Acute Effects of Walking and Standing on Executive Function in Children with Attention Deficit/Hyperactivity Disorder: A Feasibility Study.

Children with attention deficit/hyperactivity disorder (ADHD) struggle with executive functioning (EF). While physical activity (PA) benefits EF, little is known about the impact of specific activities like standing. The purpose of this study was to evaluate the feasibility of performing a rigorous experimental study to compare the effects of walking and standing on EF in children with ADHD. Six areas of feasibility were assessed: recruitment, randomization, treatment adherence, retention, acceptability of the intervention, and implementation. A randomized pilot study using three parallel conditions compared the effects of two modes of activity on EF in children 6-11 with ADHD. While there were no significant differences between walking and standing for EF, analyses suggest that it is feasible to compare effects of standing vs. walking on EF among children with ADHD. This study supports the feasibility of undertaking a larger scale study to evaluate the effect of standing on EF in children with ADHD.

Passive and social screen time in children with autism and in association with obesity.

Background: Screen time has been identified as a risk factor for childhood obesity, but the media landscape has evolved rapidly. Children with autism tend to be heavy users of screens and have an elevated prevalence of obesity. We know little about screen use patterns among children with autism vs. typically developing (TD) peers and in association with obesity. Methods: Baseline data from 10,842 participants in the Adolescent Brain Cognition Development Study was used to characterize time spent with child-reported passive screen use (television/movies/watching videos), playing video games, and using social media. Duration of screen time by autism status and gender was summarized as mean time per day; obesity was defined using CDC/WHO criteria. A propensity score analysis was used to create a matched dataset for analysis. Results: Overall, 1.7% of children were was identified as having autism. Significant mean differences were observed by autism status and gender for both passive viewing and playing video games. Compared to TD children, boys with autism spent more time (2.9 vs. 2.3 h, p < 0.001) watching TV, movies or videos, as did girls (3.0 vs. 2.0 h, p = 0.002). Compared to TD peers, boys with autism reported more video game time (102.7 vs. 77.5 min, p = 0.001), as did girls with autism (64.4 vs. 37.9 min, p = 0.03); girls with autism also spent more time on social media sites or video chat (45.5 vs. 21.9 min, p = 0.04). Overall, obesity prevalence increased with increasing screen time duration, significantly for passive screen time (p-value = 0.002) and texting (p-value = 0.02). Associations between obesity and screen time duration did not differ by autism status. Discussion: Children with autism spend more time playing video games and on passive and social screen activities than their TD peers, with some variations by gender. High rates of social media use among girls with autism and multiplayer video game use among both boys and girls with autism may challenge the notion that the high levels of screen time reflect social isolation in the group. Given potential positive aspects of screen time in children with autism movement to focus on content and context is appropriate.

Global Matrix of Para Report Cards on Physical Activity of Children and Adolescents With Disabilities.

This is an overview of the results from 14 countries or jurisdictions in a Global Matrix of Para Report Cards on physical activity (PA) of children and adolescents with disabilities. The methodology was based on the Active Healthy Kids Global Alliance's Global Matrix 4.0. Data were aligned with 10 indicators (Overall PA, Organized Sport, Active Play, Active Transport, Physical Fitness, Sedentary Behavior, Family & Peers, Schools, Community & Environment, and Government) to produce Para Report Cards. Subsequently, there were 139 grades; 45% were incomplete, particularly for Active Play, Physical Fitness, and Family & Peers. Collectively, Overall PA was graded the lowest (F), with Schools and Government the highest (C). Disability-specific surveillance and research gaps in PA were apparent in 14 countries or jurisdictions around the world. More coverage of PA data in Para Report Cards is needed to serve as an advocacy tool to promote PA among children and adolescents with disabilities.

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.

Relationship Between Childhood Obesity and Autism Spectrum Disorder Varies by Child's Age and Parents' Weight Status in a Sample of Sibling Dyads.

