CC BY
26
ORIGINAL ARTICLE
Comparing the gross motor performance levels of 7-10 age group children with autism spectrum disorder and typical developing
Ebubekir AksayABCDE
Department of Health, Rehabilitation and Disability Sport, Germany TV Eberbach e.V., Eberbach, Germany Gelisim University School of Physical Education and Sport Istanbul, Turkey
Authors' Contribution: A - Study design; B - Data collection; C - Statistical analysis; D - Manuscript Preparation; E -Funds Collection.
Abstract
Background The children and adolescents with Autism Spectrum Disorder lead a sedentary lifestyle and, as and Study Aim a result, they are more affected by health problems such as being overweight and obese. They are physically less active than their peers showing typical developing. The aim of the study is to carry out a general comparison of the gross motor performance levels of elementary school-age children living in Germany diagnosed with autism spectrum disorder and children showing typical developing.
A total of 68 children diagnosed with autism spectrum disorder and 73 children showing normal development between the ages 7 and 10 participated in the study. Of the participants, 55 were diagnosed with autism spectrum disorder were boys and 13 were girls, and the average age of the boys was 8.40±1.09 years, while the average age of the girls was 8.85±1.14 years. Of the 73 participants, 36 showing typical development consisted of boys and 37 of them consisted of girl students, and the average age of the boys was 8.56±1.08 years while the average age of the girls was 8.43±1.21 years. The Body Coordination Test for Children was used to evaluate gross motor performance components in the study.
The results of the study showed that girls had lower general body coordination than boys on average. It was concluded that children who had an autism spectrum disorder diagnosis displayed statistically lower total motor performance in all of the administered tests compared to their peers showing normal development (p<0.05).
It is considered that the data obtained will provide important clues about the motor coordination values and body composition of children with autism spectrum disorder and will contribute to taking precautions against the health risks of children with autism spectrum disorder, who are more affected by a sedentary lifestyle compared to their normally developing peers.
autism spectrum disorder, epilepsy, epileptic seizures, physical activity
Material and Methods
Results
Conclusions
Keywords:
Introduction
It is estimated that the prevalence of autism spectrum disorder (ASD) is approximately 4% worldwide. However, the diagnosis rate is between 0.3% and 1.0% [1]. While an ASD diagnosis was given to one in every 10000 people in the 1980s, it is estimated that one in 125 people in 2004 and 1 in 59 people in 2018 were diagnosed with ASD [2]. As the incidence and diagnosis rate of ASD increases, it can be observed that interest relating to the health and development of these individuals has also increased. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), ASD is evaluated as a neurodevelopmental disorder characterized by differences in social communication skills, sensory processing difficulties, restricting and repetitive behaviors and verbal or nonverbal deficiencies [1, 3]. Deficiencies and difficulties are seen in language and communication skills, social skills and social behaviors in the diagnosed individuals [4-6]. In
© Ebubekir Aksay, 2022
doi:10.15561/26649837.2022.0104
addition to these characteristics, it is stated that individuals with ASD may experience delays, troubles and deficiencies in their development of motor behavior [7-8], and motor limitations can be commonly observed regardless of the presence of mental disability [9]. It is also observed that diagnosed children and adolescents are more affected by a sedentary lifestyle due to the difficulties they encounter in the communication, social, behavioral and motor domains [10-11].
It is estimated that adolescents with ASD leading sedentary lifestyles [10-11] are also subject to health problems such as being overweight or obese, and that their risk probability is higher than their peers showing typical developing [10, 12-13]. It is emphasized that obesity, which has tripled in the last two decades, has become an important health problem for children [14], and it is thought that this rate may increase in those leading a sedentary lifestyle.
Studies that investigated the relationship between physical activity and motor proficiency have shown that children and adolescents with ASD who are
affected by a sedentary lifestyle are physically less active than their peers showing typical developing [13,15-17]. It has been observed that the trainer, the place that an activity takes place [18], social circles [19], family [20], transportation difficulties [21], number of activities and inadequacies in variety [22] are among the important factors that affect participation in an activity. As a result of inadequate participation in an activity, individuals with ASD have a higher probability of facing difficulties in gross and fine motor skills [23], gross motor performance [7, 24], balance [17, 25], throwing and catching [4, 26], flexibility [27-28], posture [29], walking [30] and movement speed [28, 31] and thus, have lower gross motor performance [7, 24] when compared to their peers showing typical developing.
Motor proficiency is accepted as an important part of motor development [32]. Although it is not a definitive criterion for determining diagnosis, 83% of children with ASD have difficulty performing age-appropriate motor skills [27, 33] and that motoric delays are frequently observed [4, 9, 17, 23, 27, 33 ]. As such, timely and correct intervention has an important role in eliminating or reducing these difficulties. It is also thought that being able to diagnose only 0.3% to 1.0% of the prevalence rate of about 4% worldwide [1] delays the initiation of intervention programs such as physical activity, and that this delay makes it difficult for children and adolescents with ASD to live healthy lives. Thus, early diagnosis is crucial to alleviate and eliminate symptoms [35]. Motoric tests can help determine the diagnosis and motor proficiency should be included when determining diagnoses [36].
In recent years, sports sciences have made significant progress in their field and developed tests that help evaluate motor proficiency simply and objectively. The primary aim of these tests is to help detect children and adolescents who have motor development disorders and troubles (32). Moreover, such methods used in a similar way should be applicable to the widest possible age range, be economical and the type that children would enjoy [37].
A review of existing literature shows that different tests are used to determine the gross motor performance levels of children and adolescents. However, there are a few test batteries in which gross motor skills are determined with the same test in both children and adolescents with typical developing and those with disabilities or impairments and motoric problems. Although The Body Coordination Test for Children (Korperkoordination Test fur Kinder=KTK) is one of these, it has been seen that the studies conducted mostly focus on children and adolescents showing typical developing.
Hypothesis. The children and adolescents with ASD lead a sedentary lifestyle and, as a result, they are more affected by health problems such as being
overweight and obese. This study, assuming that the general gross motor performance scores of children with an ASD diagnosis would be lower than their peers showing typical developing.
