received positive health behavior counseling, highlighting the value of comprehensive healthcare practices for PA promotion.

Exploring the Interaction of Disability Status and Childhood Predictors of Physical Activity and Sport Participation: An Exploratory Decision-Tree Analysis.

A secondary data analysis of 33,093 children and adolescents age 6-17 years (12% with disabilities) from a 2016-2017 National Survey of Children's Health nonrepresentative sample aimed to identify (a) unique clusters of sociodemographic characteristics and (b) the relative importance of disability status in predicting participation in daily physical activity (PA) and sports. Exploratory classification tree analyses identified hierarchical predictors of daily PA and sport participation separately. Disability status was not a primary predictor of daily PA. Instead, it emerged in the fifth level after age, sex, body mass index, and income, highlighting the dynamic intersection of disability with sociodemographic factors influencing PA levels. In comparison, disability status was a second-level predictor for sport participation, suggesting that unique factors influencing PA level are likely experienced by disabled children and adolescents. The authors employ an intersectionality lens to critically discuss implications for research in adapted PA.

Means-end problem solving in infancy: Development, emergence of intentionality, and transfer of knowledge.

Behaviors and performance of 23 typically developing infants were assessed longitudinally at 6, 9, 12, 18, and 24 months in two means-end tasks: pulling a towel or rotating a turntable to obtain a supported object. With age, infants performed more goal-directed behaviors, leading to increased problem-solving success. Intentionality emerged earlier in the towel task than in the turntable task (6.9 vs. 10.8 months). Potential knowledge transfer between the tasks was first observed at 9 months. This study provides insight into the development of means-end learning, the emergence of intentionality, and potential transfer of knowledge in tasks involving a similar concept (support) but requiring different modes of action for success (pulling vs. rotating).

Patient-Centered Medical Home and Receipt of Part C Early Intervention Among Young CSHCN and Developmental Disabilities Versus Delays: NS-CSHCN 2009-2010.

Objective To determine, among a sample of young CSHCN with developmental conditions, (1) characteristics associated with receipt of both patient-centered medical home (PCMH) and Part C early intervention, (2) the association between each PCMH criterion and receipt of Part C generally, and (3) for CSHCN with disabilities versus delays. Methods Secondary data analysis of the 2009/10 National Survey of CSHCN. Sample included CSHCN (n = 755) birth to 3 years with a developmental disability or delay that affected their function. Adjusted ordinal regression analysis examined characteristics associated with receiving both PCMH and Part C. Stratified adjusted logistic regression examined the association between PCMH criteria and Part C, by disabilities versus delays. Results 19% of our sample received both PCMH and Part C. Black, non-Hispanic children had lower odds [OR 0.44, 95% CI (0.20, 0.97)] and CSHCN with more severe developmental conditions had higher odds [OR 2.13, 95% CI (1.22, 3.17)] of receiving both services. CSHCN with a PCMH were no more likely to be receiving Part C than those without a PCMH [OR 0.85, 95% CI (0.49, 1.49)]. Receiving any one of the PCMH criterion was not associated with receiving Part C, with one exception. Among CSHCN with delays, effective care coordination was associated with lower odds of Part C [OR 0.46, 95% CI (0.21, 0.97)]. Conclusion Concurrent PCMH and Part C access was low for young CSHCN with developmental conditions affecting their function. Given the overlapping mandates for PCMH and Part C, integrated efforts are warranted to identify if lack of concurrent services in fact reflects unmet service needs.

Fundamental motor skills: A systematic review of terminology.

