Visual Supports for Children With Autism in Physical Activity.

Visual supports have been advocated as one strategy to teach children with autism in physical education. However, empirical studies documented inconsistencies in their effectiveness, with some demonstrating positive effects while others reported limited support for their use. Without a clear synthesis of information, physical educators may have difficulties in identifying and meaningfully utilizing visual supports. A systematic literature review on visual supports was conducted with synthesized current literature for physical educators to make informed decisions regarding their use for children with autism in physical education. A total of 27 articles were reviewed, which included empirical- and narrative-based manuscripts. Results suggest that picture task cards, visual activity schedules, and video prompting can be potential strategies that physical educators can use to teach motor skills to children on the spectrum. However, video modeling may need to be further investigated to fully understand how to use it in the context of physical education.

Physical Activity and Mental Health of Parents of Children With Autism Spectrum Disorder.

This study aimed to examine physical activity (PA) levels and mental health status (i.e., anxiety and depression) among parents of children with autism spectrum disorder (ASD). Secondary data analysis was conducted using the 2018 National Health Interview Survey. We identified 139 parents of children with ASD and 4,470 parents of children with no disability. Their PA levels, anxiety, and depression were analyzed. Compared with parents of children with no disability, parents of children with ASD were significantly less likely to meet the PA guideline for Americans and had lower odds of vigorous PA (aOR = 0.702), strengthening PA (aOR = 0.885), and light to moderate PA (aOR = 0.994). Parents of children with ASD reported significantly higher odds of anxiety (aOR = 1.559) and depression (aOR = 1.885). This study revealed lower PA levels and higher risks of anxiety and depression in parents of children with ASD.

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.

Development of a survey measuring parental physical activity support in parents of children with disabilities.

PURPOSE: The purposes of the current study were to develop a questionnaire to measure parental physical activity (PA) support in parents of children with disabilities and to examine factors associated with parental PA support. MATERIALS AND METHODS: A questionnaire measuring parental PA support in parents of children with disabilities (PPSQ for PCD), consisting of three constructs (encouragement, co-PA, and logistic support) with 19 items, was initially developed and evaluated by the Confirmatory Factor Analysis. Three independent multiple regression analyses were conducted to examine associations between the three constructs and parental PA orientation variables. RESULTS: With the item deletion approach, the final model with 12 items (four items in each construct) was developed, which revealed an excellent model fit (x2= 78.42 [df = 51, p = .008], CFI = 0.98, GFI = 0.94. RMSEA = 0.05). The multiple regression analyses revealed that parental orientation variables were differently associated with each construct of the PPSQ for PCD. CONCLUSIONS: The PPSQ for PCD consists of three constructs, differently associated with parental orientation variables. This questionnaire can be used as an instrument to assess parental PA support. Implications for RehabilitationThe Parental Physical Activity Questionnaire (PPAQ) can be used to assess parental physical activity support in parents of children with disabilities.The PPAQ measures three constructs (i.e., types) of parental physical activity support including encouragement, co-physical activity, and logistic support.Parental physical activity orientations (e.g., importance, enjoyment, and behavior) are differently associated with each construct of parental physical activity support.

Physical Educators' Qualifications and Instructional Practices Toward Students With Disabilities.

The purposes of this study were (a) to investigate the prevalence of physical educators who report delivering high-quality instructional practices to students with disabilities and (b) to examine the relationships between teachers' qualifications and the delivery of high-quality instructional practices. A secondary analysis using data from the School Health Policy and Practice Study 2014 data set was employed. The analytic sample included 256 physical educators who taught students with disabilities. Prevalence estimates of physical educators who reported using high-quality instructional practices were calculated. Two separate binary logistic regressions using weighted data were conducted to evaluate the relative contribution of (a) teacher qualifications and (b) educational degrees in accounting for differences in the use of high-quality instructional practices. Less than half of the sample reported using high-quality instructional practices. Considering the increasing prevalence of students with disabilities in general education classrooms, teacher education programs should prioritize providing teacher candidates with coursework that aligns with the expectations of physical educators who teach students with disabilities.