Purpose. The aim of the study is to carry out a general comparison of the gross motor performance levels of elementary school-age children of 7-10 age living in Germany diagnosed with ASD and children showing typical development (TD).
Materials and Methods
Participants.
The participants consisted of a total of 141 elementary school-age students, 68 diagnosed with ASD (DSM 5 299.00) [1] and 73 showing typical developing, living in Germany between the ages of 7 and 10.
Of the participants, 55 were diagnosed with ASD were boys and 13 were girls, and the average age of the boys was 8.40±1.09 years, while the average age of the girls was 8.85±1.14 years.
It was determined that 68 students were diagnosed with mild ASD from their identification cards issued by local governments. According to the psychiatric or medical diagnosis report, a mental disability accompanying ASD and a secondary obstacle restricting participation in physical activity were not encountered. Of the 73 participants, 36 showing typical developing consisted of boys and 37 of them consisted of girl students, and the average age of the boys was 8.56±1.08 years while the average age of the girls was 8.43±1.21 years. The 68 students with an ASD diagnosis constituted the ASD group, the 73 students showing typical developing constituted the TD group. Acute diseases, injuries, the usage of antidepressants, chronic inflammations, medication usage affecting the muscle/bone system and their simultaneous inclusion in another test were used as exclusion criteria from the study.
Data collection was performed in accordance with the provisions of "Federal Data Protection Act" (BDSG). The required approvals were obtained from relevant federation and Germany TV Eberbach Health, Rehabilitation and Disability Sport Department (TVE/GS 2018-3011). Participation in the study was voluntary, families were informed about the aims, content and data protection of the study according to the Helsinki Declaration and a signed parent consent form was obtained from the families.
Research Design
Procedures: Before the study, in order to determine the ASD group, a prepared informational brochure was given to families of children with ASD in the cities of Heidelberg and Eberbach, Germany, and its surroundings, through the school the students attend and the Rehabilitation Sports Club. A total of 179 brochures were distributed and
feedback was received from 83 families. A total of 83 families were informed about the inclusion criteria of the children in the study, either face-to-face or by phone, and information about the children's health status was obtained. After the briefing, 15 people with epilepsy, mental or physical disabilities, using antidepressants and drugs affecting the muscle/ bone system or chronic inflammation, who were simultaneously involved in another sports test were not included in the study, and an ASD group of 68 was created. To determine the TD group, families who were a member of TV Eberbach Sports Club were informed via email, and feedback was received from 81 families. A 73 people TD group was created due to eight students being unable to participate in the test due to various reasons such as illness, injuries, etc. The application of the tests were conducted by an instructor (researcher) with a rehabilitation sports license in the neurology, orthopedics, sensory and mental domains.
Data Collection Tools: KTK was used to evaluate gross motor performance components in the study. The KTK applied by Kiphard and Schilling [37-38] is commonly used in Germany to determine the gross motor performance in children and adolescents between the ages of 5 and 14 showing typical developing with brain damage and behavioral disorders. It is evaluated as a test that is applied very easily by taking simple precautions and with very low operating costs (39).
KTK consists of four sub-tests measuring total gross motor performance:
(1) Backstepping (MQ1): Three trials were made for varying widths on the basis of stepping backwards on a balance beam of 6 cm, 4.5 cm and 3 cm width, 5 cm height and 3 m length. Each trial has a maximum of eight points and is based on a maximum possible score of 72 points.
(2) One-foot jump (MQ2): Three trials were made for each height in the test performed with the principle of jumping with one foot over a total of 12 (50 cm x 20 cm x 5 cm) sponges. The 7-8 age group started with three (15 cm) sponges while the 9-10 age group started with five (25 cm) sponges, and another sponge was added after each successful trial. Three, two and one point was given to performances that were successful on the first, second and third trials, respectively. The maximum test score was 39 points for each leg, reaching a total of 78 points for both legs.
(3) Sideways jump (MQ3): A springboard (100 cm x 60 cm) fixed to the ground is divided into two from the middle with a lath (60 cm x 4 cm). The participants were asked to jump right and left over the lath as quickly as possible within 15 seconds and the total number of jumps was recorded.
(4) Sideways stepping (MQ4): Non-slip feet-shaped markers with a height of 3.7 cm were attached on
the bottom of two wooden platforms measuring 25 cm x 25 cm x 1.5 cm. The test started when the child was on a platform and they were asked to switch to the empty platform by putting their hands on the side. This application continued for 20 seconds and a second trial started after an interval of at least 10 seconds. The total number of successful switches at the end of two trials were recorded [37-38].
For the application of KTK, the children were taken into a hall in small groups of 2-3 people in the ASD group and 4-5 people in the TD group. The test's procedure was explained by the researcher and practically demonstrated, following which the participants were allowed to do a trial for each test item. The test application started when the students were certain about how the test works. The same student did not do all of the test items back to back. It was passed on to the next student after each test item, and thus, the opportunity to rest between the test items was provided. This cycle continued until the four test items were completed.
According to Kiphard and Schilling [37-38], the raw scores are inadequate to evaluate the results. In order to conduct the evaluation, each test item was converted to norm values in accordance with the original manual of KTK, and the total motor values (TMO) were determined by combining norm values. In the evaluation, out of classification (< 56), distinct impairment (56-70), inadequate (71-85), normal (86-115), good (116-130) and high (131-145) estimated motor performance classification made through standard motor values (MO) [37-38].
Body Mass Index (BMI), applied to obtain information about the participants' body composition and determined by standardized height and weight measurements, was found to be highly reliable (Doolittle et al., 1969). The measurements were made using the height and body mass Seca 769 digital weight/height measurement tool. BMI was calculated using the formula BMI = Body Mass (kg.)/Height square (m2) from the obtained data. The interpretation and classification of the BMI percentage values were determined using the AGA reference values, the most common method of determining obesity in Germany [40].
According to the WHO [41] standards, slim, normal weight, overweight and obese classifications were used when looking at the BMI values.
