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Young Children with ASD Participate in the Same Level of Physical Activity as Children without ASD: Implications for Early Intervention to Maintain Good Health

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Title: Young Children with ASD Participate in the Same Level of Physical Activity as Children without ASD: Implications for Early Intervention to Maintain Good Health
Language: English
Authors: Thomas, S., Hinkley, T., Barnett, L. M., May, T., Rinehart, N.
Source: Journal of Autism and Developmental Disorders. Aug 2019 49(8):3278-3289.
Availability: Springer. Available from: Springer Nature. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 12
Publication Date: 2019
Document Type: Journal Articles
Reports - Research
Descriptors: Young Children, Autism, Pervasive Developmental Disorders, Physical Activities, Physical Activity Level, Early Intervention, Health Promotion, Child Health, Correlation, Clinical Diagnosis
DOI: 10.1007/s10803-019-04026-9
ISSN: 0162-3257
Abstract: Primary-school-aged children and adolescents with autism spectrum disorder (ASD) are reported to engage in lower levels of moderate-to-vigorous physical activity (MVPA) compared to typically developing (TD) children (Jones et al. in PLoS ONE, 12(2):1-23, 2017). Levels of MVPA in young children with ASD remain unclear. This study aimed to investigate MVPA in 4-to-7-year-old children with (n = 37) and without (n = 40) ASD, to determine if MVPA is related to ASD diagnosis; and examine correlates to better inform interventions. Results indicated children with ASD engage in the same levels of MVPA as TD children. Future studies need to further explore MVPA in children with ASD over time to uncover when the divergence in MVPA levels occur and what factors may be associated.
Abstractor: As Provided
Entry Date: 2019
Accession Number: EJ1221789
Database: ERIC
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  Value: <anid>AN0137441301;aut01aug.19;2019Jul13.07:13;v2.2.500</anid> <title id="AN0137441301-1">Young Children with ASD Participate in the Same Level of Physical Activity as Children Without ASD: Implications for Early Intervention to Maintain Good Health </title> <p>Primary-school-aged children and adolescents with autism spectrum disorder (ASD) are reported to engage in lower levels of moderate-to-vigorous physical activity (MVPA) compared to typically developing (TD) children (Jones et al. in PLoS ONE, 12(<reflink idref="bib2" id="ref1">2</reflink>):1–23, 2017). Levels of MVPA in young children with ASD remain unclear. This study aimed to investigate MVPA in 4-to-7-year-old children with (n = 37) and without (n = 40) ASD, to determine if MVPA is related to ASD diagnosis; and examine correlates to better inform interventions. Results indicated children with ASD engage in the same levels of MVPA as TD children. Future studies need to further explore MVPA in children with ASD over time to uncover when the divergence in MVPA levels occur and what factors may be associated.</p> <p>Keywords: Autism spectrum disorder (ASD); Physical activity (PA); Participation; Sleep disorders; Moderate-to vigorous-intensity physical activity (MVPA)</p> <hd id="AN0137441301-2">Introduction</hd> <p>Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, and restricted, repetitive behaviors and interests (DSM-5; American Psychiatric Association [<reflink idref="bib2" id="ref2">2</reflink>]). ASD affects approximately 2–4% of the population (May et al. [<reflink idref="bib40" id="ref3">40</reflink>]), with sex ratio of 3:1 male to female, (Loomes et al. [<reflink idref="bib38" id="ref4">38</reflink>]) and an average diagnosis age of 4 years (Baio et al. [<reflink idref="bib4" id="ref5">4</reflink>]). Individuals with ASD are at risk of poor social and mental health outcomes that can impact on relationships, academic skills and independence (LaGasse [<reflink idref="bib36" id="ref6">36</reflink>]). Research focusing on the association between ASD symptoms and physical health outcomes has increased in the past decade, investigating what drives physical activity levels in children with ASD, such as engagement (Pan [<reflink idref="bib47" id="ref7">47</reflink>]).</p> <p>Physical activity is a complex and multidimensional behavior essential to health and development in childhood (Pettee et al. [<reflink idref="bib50" id="ref8">50</reflink>]). Being engaged in the recommended amount of physical activity is associated with favorable health outcomes, including a lower risk of obesity and diabetes, and improved mental health, quality of life and cognitive development, regardless of diagnosis (Sowa and Meulenbroek [<reflink idref="bib56" id="ref9">56</reflink>]; Timmons et al. [<reflink idref="bib61" id="ref10">61</reflink>]). Past research has noted that habits relating to engagement in physical activity during early childhood track into middle childhood, highlighting the importance of activity at an early age (Jones et al. [<reflink idref="bib34" id="ref11">34</reflink>]). An important point to note, in consideration of the findings of a recent study by McCoy et al. ([<reflink idref="bib41" id="ref12">41</reflink>]) who revealed that in a sample of over 42,000 adolescents, those with an ASD diagnosis (n = 915) were less likely to engage in physical activity than their typically developing peers. Prevalence rates of moderate to vigorous intensity physical activity among children with ASD remain unclear (Jones et al. [<reflink idref="bib33" id="ref13">33</reflink>]).</p> <p>The World Health Organization ([<reflink idref="bib69" id="ref14">69</reflink>]) recommends that typically developing children aged 3-to-5 years are physically active for at least 3 hours spread throughout the day and that children aged between 5 and 12 years engage in moderate to vigorous physical activity for at least 60 minutes per day (World Health Organization [<reflink idref="bib68" id="ref15">68</reflink>]). Past research indicates mixed findings regarding levels of physical activity in children with ASD compared to those with other developmental disorders or typically developing children, particularly in the preschool years (Bandini et al. [<reflink idref="bib5" id="ref16">5</reflink>]; Brian et al. [<reflink idref="bib8" id="ref17">8</reflink>]; Ketcheson et al. [<reflink idref="bib35" id="ref18">35</reflink>]; Pan [<reflink idref="bib47" id="ref19">47</reflink>]; Sandt and Frey [<reflink idref="bib54" id="ref20">54</reflink>]). A recent systematic review of 35 studies of children with ASD (aged 0–18 years) indicated that children with ASD participate in approximately 86 min of moderate to vigorous intensity physical activity per day (range 34–166 min/day) (Jones et al. [<reflink idref="bib33" id="ref21">33</reflink>]). Comparatively, typically developing children are reported to engage in approximately 135 min of moderate to vigorous intensity physical activity per day (SE = 2.21) (Strutz et al. [<reflink idref="bib58" id="ref22">58</reflink>]).</p> <p>Physical activity in typically developing children and adolescents is associated with variables in individual, familial and physical environment domains (Bingham et al. [<reflink idref="bib6" id="ref23">6</reflink>]; Hinkley et al. [<reflink idref="bib24" id="ref24">24</reflink>]; Sallis et al. [<reflink idref="bib53" id="ref25">53</reflink>]). These variables are considered key elements in physical activity engagement, based on the Ecological Model (Bronfenbrenner [<reflink idref="bib9" id="ref26">9</reflink>]). Bronfenbrenner viewed the environment as a series of domains that encompass a range of potential correlates that may be associated with a given behavior. To date, specific research on ecological domain correlates of moderate to vigorous physical activity has not yet been examined in preschool and early primary school aged children with ASD. Research in preschool aged children with ASD is sparse, with only three studies investigating the effect of individual level variables (Bandini et al. [<reflink idref="bib5" id="ref27">5</reflink>]; Must et al. [<reflink idref="bib44" id="ref28">44</reflink>]; Tatsumi et al. [<reflink idref="bib59" id="ref29">59</reflink>]) and one study investigating the effect of variables in the familial domain (Ayvazoglu et al. [<reflink idref="bib3" id="ref30">3</reflink>]). Results of these past studies should be interpreted with caution due to small sample sizes (Ayvazoglu et al. [<reflink idref="bib3" id="ref31">3</reflink>]; Tatsumi et al. [<reflink idref="bib59" id="ref32">59</reflink>]), use of subjectively measured physical activity (Must et al. [<reflink idref="bib44" id="ref33">44</reflink>]), no control group (Ayvazoglu et al. [<reflink idref="bib3" id="ref34">3</reflink>]) and use of incorrect cut points for age (Bandini et al. [<reflink idref="bib5" id="ref35">5</reflink>]). Due to missing statistical information, effect sizes for all four papers were unable to be established.