Factors associated with validity of consumer-oriented wearable physical activity trackers: a meta-analysis.

The purposes of this study were to examine (1) the strength of the criterion validity evidence of various consumer-oriented wearable physical activity trackers, (2) the influence of brands of consumer-oriented wearable physical activity on validity evidence and (3) factors that may contribute to differences in the strength of the criterion validity evidence. A total of 589 articles were identified through four databases. Pairs of researchers reviewed the articles to determine eligibility. A total of 29 studies with 96 validity coefficients were included in the meta-analysis. Five different moderators, including the brands of physical activity trackers, placement of devices, type of activities (ambulatory vs. lifestyle activities), population, and release year, were analysed to examine which factors impact the validity evidence. The summarised validity coefficient between activity trackers and energy expenditure ranged from r = .41 to r = .91. Moderator analyses revealed that the brand, placement of the device, and population significantly impact the magnitude of the validity evidence, while the type of activity and release year of the devices do not. Device brand, population, andplacement are each factor that significantly affects the validity coefficientsbetween consumer-oriented wearable physical activity trackers. Efforts should be made to improve the accuracy of these devices to maintain the credibility of the research and the trust of consumers.

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.

Age-Group Differences in Body Mass Index, Weight, and Height in Adults With Down Syndrome and Adults With Intellectual Disability From the United States.

The authors examined if body mass index (BMI), weight, and height across age groups differ between adults with Down syndrome (DS) and adults with intellectual disability but without DS. They conducted secondary analyses of cross-sectional data from 45,803 individuals from the United States from 2009 to 2014 of the National Core Indicators Adult Consumer Survey across five age groups: 18-29, 30-39, 40-49, 50-59, and 60+ years. For both men and women with DS, BMI and weight increased between the 18- to 29- and the 30- to 39-year age groups and decreased thereafter. For both men and women with intellectual disability, BMI and weight increased between the 18- to 29- and the 30- to 39-year age groups, stayed about the same until the 50- to 59-year age group, and decreased thereafter. Height demonstrated a small but significant decrease with older age in all groups. These cross-sectional comparisons indicate that BMI and weight may start decreasing at a younger age in adults with DS than in adults with intellectual disability.

A meta-analysis of the effect of adapted physical activity service-learning programs on college student attitudes toward people with disabilities.

AIM: The purposes of this study were to examine the effect of service learning on changes in college student attitudes toward disability and identify potential factors to improve the quality of service learning using meta-analysis. METHOD: A total of 1984 potential studies were identified through 6 different databases and 14 studies met the necessary criteria for quantitative analysis. Effect sizes were estimated as Hedges' g using random effects, and heterogeneity among effect sizes was assessed with Q and I2 statistics. RESULTS: The overall effect size was positive but small (δ = .41, SE = .05, 95% CI [.33, .50], p < 0.05). Additionally, the results confirmed that different programs have different levels of impact on the student attitudes toward disability (Q = 25.71, p < 0.05, I2 = 45.54). Service-learning programs that were part of a course requirement, on-campus, included a lecture component, and emphasized teacher-centered goals had smaller impacts than programs that were voluntary, off-campus, did not include lecture, and emphasized the achievement of common goals. CONCLUSION: The present analysis suggests that different service-learning programs have different effects, and factors like requirement status and type of involvement may lead to greater changes in attitudes toward disability.IMPLICATIONS FOR REHABILITATIONAdapted physical activity service learning has positive, yet small, effects on college student attitudes toward disability.Service-learning practitioners should aim to increase autonomy within service learning by providing multiple choices and opportunities to college students, such as a variety of practicum types, locations, and disability populations to choose from.Service-learning practitioners should encourage the development of common goals between college students and people with disabilities and integrate shared activities that are familiar to both groups in order to promote optimal contact conditions and enhance attitude change.Programs that intend to change attitudes toward people with disabilities should incorporate strategies specifically designed to target attitude change.

