Autism Spectrum Disorder and Health-Determining Behaviors: Assessing Physical Activity, Screen Time, and Sleep with the National Survey of Children's Health.

U.S. Children Meeting Physical Activity, Screen Time, and Sleep Guidelines

Autistic children are less likely to participate in sport than non-autistic children, but we know little about how patterns of participation in team and individual sport change across childhood. Drawing on a nationally representative cohort of Australian children, this study analysed trajectories of participation in team and individual sport between the ages of 8 and 15 using a group-based multiple trajectory modelling approach. A five-group solution was found to be the best fit to the data, identifying distinct patterns of sport participation over time. In comparison with non-autistic children, autistic children were more likely to belong to the 'sport avoider' group with low participation in both team and individual sport at all ages. Conversely, autistic children were less likely to be classified in the 'team sportsperson', 'ex-team sportsperson' or 'mixed sportsperson' groups. No difference in the likelihood of belonging to the 'individual sportsperson' group was found. Risk factors for trajectory group membership were similar for autistic and non-autistic children. Our findings indicate that autistic children are particularly likely to experience exclusion from team sport environments, and this exclusion persists over time. Similar rates of participation in individual sport for autistic and non-autistic children indicate that these environments may be more supportive for autistic children.Lay abstractAutistic children are less likely to participate in sport than non-autistic children, but we know little about how patterns of participation in team and individual sport change across childhood. Drawing on data for a group of Australian children whose families were reinterviewed between ages 8 and 15, the present study patterns of participation in team and individual sport over time. Findings from the analysis suggested that children could be grouped into five patterns of participation in team and individual sport between the ages of 8 and 15. In comparison with non-autistic children, autistic children were more likely to belong to the 'sport avoider' group with low participation in both team and individual sport at all ages. Conversely, autistic children were less likely to belong to the 'team sportsperson', 'ex-team sportsperson' or 'mixed sportsperson' groups. Similar numbers of autistic and non-autistic children belonged to the 'individual sportsperson' group. Factors linked to patterns of participation over time were similar for autistic and non-autistic children. Our findings indicate that autistic children are particularly likely to experience exclusion from team sport environments, and this exclusion persists over time. Similar rates of participation in individual sport for autistic and non-autistic children indicate that these environments may be more supportive for autistic children.

Limited evidence suggests inequality in the prevalence of physical activity and screen time for children of non-English-speaking backgrounds (NESB). However, factors associated with these behaviours are understudied. This study identified the prevalence and correlates of meeting guidelines (physical activity, screen time and combined) among children of English-speaking backgrounds (ESB) and NESB. Participants were from the Mothers and their Children's Health Study, a sub-study of the Australian Longitudinal Study on Women's Health (1973-1978 cohort). Mothers provided information on physical activity and screen time behaviours of up to three children (aged 2-12 years). Age-specific Australian guidelines were used to classify children as meeting or not meeting physical activity and screen time guidelines. Those born in a non-English-speaking country or primarily speaking a non-English language at home were classified as 'NESB'. Multivariable-adjusted logistic regression analyses accounting for family-level clustering were used for analysis. Data were from 4143 children (mean age 7.3 ± 2.9 years, 6.7% NESB). Around 17% children of NESB met physical activity guidelines (vs. 25% ESB, p = 0.002), 63% met screen time guidelines (vs. 58% ESB, p = 0.150), and 9% met combined physical activity and screen time guidelines (vs. 15% ESB, p = 0.011). Increasing age was inversely associated with meeting physical activity guidelines among children of both backgrounds (OR [95%CI]: NESB 0.81 [0.69-0.95], ESB 0.85 [0.82-0.87]). Family-level correlates (maternal education and physical activity level) were associated with meeting physical activity, screen time or combined guidelines among children of ESB only. A screen device in the child's bedroom was inversely associated with all outcomes among children of ESB. Children of NESB with a large yard at home had higher odds of meeting physical activity (4.14 [1.72-10.00]) and combined guidelines (4.48 [1.61-12.41]). Children of NESB were less likely to meet physical activity and combined guidelines. Interventions may need to be tailored based on ESB background, with children of NESB (particularly older children and those with limited outdoor space at home) being a higher priority for intervention. Future large-scale studies examining a broader range of potential correlates, including cultural factors, are warranted.

