Meghann Lloyd

Motor skills of toddlers with autism spectrum disorders

With increased interest in the early diagnosis and treatment of children with autism spectrum disorders (ASD), more attention has been called to the motor skills of very young children with ASD. This study describes the gross and fine motor skills of a cross-sectional group of 162 children with ASD between the ages of 12 and 36 months, as well as a subset of 58 children followed longitudinally. Gross motor and fine motor age equivalent scores were obtained for all children. A ‘motor difference’ variable was calculated for each child’s gross and fine motor skills by taking the absolute difference of the children’s age equivalent motor score and their respective chronological age. In Study 1 (the cross-sectional analysis), ANCOVA (co-varied for nonverbal problem solving) revealed significant group differences in the gross motor and fine motor age difference variables. Post-hoc analysis revealed that gross motor and fine motor differences became significantly greater with each 6-month period of chronological age. In Study 2, 58 children were measured twice, an average of 12 months apart. Results indicate that the gross motor and fine motor difference scores significantly increased between the first and second measurements. The importance of addressing motor development in early intervention treatments is discussed.

Effects of Intensity of Treadmill Training on Developmental Outcomes and Stepping in Infants With Down Syndrome : A Randomized Trial

Background and Purpose: Infants with Down syndrome (DS) are consistently late walkers. The purpose of this investigation was to test the effects of individualized, progressively more intense treadmill training on developmental outcomes in infants with DS. Subjects: Thirty infants born with DS were randomly assigned to receive lower-intensity, generalized treadmill training or higher-intensity, individualized training implemented by their parents in their homes. Methods: Research staff members monitored implementation of training, physical growth, and onset of motor milestones of all infants on a monthly basis. Results: Infants in the higher-intensity, individualized training group increased their stepping more dramatically over the course of training. Infants in the higher-intensity training group attained most of the motor milestones at an earlier mean age. Discussion and Conclusion: Treadmill training of infants with DS is an excellent supplement to regularly scheduled physical therapy intervention for the purpose of reducing the delay in the onset of walking.

Physical Activity Benefits of Learning to Ride a Two-Wheel Bicycle for Children With Down Syndrome: A Randomized Trial

Background People with Down syndrome (DS) display consistent patterns of physical inactivity. If these sedentary behaviors continue over extended periods of time, there will be negative health consequences. Objective The objective of this study was to investigate the physical activity and health-related outcomes of teaching children with DS to ride a 2-wheel bicycle. Design This study was a randomized intervention in which the control group waited 1 year to receive the intervention. Setting This intervention study was conducted in a community setting. Participants The participants were children who were 8 to 15 years of age and who had been diagnosed with DS. Intervention The participants were randomly assigned to an experimental group (bicycle intervention) or a control group (no intervention). Measurements Measurements were obtained in the month before the intervention (preintervention), at 7 weeks after the intervention, and at 12 months after the preintervention measurement for all participants. Results The results indicated no group differences at the preintervention session. Fifty-six percent of the participants in the experimental group successfully learned to ride a 2-wheel bicycle during the 5-day intervention. Analysis showed that participants who learned to ride spent significantly less time in sedentary activity at 12 months after the preintervention measurement and more time in moderate to vigorous physical activity than participants in the control group. Body fat appeared to be positively influenced over time in participants who learned to ride. Limitations It is unknown how frequently the children in the experimental group rode their bicycles after the intervention. Conclusions Most children who are 8 to 15 years of age and who have been diagnosed with DS can learn to ride a 2-wheel bicycle. Learning to ride can reduce time spent in sedentary activity and increase time spent in moderate to vigorous physical activity, which may influence the health and functioning of these children.

Body mass index of adults with intellectual disability participating in Special Olympics by world region

BACKGROUND People with intellectual disability (ID) experience poorer health and have more unmet health needs compared with people without ID, and they are often absent from population health surveillance. The aim of this study was to describe the body mass index (BMI) status of adult Special Olympics participants by world region and gender. Additionally, the general influence of age and gender on overweight/obesity of all participants was explored. METHOD A total of 11 643 (7150 male and 4493 female) Special Olympics BMI records were available from the Special Olympics International Health Promotion database. BMI was compared by gender and world region. Logistic regression was used to examine whether age and gender were associated with the likelihood of being overweight/obese (BMI ≥ 25.0). RESULTS Overall, 5.5% of the sample was underweight, 36.1% in the normal range, 24.7% overweight and 32.1% obese, and levels of overweight/obesity were very high in North America. Both age and gender were significant predictors of overweight/obesity (odds ratios 1.06 and 0.59, respectively). CONCLUSIONS Our findings demonstrate that adult Special Olympics participants have high levels of overweight and obesity; particularly among women and those from North America. It is crucial that those who work with, care for, coach and live with adults with ID who participate in Special Olympics increase efforts to promote healthy weight status.