Influence of Neighborhood Environment on Physical Activity Participation among Children with Autism Spectrum Disorder.

Despite the positive influence of environmental factors on physical activity (PA) levels of children, further investigation is necessary when considering the unique characteristics of children with autism spectrum disorder (ASD). The purpose of this study was to examine the relationship between neighborhood environment factors and PA among children with ASD by examining the extent to which (a) the built environment, (b) neighborhood safety, and (c) neighborhood support contributes to PA. A secondary data analysis using the 2016 and 2017 combined dataset of the National Survey of Children's Health was used. The total sample included 14,944 children between the ages of 6-17 years; of this, a sample of 494 children had a parent-reported diagnosis of ASD. Multivariate logistic regressions were conducted to explore the unique influences of the above three neighborhood environment factors on PA engagement. Among children with and without ASD, an association was found between feeling safe and engaging in PA, that is, the odds of engaging in PA are greater among children who were safe in their neighborhoods than children who were not in safe neighborhoods. Surprisingly, other neighborhood factors do not have a significant relationship with PA participation among children with ASD at this time. Future studies should consider how to incorporate the support of others and feeling of safety into the neighborhood along with how to improve accessibility of the built environment in order to increase PA for children with ASD. LAY SUMMARY: The results of this study showed that neighborhood factors influence physical activity (PA) among children with ASD differently compared to their peers without ASD. Children with ASD who live in safe neighborhoods are more likely to engage in PA, while other neighborhood factors, such as playgrounds and support, are not associated with an increased likelihood of engaging in PA at this time. Efforts should be made to improve neighborhood accessibility and design in order to increase PA among children with ASD.

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.

Predictors of perceived health in adults with an intellectual disability.

BACKGROUND: The effects of Intellectual disability (ID) levels, body mass index (BMI) categories, and other factors on perceived health status of adults with ID are not well-known. AIMS: We aimed to examine: (a) the relationship between perceived health and level of intellectual function; (b) the influence of different BMI categories on a perceived health; and (c) the effect of the modifiable behavioral factors on perceived health. METHODS AND PROCEDURES: We examined the aims using data from the 2013-2014 Adult Consumer Survey of the National Core Indicator. We extracted demographic (e.g. age, BMI) and modifiable behavior-related variables (e.g. physical activity participation, having a job) and used logistic regression models to analyze the relationships. OUTCOMES AND RESULTS: Logistic regressions showed that more severe ID level is associated with worse perceived health, but when other variables related to personal and behavioral characteristics were accounted for, this relationship was no longer significant. Obese adults with ID had worse perceived health than those with normal weight; this effect remained significant even after considering other variables. Those in the overweight category did not differ in perceived health status from those of normal weight. The effects of all modifiable behaviors on perceived health were significant. CONCLUSIONS AND IMPLICATIONS: Health promotion programs for adults with ID may benefit by consideration of modifiable behaviors.

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.

Physical activity guideline compliance among a national sample of children with various developmental disabilities.

BACKGROUND: Researchers have reported relatively low estimates of physical activity among children with various developmental disabilities. However, there are inconsistencies within these reports due to methodological issues. OBJECTIVE: The goals of this study were to estimate the prevalence of meeting national physical activity guidelines among children with various developmental disabilities and examine the relative influence of different disability descriptors on meeting the guidelines. METHODS: A sample of 3,010 U.S. children between the ages of 6 and 17 years with parent-reported diagnoses of autism spectrum disorder, cerebral palsy, Down syndrome, developmental disability, and/or intellectual disability was drawn from the combined 2016 and 2017 datasets of the National Survey of Children's Health. Multivariate logistic regression analyses explored the unique contributions of multiple child characteristics and disability descriptors, such as diagnosis type, severity, complexity, and functionality, toward meeting physical activity guidelines and compared the likelihood of meeting guidelines between children with these diagnoses. RESULTS: The results of this study reveal that the majority of children with developmental disabilities are not achieving adequate levels of daily physical activity, with only 19% of the study sample engaging in 60 min of physical activity daily. Child age and functionality were significant predictors of meeting physical activity guidelines among children within the sample. CONCLUSIONS: The findings of this study highlight the potentially limiting view of physical activity participation when diagnosis type is considered alone and demonstrate the importance of considering function and other individual factors as significant predictors of physical activity among children with disabilities.