The three aims of this systematic review are to describe: (1) use of the term fundamental motor/movement skills (FMS) in published articles; (2) the quality of definitions; and (3) relative use of process- and product- oriented assessments to measure FMS. The inclusion criteria included: (a) peer-reviewed article, (b) printed in English, (c) published between January 2000 and 31 December 2015, (d) presence of either the term "fundamental motor or movement skill" in the title and/or abstract, and (e) FMS were a measured outcome. There has been an increase in the number of publications on FMS in recent years, with the majority of studies conducted in Australia (n = 41, 33%). Approximately 24% of studies (n = 30) did not provide any explicit definition of FMS. A majority of studies reported the use of process-oriented measures (n = 98, 79%) compared to product-oriented measures (n = 23, 19%), and few studies used both (n = 6, 5%). We recommend that researchers provide: (1) an operational definition of FMS that states FMS are the "building blocks" (or similar terminology) of more advanced, complex movements; (2) specific categories of skills that compose FMS; and (3) at least one specific example of a FMS.

Associations between 24-h movement guidelines compliance and anxiety and depression among youth receiving special education services in the US.

BACKGROUND: Youth with disabilities are five times more likely to experience anxiety or depression than peers without disabilities. Engagement in sufficient daily physical activity (PA), adequate nightly sleep, and limited daily screen time (collectively known as 24-h movement guidelines) is associated with lower odds of anxiety and depression for peers without disabilities. Extending the investigation of these modifiable behaviors to youth with disabilities is warranted. OBJECTIVE: To estimate the association between meeting 24-h movement guidelines and anxiety and depression among a nationally representative sample of youth with disabilities. METHODS: A cross-sectional secondary analysis of the 2019-2020 NSCH was conducted and included youth 6-17 years old who were currently receiving special education services. Weighted prevalence estimates and logistic regressions were employed to estimate the association between meeting guidelines (separately and combined) and current anxiety or depression status. RESULTS: Compared to youth with disabilities who met the guideline, those not meeting the sleep or screen time guidelines, independently, had significantly higher odds of depression, or anxiety (aOR range 1.53, 2.31 respectively). Comparable odds were observed between those meeting the PA guidelines, alone or in combination, and those meeting none of the 24-h movement guidelines. CONCLUSION: Adequate nightly sleep, and limited screen time, were significantly associated with anxiety and depression among youth with disabilities, a pattern consistent to peers without disabilities. Yet, meeting more than one guideline did not further reduce odds of poor mental health, warranting further investigation of compounding benefits of the 24-h guidelines within this population.

Evidence of item bias in a national flourishing measure for autistic youth.

Flourishing is a positive health indicator that aligns with strengths-based perspectives and measures within autism research. Flourishing indicators were recently included in the National Survey of Children's Health (NSCH) and have been used to evidence disparities in flourishing experienced by autistic children compared to non-autistic peers. Yet, little has been done to examine the utility of standard flourishing items for this population. This study examined the NSCH caregiver-reported flourishing items for measurement item bias. A cross-sectional, representative sample of autistic and non-autistic US children aged 6-17 years (n = 41,691) was drawn from the 2018-2019 NSCH public dataset. A confirmatory factor analysis using a multiple indicators and multiple causes model (MIMIC-CFA) was conducted to (1) test for differential item functioning (DIF; i.e., measurement bias); and (2) estimate latent mean group differences after controlling for DIF. Findings supported a 3-factor (social competence, school motivation, and behavioral control), 10-item model structure consistent with past literature, yet measurement bias was evident for 6 of the 10 items. Persistent group differences, after accounting for DIF and covariates, indicates that caregivers of autistic children perceive their children are experiencing meaningfully lower flourishing outcomes compared to caregivers of non-autistic children. However, evidence of measurement bias for items related to the social competence dimension calls into question the applicability of this measure for autistic children. Further interpretation of group differences and use of this measure should be approached with caution.

24-Hour Movement Behaviors Among US Adults With Functional Disabilities.