Statistical Analysis
The SPSS 26 program for Mac was used in the analysis of the data. Kolmogorov-Smirnov test was used to determine whether the data fit normal distribution, alongside skewness-kurtosis values and histogram graphs, which are other assumptions of normal distributions. The distribution of the data was accepted as normal because the skewness-kurtosis values were within the range of ±2 [42]. A
t-test (independent samples t-test) was used in the comparison of two independent groups, one-way variance analysis was used in the comparison of two or more groups. The relationship between variables was analyzed using the Pearson correlation coefficient. The significance level of 0.05 was used as the criterion for the interpretation of the values obtained.
Results
Upon examining Table 1, it can be seen that 21.8% of the boys with ASD who participated in the study had normal weight, 61.8% of them were overweight and 16.4% were obese. Further, 23.1% of the girls in this group had normal weight, 61.5% of them were overweight and 15.4% were obese. On the other hand, 55.6% of the boys in the TD group had normal weight, 41.7% of them were overweight and 2.8% were obese, while 78.4% of the girls had normal weight and 21.6% of them were overweight. Overall a total of 21.1% of the children in the ASD group had normal weight, 61.8% of them were overweight and 16.2% were obese, while a total of 76.1% of the children in the TD group had normal weight, 31.5% were overweight and 1.4% were obese.
Whether the measurement values used in the
study differed significantly according to the groups and gender was examined with an independent samples t-test. According to the obtained data (Table 2), it was determined that the M01, M02, M03, M04 and TM0 measurement values did show a statistically significant difference according to groups (p < 0.05).
M01 values show a statistically significant difference between groups [t(139)=-26.37 p<0.05]. It can be seen that the children in the ASD group (65,75±6,29) have lower values of the M01 measurement values compared to the children in the TD group (104,52±10,50). The calculated M01 (r|2 = 0.83), effect size value show that the differences between the groups are ample. It can be said that 83% of the variance change in the M01 values is caused by the differences between the groups.
M02 values show a statistically significant difference between groups [t(139)=-14.98 p<0.05]. It can be seen that the children in the ASD group (61.10±6.93) have lower values of the M02 measurement values compared to the children in the TD group (88.93±13.77). The calculated M02 (r|2 = 0.62), effect size value show that the differences between the groups are ample. It can be said that 62% of the variance change in the M02 values is caused by the differences between the groups.
Table 1. Percentage values of normal weight, overweight and obese classes of the ASD and TD Groups
Normal Weight Overweight Obese
Variables Gender N % N % N %
ASD Group Boys n=55 Gils n=13 12 3 21.8 23.1 34 8 61.8 61.5 9 2 16.4 15.4
Total 15 22.1 42 61.8 11 16.2
TD Group Boys n=36 Girls n=37 20 29 55.6 78.4 15 8 41.7 21.6 1 2.8
Total 49 67.1 23 31.5 1 1.4
ASD: Autism Spectrum Disorder, TD: Typical developing
Table 2. Results of Comparing Measurement Values According to Groups (Independent Samples T-Test)
Variables Groups n M±SD t df p n2
MQ1 ASD TD 68 73 65.75±6.29 104.52±10.50 -26.37 139 0.01 0.83
MQ2 ASD TD 68 73 61.10±6.93 88.93±13.77 -14.98 139 0.01 0.62
MQ3 ASD TD 68 73 54.99±9.38 89.36±14.60 -16.50 139 0.01 0.66
MQ4 ASD TD 68 73 56.22±10.19 94.64±14.87 -17.77 139 0.01 0.69
TMQ ASD TD 68 73 71.87±5.61 92.95±13.41 -12.02 139 0.01 0.51
ASD: Autism spectrum disorder, TD: Typical developing, M: Mean, SD: Standard deviation, BMI: Body mass index (weight/height2 ), M01: Motor values/backstepping, M02: Motor values/one-foot jump, M03: Motor values/sideways jump, M04: Motor values/sideways stepping, TM0: Total motor values
M03 values show a statistically significant difference between groups [t(139)=-16.50 p<0.05]. It can be seen that the children in the ASD group (54.99±9.38) have lower values of the M03 measurement values compared to the children in the TD group (89.36±14.60). The calculated M01 (r|2 = 0.66), effect size value show that the differences between the groups are ample. It can be said that 66% of the variance change in the M03 values is caused by the differences between the groups.
M04 values show a statistically significant difference between groups [t(139)=-17.77 p<0.05]. It can be seen that the children in the ASD group (56.22±10.19) have lower values of the M03 measurement values compared to the children in the TD group (94.64±14.87). The calculated M04 (r|2 = 0.69), effect size value show that the differences between the groups are ample. It can be said that 69% of the variance change in the M04 values is caused by the differences between the groups.
TM0 values show a statistically significant difference between groups [t(139)=-12.02 p<0.05]. It can be seen that the children in the ASD group (71.87±5.61) have lower values of the TM0 measurement values compared to the children in the TD group (92.95±13.41). The calculated TM0 (r|2 = 0.51), effect size value show that the differences between the groups are ample. It can be said that 51% of the variance change in the M01 values is
caused by the differences between the groups.
According to the data specified in Table 3, it was determined that the M01, M02, M03, M04 and TM0 measurement values did show a statistically significant difference according to gender (p<0.05). When the average values are examined, it can be observed that boys have a higher average gross motor performance score as compared to girls in all of the tests.
As with the original research, engine performance was classified as unclassified (56), significant disorder (56 - 70), insufficient (71 - 85), normal (86 - 115), good (116 - 130), and advanced (131 - 145) over the standard M0 values (Table 4).