</p> <p>In the individual domain, younger children and males are generally more active, regardless of diagnosis (Jones et al. [<reflink idref="bib33" id="ref36">33</reflink>]; Memari et al. [<reflink idref="bib42" id="ref37">42</reflink>]; Troiano et al. [<reflink idref="bib62" id="ref38">62</reflink>]; Trost et al. [<reflink idref="bib64" id="ref39">64</reflink>]). Studies investigating other individual domain correlates in children with ASD, such as sleep problems, and Attention Deficit-Hyperactivity Disorder (ADHD) symptomology are limited.</p> <p>Sleep problems are estimated to affect up to 83% of children with ASD (Delahaye et al. [<reflink idref="bib19" id="ref40">19</reflink>]) and are associated with increased severity of the core ASD symptoms (Delahaye et al. [<reflink idref="bib19" id="ref41">19</reflink>]), and increase in additional clinical problems, such as ADHD and reduced motor proficiency (Hollway and Aman [<reflink idref="bib28" id="ref42">28</reflink>]; Jeste [<reflink idref="bib32" id="ref43">32</reflink>]). In typically developing child populations, those who are more physically active or have better motor proficiency have more consistent sleep patterns (Brand et al. [<reflink idref="bib7" id="ref44">7</reflink>]; Lang et al. [<reflink idref="bib37" id="ref45">37</reflink>]; Stone et al. [<reflink idref="bib57" id="ref46">57</reflink>]). Similar results have been reported in older children (9 to 18 years) with ASD (Wachob and Lorenzi [<reflink idref="bib66" id="ref47">66</reflink>]). Only one study has examined the association between objectively measured levels of physical activity and sleep problems in preschool children (Tatsumi et al. [<reflink idref="bib59" id="ref48">59</reflink>]) finding that 51% of their ASD sample (n = 31) and 12% of children in their typically developing sample (n = 16) were considered 'problem sleepers' (parent proxy report), and an association between increased sleep problems and reduced rates of physical activity. Associations between motor impairments and sleep problems have been reported in the ASD (Taylor et al. [<reflink idref="bib60" id="ref49">60</reflink>]), and more recently in the ADHD population (Papadopoulos et al. [<reflink idref="bib48" id="ref50">48</reflink>]), however no studies have investigated the impact of ADHD symptomology on moderate to vigorous physical activity in the ASD population.</p> <p>Active transport (e.g. walking or riding a bike/scooter to different locations, such as preschool) is considered to make an important contribution to children's physical activity (Roth et al. [<reflink idref="bib52" id="ref51">52</reflink>]). However, a more recent study of 5 to 6-year-old typically developing children showed no association between active transport and moderate to vigorous physical activity (Carver et al. [<reflink idref="bib11" id="ref52">11</reflink>]). To date, no studies have investigated the potential association between active transport and moderate to vigorous physical activity in children with ASD. Alongside the potential positive contributions to moderate to vigorous physical activity are constraints such as; lack of energy and weight status, where findings are mixed in both the ASD (Ayvazoglu et al. [<reflink idref="bib3" id="ref53">3</reflink>]; Bandini et al. [<reflink idref="bib5" id="ref54">5</reflink>]) and typically developing populations (Bingham et al. [<reflink idref="bib6" id="ref55">6</reflink>]; Hinkley et al. [<reflink idref="bib25" id="ref56">25</reflink>]).</p> <p>A range of familial domain variables have been explored in children with ASD, however, research is limited in younger children, where parental influence has its greatest impact, and can either foster or hinder adequate levels of engagement in physical activity (Alderman et al. [<reflink idref="bib1" id="ref57">1</reflink>]). Parents are one of the most important socializing agents for children (Gustafson and Rhodes [<reflink idref="bib23" id="ref58">23</reflink>]). Results regarding the influence of parental physical activity behaviors (such as role modelling, and parental beliefs) on typically developing children's activity levels are mixed, with more recent research indicating that the association between parental behaviors and child physical activity levels may not hold for younger children (Bingham et al. [<reflink idref="bib6" id="ref59">6</reflink>]; Hinkley et al. [<reflink idref="bib24" id="ref60">24</reflink>]). Lack of resources and finances, have been associated with lower levels of objectively measured physical activity in a small sample (n = 6) of 4 to 13-year-old children with ASD (Ayvazoglu et al. [<reflink idref="bib3" id="ref61">3</reflink>]). Similar findings were reported in an exploratory study by Must et al. ([<reflink idref="bib44" id="ref62">44</reflink>]) in a sample of children with ASD (n = 53) and a typically developing comparison sample (n = 58), utilising subjectively measured physical activity. Memrari et al. ([<reflink idref="bib43" id="ref63">43</reflink>]) also reported a flow on effect from familial domain barriers, such as low income and lack of social support, on child physical activity to physical environment barriers of child physical activity, such as reduced access to parks and recreational services in a sample of 6 to 15 year old children with ASD (n = 83), using subjectively measured physical activity.</p> <p>Access to parks and playgrounds has been associated with increased levels of physical activity in children with ASD (Obrusnikova and Cavalier [<reflink idref="bib45" id="ref64">45</reflink>]; Memrari et al. [<reflink idref="bib43" id="ref65">43</reflink>]), however this association was not found for typically developing children (Ferreira et al. [<reflink idref="bib21" id="ref66">21</reflink>]). Whilst increased concerns about child safety were associated with lower levels of physical activity in children with ASD (Ayvazoglu et al. [<reflink idref="bib3" id="ref67">3</reflink>]), no significant association was found in the typically developing population (Carver et al. [<reflink idref="bib10" id="ref68">10</reflink>]).</p> <p>Limited research has explored the associations between moderate to vigorous intensity physical activity and ecological correlates in pre-school and early-school aged children in the ASD population, a time where the impact of formal schooling and organized sport has yet to impact on levels of moderate to vigorous intensity physical activity. The current study examines this gap in the existing literature, particularly in the ASD population in an Australian context. Therefore, based on the study by Bandini et al. ([<reflink idref="bib5" id="ref69">5</reflink>]) this study aimed to (<reflink idref="bib1" id="ref70">1</reflink>) describe the levels of moderate to vigorous intensity physical activity in 4 to 7-year-old children with ASD compared to typically developing children; and (<reflink idref="bib2" id="ref71">2</reflink>) understand what variables in each domains of the ecological model are associated with moderate to vigorous intensity physical activity individually in these groups. It was expected that in comparison to typically developing children, (<reflink idref="bib1" id="ref72">1</reflink>) children with ASD would experience similar levels of moderate to vigorous intensity physical activity; (<reflink idref="bib2" id="ref73">2</reflink>) variables in the individual domain experienced by children with ASD (e.g. ADHD severity, greater sleep difficulties, and constraints to moderate to vigorous intensity physical activity) would be associated with lower levels of moderate to vigorous intensity physical activity in comparison to typically developing children; and (<reflink idref="bib3" id="ref74">3</reflink>) variables in the familial and physical environment domains would lead to higher levels of moderate to vigorous intensity physical activity in both the ASD and typically developing groups.