International BMI comparison of children and youth with intellectual disabilities participating in Special Olympics

The purpose of this study was to describe the BMI status of children and youth with intellectual disabilities by world region, gender and age. A total of 9678 children and youth records were available from the Special Olympics International Health Promotion database after data cleaning (6084 boys and 3594 girls). Children were defined as 8-11 year olds (n=2035), and youth were defined as 12-18 year olds (n=7643). BMI prevalence rates were computed using the International Obesity Task Force (IOTF) cut-points, and logistic regression was used to determine if either age or gender was associated with being overweight or obese. Approximately 30% of the sample was overweight or obese; however, the prevalence rates in North America were much higher, particularly among girls. Fifty-four percent of girls (95% confidence interval [CI], 51.4-57.2%) were overweight or obese. Logistic regression revealed that both age and gender were significant predictors in North America; however this pattern was not consistent throughout the world regions. BMI status is a significant indicator of health, and these findings suggest that overweight and obesity are significant health concerns for children and youth with intellectual disabilities around the world. Obesity rates in this population are particularly high in North America, and the odds of becoming overweight or obese increased with age in North America. It is critical that health professionals increase Health Promotion efforts, including physical activity and healthy eating behaviors for children and youth with intellectual disabilities.

Canadian Agility and Movement Skill Assessment (CAMSA): Validity, objectivity, and reliability evidence for children 8–12 years of age

Purpose The primary aim of this study was to develop an assessment of the fundamental, combined, and complex movement skills required to support childhood physical literacy. The secondary aim was to establish the feasibility, objectivity, and reliability evidence for the assessment. Methods An expert advisory group recommended a course format for the assessment that would require children to complete a series of dynamic movement skills. Criterion-referenced skill performance and completion time were the recommended forms of evaluation. Children, 8–12 years of age, self-reported their age and gender and then completed the study assessments while attending local schools or day camps. Face validity was previously established through a Delphi expert (n = 19, 21% female) review process. Convergent validity was evaluated by age and gender associations with assessment performance. Inter- and intra-rater (n = 53, 34% female) objectivity and test–retest (n = 60, 47% female) reliability were assessed through repeated test administration. Results Median total score was 21 of 28 points (range 5–28). Median completion time was 17 s. Total scores were feasible for all 995 children who self-reported age and gender. Total score did not differ between inside and outside environments (95% confidence interval (CI) of difference: −0.7 to 0.6; p = 0.91) or with/without footwear (95%CI of difference: −2.5 to 1.9; p = 0.77). Older age (p < 0.001, η2 = 0.15) and male gender (p < 0.001, η2 = 0.02) were associated with a higher total score. Inter-rater objectivity evidence was excellent (intraclass correlation coefficient (ICC) = 0.99) for completion time and substantial for skill score (ICC = 0.69) for 104 attempts by 53 children (34% female). Intra-rater objectivity was moderate (ICC = 0.52) for skill score and excellent for completion time (ICC = 0.99). Reliability was excellent for completion time over a short (2–4 days; ICC = 0.84) or long (8–14 days; ICC = 0.82) interval. Skill score reliability was moderate (ICC = 0.46) over a short interval, and substantial (ICC = 0.74) over a long interval. Conclusion The Canadian Agility and Movement Skill Assessment is a feasible measure of selected fundamental, complex and combined movement skills, which are an important building block for childhood physical literacy. Moderate-to-excellent objectivity was demonstrated for children 8–12 years of age. Test–retest reliability has been established over an interval of at least 1 week. The time and skill scores can be accurately estimated by 1 trained examiner.