According to the classification, 12.7% of the boys with ASD were "unclassified" and 87.3% were in the "significant disorder" category, while 76.9% of the girls with ADS were "unclassified" and 23.1% were in the "significant disorder" category. 16.7% of boys with typical development scored "inadequate", 83.3% scored "normal", while 10.8% of girls scored "significant disorder", 46% scored "inadequate", and 43.2% scored "normal". In general, 25% of ASD participants performed "out of classification", while 75% demonstrated "significant disorder". While 5.5% of participants in the typical development group demonstrated "significant disorder", 31.5% demonstrated "inadequate" performance, and 63% demonstrated "normal" performance. According to
Table 3. Results of Comparing the ASD/TD Groups Measurement Values According to Gender
Items Groups Gender n M±SD t df p n2
MQ1 ASD Boys Girls 55 13 67.11±5.78 60.00±5.13 4.07 66 0.01 0.20
TD Boys Girls 36 37 108.47±9.33 100.68±10.24 3.40 71 0.01 0.14
MQ2 ASD Boys Girls 55 13 62.69±6.19 54.38±5.95 4.38 66 0.01 0.22
TD Boys Girls 36 37 96.08±12.25 81.97±11.52 5.07 71 0.01 0.26
MQ3 ASD Boys Girls 55 13 57.65±7.77 43.69±7.03 5.93 66 0.01 0.34
TD Boys Girls 36 37 97.36±11.36 81.57±13.20 5.47 71 0.01 0.29
MQ4 ASD Boys Girls 55 13 59.04±9.05 44.31±4.64 5.67 66 0.01 0.32
TD Boys Girls 36 37 98.14±14.27 91.24±14.85 2.12 71 0.04 0.05
TMQ ASD Boys Girls 55 13 73.87±3.87 63.38±3.43 8.97 66 0.01 0.54
TD Boys Girls 36 37 100.58±11.80 85.51±10.44 5.78 71 0.01 0.32
*p<0.05, M: Mean, SD: Standard deviation, BMI: Body mass index (weight/height2 ), Min.: Minimum, Max.: Maximum, ASD: Autism spectrum disorder, TD: Typical developing, M01: Motor values/backstepping, M02: Motor values/one-foot jump, M03: Motor values/sideways jump, M04: Motor values/sideways stepping, TMQ: Total motor values
these findings, children with typical development have higher values than children with ASD, and girls have lower values in both groups. According to the classification identified, it can be interpreted that children with ASD exhibited inadequate performance but had a higher tendency towards the distinct impairment category, while children with TD exhibited normal performance, but had a higher tendency towards the inadequate category.
The relationship between variables was examined using the Pearson correlation coefficient (Table 5). While there was no statistically significant relationship between age and the M01, M03, M04 and TM0 variables (p > 0.05), it was determined that there was a statistically low significant negative correlation between age and M02 values (r = -0.20, p < 0.05). It was determined that there is a statistically low significant negative correlation between BMI values and the M01, M02, M03, M04 and TM0 values (p < 0.05).
A one-way ANOVA test was used to compare the measurement values used in the study according to BMI categories and the Bonferroni multiple comparison test, a post-hoc test, was used to determine which motor performance categories the difference was in (Table 6).
M01 values show a statistically significant difference according to BMI classes [ F(2,138)=16.91 p<0.05]. According to the Bonferroni multiple comparison tests used to determine which BMI classes differ, people with normal weights have significantly higher M01 values than those who are overweight or obese.
M02 values show a statistically significant difference according to BMI classes [ F(2,138)=5.92 p<0.05]. According to the Bonferroni multiple comparison tests used to determine which BMI classes differ, people with normal weights have significantly higher M02 values than those who are overweight or obese.
Table 4..The results of a comparison of performance classification values by group and gender.
ASD Group TG Group
Gender Performance Categories N % N %
unclassified (<56) 7 12,7 0 0
Boys significant disorder (56-70) 48 87,3 0 0
insufficient (71-85) 0 0 6 16.7
normal (86-115) 0 0 30 83.3
unclassified (<56) 10 76,9 0 0
Girls significant disorder (56-70) 3 23,1 4 10.8
insufficient (71-85) 0 0 17 46
normal (86-115) 0 0 16 43.2
unclassified (<56) 17 25 0 0
Boys/Girls Total/ significant disorder (56-70) insufficient (71-85) 51 0 75 0 4 23 5.5 31.5
normal (86-115) 0 0 46 63
Total 68 100 73 100
ASD: Autism spectrum disorder TD: Typical developing.
Table 5. Examining the Relationship between Variables
Items Age BKI
M01 r p 0.09 0.29 -0.25 0.01*
M02 r p -0.20 0.02* -0.25 0.01*
M03 r p -0.08 0.32 -0.28 0.01*
M04 r p 0.02 0.79 -0.27 0.01*
TM0 r p -0.03 0.74 -0.22 0.01*
*p<0.05, BMI: Body mass index (weight/height2 ), MQ1: Motor values/backstepping, MQ2: Motor values/ one-foot jump, M03: Motor values/sideways jump, M04: Motor values/sideways stepping, TMQ: Total motor values
Table 6. Results of Comparing the Measurement Values According to the KTK Motoric Performance Categories
Items Groups M±SD Coefficient of Sum of df Mean of F p n2 Post
Variance squares squares hoc
Normal Weight1 95.54±19.22 Between Groups 12500.673 2 6250.337
M01 Overweight2 79.59±20.11 Within Group 50999.894 138 369.564 16.91 0.01 0.19 1>2.3
Obese3 67.75±12.92 Total 63500.567 140
Normal Weight1 80.78±16.86 Between Groups 3488.364 2 1744.182
MQ2 Overweight2 71.88±18.20 Within Group 40654.870 138 294.601 5.92 0.01 0.07 1>2.3
Obese3 67.08±11.82 Total 44143.234 140
Normal Weight1 80.48±20.31 Between Groups 7782.965 2 3891.483
M03 Overweight2 67.78±20.29 Within Group 55049.219 138 398.907 9.75 0.01 0.12 1>2.3
Obese3 58.75±15.68 Total 62832.184 140
Normal Weight1 85.23±22.06 Between Groups 10310.604 2 5155.302
M04 Overweight2 69.69±22.25 Within Group 64553.581 138 467.780 11.02 0.01 0.13 1>2.3
Obese3 62.25±14.15 Total 74864.184 140
Normal Weight1 87.32±15.20 Between Groups 2623.979 2 1311.989
TMQ Overweight2 79.69±13.95 Within Group 28066.206 138 203.378 6.45 0.02 0.08 1>2.3
Obese3 75.25±9.71 Total 30690.184 140
M: Mean, SD: Standard deviation, 1 M01: Motor values/backstepping, M02: Motor values/one-foot jump, MQ3: Motor values/sideways jump, M04: Motor values/sideways stepping, TMQ: Total motor values
M03 values show a statistically significant difference according to BMI classes [ F(2,138)=9.75 p<0.05]. According to the Bonferroni multiple comparison tests used to determine which BMI classes differ, people with normal weights have significantly higher M03 values than those who are overweight or obese
M04 values show a statistically significant difference according to BMI classes [ F(2,138)=11.02 p<0.05]. According to the Bonferroni multiple comparison tests used to determine which BMI classes differ, people with normal weights have significantly higher M04 values than those who are overweight or obese.