</p> <hd id="AN0137441301-3">Method</hd> <p></p> <hd id="AN0137441301-4">Participants</hd> <p>The current study was approved by Deakin Human Research Ethics Committee (2014-061) and the Department of Education and Training (2015_002795). Informed consent was obtained from parents in accordance with the Declaration of Helsinki. The reporting of this study conforms to the STROBE statement (von Elm et al. [<reflink idref="bib65" id="ref75">65</reflink>]). The sample comprised of 77 children aged 4 to 7 years, including those with ASD (n = 37), and a comparison sample of typically developing children (n = 40). Participants with ASD were recruited from specialist Autism services and private pediatric clinics in Melbourne, Victoria (consent rate of 8%, 37/470). Inclusion criteria were a confirmed diagnosis of DSM-IV Autistic Disorder or Asperger's Disorder or DSM-5 Autism Spectrum Disorder (ASD) from a pediatrician or multidisciplinary clinical team. Participants without an ASD diagnosis were recruited from a primary school (convenience sampling) in the greater Melbourne region (consent rate of 16%, 40/250).Children were included regardless of other comorbidities except if they had a genetic condition (e.g. Fragile X Syndrome) or a condition which impacts on their physical activity (e.g. Cerebral Palsy).</p> <p>We further excluded typically developing children (n = 2) who had high levels of autistic symptoms based on scores ≥ 60 on The Social Responsiveness Scale II Parent Report <bold>(</bold>SRS-II; Constantino 2013), and ASD children (n = 2) with scores < 59 on the SRS-II, considered in the 'normal' range of functioning. The SRS-II provided a measurement of ASD severity, as it is used to assess social awareness, social information processing, capacity for reciprocal social communication, social anxiety/avoidance, and autistic preoccupations and traits in children from four to 18 years. Parents use a rating scale to rate the severity of a child's symptoms that occurred in the past 6 months. Items are rated on a four-point scale: "not true" "sometimes true" "often true" "almost always true." Constantino and Gruber ([<reflink idref="bib18" id="ref76">18</reflink>]) found that the overall SRS parent rated scale has good internal consistency (<emph>α</emph> =.94 in males; <emph>α</emph> =.93 in females).</p> <hd id="AN0137441301-5">Procedure</hd> <p>Parents of children with ASD were invited into the study via a letter sent from specialist Autism services and private pediatric clinics, which included the plain language statement and consent form. Families who wished to participate were invited to directly contact researchers at Deakin University. Families attended an assessment session at their local Autism service provider, Deakin University or at the family's home if they preferred. Parents of typically developing children were contacted via a letter distributed to them via their school, which included the plain language statement and consent form. These children were tested at their school. All parents provided written informed consent for themselves and their children to participate. Child assessments were completed within 2 h and included breaks as required. Participants were asked to wear the ActiGraph accelerometer for eight consecutive days (not including sleeping or water-based activities). During assessment of their child, parents of children with ASD completed surveys according to their standard instructions, whilst parents of typically developing children completed the survey and battery of measures at home and returned them to school, along with the ActiGraph monitor.</p> <hd id="AN0137441301-6">Measures</hd> <p></p> <hd id="AN0137441301-7">Outcome Variable</hd> <p>Average weekly levels of child moderate to vigorous intensity physical activity were assessed using ActiGraph accelerometers (model wGT3X + BT). ActiGraph accelerometers are small, lightweight devices, which children wear on a belt on the right iliac crest. This is a widely used objective method of assessing free-living, habitual physical activity in children (Trost et al. [<reflink idref="bib63" id="ref77">63</reflink>]) with established validity, reliability and utility in early childhood (Cliff et al. [<reflink idref="bib12" id="ref78">12</reflink>]).</p> <hd id="AN0137441301-8">Independent Variables</hd> <p>Primary caregivers reported on their child's date of birth and sex, and their own age, sex, country of birth, employment status, highest education level, marital status, and relationship to child in the study. Respondents were also asked to report on the same measures for their partner (if relevant). The survey included individual, familial and physical environment domain variables thought to be associated with moderate to vigorous intensity physical activity as described below.</p> <p>Levels of children's hyperactivity and inattention were assessed using the Conners Parent Rating Scale–Revised: Long Form (CPRS–R: L; Conners [<reflink idref="bib15" id="ref79">15</reflink>]) for a measure of overall ADHD symptomology. This standardized questionnaire determines ADHD symptomology in children aged from three through 17 years based on DSM-IV-TR criteria. The CPRS-R: L contains 80 items rated on a four-point Likert scale ranging from "not true at all" to "very much true". Conners et al. ([<reflink idref="bib17" id="ref80">17</reflink>]) found that in regard to internal consistency, most alpha coefficients for the 14 subscales ranged from.70 to above.90. Test–retest analyses indicated acceptable stability (ranges as follows: Parent Content α =.70 to.96, Parent Symptom α =.66 to.95 (Conners [<reflink idref="bib16" id="ref81">16</reflink>]). For the purposes of this study, the total score of ADHD symptomology was used.</p> <p>The Wechsler Preschool and Primary Scales of Intelligence IV Australian (WPPSI-IV) (Wechsler [<reflink idref="bib67" id="ref82">67</reflink>]) provided an estimate of intelligence (verbal, perceptual, performance IQ and a total, full scale score). Children with ASD, who were unable to complete the WPPSI-IV due to low cognitive level, completed the Psychoeducational Profile 3 (PEP-3; Schopler et al. [<reflink idref="bib55" id="ref83">55</reflink>]), which provides a cognitive developmental age for children aged between birth and 7 years. The PEP-3 includes tasks suited for young children with ASD and intellectual delays. For the purposes of this study, cognitive level for the ASD group was split into a dichotomous variable of intellectual disability (yes/no); with 'yes' being scores of 69 or below on the WPPSI-IV or undertaking the PEP-3, due to the two scales not being directly comparable, whilst cognitive level for the typically developing group was measured as a continuous scale using the WPPSI-IV Full Scale IQ (FSIQ).</p> <p>The Child Sleep Habits Questionnaire (CSHQ) (Owens et al. [<reflink idref="bib46" id="ref84">46</reflink>]) was used to assess sleep problems in both samples. The CSHQ is a retrospective, 33-item parent questionnaire that examines sleep behavior in young children, measured over eight subscales (bedtime resistance, sleep onset delay; sleep duration; sleep anxiety; night Waking's; sleep-disordered breathing; parasomnias; and daytime sleepiness) and a total score—used in the current study. Parents were asked to recall sleep behaviors occurring over a "typical" recent week and rate them on a three-point scale: "usually" if the sleep behavior occurred 5 to 7 times/week; "sometimes" for 2 to 4 times/week; and "rarely" for 0 to 1 time/week. Owens et al. ([<reflink idref="bib46" id="ref85">46</reflink>]) found test–retest reliability to be acceptable (range α =.62–.79) and internal consistency to be adequate (clinical sample α =.78; community sample α =.68).