Background: Children with autism spectrum disorder (ASD) are more likely to have obesity compared to children without ASD, but studies may report biased estimates because of limitations accounting for potentially important factors that may differ between these two groups of children. This study of siblings in "simplex" families (i.e., families that include only one offspring with ASD) avoids these potential pitfalls. Methods: The Simons Simplex Collection was used to create sibling dyads comprising a child with a clinically confirmed diagnosis of ASD and a full sibling without ASD within the same biological family. Child obesity, determined from measured heights and weights, was compared across three child age strata (4-7.9, 8-10.9, 11-18.0 years) and by parents' weight status using generalized estimating equations log-binomial regression models. Results: Among 1378 sibling dyads, 4-18 years of age, the prevalence of obesity significantly increased with age, with larger sibling differences at older ages. For ages 4-7.9 years, the obesity prevalence for children with ASD was 15.0% compared to 16.2% for siblings (p = 0.57). For ages 11-18.0 years, prevalence for children with ASD was 30.7% compared to 21.4% for siblings (p = 0.003). Parental obesity significantly affected sibling obesity. Conclusion: From this unique data resource that accounted for shared family environments, the prevalence of obesity diverged significantly at older ages between children with ASD and their full siblings without ASD and was associated with parental obesity status similarly for children with and without a diagnosis of ASD. Recognizing these age-related differences has important implications for targeting preventive interventions.

Promoting Physical Activity Among Children and Adolescents With Disabilities: The Translation of Policy to Practice Internationally.

BACKGROUND: Physical inactivity among children and adolescents with disabilities (CAWD) is a global public health issue. Policy efforts to promote physical activity (PA) among CAWD have increased. This study summarizes the international policy trend for promoting PA among CAWD, with behavioral and policy insights specific to CAWD from country/regional indicators from the Active Healthy Kids Global Alliance Matrix on Physical Activity for Children and Adolescents to determine policy translation into practice. METHODS: International and national PA policy documents on CAWD were assessed. Data from the Global Matrix Para Report Cards on the behavioral and government indicators from 14 countries or regions (grouped by human development index) were reviewed and compared. RESULTS: Policy instruments began promoting PA for CAWD in 1989 via the Convention on the Rights of the Child. International policy has been advocating PA specifically for CAWD recently. In 2020, the World Health Organization published specific PA guidelines for CAWD. Data from the 14 Para Report Car found 14 grades on the average behavioral indicator and 12 on the government indicator. A gap between the average behavioral indicator (D-) and the government indicator (C+) was found in the Para Report Card data. CONCLUSIONS: Although international policies are consistent in their attention to the needs of CAWD, national/regional policies vary. Coverage ranges from nonexistent to embedded in broader inclusion concepts. A gap in policies to promote PA of CAWD is prevalent and is more prominent in countries or regions with a lower human development index ranking.

A Pilot Dance Intervention to Encourage Physical Activity Engagement for Adolescent Girls with Intellectual Disabilities.

Adolescent girls with intellectual disabilities (ID) are at risk for low physical activity (PA) participation due to their limited opportunities. PURPOSE: To evaluate the feasibility and preliminary efficacy of a 12-week dance intervention to promote engagement in moderate-to-vigorous PA (MVPA) and increase cardiorespiratory fitness. METHODS: The 12-week intervention included two 75-min weekly dance sessions. Continuous heart-rate (HR) monitoring assessed time spent below/at/above each girl's target HR zone. Cardiorespiratory fitness was measured by the 6-min walk test (6MWT). Survey items assessed participant enjoyment and participant and parent satisfaction. RESULTS: The mean (SD) age of 18 adolescent girls was 17.3 (2.7) years. Overall, girls attended 88% of sessions and spent 52.3% of each session in MVPA. Mean MVPA was unchanged across the 12 weeks, but the pattern differed across the three sites. We observed a non-significant pre-post increase of 74.6 feet on the 6MWT. Post-intervention surveys indicated that most girls liked the program, perceived improved fitness, and wished to continue dancing. The majority also reported a preference for a girls-only dance program exclusively for those with ID. CONCLUSION: Our findings suggest that dance is viable for promoting PA for girls with ID. More frequent exercise training is likely needed to improve cardiorespiratory fitness.