TM0 values show a statistically significant difference according to BMI classes [ F(2,138)=6.45 p<0.05]. According to the Bonferroni multiple comparison tests used to determine which BMI classes differ, people with normal weights have significantly higher TM0 values than those who are overweight or obese.
Discussion
The aim of the study was to compare the general gross motor performance levels of children diagnosed with ASD and children showing typical developing in the elementary school-age bracket through KTK, which has been evaluated as a test that is very easy to apply, with very low activity cost and simple precautions. It was seen that children diagnosed with ASD had higher BMI values after KTK, and that in all of the applied tests (backstepping, one-foot jump, sideways jump, sideways stepping), children diagnosed with ASD displayed lower motor performance compared to their peers showing
typical developing. It was concluded from the obtained data that the girls participating in the study had lower overall body coordination than boys, on average.
Studies have reported that children and adolescents with ASD lead a sedentary lifestyle and, as a result, they are more affected by health problems such as being overweight and obese [1011], and that the probability of being overweight and obese was higher in children diagnosed with ASD compared to their peers showing typical developing [12-13, 43]. Moreover, the results reported in the limited number of studies in which the BMI values of children with ASD are determined, differ from each other. In a study Takeuchi [44] conducted with a group of 13 people diagnosed with ASD, it was stated that the BMI values of the participants were low. However, in their study conducted with a group of 17 people, Tyler et al. [45] reported that the BMI values were normal. In a study conducted with a larger sample group, Egan et al. [46] evaluated 273 children with ASD and stated that 17% of the participants were overweight and approximately 22% of them were obese. Similarly, in a study they conducted with 429 children with ASD in the age group 6-11, Xiong et al. [47] stated that 51% of the participants were overweight or obese. Curtin et al. [48] also examined obesity in children with ASD and found that the probability of being obese was 40% higher in children with ASD as compared to children showing typical developing. In this study, it was observed that 78% of children with ASD and 32.9% of the children showing typical developing were overweight and obese, while the results strengthen the assumption that children with ASD
have a higher risk of obesity and being overweight. Thus, the data obtained support the results of other studies [48-51].
Further, in general, it has been reported that children and adolescents diagnosed with ASD participate in physical activity to a limited extent [4, 52-53]. In studies investigating the relationship between physical activity, motor proficiency [4, 13, 15-17, 33, 49, 52, 54] and gross motor performance [7, 24], it was found that the gross motor performance of adolescents with ASD, who are affected by a sedentary lifestyle, were lower than their peers showing typical developing and the reported results are parallel to those in this study [55-56]. In their study, Kiphard and Schilling [37] obtained a general (gender and all age groups) 100±15 TM0 value. While results close to the Germany-based sample were reported in similar studies [57-60], lower TM0 values were reported in some studies [61-62] and higher values were reported in others [63-64]. In this study, it is seen that the TM0 values of the ASD and TD groups differ from other studies as they remain below the KTK norm values reported by Kiphard and Schilling [37]. Staples and Reid [34] observed in their study, with 25 children diagnosed with ASD in the 9-12 age group, that the diagnosed children attained lower values compared to their age. In a similar study, Freitag et al. [65] stated that individuals who were diagnosed with Asperger syndrome had low gross motor performance and reported results parallel to this current study.
Performance differences between genders were observed in some of the conducted studies. Antunes et al. [66], stated that boys displayed higher performance compared to girls in the backwards balancing and stepping sideways tests. In a study they conducted, Fransen et al. [67] and Hardman et al. [60] obtained higher values in girls compared to boys in the backwards balancing test; however, they stated that boys displayed overall higher performance compared to girls in other parts of the test. In this study, it was also determined that boys attained higher TM0 values as compared to girls and results similar to other studies were obtained.
In a study where an eight-week traditional dance program was given to 10 adolescents diagnosed with ASD, Arzoglou et al. [68] tried to determine the gross motor performance of the participants with KTK. They reported that the TM0 values were lower
than the standard norm values. The TM0 values in this study were also determined to be lower, which is consistent with the results of other such studies.
Conclusion and Suggestions
This study was designed about an important area such as ASD, which has increasingly become the subject of research in recent years. It aims to shed light on future research and support the existing database by comparing the gross motor performance of children with an ASD diagnosis and children showing typical developing. As a result of this study, it was determined that children with ASD were overweight and obese when compared to their peers showing typical developing. From these results, it is thought that children with ASD are at a higher risk for obesity and being overweight. The obtained data show that the gross motor performance of children with ASD is lower than their peers showing typical developing, and that girls had lower TM0 scores compared to boys in both groups. However, although it was found that children with ASD had lower TM0 scores, this result should not be interpreted as children showing typical developing do not have gross motor performance problems. It was found that children showing typical developing also had TM0 scores under the standard norm values, suggesting that the gross motor performance problem is not solely caused by ASD.
It should be noted that the conducted study was limited to a relatively small sample and only focused on children living in Germany. As such, future studies that study international, more ethnically diverse and more comprehensive samples are needed alongside experimental studies to recommend KTK in determining gross motor performance in children with ASD, following which the current study's results can be verifiable. Simultaneously, it is recommended that clinicians diagnosing and treating children with ASD additionally evaluate motor coordination deficits and take early intervention precautions for motor problems to contribute towards eliminating these problems.
Funding
This research received no external funding.
Conflicting interest
The author declares no conflict of interest.