Autism spectrum disorder (ASD) is a developmental disorder characterized by persistent deficits in social communication and interaction. Speech is an important form of social communication. Prosody (e.g. vocal pitch, rhythm, etc.), one aspect of the speech signal, is crucial for ensuring information about the emotionality, excitability, and intent of the speaker, is accurately expressed. The objective of this study was to gain a better understanding of how auditory information is used to regulate speech prosody in autistic and non-autistic children, while exploring the relationship between the prosodic control of speech and social competence. Eighty autistic (M = 8.48 years, SD = 2.55) and non-autistic (M = 7.36 years, SD = 2.51) participants produced vocalizations while exposed to unaltered and frequency altered auditory feedback. The parent-report Multidimensional Social Competence Scale was used to assess social competence, while the Autism-Spectrum Quotient and the Autism Spectrum Rating Scales were used to assess autism characteristics. Results indicate that vocal response magnitudes and vocal variability were similar across autistic and non-autistic children. However, autistic children produced significantly faster responses to the auditory feedback manipulation. Hierarchical multiple regressions indicated that these faster responses were significantly associated with poorer parent-rated social competence and higher autism characteristics. These findings suggest that prosodic speech production differences are present in at least a subgroup of autistic children. These results represent a key step in understanding how atypicalities in the mechanisms supporting speech production may manifest in social-communication deficits, as well as broader social competence, and vice versa. Autism Res 2020, 13: 1880-1892. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: In this study, autistic and non-autistic children produced vowel sounds while listening to themselves through headphones. When the children heard their vocal pitch shifted upward or downward, they compensated by shifting their vocal pitch in the opposite direction. Interestingly, autistic children were faster to correct for the perceived vowel sound changes than their typically developing peers. Faster responses in the children with ASD were linked to poorer ratings of their social abilities by their parent. These results suggest that autistic and non-autistic children show differences in how quickly they control their speech, and these differences may be related to the social challenges experienced by autistic children.

This study aimed to explore the association between meeting 24‐h movement guidelines and academic performance among Chinese children and adolescents. Cross‐sectional data on 67,281 Chinese children and adolescents were used for the analyses. Adherence to 24‐h movement guidelines and academic performance (i.e., grades in Chinese, Math, and English), as well as sociodemographic information, were measured using a self‐reported questionnaire. 24‐h movement guidelines recommend at least 60 min/day of moderate to vigorous physical activity (MVPA), no more than 2 h/day of recreational screen time (ST), and 9–11 h/night of sleep for ages 11–13 years or 8–10 h/night for ages 14–17 years. Multilevel generalized linear models were used to explore the associations between 24‐h movement guidelines and academic performance. Results indicated that compared to not meeting any of the three 24‐h movement guidelines, participants meeting one or more guidelines were more likely to report better academic performance in Chinese, Math, and English. Meeting all the three guidelines was associated with better academic performance in Chinese (odds ratio [OR] = 1.56), Math (OR = 1.51), and English (OR = 1.73). Additionally, meeting the physical activity (PA) guidelines only was associated with better academic performance in Chinese; meeting only the ST guidelines, both ST and sleep guidelines, and both ST and PA guidelines were associated with better academic performance in Chinese, Math, and English. Subgroup analyses indicated that the associations between 24‐h movement guidelines and academic performance varied across grade groups and course subjects. As such, in general, adherence to 24‐h movement guidelines was related to better self‐reported academic performance. Healthy movement behaviors should be promoted for health and academic achievement in Chinese children and adolescents.