Research Trends and Recommendations for Physical Activity Interventions Among Children and Youth With Disabilities: A Review of Reviews.

This scoping review synthesized reviews of physical activity (PA) interventions for children and youth with disabilities to highlight promising elements of effective interventions, research methodological limitations, and research priorities. Twenty studies were eligible and underwent three rounds of review by an expert panel. Rich and diverse PA programs derived potential short-term benefits toward health, function, and PA. Strategies to increase sample sizes included embedding programs in the community and using information communication technology to deliver exercise programs. Methodological limitations of interventions included a lack of generalizability, transferability, and scientific rigor. Three research priorities were identified: develop and report precision-based intervention strategies, identify strategies that promote both long-term and sustainable PA participation and outcomes, and develop scalable interventions and recruitment strategies. If addressed, these areas could enhance the impact of PA interventions for children and youth with disabilities.

Evaluating the potential of Special Olympics fitness models as a health intervention for adults with intellectual disabilities.

BACKGROUND: People with intellectual disabilities (ID) have high prevalence of cardiovascular disease (CVD) risk factors; yet, few behavioral health interventions are designed and implemented for people with ID. OBJECTIVE: This study examined Special Olympics Inc. (SOI) fitness models as a potential intervention to reduce CVD risk in people with ID. METHODS: Data from SOI fitness models implemented in 2016-2018 were assessed. Special Olympics Programs received funding, resources, and technical assistance from SOI to conduct fitness models centered on inclusive physical activity and goal setting. Weight, body mass index, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured at baseline and 4-12 weeks into the model. Multi-level multivariable quintile linear regression assessed change. RESULTS: 383 participants with ID (athletes) and 281 partners without ID met inclusion criteria. Mean weight loss among athletes was 0.67 kg and 132 (31.9%) lost ≥ 1 kg. Blood pressure decreased in SBP quintile 4 (-7.52 mm Hg, 95% confidence interval [CI]: 11.8, -4.0), SBP quintile 5 (-9.52 mm Hg, 95% CI: 13.5, -5.6), and DBP quintile 5 (-7.49 mm Hg, 95% CI: 13.1, -1.9). Partners had similar results. Strongest effects were in a 'high-risk' group that was in the quintile 4 or 5 in all baseline measures. CONCLUSION: In fitness models developed to improve fitness for people with ID, there was a reduction in weight and blood pressure. SOI fitness models show promise and potential as a health intervention. This work enables further examination of indicators for successful implementation and evaluation of health.

Does physical activity differ between youth with and without intellectual disabilities?

BACKGROUND: Children and youth with intellectual disabilities (ID) are known to face obstacles to physical activity participation, yet the activity patterns of this population are not well characterized. OBJECTIVE/HYPOTHESIS: In this study, time spent in moderate to vigorous physical activity (MVPA), type, and frequency of participation in physical activities were assessed in youth with ID and in a comparison group of typically developing (TD) youth. METHODS: Weekly participation in MVPA in 38 youth with ID and 60 TD youth was assessed via accelerometry. Participants were also administered an interview about the frequency and type of physical activities they engaged in over the past year. RESULTS: After adjusting for age and sex, youth with ID spent significantly less time in MVPA (33.5 vs. 46.5 min/day, p = 0.03) and were less likely to meet the US Physical Activity Guidelines than TD youth (6% vs. 29%, p = 0.01). Although time in MVPA was lower in youth with ID, females with ID participated in physical activities more frequently than TD females (47.1 vs. 28.2 times/month, p = 0.008) and also reported engaging in a greater variety of physical activities (7.8 vs. 5.2 activities/year, p = 0.01). No differences between males in the frequency of physical activity participation or the number of activities performed were observed. Both groups reported walking/hiking and active video as top activities. CONCLUSIONS: Findings emphasize the need for targeted efforts to increase MVPA in youth with ID.