</p> <p>Additional potential correlates were collated using a subset of items from the Healthy Activity Preschool and Primary Years (HAPPY) survey (Hinkley et al. [<reflink idref="bib27" id="ref86">27</reflink>], [<reflink idref="bib26" id="ref87">26</reflink>]). The HAPPY survey has reported test–retest reliability of Kappa > 0.6 and agreement ≥ 60% on categorical variables and an ICC ≥ 0.50 for continuous variables (Hinkley et al. [<reflink idref="bib27" id="ref88">27</reflink>], [<reflink idref="bib26" id="ref89">26</reflink>]). Specific item reliability scores are presented in "Appendix".</p> <hd id="AN0137441301-9">Data Management and Statistical Analysis</hd> <p>Following established protocols for accelerometer use, counts were recorded in 15-s epochs to accurately capture the sporadic nature of children's physical activity (Colley et al. [<reflink idref="bib14" id="ref90">14</reflink>]). Downloaded data were reduced to total counts/day, minutes/day in intensity and average time in moderate to vigorous intensity physical activity using age-appropriate cut-points. For children aged 4-to-6 years (not at school) (n = 39) the study utilized the cut points from the Pate et al. ([<reflink idref="bib49" id="ref91">49</reflink>]) study, as validated by Janssen et al. ([<reflink idref="bib30" id="ref92">30</reflink>]) (≥ 420 counts 15 s<sups>−1</sups>). For children aged six and over attending school (n = 15), Freedson et al. ([<reflink idref="bib22" id="ref93">22</reflink>]) cut points were applied (≥ 743 counts 15 s<sups>−1</sups>). A valid day was set at 6 h of wear time, and a valid week comprised of any 4 days (Hinkley et al. [<reflink idref="bib27" id="ref94">27</reflink>], [<reflink idref="bib26" id="ref95">26</reflink>]; Janz et al. [<reflink idref="bib31" id="ref96">31</reflink>]). Individual participant data were extracted from raw data based on both the age of participant (in years) and the appropriate cut point for age and school status.</p> <p>Prior to conducting analysis, all data were screened for missing values, outliers and data entry errors. Demographic characteristics of children with ASD, and typically developing children with and without available physical activity data, were compared using t-tests and Chi squared tests (see Table 1). Characteristics for the total sample of children with available moderate to vigorous intensity physical activity data were also calculated. The moderate to vigorous intensity physical activity minutes each group (ASD and typically developing) engaged in were examined, based on participants with available and valid moderate to vigorous intensity physical activity data, via the use of an ANOVA.</p> <p>Sample characteristics of the ASD and typically developing cohorts</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>ASD (no PA) (n = 7)</p></th><th align="left"><p>ASD (PA data) (n = 30)</p></th><th align="left"><p>p</p></th><th align="left"><p>Typically developing (no PA) (n = 14)</p></th><th align="left"><p>Typically developing (PA data) (n = 23)</p></th><th align="left"><p>p</p></th><th align="left"><p>P (ASD and Typically developing with available data)</p></th></tr></thead><tbody><tr><td align="left" colspan="8"><p>Child</p></td></tr><tr><td align="left"><p> Age in years: M (SD)</p></td><td char="(" align="char"><p>5.20 (.75)</p></td><td char="(" align="char"><p>4.97 (.85)</p></td><td char="." align="char"><p>.60</p></td><td char="(" align="char"><p>5.11 (.61)</p></td><td char="(" align="char"><p>5.26 (.54)</p></td><td char="." align="char"><p>.52</p></td><td char="." align="char"><p>.06</p></td></tr><tr><td align="left"><p> Male: n (%)</p></td><td char="(" align="char"><p>5 (83.3%)</p></td><td char="(" align="char"><p>26 (78.8%)</p></td><td char="." align="char"><p>.81</p></td><td char="(" align="char"><p>6 (42.9%)</p></td><td char="(" align="char"><p>11 (45.8%)</p></td><td char="." align="char"><p>.86</p></td><td char="." align="char"><p>.02</p></td></tr><tr><td align="left"><p>Diagnosis (ASD group only)</p></td><td char="(" align="char" /><td char="(" align="char" /><td char="." align="char"><p>.10</p></td><td char="(" align="char" /><td char="(" align="char" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Autistic</p></td><td char="(" align="char"><p>5 (83.3%)</p></td><td char="(" align="char"><p>11 (36.7%)</p></td><td align="left" /><td char="(" align="char" /><td char="(" align="char" /><td align="left"><p>N/A</p></td><td align="left" /></tr><tr><td align="left"><p> ASD</p></td><td char="(" align="char" /><td char="(" align="char"><p>11 (36.7%)</p></td><td align="left" /><td char="(" align="char" /><td char="(" align="char" /><td align="left" /><td align="left"><p>N/A</p></td></tr><tr><td align="left"><p> PDD-NOS</p></td><td char="(" align="char"><p>1 (16.7%)</p></td><td char="(" align="char"><p>6 (18.2%)</p></td><td align="left" /><td char="(" align="char" /><td char="(" align="char" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Asperger's disorder</p></td><td char="(" align="char" /><td char="(" align="char"><p>2 (6.7%)</p></td><td align="left" /><td char="(" align="char" /><td char="(" align="char" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Intellectual disability [yes (n(%)]</p></td><td char="(" align="char"><p>2 (33.3%)</p></td><td char="(" align="char"><p>8 (24.2%)</p></td><td char="." align="char"><p>.65</p></td><td char="(" align="char"><p>0 (0%)</p></td><td char="(" align="char"><p>1 (4.2%)</p></td><td char="." align="char"><p>.45</p></td><td char="." align="char"><p>.02</p></td></tr><tr><td align="left" colspan="8"><p>Parent</p></td></tr><tr><td align="left"><p> Sex [female (n %)]</p></td><td char="(" align="char"><p>3 (50%)</p></td><td char="(" align="char"><p>28 (84.8%)</p></td><td char="." align="char"><p>.33</p></td><td char="(" align="char"><p>12 (90%)</p></td><td char="(" align="char"><p>22 (95.7%)</p></td><td char="." align="char"><p>.73</p></td><td char="." align="char"><p>.27</p></td></tr><tr><td align="left"><p> Age in years M (SD)</p></td><td char="(" align="char"><p>40.40 (6.80)</p></td><td char="(" align="char"><p>36.03 (7.50)</p></td><td char="." align="char"><p>.25</p></td><td char="(" align="char"><p>37.00 (3.00)</p></td><td char="(" align="char"><p>37.08 (3.65)</p></td><td char="." align="char"><p>.96</p></td><td char="." align="char"><p>.93</p></td></tr><tr><td align="left" colspan="8"><p>Educational qualifications</p></td></tr><tr><td align="left"><p> Year 12</p></td><td char="(" align="char"><p>0 (0%)</p></td><td char="(" align="char"><p>2 (3%)</p></td><td char="." align="char" rowspan="3"><p>.28</p></td><td char="(" align="char"><p>0 (0%)</p></td><td char="(" align="char"><p>1 (4.3%)</p></td><td char="." align="char" rowspan="3"><p>.14</p></td><td char="." align="char" rowspan="3"><p>.01</p></td></tr><tr><td align="left"><p> Technical/trade certificate/apprenticeship</p></td><td char="(" align="char"><p>2 (40%)</p></td><td char="(" align="char"><p>6 (18.2%)</p></td><td char="(" align="char"><p>1 (33.3%)</p></td><td char="(" align="char"><p>0 (0%)</p></td></tr><tr><td align="left"><p> University degree/post graduate</p></td><td char="(" align="char"><p>2 (40%)</p></td><td char="(" align="char"><p>21 (65.6%)</p></td><td char="(" align="char"><p>12 (90%)</p></td><td char="(" align="char"><p>20 (86.9%)</p></td></tr><tr><td align="left" colspan="8"><p>Employment status</p></td></tr><tr><td align="left"><p> Full time employment</p></td><td char="(" align="char"><p>0 (0%)</p></td><td char="(" align="char"><p>5 (16.1%)</p></td><td char="." align="char" rowspan="3"><p>.10</p></td><td char="(" align="char"><p>2 (20%)</p></td><td char="(" align="char"><p>2 (13.3%)</p></td><td char="." align="char" rowspan="3"><p>.33</p></td><td char="." align="char" rowspan="3"><p>.001</p></td></tr><tr><td align="left"><p> Full time home duties/unemployed</p></td><td char="(" align="char"><p>4 (66.7%)</p></td><td char="(" align="char"><p>14 (45.1%)</p></td><td char="(" align="char"><p>2 (20%)</p></td><td char="(" align="char"><p>1 (6.7%)</p></td></tr><tr><td align="left"><p> Part time employment</p></td><td char="(" align="char"><p>0 (0%)</p></td><td char="(" align="char"><p>9 (29%)</p></td><td char="(" align="char"><p>5 (50%)</p></td><td char="(" align="char"><p>12 (80%)</p></td></tr><tr><td align="left"><p>Martial status [married (n %)]</p></td><td char="(" align="char"><p>5 (83.3%)</p></td><td char="(" align="char"><p>26 (83.9%)</p></td><td char="." align="char"><p>.40</p></td><td char="(" align="char"><p>9 (90%)</p></td><td char="(" align="char"><p>24 (100%)</p></td><td char="." align="char"><p>.34</p></td><td char="." align="char"><p>.07</p></td></tr><tr><td align="left"><p>Place of birth [Australia (n %)]</p></td><td char="(" align="char"><p>4 (66.7%)</p></td><td char="(" align="char"><p>26 (78.8%)</p></td><td char="." align="char"><p>.96</p></td><td char="(" align="char"><p>1 (33.3%)</p></td><td char="(" align="char"><p>13 (56.5%)</p></td><td char="." align="char"><p>.46</p></td><td char="." align="char"><p>.15</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>ASD</emph> Autism spectrum disorder, <emph>PDD-NOS</emph> pervasive developmental disorder not otherwise specified</p> <p>Due to the different distribution of sex and cognitive ability between the groups, partial correlational analysis were run, controlling for sex and cognitive ability, to ascertain what ecological variables were associated with moderate to vigorous intensity physical activity for the ASD and typically developing groups separately. Fishers r-to-z transformations were performed to determine if the groups were significantly different across each of the ecological variables. Significance was determined at p <.05. Effect sizes were calculated by standardizing to a mean of 0 and a standard deviation (SD) of 1. Effect sizes are considered as small i.e. ∼ 0.20 SD, moderate i.e. ∼ 0.50 SD and large i.e. ~ 0.80 SD (Cohen [<reflink idref="bib13" id="ref97">13</reflink>]). Posthoc power analyses were conducted using G*Power (Faul et al. [<reflink idref="bib20" id="ref98">20</reflink>]), using an alpha of.05 and a moderate effect size of.60, with partial correlations and Fishers r-to-z transformations obtaining a power score of.66 and.10 respectively. The use of a moderate effect size is in line with previous research in this space (Ketcheson et al. [<reflink idref="bib35" id="ref99">35</reflink>]; Pan [<reflink idref="bib47" id="ref100">47</reflink>]; Sandt and Frey [<reflink idref="bib54" id="ref101">54</reflink>]). All analyses were conducted using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp [<reflink idref="bib29" id="ref102">29</reflink>]).</p> <hd id="AN0137441301-10">Results</hd> <p></p> <hd id="AN0137441301-11">Participant Characteristics</hd> <p>As shown in Table 1, there were no significant differences in demographic and child characteristics between participants with (n = 54) or without (n = 20) physical activity data. For the purposes of the current paper, only participants with valid physical activity data will be included in the analysis and discussion. For participants with physical activity data, there were a significantly higher percentage of males in the ASD (n = 31) group compared to the typically developing (n = 23) group, where a similar number of males (n = 11) and females (n = 12) were included. As expected, there were significantly more children with ASD with an intellectual disability (25%), compared to the typically developing (1/23) sample. The parents of the typically developing group reported significantly higher qualifications than the ASD group (over 90% of typically developing parents obtaining a university qualification or higher, compared to 66% of ASD parents).</p> <hd id="AN0137441301-12">Levels of Physical Activity of ASD and Typically Developing Children</hd> <p>Results of the <emph>t</emph> test indicated no significant difference in mean time engaged in moderate to vigorous intensity physical activity between the ASD and typically developing groups (t (<reflink idref="bib52" id="ref103">52</reflink>) =.25, <emph>p</emph> =.81, [− 20.95, 26.75]). Due to boys in the combined ASD and typically developing samples being more active (t (<reflink idref="bib52" id="ref104">52</reflink>) = 2.16, p <.05) than girls, and that there was a higher percentage of boys in the ASD group, sample means were then examined between males and females in each group. The results of the ANOVA showed that, after controlling for sex, there was no significant difference in levels of moderate to vigorous intensity physical activity between the ASD and typically developing groups, however main effects for age (in months) indicated differences nearing significance (F(<reflink idref="bib1" id="ref105">1</reflink>,<reflink idref="bib49" id="ref106">49</reflink>) = 3.78, <emph>p</emph> =.06).</p> <p>Although children with ASD + ID participated in 6 min less moderate to vigorous intensity physical activity than those with only ASD, t-tests found no significant difference in levels of moderate to vigorous intensity physical activity between ASD + ID (M = 90.92, SD = 58.26) and ASD alone (M = 82.19, SD = 40.13), (t(<reflink idref="bib29" id="ref107">29</reflink>) =.47, <emph>p</emph> =.64, <emph>d</emph> =.37). For the typically developing group, Spearman's correlations revealed similarly, no association between the continuous variable of IQ score and moderate to vigorous intensity physical activity (r =.26, <emph>p</emph> =.27).</p> <hd id="AN0137441301-13">Ecological Correlates of Moderate to Vigorous Intensity Physical Activity in Children with AS...</hd> <p>Regarding individual domain variables, <emph>child behavioral sleep problems</emph> were negatively associated with child moderate to vigorous intensity physical activity levels in the ASD group (see Table 2). For the typically developing children only, <emph>child independently active</emph> was positively associated with child moderate to vigorous intensity physical activity levels. Fisher's r-to-z scores indicated no significant difference between the ASD and typically developing groups for individual domain variables.</p> <p>Means and standard deviations for domain variables; partial correlations and Fishers r-to-z scores for child MVPA levels</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Domain</p></th><th align="left"><p>Variable</p></th><th align="left"><p>ASD M (SD) (N = 31)</p></th><th align="left"><p>Typically developing M (SD) (n = 23)</p></th><th align="left"><p>p</p></th><th align="left"><p>ASD correlations with MVPA (N = 31)</p></th><th align="left"><p>Typically developing correlations with MVPA (n = 23)</p></th><th align="left"><p>Fishers r-to-z</p></th></tr></thead><tbody><tr><td align="left"><p>Individual</p></td><td align="left"><p>Age (in months)</p></td><td char="(" align="char"><p>64.58 (10.10)</p></td><td char="(" align="char"><p>69.86 (5.73)</p></td><td char="." align="char"><p>.02</p></td><td char="." align="char"><p>−.12</p></td><td char="." align="char"><p>.15</p></td><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Conners t-score</p></td><td char="(" align="char"><p>60.71 (9.89)</p></td><td char="(" align="char"><p>61.30 (16.64)</p></td><td char="." align="char"><p>.88</p></td><td char="." align="char"><p>.00</p></td><td char="." align="char"><p>.07</p></td><td align="left" /></tr><tr><td align="left" /><td align="left"><p>CSHQ total</p></td><td char="(" align="char"><p>48.10 (9.87)</p></td><td char="(" align="char"><p>45.04 (6.68)</p></td><td char="." align="char"><p>.21</p></td><td char="." align="char"><p>−.38**</p></td><td char="." align="char"><p>.11</p></td><td char="." align="char"><p>− 1.63</p></td></tr><tr><td align="left" /><td align="left"><p>Child independently active</p></td><td char="(" align="char"><p>3.74 (.86)</p></td><td char="(" align="char"><p>3.43 (1.63)</p></td><td char="." align="char"><p>.20</p></td><td char="." align="char"><p>.15</p></td><td char="." align="char"><p>.45**</p></td><td char="." align="char"><p>− 1.23</p></td></tr><tr><td align="left" /><td align="left"><p>Active transport</p></td><td char="(" align="char"><p>7.40 (2.59)</p></td><td char="(" align="char"><p>7.34 (2.59)</p></td><td char="." align="char"><p>.94</p></td><td char="." align="char"><p>.06</p></td><td char="." align="char"><p>.12</p></td><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Child constraints</p></td><td char="(" align="char"><p>18.87 (4.67)</p></td><td char="(" align="char"><p>16.05 (5.53)</p></td><td char="." align="char"><p>.04</p></td><td char="." align="char"><p>−.22</p></td><td char="." align="char"><p>−.04</p></td><td align="left" /></tr><tr><td align="left"><p>Familial</p></td><td