movement patterns and physical activity in children with neurodevelopmental disorders

266 Pages·2017·4.52 MB·English

MOVEMENT PATTERNS AND PHYSICAL
ACTIVITY IN CHILDREN WITH
NEURODEVELOPMENTAL DISORDERS

Deirdre Kindregan
BSc. (Hons) Physio

Submitted for the degree of Doctor in Philosophy

University of Dublin, Trinity College
Discipline of Physiotherapy
School of Medicine

November 2017

DECLARATION

I declare that this thesis has not been submitted as an exercise for a degree at this or
any other university and it is entirely my own work.
I agree to deposit this thesis in the University’s open access institutional repository or
allow the Library to do so on my behalf, subject to Irish Copyright Legislation and
Trinity College Library conditions of use and acknowledgement.

Signed: _____________________________
Deirdre Kindregan, November 2017

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SUMMARY
Autism Spectrum Disorder (ASD) is a group of complex neurodevelopmental disorders
characterised by difficulty with social communication and restricted and repetitive
behaviours. Developmental Coordination Disorder (DCD) is a neurodevelopmental
disorder characterised by motor impairments which interfere with activities of daily
living. Children with ASD and/or DCD exhibit signs of poor motor function, with
potential impacts on physical activity, and are at higher risk of overweight/obesity
than typically developing (TD) children.
Two literature reviews were carried out: one examining gait deviations in ASD and one
examining physical activity (PA) in children with ASD or DCD. The results of both
reviews were inconclusive as many studies had contradictory results. However, there
was evidence or deviations in gait patterns and PA levels in the literature.
Chapter 4 measured PA levels in children with ASD and/or DCD in comparison to TD
peers through survey means and Chapter 5 objectively measured PA and fitness in
children with ASD and/or DCD compared to TD children. Children with ASD and/or DCD
were found to be less active, more sedentary and less fit than TD peers.
Chapter 6 determined gait patterns and motor function in children with ASD and/or
DCD compared to TD children. Several differences in gait parameters between children
with ASD and comorbid DCD and TD controls were noted including increased step
width, reduced step length, and increased knee flexion and foot progression angle.
Significant differences in motor function scores were evident with the TD controls
scoring consistently higher on all categories of the coordination test.
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These results indicated barriers to PA in children with neurodevelopmental disorders.
When this was examined further in Chapter 7, children with neurodevelopmental
disorders were found to face similar barriers to TD children (as described in published
research) and additional barriers. Those specific to children with neurodevelopmental
disorders included tactile sensitivity and unsupportive environments.
This thesis highlighted deficits in physical activity and fitness in children with
neurodevelopmental disorders that indicate risk of poor health outcomes. Some
deficits in gait were detected that appear to be more pronounced in the dual diagnosis
group. This study added to the literature by examining the impact of comorbidity.
Significant additional barriers to exercise exist for individuals with
neurodevelopmental disorders that are clearly impacting their ability to meet
recommended levels of physical activity.
This research has investigated a relatively understudied topic which has the potential
to increase risks for significant negative health outcomes. Further studies would help
to clarify how best to encourage engagement with exercise in order to promote
physical health and wellbeing, and to investigate the relationship between motor
impairment and physical activity.