The Effect of Different Intervention Approaches on Gross Motor Outcomes of Children With Autism Spectrum Disorder: A Meta-Analysis.

Despite the rising interest in intervention for children with autism spectrum disorder, the extent to which interventions are effective on gross motor outcomes is currently unknown. The purpose of this study was to analyze the effect of different intervention approaches on gross motor outcomes among children with autism spectrum disorder using meta-analysis. A total of 18 studies met the inclusion criteria for quantitative analysis. Pre- and posttest means and SDs were extracted to calculate effect sizes. Potential moderator variables were chosen based on important intervention characteristics. The results suggest that interventions have a large effect on gross motor outcomes among children with autism spectrum disorder (δ = 0.99, SE = 0.19, p < .001, 95% confidence interval [0.62, 1.36]). The interventions that were 16 total hours or longer had a significantly larger effect than those less than 16 hr. In addition, the interventions in experimental settings had significantly larger effects than the interventions in practical settings. Future interventions should consider intensity, including not only the duration of the intervention but also the intensity in which specific intervention goals are targeted.

Influence of physical activity on the health-related quality of life of young adults with and without autism spectrum disorder.

BACKGROUND: Health-related quality of life constructs has been used to understand the multiple dimensions (i.e., physical health, psychological, environment and social relationships) that affect a person's health status. In order to improve health-related quality of life for young adults, it is important to understand the factors that influence each dimension. The purpose of this paper was to examine the influence of the presence of autism spectrum disorder and physical activity on the multiple domains of health-related quality of life for young adults. METHODS: Three-hundred and twenty participants, including young adults with ASD, completed a questionnaire about their physical activity and health-related quality of life. RESULTS: Five multiple regressions revealed that the presence of autism spectrum disorder significantly predicted overall health-related quality of life, the physical health domain, psychological domain, and the environment domain. Additionally, physical activity significantly predicted each domain and overall health-related quality of life regardless of the presence of autism spectrum disorder. CONCLUSION: Practitioners should recognize the limitations that individuals with autism spectrum disorder may experience regarding their health-related quality of life, and utilize physical activity as a tool for improving health-related quality of life. Implications for Rehabilitation In order to address an individual's overall health, practitioners must consider multiple dimensions of health-related quality of life. Autism spectrum disorders influence how people perceive multiple dimensions of their health. Physical activity is a tool for improving perceptions of the multiple dimensions of health for individuals with and without autism spectrum disorders.

Meta-Analysis of Physical Activity Levels in Youth With and Without Disabilities.

The purpose of this study was to explore the current levels of physical activity among youth with disabilities using meta-analysis. The search identified 11 publications including 729 participants (age 4-20 yr). The overall effect size for 11 studies was Hedges g = 0.60 (SE = 0.18, 95% confidence interval [CI] [0.24, 0.96], p < .05, k = 11) using a random-effects model. The findings suggest that differences in physical activity levels between youth with and without disabilities are complex. Results indicated that youth without disabilities engaged in higher levels of physical activity of moderate to vigorous intensity (g = 0.66, SE = 0.18, p < .05). However, no differences were found in light-intensity physical activity (g = -0.03, SE = 0.16, p > .85). Results also suggested that the differences in physical activity between youth with and without disabilities were affected by age (<12 yr, g = 0.83, SE = 0.24, 95% CI [0.37, 1.29], p < .05, and >13 yr, g = 0.37, SE = 0.10, 95% CI [0.18, 0.57], p < .05; Q value = 3.20, df = 1, p < .05), with children with disabilities engaging in less physical activity than children without disabilities in younger ages. Differences in physical activity level between youth with and without disabilities are functions of intensity of physical activity and age but may not be of type of disability (Q value = 0.22, df = 1, p > .6).