The Canadian Assessment of Physical literacy: Development of a model of children's capacity for a healthy, active lifestyle through a Delphi process

BACKGROUND The Canadian Assessment of Physical Literacy (CAPL) was conceptualized as a tool to monitor childrens physical literacy. The original model (fitness, activity behavior, knowledge, motor skill) required revision and relative weights for calculating/interpreting scores were required. METHODS Nineteen childhood physical activity/fitness experts completed a 3-round Delphi process. Round 1 was open-ended questions. Subsequent rounds rated statements using a 5-point Likert scale. Recommendations were sought regarding protocol inclusion, relative importance within composite scores and score interpretation. RESULTS Delphi participant consensus was achieved for 64% (47/73) of statement topics, including a revised conceptual model, specific assessment protocols, the importance of longitudinal tracking, and the relative importance of individual protocols and composite scores. Divergent opinions remained regarding the inclusion of sleep time, assessment/ scoring of the obstacle course assessment of motor skill, and the need for an overall physical literacy classification. CONCLUSIONS The revised CAPL model (overlapping domains of physical competence, motivation, and knowledge, encompassed by daily behavior) is appropriate for monitoring the physical literacy of children aged 8 to 12 years. Objectively measured domains (daily behavior, physical competence) have higher relative importance. The interpretation of CAPL results should be reevaluated as more data become available.

Effectiveness of a fundamental motor skill intervention for 4-year-old children with autism spectrum disorder: A pilot study

A wait-list control experimental design was employed to investigate the effectiveness of a fundamental motor skill intervention at improving the motor skills, adaptive behavior, and social skills of 4-year-old children with autism spectrum disorder (experimental n = 5, control n = 4); the impact of intervention intensity was also explored. The experimental group significantly improved their object manipulation and overall motor scores from pre- to post-intervention. The wait-list control design revealed no group-by-time interactions; however, with the groups combined time was a significant factor for all motor variables. There were no significant changes in adaptive behavior and social skills. These preliminary findings suggest that a fundamental motor skill intervention may benefit young children with autism spectrum disorder. Future research with larger samples is warranted.

A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder

The purpose of this review was to systematically search and critically analyse the literature pertaining to behavioural outcomes of exercise interventions for individuals with autism spectrum disorder aged ⩽16 years. This systematic review employed a comprehensive peer-reviewed search strategy, two-stage screening process and rigorous critical appraisal, which resulted in the inclusion of 13 studies. Results demonstrated that exercise interventions consisting individually of jogging, horseback riding, martial arts, swimming or yoga/dance can result in improvements to numerous behavioural outcomes including stereotypic behaviours, social-emotional functioning, cognition and attention. Horseback riding and martial arts interventions may produce the greatest results with moderate to large effect sizes, respectively. Future research with well-controlled designs, standardized assessments, larger sample sizes and longitudinal follow-ups is necessary, in addition to a greater focus on early childhood (aged 0–5 years) and adolescence (aged 12–16 years), to better understand the extent of the behavioural benefits that exercise may provide these populations.

Body mass index of children and youth with an intellectual disability by country economic status

OBJECTIVE Individuals with intellectual disabilities are at higher risk for health disparities including overweight and obesity; however, little is known at the population level about the BMI status of children and youth with intellectual disabilities. This study is a secondary analysis of BMI status (underweight, normal weight, overweight and obese) in children and youth (8-<18years) participating in Special Olympics by country economic status. METHODS A total of 14,032 participants (n=8,856 male) measured height and weight records were available from the Special Olympics International Health Promotion database. The 141 countries in the database were re-coded according to the World Banks classification of country economic status. BMI prevalence rates were calculated for underweight, normal weight, overweight, and obesity for children and youth using IOTF cutoffs by economic status. Chi-squared analyses and Fishers exact test were used to examine differences in weight status by economy and sex. FINDINGS Overall, 27.87% of Special Olympics participants from low-income economies, 31.04% from lower middle-income, 25.29% from upper middle-income, and 42.36% from high-income economies had BMI levels outside of the normal range. The low-income countries had higher rates of underweight and the high-income countries had higher rates of obesity. CONCLUSIONS The high levels of both underweight and overweight/obesity found in this population of children and youth participating in Special Olympics represents a double burden of health risk. More research is needed to understand why this population experiences such disparities in BMI status and to develop health promotion initiatives targeted at this population.