Parental concern regarding obesity in children with autism spectrum disorder in the United States: National Survey of Children's Health 2016.

BACKGROUND: The prevalence of obesity in children with autism spectrum disorder (ASD) exceeds that of the general population, but the level of parental concern about obesity in these children is unexplored. OBJECTIVE: We estimate the prevalence of obesity in children 10-17 years in the redesigned National Survey of Children's Health (NSCH) 2016, and compare parental concern about obesity between parents of children with and without ASD. METHODS: The nationally representative NSCH 2016 oversampled parents of children with parent-report of special health care needs, including ASD. Parents opted to complete the survey via the web or surface mail. Following report of their child's height and weight, parents were asked "Are you concerned about their weight?" Response options included: "Yes, it's too high," "Yes, it's too low," or "No, I am not concerned." Obesity (>95th percentile BMI) was defined using the 2000 CDC growth reference. We used logistic regression to compare odds of obesity, and odds of parental concern, between children with and without ASD. RESULTS: In 24,251 children, ASD (n = 699) increased obesity risk after adjusting for age, sex, and race/ethnicity (OR = 1.54, 95%CI: 1.11, 2.14). ASD medication did not significantly affect obesity. ASD increased obesity concern (OR = 2.17, 95%CI: 1.53, 4.81) among parents with obese children. Parents of boys with obesity and ASD had less obesity concern if he was taking medication for ASD (OR = 0.258, 95%CI: 0.09, 0.78). CONCLUSION: While the prevalence of obesity is elevated in children with ASD, parental obesity concern is high, suggesting opportunities for the development of parent-focused obesity prevention and treatment interventions for this population.

Interventions to promote physical activity for youth with intellectual disabilities.

OBJECTIVE: To describe interventions designed to promote physical activity for youth with intellectual disabilities. MATERIALS AND METHODS: A systematic review of nine databases until January 31, 2015 identified 213 citations. The inclusion criteria were: a) the study sample consisted of youth with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Eleven articles from the 213 citations met this criterion. RESULTS: Nine studies reported significant increases in physical activity behavior. CONCLUSIONS: Conclusions cannot be made regarding intervention components that impacted outcome variables, if the observed effects were specifically due to the intervention or if interventions could be maintained long-term. To advance the knowledge base in this area, a concerted effort should be made to increase rigor in study conceptualization and research design.

Interventions to promote physical activity for adults with intellectual disabilities.

OBJECTIVE: To describe interventions designed to promote physical activity for adults with intellectual disabilities and the effects on overall physical activity levels and on health outcomes. MATERIALS AND METHODS: A systematic review of eight databases until January 31, 2015 identified 383 citations. The inclusion criteria were: a) the study sample consisted of adults with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Six articles from the 383 citations met this criterion. RESULTS: Three studies resulted in significant increases in physical activity behaviour; however well-controlled trials designed to improve weight status by increasing physical activity did not produce significant effects. CONCLUSION: Overall, the results indicate that interventions to increase physical activity should simultaneously target the individual with intellectual disability as well as their proximal environment over a sustained period of time.

Interventions to promote physical activity for adults with intellectual disabilities / Intervenciones para promover la actividad física para adultos con discapacidad intelectual

Abstract: Objective: To describe interventions designed to promote physical activity for adults with intellectual disabilities and the effects on overall physical activity levels and on health outcomes. Materials and methods: A systematic review of eight databases until January 31, 2015 identified 383 citations. The inclusion criteria were: a) the study sample consisted of adults with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Six articles from the 383 citations met this criterion. Results: Three studies resulted in significant increases in physical activity behaviour; however well-controlled trials designed to improve weight status by increasing physical activity did not produce significant effects. Conclusion: Overall, the results indicate that interventions to increase physical activity should simultaneously target the individual with intellectual disability as well as their proximal environment over a sustained period of time.