References
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; 2013. https://doi.org/10.1176/appi.books.9780890425596
2. Autism Society of America. [Internet]; 2014 [cited 2021 Nov 15]. Available from: https://www.autism-society.org/_
3. Tarver J, Pearson E, Edwards G, Shirazi A, Potter L, Malhi P, et al. Anxiety in autistic individuals who speak few or no words: A qualitative study of parental experience and anxiety management. Autism, 2021; 25(2): 429-439. https://doi.org/10.1177/1362361320962366
4. Aksay E, Alp A. The effects of a physical activity rehabilitation program on the motor skills and physical performance of children with autism spectrum disorder (ASD). Movement therapy and ASD. International Journal of Academic Research, 2014; 6(1): 12-19. https://doi.org/10.7813/2075-4124.2014/6-1/B.2
5. Callahan EH, Gillis JM, Romanczyk RG, Mattson RE. The behavioral assessment of social interactions in young children: An examination of convergent and incremental validity. Research in Autism Spectrum Disorders, 2011; 5(2): 768-774. https://doi.org/10.1016Zj.rasd.2010.09.004
6. Yarimkaya E, ilhan EL. The Effect of Peer-Mediated Physical Activities on Communication Deficit of Children with Autism Spectrum Disorder. Beden Egitimi ve Spor Bilimleri Dergisi, 2020; 14(2): 233245.
7. Green D, Charman T, Pickles A, Chandler S, Loucas T, Simonoff E, et al. Impairment in movement skills of children with autistic spectrum disorders. Developmental Medicine & Child Neurology, 2009; 51: 311-316. https://doi.org/10.1111/j.14698749.2008.03242.x.
8. Ozonoff S, Young GS, Goldring S, Greiss-Hess L, Herrera AM, Steele J, et al. Gross motor development, movement abnormalities, and early identification of autism. Journal of Autism and Developmental Disorders, 2008; 38: 644-656. https://doi.org/10.1007/s10803-007-0430-0
9. Bhat AN, Landa RJ, Galloway JC. Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorder. Journal oftheAmerican Physical Therapy Association, 2011; 91: 1-14. https://doi.org/10.2522/ptj.20100294
10. Curtin C, Anderson SE, Must A, Bandini L. The prevalence of obesity in children with autism: A secondary data analysis using nationally representative data from the National Survey of Children's Health. BMC Pediatrics, 2010; 10: 2-5. https://doi.org/10.1186/1471-2431-10-11
11. Srinivasan SM, Pescatello LS, Bhat AN. Current perspectives on physical activity and exercise recommendations for children and adolescents with Autism Spectrum Disorders. Physical Therapy, 2014; 201(94): 875-889. https://doi.org/10.2522/ptj.20130157
12. De Vinck-Baroody O, Shui A, Macklin EA, Hyman SL, Leventhal JM, Weitzman C. Overweight and obesity in a sample of children with autism spectrum disorder. Academic Pediatrics, 2015; 15: 396-404. https://doi.org/10.1016/j.acap.2015.03.008
13. McCoy SM, Jakicic JM, Gibbs BB. Comparison of obesity, physical activity, and sedentary behaviors between adolescents with autism spectrum disorders and without. Journal of Autism and Developmental Disorders, 2016; 46: 2317-2326. https://doi.org/10.1007/s10803-016-2762-0
14. Curtin C, Mirjana J, Bandini L. Obesityin Children with Autism Specktrum Disorder. Harvard Review of Psychiatry, 2014;22(2): 93.103. https://doi.org/10.1097/ HRP.0000000000000031
15. MacDonald M, Esposito P, Ulrich D. The physical activity patterns of children with autism. BMC Research Notes, 2011; 4: 422. https://doi.org/10.1186/1756-0500-4-422
16. Pan CY, Frey GC. Physical activity patterns in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 2006; 36: 597-606. https://doi. org/10.1007/s10803-006-0101-6.
17. Whyatt CP, Craig CM. Motor skills in children aged 7-10 years, diagnosed with autism spectrum disorder Journal of Autism and Developmental Disorders, 2012; 42: 1799-1809. https://doi.org/10.1007/s10803-011-1421-8
18. Duquette MM, Carbonneau H, Roult R, Crevier L. Sport and physical activity: Facilitating interventions with young people living with an autism spectrum disorder. Physical Activity Review, 2016; 4: 40-49. https://doi.org/10.16926/par.2016.04.05
19. Obrusnikova I, Cavalier AR. Perceived Barriers and Facilitators of Participation in After-School Physical Activity by Children with Autism Spectrum Disorders. J Dev Phys Disabil, 2011;23:195-211. https://doi.org/10.1007/s10882-010-9215-z
20. Haegele JA, Lee J, Chang SH. Physical Activity of Parents of Children with Autism Spectrum Disorder. International Journal of Disability, Development and Education, 2017;64:368-77. https://doi.org/10.1080/1034912X.2016.1232375
21. Shields N, Synnot AJ. An exploratory study of how sports and recreation industry personnel perceive the barriers and facilitators of physical activity in children with disability. Disability and Rehabilitation, 2014; 36(24): 2080-2084. https://doi.org/10.3109/09638288.2014.892637
22. Stiller A, Neuman M. Freizeitangebote für autistische Kinder und Jugendliche: Wie zufrieden sind Eltern und was wünschen sie sich für ihre Kinder? [Leisure activities for autistic children and adolescents: How satisfied are parents and what do they want for their children?]. Praxis der Kinderpsyhologie und Kinderpsychiatrie, 2021; 70: 217-38. (In German). https://doi.org/10.13109/prkk.2021.70.3.217
23. Provost B, Heimerl S, Lopez, B. Levels of gross and fine motor development in young children with autism spectrum disorder. Physical & Occupational Therapy, 2007; 27: 21-36.