This study aimed to quantify and compare physical activity, sitting time, and sleep behaviors among US adults with and without disabilities using the 2020 Canadian 24-hour movement framework. The weighted prevalence of 24-hour movement guideline adherence was estimated among a nationally representative sample from the 2017 to 2018 National Health and Nutrition Examination Survey of US adults (18-65 years old) with (n = 1070) and without (n = 33,370) functional disabilities in vision, hearing, mobility, cognitive, and self-care domains. The adjusted odds of single and combination guideline compliance were estimated by disability type, in reference to adults without disabilities, using separate multivariable logistic regressions. After adjusting for age, sex, and income, adults with disabilities in mobility, cognitive, or self-care domains had approximately half the odds of meeting all 3 guidelines, compared with adults without disabilities (adjusted odds range: 0.49-0.77). Significantly lower adherence was observed among adults with functional disabilities, compared with no disabilities, for sleep, and moderate to vigorous physical activity, but not sedentary guidelines. This report establishes baseline prevalence estimates for guidelines compliance among US adults with functional disabilities ages 18-65 years old. Low guideline adherence, and evidence for significant differences in physical activity and sleep, signals a need to further explore combination health behaviors among adults with disabilities.

US adults with visual impairments meeting 24-h movement guidelines: Updated national prevalence estimates.

BACKGROUND: Despite known benefits of engaging in recommended amounts of physical activity (PA), sleep, and sedentary behavior (SB), little is known about how adults with visual impairments (VIs) meet these guidelines in isolation or simultaneously. OBJECTIVE: This study estimated (a) the prevalence of US adults with VIs who are partially or fully meeting the 24-h movement guidelines, and (b) the differential contribution of work-related, leisure, and transportation to total time accrued for PA. METHODS: A cross-sectional sample of adults with VIs (n = 466) was drawn from the National Health and Nutritional Examination Survey (NHANES) 2015-2018 combined datasets. Guideline adherence was measured using self-report items for average time spent physically active, sitting and sleeping. Weighted prevalence estimates were produced for meeting guidelines separately and in combination. The average percent of PA minutes accrued across work-related, leisure and transportation were compared among those meeting PA guidelines. RESULTS: An estimated 29.6% (SE = 3.6) of US adults with VIs met all three guidelines. An estimated 59.3% (SE = 3.5) adults with VIs met PA guidelines alone or in combination with SB and sleep. Within this group, the majority of weekly PA minutes (average 63.9%) was accrued at work. CONCLUSIONS: An estimated two thirds of adults with VIs are not engaged in healthful 24-h movement behaviors. Targeted interventions for adults with VIs are warranted that may require a comprehensive approach to PA, SB, and sleep. Work emerged as an important location for adults with VIs to accrue PA, inviting future research to explore associations between employment and 24-h movements within this population.

Item development, internal consistency, and known-groups validity of the Self-Directed Mobility Scale.

PURPOSE: The aims of the current study include to: (1) describe the item development; and (2) begin the process of establishing the internal consistency and known-groups validity of the Self-Directed Mobility Scale. The purpose of the scale is to assess paediatric physical and occupational therapists' views towards self-directed mobility and their perceived ability and intentions to advocate for children's access to self-directed mobility. METHODS: Three individuals with expertise in kinesiology, psychology, paediatric rehabilitation, and disability studies served as the expert panel for item development. Four samples were included to determine internal consistency and known-groups validity: 350 physical therapists, 89 occupational therapists, 279 kinesiology undergraduate students, and 528 health and wellness undergraduate students. RESULTS: The internal consistency was above the acceptable level of 0.70 (range = 0.72-0.77) for all samples when two items regarding promoting other motor skills prior to powered mobility use and the temporary use of a mobility device were removed. Known-groups validity was established between all samples. CONCLUSIONS: The Self-Directed Mobility Scale appears to be a valid tool for assessing views of self-directed mobility and mobility advocacy intentions in paediatric physical and occupational therapists, as well as undergraduate students. Future work should examine the internal consistency based on study sample to ensure the (> 0.70) acceptable Cronbach's alpha level is met.Implications for rehabilitationThe Self-Directed Mobility Scale is a viable measurement tool to assess views of self-directed mobility and mobility advocacy intentions of pediatric physical and occupational therapists.In combination with other measures, the Self-Directed Mobility Scale may be used in future rehabilitation research to evaluate factors associated with provision of mobility technology to children with disabilities.