Background: Vocabulary composition and word-learning biases are closely interrelated in typical development. Such word-learning biases are influenced by perceptually and conceptually salient word features, including imageability, concreteness, iconicity, and attention to shape. Autistic children often have delayed language acquisition, but there is currently little research examining the underlying mechanisms autistic children use to acquire words. The current study aimed to examine the noun composition of autistic children across a range of vocabulary sizes by examining associations between expressive noun vocabulary size and imageability, iconicity, concreteness and evidence for the shape bias, and to examine whether these patterns differ from their non-autistic peers. Methods: Participants for the word features analyses included 246 autistic children who were reported to produce between 5-312 nouns, and 940 expressive-vocabulary non-autistic children. Participants in the shape bias analyses included 272 autistic children who were reported to produce between 1-312 nouns, and 1,021 expressive-vocabulary and non-autistic children. Expressive vocabulary knowledge was measured using the MacArthur-Bates Communicative Development Inventory (Fenson et al., 2007). Results: Each analysis indicated that imageability, iconicity, and concreteness were associated with noun vocabulary size for both groups. Both groups displayed nonlinear change across vocabulary size, and group differences were found for each perceptual feature except imageability The pattern of the associations differed slightly for concreteness and iconicity for the autistic group, primarily at the very earliest points in noun vocabulary learning. Across the three word features, both autistic and non-autistic children learn highly imageable, iconic, and concrete words during the earliest stages of noun learning. Both groups also demonstrated evidence for the shape bias system, but the trajectory of growth of evidence for the system differed between the two groups. Conclusions: Imageability, iconicity, and concreteness were identified as significant lexicosemantic features for describing expressive noun vocabulary size in autistic children. Although slight differences across word features were observed, autistic children seem to have broadly similar noun vocabularies to their non-autistic peers. Furthermore, autistic children with smaller vocabularies produced more words that are highly imageable, iconic, and concrete, whereas children with larger vocabularies produced words that are less perceptually salient, indicating a potential shift away from reliance on perceptual-based language processing. We report unique information about nonlinear growth patterns associated with each word feature, with evidence for the shape system, and distinctions in these growth patterns between groups. Future studies should explore word-learning and lexical growth patterns involving early verb acquisition in autistic children.

BackgroundAutistic children report higher levels of bullying victimization than their non-autistic peers. However, autistic children with fewer social difficulties, as measured on the Autism Diagnostic Observation Schedule (ADOS), are more likely to report being bullied. Autistic children with stronger social skills may not only be more likely to identify and report incidents of bullying, but they may also be more likely to interact with their non-autistic peers, increasing their likelihood of being victimized. Autistic girls may be especially at-risk of experiencing bullying victimization, as a growing body of research suggests that autistic girls demonstrate fewer social difficulties and are more socially motivated than autistic boys. Here, we explored reported problems with peers and bullying victimization among a carefully matched sample of autistic and non-autistic boys and girls. Qualitative methods were further implemented to gain a more holistic understanding of the social experiences of autistic boys and girls.MethodsThis mixed-methods study analyzed the transcribed clinical evaluations of 58 autistic children (29 girls) matched to 42 non-autistic children (21 girls) on age and IQ. Within each diagnostic group, boys and girls were matched on ADOS severity score. We compared reported problems with peers and bullying victimization across sex and diagnosis. Among autistic children, we further examined whether ADOS social affect (SA), restricted repetitive behaviors, and severity scores predicted problems with peers and bullying victimization. We then identified themes related to personal experiences of victimization.ResultsAutistic children were more likely than non-autistic children to have experienced bullying victimization, and autistic children with lower ADOS severity and SA scores were more likely to report having been bullied. While autistic boys and girls reported similar levels of bullying victimization, qualitative analyses revealed sex differences in the underlying causes of peer conflict.LimitationsThis study was a secondary data analysis. The standardized set of questions on the ADOS limited the amount of information that children provided about their peer relationships, and variations in follow-up questions may have influenced children’s responses.ConclusionsAlthough autism symptomatology places autistic children at greater risk for bullying victimization compared to their non-autistic peers, greater social challenges among autistic children are associated with lower rates of victimization. This study further highlights the importance of using mixed-methods approaches to discover nuances in the social experiences of autistic girls and boys that may become opportunities for support.