2022
https://doi.org/10.1080/J006v27n03_03
24. Fournier KA, Hass CJ, Naik SK, Lodha N, Cauraugh JH. Motor coordination in autism spectrum disorders: a synthesis and meta-analysis. Journal of Autism and Developmental Disorders, 2010; 40(10): 1227-1240. https://doi.org/10.1007/s10803-010-0981-3
25. Yilmaz I, Yanardag M, Birkan BA, Bumin G. Effects of swimming training on physical fitness and water orientation in autism. Pediatrics International, 2004; 46: 624-626. https://doi.org/10.1111/j.1442-200x.2004.01938.x
26. Utley A, Steenbergen B, Astill S. Ball catching in children with developmental coordination disorder: Control of degrees of freedom. Developmental Medicine & Child Neurology, 2006; 49(1): 34-8. https://doi.org/10.1017/S0012162207000096.x
27. Hilton C, Wente L, LaVesser P, Ito M, Reed C, Hertzberg G. Relationship between motor skill impairment and severity in children with asperger syndrome. Research in Autism Spectrum Disorders, 2007; 1: 339-349. https://doi.org/10.1016/j.rasd.2006.12.003
28. Minshew NJ, Sung MB, Jones BL, Furman JM. Underdevelopment of the postural control system in autism. Neurology, 2004; 63(11): 2056-2061. https://doi.org/10.1212/01. WNL.0000145771.98657.62
29. Downey R, Rapport MJ. Motor activity in children with autism: a review of current literature. Pediatric Physical Therapy, 2012; 24(1): 2-20. https://doi.org/10.1097/PEP.0b013e31823db95f
30. Rinehart N, Tonge B, Bradshaw J, Lansek R, Enticott PG, McGinley J, et al. Gait function in high-functioning autism and Asperger's disorder. European Child and Adolescent Psychiatry, 2006; 15(5): 256-64. https://doi.org/10.1007/s00787-006-0530-y
31. Memari A, Ghanounib P, Gharibzadehc S, Eghlidi J, Ziaee V, Moshayedi P. Postural sway patterns in children with autism spectrum disorder compared with typically developing children. Research in Autism Spectrum Disorders, 2013; 7(2): 325-32. https://doi.org/10.1016Zj.rasd.2012.09.010
32. Khodaverdi Z, Bahram A, Khalaji H, Kazemnejad A, Ghadiri F, Lopes PV. Performance assessments on three different motor competence testing batteries in girls aged 7-10. Sport Sciences for Health, 2020; 16:747-753. https://doi.org/10.1007/s11332-020-00653-3
33. Barrodi Sedehi AA, Ghasemi A, Kashi A, Azimzadeh E. The relationship between the motor skills level and the severity of autism disorder in children with autism. Pedagogy of Physical Culture and Sports, 2021;25(1):59-65. https://doi.org/10.15561/26649837.2021.0108
34. Staples KL, Reid G. Fundamental movement skills and autism spectrum disorders. Journal of Autism and Developmental Disorders, 2010; 40: 209-217. https://doi.org/10.1007/s10803-009-0854-9.
35. Mulligan S, White BP. Sensory and motor behaviors of infant siblings of children with and without autism. The American Journal of Occupational Therapy, 2012; 556-566.
https://doi.org/10.5014/ajot.2012.004077
36. Vasileva N. Diagnosis and therapy of motor disturbances in children with autism. Journal of Special Education and Rehabilitation, 2012; 13: 55-68. https://doi.org/10.2478/v10215-011-0025-3
37. Kiphard EJ, Schilling F. Körperkoordinationstest fur Kinder. 2. Überarbeitete und ergänzte Auflage [Body coordination test for children. 2. Revised and expanded edition]. Weinheim: Beltz Test GmbH.; 2007. (In German).
38. Kiphard EJ, Schilling F. Körperkoordinationstest für Kinder [Body coordination test for children]. Weinheim: Beltz Test GmbH. 1974. (In German).
39. Cools W, Martelaer KD, Samaey C, Andries C. Movement skill assessment of typically developing preschool children: a review of seven movement skill assessment tools. The Journal of Sports Science and Medicine, 2009; 8: 154-168.
40. Wabitsch M, Kunze D. (federführend für die AGA). Konsensbasierte (S2) Leitlinie zur Diagnostik, Therapie und Prävention von Übergewicht und Adipositas im Kindes- und Jugendalter. [Consensus-based (S2) guideline for the diagnosis, therapy and prevention of overweight and obesity in children and adolescents]. Hg. v. Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA). Version 15.10.2015. [Internet]; 2015. [cited 2021 Nov 15]. (In German) Available from: https://www. maria-rudack.de/userfiles/downloads/pdf/AGA_S2_ Leitlinie.pdf
41. Word Health Organisation. [Internet]; 2007. [cited 2021 Nov 15]. Available from: https://www.who.int/ growthref/who2007_bmi_for_ age_field/en/
42. George D, Mallery M. SPSS for Windows Step by Step: A Simple Guide and Reference, 17.0 update (10a ed.) Pearson: Boston; 2010.
43. Curtin C, Mirjana J, Bandini L. Obesityin Children with Autism Specktrum Disorder. Harvard Review of Psychiatry, 2014;22(2): 93.103. https://doi.org/10.1097/ HRP.0000000000000031
44. Takeuchi E. Incidence of obesity among school children with mental retardation in Japan. American Journal of Mental Retardation, 1994; 99(3): 283-288.
45. Tyler K, MacDonald M, Menear K. Physical activity and physical fitness of school-aged children and youth with autism spectrum disorders. Autism Research and Treatment, 2014; 312163: 1-6. https://doi.org/10.1155/2014/312163.
46. Egan AM, Dreyer ML, Odar CC, Beckwith M, Garrison CB. Obesity in Young Children with Autism Spectrum Disorders: Prevalence and Associated Factors. Childhood Obesity, 2013; 9(2):125-131. https://doi.org/10.1089/chi.2012.0028
47. XiongN, Ji C, Li Y, He Z, Bo H, Zhao Y. The physical status of children with autism in China. Research in developmental disabilities, 2007; 30(1): 70-76. https://doi.org/10.1016Zj.ridd.2007.11.001
48. Curtin C, Bandini L, Perrin E, Tybor D, Must A. Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: A chart review. BMC Pediatrics, 2005; 25(5): 48.