Updated National Estimates of Disparities in Physical Activity and Sports Participation Experienced by Children and Adolescents With Disabilities: NSCH 2016-2017.

BACKGROUND: Children and adolescents with disabilities often report low levels of physical activity (PA). Estimating the magnitude of PA disparities has been previously challenged by underreporting and variability in subsampling of disability. Using the National Survey of Children's Health, this study estimated the population-level PA disparities experienced and the association between disability status and PA engagement. METHODS: Weighted prevalence of PA engagement (National Physical Activity Guidelines for Americans (2nd edition) and sports participation) was compared across disability groups for children (n = 20,867, 6-11 y) and adolescents (n = 28,651, 12-17 y) and found to be 12%. Age-stratified multivariable logistic regressions estimated the likelihood of PA engagement as a function of disability status and type, after adjusting for child and household factors. RESULTS: Children, but not adolescents, with disabilities had significantly lower odds of being sufficiently active compared with peers without disabilities (adjusted odds ratio = 0.75; 95% confidence interval, 0.60-0.94). Across age groups, the lowest prevalence rates were observed among those experiencing function and mobility disabilities. Children and adolescents were significantly less likely to participate in sports compared with peers. CONCLUSION: Children with function and mobility disabilities were identified as priority subpopulations least likely to be sufficiently active. The disparity in sports participation highlights a critical intervention point for increasing PA among children with disabilities.

Mobility is a fundamental human right: Factors predicting attitudes toward self-directed mobility.

BACKGROUND: Emergent disability studies research is interested in the community's views on how disability, including self-directed mobility, influences social and environmental policies. We anticipate that individuals' alignment with disability models, or sets of assumptions about the cause, nature, and treatment of disability, will influence attitudes about self-directed mobility. Self-directed mobility is defined as mobility that is controlled by an individual and may include walking or assisted ambulation through the use of mobility technology such as prosthetics, walking aids, manual wheelchairs, or motorized wheelchairs. OBJECTIVE: The purpose of this study was to explore how demographic factors, contact with people with disabilities, attitudes toward people with disabilities, and alignment with social or medical models of disability predict attitudes toward self-directed mobility. METHODS: 1545 students at a public university completed demographic questions, and measures of disability attitudes, disability model orientation, and self-directed mobility. RESULTS: The predictors explained 16.60% of the variance in participants' attitudes toward self-directed mobility (R2 = 0.166, F(7,1537) = 43.9, p < .001). Significant predictors included: female gender (ß = -0.14, p < .01), more positive attitudes toward people with disabilities (ß = -0.30, p < .001), and social model orientation (ß = 0.59, p < .001). CONCLUSIONS: Participants who more strongly agreed with disability as a social construct (social model) were in stronger agreement that self-directed mobility is a fundamental right. Future research extending to rehabilitation professionals is warranted.

Prematurity may negatively impact means-end problem solving across the first two years of life.

Preterm infants are at risk for delays in motor, perceptual, and cognitive development. While research has shown preterm infants may exhibit learning delays in the first months of life, these delays are commonly under-diagnosed. The purpose of this study was to longitudinally evaluate behavioral performance and learning in two means-end problem-solving tasks for 30 infants born preterm (PT) and 23 born full-term (FT). Infants were assessed at 6, 9, 12, 18, and 24 months-old in tasks that required towel pulling or turntable rotation to obtain a distant object. PT infants performed more non-goal-directed and less goal-directed behavior than FT infants throughout the study, resulting in a lower success rate among PT infants. PT infants showed delayed emergence of intentionality (prevalence of goal-directed behaviors) compared to FT infants in both tasks. Amount and variability of behavioral performance significantly correlated with task success differentially across age. The learning differences documented between PT and FT infants suggest means-end problem-solving tasks may be useful for the early detection of learning delays. The identification of behaviors associated with learning and success across age may be used to guide interventions aimed at advancing early learning for infants at risk.