Physical Activity Promotion for Persons Experiencing Disability: The Importance of Interdisciplinary Research and Practice.

This paper examines the need for interdisciplinary knowledge in the formation of public health models for health-promoting physical activity (PA) for people experiencing disability. PA promotion for people experiencing disability is a multifaceted endeavor and requires navigating a multitude of complicated and interactive factors. Both disability and health are multifaceted constructs and the relationship between PA and health is embedded within a complicated web of interactive influences. PA promotion must consider interacting biological and psychosocial factors within the person and in the sociopolitical environment. Models for research and practice need to evolve from value and belief systems that center on people experiencing disability without stigmatizing them. We argue that interdisciplinary research and practice is needed in navigating the intricacies of PA promotion toward improving the health of people experiencing disability and facilitating inclusion, empowerment, and dignity.

The motivational process for physical activity in young adults with autism spectrum disorder.

BACKGROUND: Many young adults, specifically those with a diagnosis of autism spectrum disorder (ASD), do not meet the national physical activity (PA) guidelines. One way to address this problem may be to examine the factors that motivate individuals to engage in PA. However, the majority of current literature does not consider the unique characteristics of individuals with ASD, which may influence their motivation. OBJECTIVE: The purpose of this research was to examine Self-Determination Theory predictors for PA for young adults with ASD. METHODS: Respondents included 143 young adults with ASD who completed a survey pertaining to their motivational process to engage in physical activity, based on self-determination theory variables. RESULTS: Goodness of fit indices reported from a path analysis suggests the current data closely align with the self-determination theory (χ2 (3, N = 143) = 11.99, p > .01, GFI = 0.97, NFI = 0.95, CFI = . 96, RMSEA = 0.15). The three basic psychological needs explained 39% of the variance within respondents' self-determined motivation, and self-determined motivation explained 8% of the variance in PA levels. CONCLUSIONS: These findings support utilizing the self-determination theory within health promotion efforts for young adults with ASD. Practitioners should focus on enhancing the perceived basic psychological needs of young adults within physical activity settings.

Impact of enjoyment on physical activity and health among children with disabilities in schools.

BACKGROUND: Enjoyment in school-based physical activity (PA) programs, such as recess or physical education may be important for promoting children's health, but there is a lack of evidence explaining how enjoyment affects health in children with disabilities. HYPOTHESES: Enjoyment in school-based PA programs will positively influence general health through participating in more daily PA, and this relationship will vary between younger and older children with disabilities. METHODS: We conducted secondary analysis of data from the 2012 National Youth Fitness Survey. The sample included 241 children with disabilities (age 5-15 years; 129 boys and 112 girls) identified using three criteria: (a) having an impairment, health problem and mobility limitations; (b) needing special equipment; or (c) receiving special education services. Variables extracted were the number of days per week participating for at least 60 min in PA a day; general perceived health; enjoyment in school recess (for ages 5-11 y) or physical education (for ages 12-15 y). Mediation analysis was conducted to test the research hypotheses. RESULTS: Daily PA participation significantly mediated the relationship between enjoyment in physical education/recess and general health. Children who enjoyed physical education or recess more participated in PA, and those who spent more days being physical active were healthier than their counterparts. However, this mediating relationship, when divided by age groups, was shown for only older group (ages 12-15 y) that received physical education. CONCLUSIONS: Physical educators should provide enjoyable PA opportunities during physical education classes for students with disabilities for promoting their health.