Autistic children have been shown to have poorer bone health than their non-autistic peers, but previous evidence on this topic has been based on small clinical samples and is limited by how bone health has been measured. The association between autism and bone health may also reflect confounding by correlated genetic or environmental factors, but prior studies have not addressed this issue. We address these issues using data from a population-representative cohort of Australian children with bone health measured by peripheral quantitative computed tomography (pQCT) for both children and parents. Data for 1,274 children (66 autistic, 1,208 non-autistic) aged 11-12 years (50% male) were drawn from the Child Health CheckPoint within the Longitudinal Study of Australian Children. pQCT measures at the tibial diaphysis (ankle) and metaphysis (shin) were recorded using an identical protocol for children and one attending parent. Child autism was parent reported. Regression analyses were used to compare differences between autistic and non-autistic children, and between parents of autistic children and parents of non-autistic children. Our findings indicate poorer bone health as assessed by tibial pQCT among autistic children compared to non-autistic children at both the metaphysis and diaphysis. No differences in pQCT measures were found between parents of autistic and non-autistic children, suggesting no evidence of confounding by shared genetic or environmental factors. These findings reinforce the need to support improved bone development among autistic children and suggest that differences in bone health are likely driven by behavioural factors that are potentially amenable to intervention.

Compliance with the 24-Hour movement guidelines for the early years: Cross-sectional and longitudinal associations with executive function and psychosocial health in preschool children

Background/Objectives: This study aims to examine the relationships between 24-h movement guideline (24HMG) adherence and macronutrient intake, as well as assess dose–response relationships between 24-h movement behaviors and macronutrient intake among students aged 6–17 years. Methods: The study included 3624 participants aged 6 to 17 years from four rounds (2004–2011) of the Chinese Health and Nutrition Survey (CHNS). Participants’ 24-h movement behaviors and dietary intakes were evaluated. Results: Adherents to physical activity (PA) guideline had higher carbohydrate, fat, and protein intake (all p < 0.05). Those following the screen time (ST) guideline had a higher percentage of dietary energy intake (E%) from carbohydrates but a lower percentage from fat (all p < 0.05). Sleep (SLP) guideline adherents demonstrated lower protein intake and E% (all p < 0.05). PA guideline adherents were less likely to exceed carbohydrate Dietary Reference Intakes (DRIs) (OR = 0.83, 95% CI: 0.69–0.99), but more likely to surpass fat DRIs (OR = 1.20, 95% CI: 1.02–1.40). ST guideline adherents were more likely to exceed carbohydrate DRIs (OR = 1.32, 95% CI: 1.11–1.56) and less likely to surpass fat DRIs (OR = 0.78, 95% CI: 0.68–0.91). Dose–response analyses showed that moderate-to-vigorous physical activity (MVPA) and ST had positive linear associations with carbohydrate intake below DRIs. ST also showed positive linear associations with fat intake above DRIs. MVPA showed a nonlinear relationship with fat intake above DRIs. Conclusions: Among Chinese children and adolescents aged 6–17 years, those who meet the PA guideline should be cautious about the risk of excessive fat intake, while those adhering to the ST guideline should be aware of the risk of excessive carbohydrate intake in their daily diet. For promoting health and maintaining balanced macronutrient intake, MVPA should range from 60 to 90 min per day. This study underscores the importance of adjusting macronutrient intake according to levels of 24-h movement behaviors, especially MVPA and ST.