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ACKNOWLEDGEMENTS
To my supervisors, Dr. John Gormley and Prof. Louise Gallagher – I would not have
made it this far without you both. Thank you both for all your advice, guidance and
kind support for the duration of this thesis.
It would be remiss not to mention Sarah-Marie Feighan in this section. Over the years
you have provided a lot of laughter and your can-do attitude has been inspiring. I
cannot thank you enough for the help and encouragement you’ve given me through
this thesis.
To my fellow postgrads in the Physiotherapy Department – thank you for being a
constant source of encouragement and kindness. Many, many cups of tea and just as
many laughs! Particular thanks to those who contributed to this thesis in many ways.
I also had the privilege of being part of the Autism Research Group. Thank you to
everyone involved for your honest feedback and encouragement. A special thanks to
Jackie, Niamh and Ana. To Eleisa, for countless meetings and invaluable statistical
advice – thank you.
I would like to thank all the children and parents who took part in this research. I
enjoyed meeting you all and I hope you enjoyed the experience of taking part in
research. Particularly, to my nephew Conor for countless trips to the lab and for being
my number one control – thanks buddy!
I owe so many thanks to Mam, Dad, Barry, Fiona, Lisa and Rory. You have all been
there during the tougher moments of the last few years with support, encouragement
and love (and proofreading!).
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TABLE OF CONTENTS
DECLARATION ............................................................................................................. ….i
SUMMARY .................................................................................................................... …ii
ACKNOWLEDGEMENTS ................................................................................................ ..iv
LIST OF FIGURES ........................................................................................................... …v
LIST OF TABLES ............................................................................................................. .xii
LIST OF APPENDICES .................................................................................................... xivx
LIST OF PUBLICATIONS FROM THE WORK IN THIS THESIS .......................................... ..xv
LIST OF ABBREVIATIONS .............................................................................................. xvii
TABLE OF CONTENTS ................................................................................................... ..vi
CHAPTER 1: INTRODUCTION ........................................................................................ …1
1.1 NEURODEVELOPMENTAL DISORDERS ............................................................... …1
1.2 AUTISM SPECTRUM DISORDER .......................................................................... …1
1.2.1 Diagnostic Criteria for ASD .......................................................................... …3
1.3 DEVELOPMENTAL COORDINATION DISORDER .................................................. …4
1.3.1 Diagnostic Criteria for DCD .......................................................................... …4
1.3.2 Autism Spectrum Disorder and Developmental Coordination Disorder..... …5
1.4 PHYSICAL ACTIVITY ............................................................................................. …6
1.4.1 Physical Activity and Health ........................................................................ …6
1.4.2 Measurement of Physical Activity ............................................................... …8
1.4.3 Sedentary Behaviour and Physical Inactivity ............................................... ...9
1.4.4 Physical Activity in Childhood ...................................................................... .10
1.4.5 Physical Activity in Children with ASD ......................................................... .11
1.4.6 Physical Activity in Children with DCD ........................................................ .12
1.5 FITNESS ............................................................................................................... .13
1.5.1 Components of Fitness ................................................................................ .13
1.5.2 Fitness in Childhood .................................................................................... .13
1.5.3 Fitness in Children with ASD ........................................................................ .14
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1.5.4 Fitness in Children with DCD ....................................................................... .14
1.6 GAIT .................................................................................................................... .15
1.6.1 Introduction to Gait ..................................................................................... .15
1.6.3 Gait Analysis ................................................................................................ .16
1.6.2 Requirements for Normal Gait .................................................................... .17
1.6.4 Gait Development in Childhood .................................................................. .18
1.6.5 Gait in Children with ASD ............................................................................ .18
1.6.6 Gait in Children with DCD ............................................................................ .19
1.7 MOTOR SKILLS AND COORDINATION ................................................................. .19
1.7.1 Development of Motor Function and Coordination in Childhood .............. .19
1.7.2 Motor Function and Coordination in Children with ASD ............................ .20
1.7.3 Motor Function and Coordination in Children with DCD ............................ .20
1.8 RATIONALE FOR THESIS ...................................................................................... .20
1.9 AIMS OF PHD ...................................................................................................... .21
CHAPTER 2: LITERATURE REVIEWS .............................................................................. .23
2.1 LITERATURE REVIEW 1: GAIT DEVIATIONS IN CHILDREN WITH AUTISM
SPECTRUM DISORDERS ............................................................................................ .23
2.1.1 Introduction ................................................................................................. .23
2.1.2 Methods ....................................................................................................... .25
2.1.3 Results .......................................................................................................... .28
2.1.4 Discussion .................................................................................................... .33
2.2 LITERATURE REVIEW 2: PHYSICAL ACTIVITY IN CHILDREN WITH ASD AND/OR
DCD ...................................................................................................................... .40
2.2.1 Introduction ................................................................................................. .40
2.2.2 Methods ....................................................................................................... .40
2.2.3 Results .......................................................................................................... .45
2.2.4 Discussion .................................................................................................... .50