align="left"><p>Parents active with child</p></td><td char="(" align="char"><p>7.77 (2.55)</p></td><td char="(" align="char"><p>7.48 (2.12)</p></td><td char="." align="char"><p>.66</p></td><td char="." align="char"><p>.23</p></td><td char="." align="char"><p>.11</p></td><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Parental role modelling</p></td><td char="(" align="char"><p>7.13 (1.96)</p></td><td char="(" align="char"><p>7.39 (2.12)</p></td><td char="." align="char"><p>.60</p></td><td char="." align="char"><p>.31</p></td><td char="." align="char"><p>.05</p></td><td align="left" /></tr><tr><td align="left" /><td align="left" colspan="7"><p>Parental beliefs</p></td></tr><tr><td align="left" rowspan="2" /><td align="left"><p>Sat<italic>isfied with child PA</italic></p></td><td char="(" align="char"><p>3.61 (1.02)</p></td><td char="(" align="char"><p>3.56 (1.80)</p></td><td char="." align="char"><p>.87</p></td><td char="." align="char"><p>.34*</p></td><td char="." align="char"><p>.16</p></td><td char="." align="char"><p>.06</p></td></tr><tr><td align="left"><p><italic>Enough activity for health</italic></p></td><td char="(" align="char"><p>3.94 (.89)</p></td><td char="(" align="char"><p>3.65 (1.15)</p></td><td char="." align="char"><p>.21</p></td><td char="." align="char"><p>.31</p></td><td char="." align="char"><p>−.05</p></td><td align="left" /></tr><tr><td align="left" rowspan="3" /><td align="left" colspan="7"><p>Parental constraints</p></td></tr><tr><td align="left"><p><italic>Too tired</italic></p></td><td char="(" align="char"><p>2.65 (.80)</p></td><td char="(" align="char"><p>2.73 (1.21)</p></td><td char="." align="char"><p>.75</p></td><td char="." align="char"><p>−.24</p></td><td char="." align="char"><p>−.03</p></td><td align="left" /></tr><tr><td align="left"><p><italic>Other child/ren</italic></p></td><td char="(" align="char"><p>2.77 (1.45)</p></td><td char="(" align="char"><p>2.52 (1.20)</p></td><td char="." align="char"><p>.50</p></td><td char="." align="char"><p>−.36*</p></td><td char="." align="char"><p>−.02</p></td><td char="." align="char"><p>− 1.22</p></td></tr><tr><td align="left" rowspan="2" /><td align="left" colspan="7"><p>Parental rules</p></td></tr><tr><td align="left"><p><italic>Free play in the backyard</italic></p></td><td char="(" align="char"><p>4.13 (1.02)</p></td><td char="(" align="char"><p>4.39 (.94)</p></td><td char="." align="char"><p>.34</p></td><td char="." align="char"><p>.08</p></td><td char="." align="char"><p>−.46**</p></td><td char="." align="char"><p>1.93</p></td></tr><tr><td align="left" /><td align="left"><p><italic>Free play in the street</italic></p></td><td char="(" align="char"><p>4.58 (.67)</p></td><td char="(" align="char"><p>3.82 (1.07)</p></td><td char="." align="char"><p>.003</p></td><td char="." align="char"><p>.06</p></td><td char="." align="char"><p>−.01</p></td><td align="left" /></tr><tr><td align="left"><p>Physical environment</p></td><td align="left"><p>Suitability of playgrounds</p></td><td char="(" align="char"><p>19.20 (4.35)</p></td><td char="(" align="char"><p>19.96 (2.99)</p></td><td char="." align="char"><p>.48</p></td><td char="." align="char"><p>.36*</p></td><td char="." align="char"><p>−.15</p></td><td char="." align="char"><p>1.69</p></td></tr><tr><td align="left" /><td align="left"><p>Access to toys and equipment</p></td><td char="(" align="char"><p>12.45 (5.89)</p></td><td char="(" align="char"><p>11.82 (4.91)</p></td><td char="." align="char"><p>.68</p></td><td char="." align="char"><p>.04</p></td><td char="." align="char"><p>.32</p></td><td align="left" /></tr></tbody></table> </ephtml> </p> <p>*<.10;**<.05; ***<.001; <emph>MVPA</emph> moderate- to vigorous-intensity physical activity, <emph>CHSQ</emph> child sleep habits questionnaire, <emph>PA</emph> physical activity, <emph>M</emph> mean, <emph>SD</emph> standard deviation</p> <p>For familial domain variables, parental <emph>satisfaction with child PA levels</emph> was positively associated with child moderate to vigorous intensity physical activity levels for the ASD group, however these variables were not associated with child moderate to vigorous intensity physical activity levels in the typically developing group (see Table 2). Fisher's r-to-z scores indicated no significant difference between the ASD and typically developing group. Parents reporting that they were constrained in supporting their child's physical activity because they had to care for their <emph>other child/ren</emph> was negatively associated with child moderate to vigorous intensity physical activity levels in the ASD group only, with Fisher's r-to-z scores indicating no significant difference between the ASD and typically developing groups. With respect to parental rules, <emph>children being allowed to play freely in the backyard</emph>, was negatively associated with child moderate to vigorous intensity physical activity in the typically developing group only. Fisher's r-to-z scores indicated no significant difference between the ASD and typically developing group. Regarding physical environment domain variables, only <emph>suitability of neighborhood playgrounds</emph> was positively associated with child moderate to vigorous intensity physical activity in the ASD group only (see Table 2), with Fisher's r-to-z scores indicating no significant difference between the ASD and typically developing groups.</p> <hd id="AN0137441301-14">Discussion</hd> <p>This study aimed to investigate whether the levels of physical activity engaged in by 4 to 7-year-old children with ASD differed to typically developing children and identify ecological domain correlates of moderate to vigorous intensity physical activity. The results of the current study found support for the hypothesis that children aged between 4 and 7 years with ASD would experience similar levels of moderate to vigorous intensity physical activity compared to typically developing children. Such findings are in line with those of Bandini et al. ([<reflink idref="bib5" id="ref108">5</reflink>]) who reported similar levels of objectively measured physical activity in ASD and typically developing participants, and that of Ketcheson et al. ([<reflink idref="bib35" id="ref109">35</reflink>]) who report similar levels of physical activity in children aged 2 to 5 years, with and without ASD.</p> <p>It was hypothesized that individual domain variables (greater sleep difficulties, and child constraints) would be associated with lower levels of moderate to vigorous intensity physical activity, whilst children being <emph>independently active</emph> and <emph>active transport</emph>, would be associated with higher levels of moderate to vigorous intensity physical activity. Child age was also examined, with results nearing significance, indicating that this may have an effect on physical activity levels, when accounting for child sex. However, no significant associations (positive or negative) were found. Only one other study to date has explored the association between physical activity and sleep in children with and without ASD (Tatsumi et al. [<reflink idref="bib59" id="ref110">59</reflink>]) finding an association between sleep problems and reduced levels of physical activity in a small sample of children with and without ASD. The results of the current study lend support for this association, as behavioral sleep problems were associated with moderate to vigorous intensity physical activity in the ASD group. However, this association was not significantly different from the typically developing group, so either the sample was not large enough to show a difference, or associations between moderate to vigorous intensity physical activity or sleep issues are similar for both typically developing children with ASD. Nonetheless, it should be noted that the sample size was the same for the ASD group in both studies (n = 31) and the sample for the current studies typically developing group was slightly larger than that of Tatsumi et al. (n = 23 and n = 16 respectively).