This study aimed to investigate movement behaviors of Thai preschoolers (aged 3-6 years) occurring outside kindergarten in urban areas across Thailand. Surveillance of digital Media in eArLy chiLdhood Questionnaire® was used to collect data from 1051 parents recruited from 12 schools. Descriptive statistics and logistic regressions were applied for data analysis. Thai preschoolers engaged in physical activity (PA), sedentary screen time, and sleep on weekends significantly more than weekdays with no significant sex differences. Preschoolers met the sleep guidelines the most (62.3%), followed by PA guidelines (48.0%), and screen time (ST) guidelines the least (44.1%). Only 14.6% met the integrated movement guidelines, and 11% met none of the guidelines. Age was positively associated with meeting the PA guidelines, and negatively associated with meeting the sleep and integrated movement guidelines. The number of digital devices at home and geographical region influenced preschoolers in meeting the PA and ST guidelines. Thai preschoolers' time spent on all forms of activities outside kindergarten was significantly more on weekends than weekdays with no sex disparity. The prevalence of meeting the integrated movement guidelines was low, and needs to be addressed through comprehensive programs including all forms of activities concurrently. Thai preschoolers engaged in physical activity (PA), screen time (ST), and sleep on weekends significantly more than weekdays with no significant sex differences. Only 14.6% of preschoolers met the integrated movement guidelines. Age had a significant relationship with meeting the PA, sleep, and integrated movement guidelines. Meeting the PA and ST guidelines in preschoolers was positively associated with the number of digital devices at home. Despite some limitations, this study presented preschoolers' time engaged in the three movement behaviors concurrently, and provided important inputs for development of the national strategic plan to promote PA among Thai children and youth.

BackgroundThe World Health Organization (WHO) has developed guidelines for 24-h physical activity (PA), sedentary behaviour and sleep for young children. Lower socioeconomic status (SES) has been linked to a lower likelihood of meeting these guidelines. The outbreak of the novel coronavirus disease (COVID-19) raised concerns about young children’s opportunities to meet the guidelines. The study focused on the prevalence of meeting the WHO’s 24-h guidelines on screen time (ST), PA and sleep among 2–6-year-old children, in association with family SES, before COVID-19 outbreak in 2019, and during the pandemic in 2020 and 2021 in Finland.MethodsData were collected at three timepoints by an online survey through day-care centres. Meeting the WHO 24-h guidelines was defined for each behaviour, from a parent-reported seven-day recall of a typical day on weekdays and weekend days and adapted to the national context. Children were considered to meet the ST guideline if they had maximum of 60 min of ST, the PA guideline if they had minimum of 60 min of outdoor PA, and the sleep guidelines if they had minimum of 11/10/9 h (2/3–5/6 years) of good or very good quality sleep. Binary logistic regression models were used to examine the odds ratios of meeting the guidelines.ResultsThe prevalence of meeting the ST guideline was highest before the COVID-19 pandemic in 2019. The PA guideline was most met during the strict pandemic restrictions in 2020. Children from higher SES families were more likely to meet the ST and sleep duration guidelines either on weekdays or weekends. The PA guideline was met more on weekdays by children whose parents had lower education levels at all timepoints. In 2020, sleep quality guideline was less likely met by children with parents with the highest education levels.ConclusionHigher SES may increase the odds of young children meeting the ST and sleep duration guidelines, but the results are more complex regarding PA and SES. The impact of the COVID-19 pandemic on ST, outdoor PA, and sleep of young children varied by family SES, and further research is recommended to identify causality of these relationships.