https://doi.org/10.1186/1471-2431-5-48
49. Aksay E, Güllü M. Effects of physical activity programs with visual stimuli on physical development of children with autism spectrum disorder. Visual stimuli and movement therapy. Journal of Education and Sociology, 2014; 5(1): 34-43. https://doi.org/10.7813/jes.2014/5-V6
50. BofosaT,MiangindulaB,EkisawaNC,BumokoG,Lasi K. Prevalence of overweight and obesity in sedentary children and adolescents with or without intellectual disability in the Democratic Republic of Congo. Turkish Journal of Kinesiology, 2019; 5(3): 117-123. https://doi.org/10.31459/turkjkin.575580
51. Evans EW, Must A, Anderson SE, Curtin C, Scampini R, Maslin, M et al. Dietary Patterns and Body Mass Index in Children with Autism and Typically Developing Children. Research in autism spectrum disorders, 2012; 6(1): 399-405. https://doi.org/10.10Wj.rasd.2011.06.014
52. Aksay E. Egitmen ve Aile Destekli Uyarlanmi^ Fiziksel Aktivitelerin Otizm Spektrum Bozuklugu Olan Gen^lerin Fiziksel Uygunluk Düzeylerine Etkileri: Deneysel ^ali§ma [The Effects of Trainer-and Family-Supported Adjusted Physical Activities on the Physical Fitness Levels of Youngsters with Autism Spectrum Disorder: Experimental Study]. Turkiye Klinikleri Journal of Sports Sciences, 2021; 13(3):416-24. (In Turkish). https://doi.org/10.5336/sportsci.2021-83608
53. Hoppen T. Kinder mit Autismus-SpektrumStörung bewegen sich zu wenig!. [Children with Autism Spectrum Disorder do not exercise enough]. Pädiatrie, 2021; 33: 15. (In German). https://doi.org/10.1007/s15014-021-3691-8
54. Ko^ak Uyaroglu A, Ertüzün E, Ta§ Arslan F. The effect of the therapeutic recreation program for children with autistic spectrum disorder on their social skills. Balt JHealth Phys Activ 2021; 1(2): 23-31. https://doi.org/10.29359/BJHPA.2021.SuppL2.03
55. Nazzarali N, Glazebrook CM, Elliott D. Movement planning and reprogramming in individuals with autism. Journal of Autism and Developmental Disorders, 2009; 39: 1401-1411. https://doi.org/10.1007/s10803-009-0756-x
56. Rinehart NJ, Bradshaw JL, Bereton A, Tonge BJ. Movement preparation in high-functioning autism and Asperger disorder: a serial choice reaction time task involving motor reprogramming. Journal of Autism and Developmental Disorders, 2001; 31: 7988.
57. Altfeld K. Die Entwicklung der Gesamtkörperkoordination im Grundschulalter. [The development of total body coordination in elementary school age]. [Thesis]. Cologne; 1998. (In German).
58. Drees C. Bestimmung der Häufigkeit psychomotorischer Auffälligkeiten bei Schulkindern im Alter von 6-8 Jahren [Determination of the frequency of psychomotor abnormalities in school children aged 6 - 8 years]. [Thesis]. Cologne; 1998. (In German).
59. Dordel S, Drees C, Liebel A. Motorische
Auffälligkeiten in der Eingangsklasse der Grundschule. Haltung und Bewegung [Motor abnormalities in the entry class of elementary school]. Posture and movement, 2000; 20(3): 5-16. (In German).
60. Vandorpe B, Vandendriessche J, Lefevre J, Pion J, Vaeyens R, Matthys, et al. The Körperkoordinations Test für Kinder: reference values and suitability for 6-12-year-old children in Flanders. Journal of Medicine & Science in Sports, 2011; 21(3):378-88. https://doi.org/10.1111/j.1600-0838.2009.01067.x
61. Hardman CM, Wanderley Junior RS, Oliveira E, Barros M. Relationship between physical activity and BMI with level of motor coordination performance in schoolchildren. Rev Bras Cineantropom Desempenho Hum. 2017; 19: 50-61. https://doi.org/10.5007/1980-0037.2017v19n1p50
62. Prätorius B, Milani TL. Motorische Leistungsfähigkeit bei Kindern: Koordinationsund Gleichgewichtsfähigkeit: Untersuchung des Leistungsgefälles zwischen Kindern mit verschiedenen Sozialisationsbedingungen [Motor performance in children: Coordination and balance: Investigation of the performance gap between children with different socialization conditions]. Deutsche Zeitschrift für Sportmedizin, 2004; 55(7/8). (In German).
63. Chovanova E. Differences in motor coordination levels between the Slovak and Portuguese school-aged populations. Physical Activity Review, 2018; 6: 251-256. https://doi.org/10.16926/par.2018.06.29
64. Sögüt M. A comparison of serve speed and motor coordination between elite and club level tennis players. JournalofHumankinetics, 2017; 55(1): 171-6. https://doi.org/10.1515/hukin-2017-0015
65. Freitag CM, Kleser C, Schnieder M, Von Gontard A. Quantitative assessment of neuromotor function in adolescents with high functioning autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 2007; 37: 948-959. https://doi.org/10.1007/s10803-006-0235-6
66. Antunes AM, Maia JA, Stasinopoulos MD, Gouveia ER, Thomis MA, Lefevre JA, et al. Gross motor coordination and weight status of Portuguese children aged 6-14 years: Motor Coordination and Weight Status. Am J Hum Biol, 2015;27:681-9. https://doi.org/10.1002/ajhb.22715
67. Fransen J, D'Hondt E, Bourgois J, Vaeyens R, Philippaerts RM, Lenoir M. Motor competence assessment in children: Convergent and discriminant validity between the BOT-2 Short Form and KTK testing batteries. Research in Developmental Disabilities, 2014; 35(6): 1375-1383. https://doi.org/10.1016/j.ridd.2014.03.011
68. Arzoglou D, Tsimaras V, Kotsikas G, Fotiadou E, Sidiropoulou M, Proios M, et al. The effect of a traditional dance training program on neuromuscular coordination of individuals with autism. Journal of Physical Education and Sport, 2013;13(4): 563- 569. https://doi.org/10.7752/jpes.2013.04088
2022
Information about the author:
Ebubekir Aksay; Prof. Dr.; https://orcid.org/0000-0002-5706-6698; eaksay@yahoo.dej_Department of Health, Rehabilitation and Disability Sport, Germany TV Eberbach e.V.; Eberbach, Germany; Gelisim University; School of Physical Education and Sport; Istanbul, Turkey.
Cite this article as:
Aksay E. Comparing the gross motor performance levels of 7-10 age group children with autism spectrum disorder and typical developing. Pedagogy of Physical Culture and Sports, 2022;26(1):26-37. https://doi.org/10.15561/26649837.2022.0104
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/deed.en).
Received: 07.12.2021
Accepted: 21.01.2022; Published: 26.02.2022