Resumen: Objetivo: Describir las intervenciones diseñadas para promover la actividad física para adultos con discapacidad intelectual y los efectos en los niveles de actividad física en general y en los resultados de salud. Material y métodos: Una revisión sistemática de ocho bases de datos hasta el 31 de enero de 2015 identificó 383 citas. Los criterios de inclusión fueron: a) los participantes del estudio fueron adultos con discapacidad intelectual; b) el estudio implementó una intervención para iniciar, aumentar o mantener la actividad física; c) se usaron datos cuantitativos o cualitativos para informar la efectividad de la intervención. Seis artículos de 383 cumplieron con los criterios. Resultados: Tres estudios resultaron en aumentos significativos en conductas de actividad física; sin embargo, los ensayos controlados diseñados para mejorar el peso corporal al aumentar la actividad física no produjeron efectos significativos. Conclusión: En general, los resultados indican que las intervenciones para aumentar la actividad física deben dirigirse simultáneamente al individuo con discapacidad intelectual, así como su entorno próximo durante un periodo de tiempo sostenido.

Interventions to promote physical activity for youth with intellectual disabilities / Intervenciones para promover la actividad física para jóvenes con discapacidad intelectual

Abstract: Objective: To describe interventions designed to promote physical activity for youth with intellectual disabilities. Materials and methods: A systematic review of nine databases until January 31, 2015 identified 213 citations. The inclusion criteria were: a) the study sample consisted of youth with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Eleven articles from the 213 citations met this criterion. Results: Nine studies reported significant increases in physical activity behavior. Conclusions: Conclusions cannot be made regarding intervention components that impacted outcome variables, if the observed effects were specifically due to the intervention or if interventions could be maintained long-term. To advance the knowledge base in this area, a concerted effort should be made to increase rigor in study conceptualization and research design.

Resumen: Objetivo: Describir las intervenciones diseñadas para promover la actividad física para jóvenes con discapacidad intelectual. Material y métodos: Una revisión sistemática de nueve bases de datos hasta el 31 de enero de 2015 identificó 213 citas. Los criterios de inclusión fueron: a) la muestra del estudio consistió en jóvenes con discapacidad intelectual, b) el estudio implementado fue una intervención para iniciar, aumentar o mantener la actividad física y datos c) cuantitativos o cualitativos se utilizaron para informar la efectividad de la intervención. Once artículos de 213 citas cumplen este criterio. Resultados. Nueve estudios informaron aumentos significativos en el comportamiento de la actividad física. Conclusión: No se pueden establecer conclusiones con respecto a los componentes de intervención variables de resultado, considerando si los efectos observados fueron específicamente debido a la intervención o intervenciones podrían mantenerse a largo plazo. Para avanzar en la base de conocimientos en esta área, se necesita un esfuerzo concertado para aumentar el rigor en el estudio unívoco.

Physical Activity Levels, Frequency, and Type Among Adolescents with and Without Autism Spectrum Disorder.

We compared time spent in moderate and vigorous physical activity (MVPA), type, and frequency of participation in physical activities between adolescents with ASD (n = 35) and typically developing (TD) adolescents (n = 60). Accelerometers measured MVPA and participants were interviewed about engagement in physical activities. Adolescents with ASD spent less time in MVPA compared to TD adolescents (29 min/day vs. 50 min/day, p < 0.001) and fewer met the Physical Activity Guidelines for Americans (14 vs. 29%, p > 0.05). Among adolescents <16 years old, those with ASD participated in fewer activities than TD adolescents (5.3 vs. 7.1 activities, p < 0.03). Walking/hiking and active video gaming were among the top activities for both groups. Findings support the need for interventions that meet the needs of youth with ASD.

The Effect of Age on the Prevalence of Obesity among US Youth with Autism Spectrum Disorder.