For non-autistic children, it is well established that linguistic awareness skills support their success with reading and spelling. Few investigations have examined whether these same linguistic awareness skills play a role in literacy development for autistic elementary school-age children. This study serves as a first step in quantifying the phonological, prosodic, orthographic, and morphological awareness skills of autistic children; how these skills compare to those of non-autistic children; and their relation to literacy performance. We measured and compared the phonological, prosodic, orthographic, and morphological awareness skills of 18 autistic (with average nonverbal IQs) and 18 non-autistic elementary school-age children, matched in age, nonverbal IQ, and real-word reading. The relations between linguistic awareness and the children's word-level literacy and reading comprehension skills were examined, and we explored whether the magnitude of these relations was different for the two groups. Regression analyses indicated the relative contribution of linguistic awareness variables to performance on the literacy measures for the autistic children. The non-autistic children outperformed the autistic children on most linguistic awareness measures. There were moderate-to-strong relations between performances on the linguistic awareness and literacy measures for the non-autistic children, and most associations were not reliably different from those for the autistic children. Regression analyses indicate that the performance on specific linguistic awareness variables explains unique variance in autistic children's literacy performance. Although less developed than those of their non-autistic peers, the linguistic awareness skills of autistic elementary school-age children are important for successful reading and spelling.

Many autistic individuals face social challenges that may be due to the negative perceptions of their non-autistic peers. This study investigated school-aged children’s first impressions of autistic and non-autistic children. Thirty-seven children (ages 5-12 years) watched brief videos of autistic and non-autistic children discussing their interests and rated these children’s traits, and their behavioral intentions towards the children. Autistic children were rated as more awkward, aggressive, and less likeable, though the raters’ willingness to interact with the children in the videos was similar for both autistic and non-autistic children. The raters’ negative perceptions of the autistic children were not related to the raters' age, IQ, sex, autistic traits, or social competence. Future work should aim to further investigate what factors influence biases. These findings highlight the need for interventions in school settings to address early perceptions of autism. Educating children about autism can help challenge stereotypes and promote inclusion, ultimately fostering more positive interactions between autistic and non-autistic children.

Autistic people are often portrayed as lacking empathy. Yet they are not indifferent to others’ feelings. To advance our understanding of the early development of empathy in autistic children, this longitudinal study followed the development of four empathy abilities: emotion contagion, attention to others, emotion acknowledgment, and prosocial actions, in 1- to 6-year-old autistic children (N = 61; Mage = 55.49 months), in comparison with non-autistic peers (N = 145; Mage = 52.16 months). Once a year, for 4 consecutive years, children’s empathic reactions were evaluated by experimenters who acted out emotional episodes to elicit empathy in children, and by parents who filled out empathy questionnaires. We confirmed autistic children’s difficulty attending to others, acknowledging others’ emotions, and initiating prosocial actions. However, according to parents, they did not differ from non-autistic children in emotion contagion with others’ negative emotions. Notably, autistic children showed a greater increase in prosocial actions over time than their non-autistic peers. We discussed how to interpret these findings in light of the “double empathy problem,” and stressed the importance of removing the stereotypical view of autism. Furthermore, this study was among the first to show that autistic children have the potential to learn and to improve empathy skills.Lay abstractEmpathy is a highly valued human capacity. Yet, autistic people are often portrayed as lacking in empathy. Recent research, which views empathy as a complex construct emerging from multiple interrelated emotional and cognitive processes, argues that, although many autistic people do have difficulty understanding others’ emotions, and this may hinder them from responding to others in a prosocial manner, they are not indifferent to other people’s feelings. Hoping to contribute to a better understanding of the unique challenges that autistic children face in their empathy development, we followed the development of four empathy abilities: emotion contagion, attention to others, emotion acknowledgment, and prosocial actions, in 1- to 6-year-old autistic children, in comparison with non-autistic children. Once a year, for 4 consecutive years, children’s empathy abilities were evaluated by experimenters who acted out emotional episodes to provoke empathy in children, and by parents who filled out empathy questionnaires. We found that autistic children experienced indeed more difficulty attending to others, acknowledging others’ emotions, and initiating prosocial actions toward others. However, according to parents, they did not differ from their non-autistic peers in feeling along with others’ negative emotions. This indicates that it might not be the case that autistic children did not want to act empathetically toward others. Rather, they might not know how to do so. Notably, despite these difficulties, when looking at children’s developmental trajectories, autistic children showed similar improvements over time as non-autistic children. This provides evidence that autistic children have the potential to learn and to improve their empathy skills.