</p> <p>Regarding familial domain variables, parental beliefs were associated with moderate to vigorous intensity physical activity in the ASD group only. Again, this association was not significantly different from the typically developing group. Loprinzi and Trost ([<reflink idref="bib39" id="ref111">39</reflink>]) found no association between familial domain variables and moderate to vigorous intensity physical activity in typically developing children whereas Pugliese and Tinsley ([<reflink idref="bib51" id="ref112">51</reflink>]) found an association between familial domain variables and moderate to vigorous intensity physical activity in the typically developing population. More recently, Bingham et al. ([<reflink idref="bib6" id="ref113">6</reflink>]) reported inconsistent results regarding to familial domain variables and moderate to vigorous intensity physical activity in their systematic review of typically developing children.</p> <p>The current study found associations between suitability of playgrounds and child moderate to vigorous intensity physical activity in the ASD group only which provides support for prior studies in the ASD population (Obrusnikova and Cavalier [<reflink idref="bib45" id="ref114">45</reflink>], Memrari et al. [<reflink idref="bib43" id="ref115">43</reflink>]). This may imply that suitability of playgrounds may play a bigger role in the level of moderate to vigorous intensity physical activity that children with ASD engage in, compared to typically developing children; although this association was not significantly different to typically developing children when assessed by the Fishers test. The inconsistent nature of findings both within and between groups may be due to a range of factors, such as parents of ASD children being more aware of physical activity levels because of their child's participation in early intervention, or having different expectations of them due to their diagnosis or simply due the study being under powered.</p> <p>The strengths of the current study include the use of robust methodology for determining the diagnosis of ASD and rigorous objective assessment of children's moderate to vigorous intensity physical activity. This study was the first to investigate a range of potential correlates across three domains of the ecological model of moderate to vigorous intensity physical activity in children with ASD.</p> <p>The current study is also the first to investigate moderate to vigorous intensity physical activity levels of children with ASD in Australia utilizing a predominately matched sample. Recruiting such a young sample with ASD, is challenging as it is at a time were most children are newly diagnosed. Adding such complex testing at this time sensitive period often proves too stressful families in terms of respondent burden. Adding to the difficulty of recruiting, were the requirements of the wearing of objective monitoring of activity level for an extended period, which was too challenging for some young participants, due to sensory issues. Bandini et al. ([<reflink idref="bib5" id="ref116">5</reflink>]) note that only 66% of their ASD sample and 81% of their typically developing sample had valid physical activity data. The current study experienced a similar success rate, with 82% of the ASD sample with valid data and 63% of the typically developing sample with valid data. The current study also utilised age appropriate cut points which have been previously validated (Janssen et al. [<reflink idref="bib30" id="ref117">30</reflink>]), an important contribution to the literature. This builds on past work by Bandini et al. ([<reflink idref="bib5" id="ref118">5</reflink>]) who highlight that the application of one set of cut points to their sample of 3 to 11-year-old children may have resulted in errors in the interpretation on levels of activity experienced by participants in their study.</p> <p>The main limitation was a small sample size which reduced the power and may have contributed to a lack of statistically significant differences found between ASD and typically developing children, despite means suggesting group differences; alternatively, no differences may exist in this age range. Most previous studies using objective measures of physical activity in children with ASD have had participant numbers less than the current study (i.e. Ayvazoglu et al. [<reflink idref="bib3" id="ref119">3</reflink>]; Ketcheson et al. [<reflink idref="bib35" id="ref120">35</reflink>]; Pan [<reflink idref="bib47" id="ref121">47</reflink>]; Sandt and Frey [<reflink idref="bib54" id="ref122">54</reflink>]; Tatsumi et al. [<reflink idref="bib59" id="ref123">59</reflink>]). Effect sizes of the current study were similar to that of past research (e.g. Ketcheson et al. [<reflink idref="bib35" id="ref124">35</reflink>]; Pan [<reflink idref="bib47" id="ref125">47</reflink>]; Sandt and Frey [<reflink idref="bib54" id="ref126">54</reflink>]). As such this study will add to the literature by highlighting variables which might enhance physical activity that can be investigated in the future in this target group. Potential differences may also be accounted for by the impact of ID, which was unable to be adequately assessed. Previous research in physical activity levels in ASD is further limited by most studies opting to exclude children with an additional ID diagnosis (i.e. Memrari et al. [<reflink idref="bib43" id="ref127">43</reflink>]). The current findings indicated no difference in the low levels of moderate to vigorous intensity physical activity engagement between children with ASD and typically developing children. This highlights a potential window of opportunity to better engage children with ASD, to establish adequate levels of moderate to vigorous intensity physical activity early on. This may lead to improvements in levels of engagement in moderate to vigorous intensity physical activity throughout adolescence and adulthood, where levels of moderate to vigorous intensity physical activity decrease, relative to controls (McCoy et al. [<reflink idref="bib41" id="ref128">41</reflink>]). The study also highlights a potential association between sleep and moderate to vigorous intensity physical activity in children with ASD, lending further support to the notion that sleep impairments are associated with a more severe phenotype of ASD (Jeste [<reflink idref="bib32" id="ref129">32</reflink>]), which may have implications for improving engagement in moderate to vigorous intensity physical activity.</p> <p>In summary, the preschool years present a unique window of opportunity for children with developmental disorders, such ASD, to be appropriately engaged in moderate to vigorous intensity physical activity, to ensure more positive outcomes in the later years. This study has provided exploratory research to set the scene for future research to investigate ecological domain correlates of moderate to vigorous intensity physical activity using larger and equivalent matched samples to detect potential group differences and meaningful associations between children with and without ASD. Furthermore, the preliminary findings of this study support the need for further studies to explore what drives moderate to vigorous intensity physical activity engagement in children with ASD.</p> <hd id="AN0137441301-15">Funding</hd> <p>The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: S.T. is funded by a Rotary Health Illawarra Sunrise scholarship. T.H. was funded by a National Health and Medical Research Council Early Career Fellowship (APP1070571). This study was funded by Deakin University's Faculty of Health. N.R received funding from the Moose Foundation and the Australian Football League to conduct research in the field of neurodevelopmental disorders and inclusion. Nicole Rinehart also received funding from the Ferrero Group Australia as part of its Kinder + Sport pillar of Corporate Social Responsibility initiatives to promote active lifestyles among young people.</p> <hd id="AN0137441301-16">Acknowledgments</hd> <p>The authors thank all families and pediatricians for taking part in the study and Rotary Health for their continued support.