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CHAPTER 3: METHODS ................................................................................................. .55
3.1: ETHICAL APPROVAL ........................................................................................... .55
3.2: RECRUITMENT OF PARTICIPANTS ..................................................................... .55
3.3: DIAGNOSTIC ASSESSMENTS .............................................................................. .57
3.3.1: Autism Diagnostic Observational Schedule, 2nd Edition (ADOS-2) ............. .58
3.3.2: Autism Diagnostic Interview, Revised Edition (ADI-R) ............................... .59
3.3.3: Wechsler Abbreviated Scale of Intelligence, 1st Edition (WASI) ................ .59
3.3.4: Social Responsiveness Scale (SRS) .............................................................. .60
3.3.5: Social Communication Questionnaire (SCQ) .............................................. .60
3.3.6: Child Behaviour Checklist (CBCL) ................................................................ .61
3.4: PHYSICAL ACTIVITY AND FITNESS ...................................................................... .62
3.4.1: Gas Analysis ................................................................................................ .62
3.4.2: Objective Measure of Physical Activity – Actigraph GT3X+ ....................... .63
3.4.3: Subjective Measure of Physical Activity ..................................................... .64
3.4.4: Body Composition ...................................................................................... .64
3.4.5: 20 Metre Multistage Fitness Test ............................................................... .65
3.5: Motor Function ................................................................................................. .66
3.5.1: Gait Analysis ............................................................................................... .66
3.5.2: Motor Coordination ................................................................................... .74
3.6 Testing Protocol for Chapter 5 and Chapter 6 ................................................... .76
CHAPTER 4: PHYSICAL ACTIVITY IN CHILDREN WITH AUTISM SPECTRUM DISORDER
AND/OR DEVELOPMENTAL COORDINATION DISORDER ............................................. .79
4.1 INTRODUCTION .................................................................................................. .79
4.2 METHODS ........................................................................................................... .80
4.2.1 Modification of a Validated Questionnaire for Use as an Online Survey ... .80
4.2.2 Recruitment methods .................................................................................. .82
4.2.3 Data Analysis ............................................................................................... .83

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4.3 RESULTS .............................................................................................................. .83
4.3.1 School Transport .......................................................................................... .84
4.3.2 Physical Education Class (PE) ....................................................................... .85
4.3.4 Leisure-time Physical Activity ...................................................................... .86
4.3.5 Number of Sports ........................................................................................ .89
4.3.6 Individual and Team Activities ..................................................................... .89
4.3.7 Leisure-time Sedentary Behaviour .............................................................. .90
4.4 DISCUSSION ........................................................................................................ .91
CHAPTER 5: PHYSICAL ACTIVITY AND FITNESS ............................................................ .99
5.1 INTRODUCTION .................................................................................................. .99
5.2 METHODS ........................................................................................................... 100
5.2.1 Data Collection ............................................................................................ 100
5.2.1 Data Analysis ................................................................................................ 101
5.3 RESULTS .............................................................................................................. 102
5.3.1 Physical Activity (PA) ................................................................................... 103
5.3.2 Fitness .......................................................................................................... 108
5.3.4 Energy Expenditure ..................................................................................... 109
5.4 DISCUSSION ........................................................................................................ 110
CHAPTER 6: MOTOR FUNCTION .................................................................................. 115
6.1 INTRODUCTION .................................................................................................. 115
6.2 METHODS ........................................................................................................... 116
6.3 RESULTS .............................................................................................................. 118
6.3.1 Participants .................................................................................................. 118
6.3.2 Gait Analysis ................................................................................................ 119
6.3.3 Motor Coordination ..................................................................................... 124
6.3.4 Relationship Between Gait Parameters and Motor Coordination .............. 125
6.3.5 Relationship Between Motor Function and ASD Severity/IQ ...................... 125
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