BACKGROUND: We sought to assess the association between age and the prevalence of obesity among children with and without autism spectrum disorder (ASD) in the 2011-2012 National Survey of Children's Health. METHODS: Analyses were restricted to 43,777 children, ages 10-17, with valid measures of parent-reported weight, height, and ASD status. Exploratory analyses describe the impact of sex, race/ethnicity, and household income on the relationship between age and obesity in ASD. RESULTS: Although the overall prevalence of obesity among children with ASD was significantly (p < 0.001) higher than among children without ASD (23.1% vs. 14.1%, 95% confidence interval for difference 3.6 to 14.4), child age significantly (p = 0.035) modified this difference. In a multivariable logistic regression analysis, adjusted for sex, race/ethnicity, and household income, the odds of obesity among children with ASD compared with children without ASD increased monotonically from ages 10 to 17 years. This pattern arose due to a consistently high prevalence of obesity among children with ASD and a decline in prevalence with advancing age among children without ASD. These findings were replicated using a propensity score analysis. Exploratory analyses suggested that the age-related change in obesity disparity between children with and without ASD may be further modified by sex, race/ethnicity, and household income. CONCLUSIONS: The patterns of prevalence observed with increasing age among children with and without ASD were unexpected. A better understanding of the etiological and maintenance factors for obesity in youth with ASD is needed to develop interventions tailored to the specific needs of these children.

Results From the United States of America's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: The 2016 United States (U.S.) Report Card on Physical Activity for Children and Youth provides a comprehensive evaluation of physical activity levels and factors influencing physical activity among children and youth. METHODS: The report card includes 10 indicators: Overall Physical Activity, Sedentary Behavior, Active Transportation, Organized Sport Participation, Active Play, Health-related Fitness, Family and Peers, School, Community and the Built Environment, and Government Strategies and Investments. Nationally representative data were used to evaluate the indicators using a standard grading rubric. RESULTS: Sufficient data were available to assign grades to 7 of the indicators, and these ranged from B- for Community and the Built Environment to F for Active Transportation. Overall Physical Activity received a grade of D- due to the low prevalence of meeting physical activity guidelines. A grade of D was assigned to Health-related Fitness, reflecting the low prevalence of meeting cardiorespiratory fitness standards. Disparities across age, gender, racial/ethnic and socioeconomic groups were observed for several indicators. CONCLUSIONS: Continued poor grades suggest that additional work is required to provide opportunities for U.S. children to be physically active. The observed disparities indicate that special attention should be given to girls, minorities, and those from lower socioeconomic groups when implementing intervention strategies.

Intellectual disability is associated with increased risk for obesity in a nationally representative sample of U.S. children.

BACKGROUND: Data on obesity prevalence in children with intellectual disability (ID) are scarce. OBJECTIVE: We estimated rates of obesity among children aged 10-17 years with and without ID in a nationally representative dataset that included measures of child weight and ID status, as well as family meal frequency, physical activity, and sedentary behavior. METHODS: Chi-square tests compared prevalence of obesity, demographic and behavioral characteristics between children with and without ID as reported in the 2011 National Survey of Children's Health. Tests for interaction in logistic regression models determined whether associations between obesity and behavioral characteristics were different between children with/without ID. RESULTS: Obesity prevalence for children with ID was 28.9% and 15.5% for children without ID. After adjusting for age, sex, race/ethnicity and poverty level, the odds ratio was significantly 1.89 times greater among children with ID than among those without ID (95% CI: 1.14 to 3.12). Among children with ID, 49.8% ate at least one meal with family members every day compared to 35.0% without ID (p < 0.002), and 49.5% with ID participated in frequent physical activity compared to 62.9% (p < 0.005). Prevalence of obesity was higher among all children who ate family meals every day compared to fewer days per week, and the effect was significantly more pronounced among those with ID (p = 0.05). CONCLUSIONS: Prevalence of obesity among youth with ID was almost double that of the general population. Prospective studies are needed in this population to examine the impact of consistent family mealtimes and infrequent physical activity.