</p> <hd id="AN0137441301-17">Appendix: Subset of Ecological Correlates from the HAPPY Survey</hd> <p></p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Construct</p></th><th align="left" colspan="2"><p>Survey question</p></th><th align="left"><p>Reliability</p></th></tr></thead><tbody><tr><td align="left" colspan="4"><p>Individual</p></td></tr><tr><td align="left"><p> Child preference for activity</p></td><td align="left" colspan="2"><p><italic>My child is active by him/herself</italic> (measured on a 5-point scale, with a possible total score of 1–5)</p></td><td align="left"><p>Kappa: 0.78</p></td></tr><tr><td align="left"><p> Child constraints</p></td><td align="left" colspan="2"><p><italic>My child does not have enough energy to do more physical activity; my child does not have enough time to do physical activity; my child does not have anyone to be physically active with, my child just does not enjoy being physically activity; the right facilities are not available for my child to do more physical activity; my child is too overweight to participate in physical activity; my child feels uncomfortable with groups of children; my child does not have good enough skills to do more physical activity; my child will have more freedom and opportunities to be active when he/she is older partner</italic> (each item measured on a 5-point scale, and combined to give an overall 'constraints' score, with a possible total score of 9–40)</p></td><td align="left"><p>ICC: 0.68</p></td></tr><tr><td align="left"><p> Active transport</p></td><td align="left" colspan="2"><p><italic>How often does your child usually: walk to kinder/school; walk to other destinations; ride a bike/scooter to kinder/school; ride a bike/scooter to other destinations partner</italic> (each item measured on a 5-point scale, and combined to give an overall 'active transport' score, with a possible total score of 4–20)</p></td><td align="left"><p>ICC: 0.75</p></td></tr><tr><td align="left" colspan="4"><p>Parental correlates</p></td></tr><tr><td align="left"><p> Parental constraints</p></td><td align="left" colspan="2"><p><italic>I am too tired to support my child to be active (e.g. play outside with him/her, take him/her to park); Looking after my other child/ren stops me from supporting my child to be active</italic> (each item measured on a 5-point scale, with a possible score of 1–5 for each measure)</p></td><td align="left"><p>Kappa: 0.69</p></td></tr><tr><td align="left"><p> Beliefs</p></td><td align="left" colspan="2"><p><italic>I am satisfied with the amount of physical activity my child does; My child does enough physical activity to keep him/her healthy;</italic> (each item measured on a 5-point scale, with a possible total score of 1–5 for each variable)</p></td><td align="left"><p>Internal reliability = 0.63</p></td></tr><tr><td align="left"><p> Rules</p></td><td align="left" colspan="2"><p><italic>My child is able to play freely in the backyard whenever he/she wants to; My child is able to play freely in the street whenever he/she wants to</italic> (each item measured on a 5-point scale, with a possible total score of 1–5)</p></td><td align="left"><p>0.62</p></td></tr><tr><td align="left"><p> PA role models (parents)</p></td><td align="left" colspan="2"><p><italic>My child sees me being active, my child sees my partner being active</italic> (measured on a 5-point scale from strongly disagree to strongly agree; possible total score of 2–10)</p></td><td align="left"><p>ICC: 0.64</p></td></tr><tr><td align="left"><p>Parents physically active with child</p></td><td align="left" colspan="2"><p>Assessed by asking how often are the following people physically active with your child? <italic>You, your partner</italic> (measured on a 5-point scale, and combined to give an overall 'active with child' score; possible total score of 2–10)</p></td><td align="left"><p>ICC: 0.61</p></td></tr><tr><td align="left"><p>Physical environment</p></td><td align="left" colspan="2" /><td align="left" /></tr><tr><td align="left"><p> Suitability of neighbourhood playgrounds</p></td><td align="left" colspan="2"><p><italic>Number of suitable playgrounds in the neighbourhood, variety and suitability of equipment, and usability of playgrounds</italic> (each item measured on a 5-point scale, and combined to give an overall 'suitability' score with a possible total score of 5–25)</p></td><td align="left"><p>ICC: 0.59</p></td></tr><tr><td align="left"><p> Toys and equipment available</p></td><td align="left" colspan="2"><p>Child access to toys and equipment at home to be physically active with (e.g. <italic>balls, billy cart, skipping rope, trampoline</italic>) were summed via the use of available equipment answered '<italic>yes/no'</italic> for a possible 'total equipment' score ranging from 0 to 24</p></td><td align="left"><p>ICC: 0.89</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0137441301-18">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0137441301-19"> <title> References </title> <blist> <bibl id="bib1" idref="ref57" type="bt">1</bibl> <bibtext> Alderman BL, Benham-Deal TB, Jenkins JM. 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  Data: Young Children with ASD Participate in the Same Level of Physical Activity as Children without ASD: Implications for Early Intervention to Maintain Good Health
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  Data: English
– Name: Author
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  Data: <searchLink fieldCode="AR" term="%22Thomas%2C+S%2E%22">Thomas, S.</searchLink><br /><searchLink fieldCode="AR" term="%22Hinkley%2C+T%2E%22">Hinkley, T.</searchLink><br /><searchLink fieldCode="AR" term="%22Barnett%2C+L%2E+M%2E%22">Barnett, L. M.</searchLink><br /><searchLink fieldCode="AR" term="%22May%2C+T%2E%22">May, T.</searchLink><br /><searchLink fieldCode="AR" term="%22Rinehart%2C+N%2E%22">Rinehart, N.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. Aug 2019 49(8):3278-3289.
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  Data: Springer. Available from: Springer Nature. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
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  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
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  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2019
– Name: TypeDocument
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  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Autism%22">Autism</searchLink><br /><searchLink fieldCode="DE" term="%22Pervasive+Developmental+Disorders%22">Pervasive Developmental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Activities%22">Physical Activities</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Activity+Level%22">Physical Activity Level</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Intervention%22">Early Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Promotion%22">Health Promotion</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Health%22">Child Health</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+Diagnosis%22">Clinical Diagnosis</searchLink>
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  Label: DOI
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  Data: 10.1007/s10803-019-04026-9
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Primary-school-aged children and adolescents with autism spectrum disorder (ASD) are reported to engage in lower levels of moderate-to-vigorous physical activity (MVPA) compared to typically developing (TD) children (Jones et al. in PLoS ONE, 12(2):1-23, 2017). Levels of MVPA in young children with ASD remain unclear. This study aimed to investigate MVPA in 4-to-7-year-old children with (n = 37) and without (n = 40) ASD, to determine if MVPA is related to ASD diagnosis; and examine correlates to better inform interventions. Results indicated children with ASD engage in the same levels of MVPA as TD children. Future studies need to further explore MVPA in children with ASD over time to uncover when the divergence in MVPA levels occur and what factors may be associated.
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  Data: 2019
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  Data: EJ1221789
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        Value: 10.1007/s10803-019-04026-9
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      – TitleFull: Young Children with ASD Participate in the Same Level of Physical Activity as Children without ASD: Implications for Early Intervention to Maintain Good Health
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