A remotely-delivered pilot and feasibility program to promote physical and food literacy in adolescents with intellectual disabilities

BACKGROUND

Youth with intellectual disabilities experience disparities in physical activity and diet quality. Physical and food literacy are hypothesised to support adoption of healthy lifestyles; however, few such interventions have been developed for this population.

METHOD

Participants with intellectual disabilities ages 12-16 years were recruited for a 12-week online sports skills and nutrition education intervention. Feasibility, acceptability, and preliminary efficacy were assessed by attendance, satisfaction, and pre-post measures of motor skills, perceived competence and motivation for physical activity, classifying foods, making healthy choices, and food consumption.

RESULTS

Six teens participated in the program and attended 87.5% of the sessions. Satisfaction data suggested that the program was well-received by both teens and parents. Trends toward improvements on physical activity and nutrition outcome measures were observed.

CONCLUSIONS

Preliminary data from this pilot study suggest that physical and food literacy in youth with intellectual disabilities can be improved, which in turn may contribute to the adoption of healthy lifestyles.

GamerFit-ASD beta test: adapting an evidence-based exergaming and telehealth coaching intervention for autistic youth

Background

Health disparities faced by autistic youth are exacerbated by inadequate physical activity (PA) and sleep, whereas healthy PA and sleep may improve mood and function. Adaptive Game Squad (AGS) is an evidence-based telehealth coaching and exergaming intervention to improve PA and sleep for adolescents with diverse neurodevelopmental and psychiatric conditions. This study aimed to adapt AGS for autistic youth ages 10-15 years; beta-test the modified intervention for feasibility, accessibility, and engagement; and further refine the intervention for a larger planned demonstration pilot.

Methods

Interdisciplinary experts adapted AGS to create GamerFit-ASD, a 12-week intervention that included a progressive exergame schedule, Fitbit step-tracking, weekly health coaching, and health tip/exercise videos. For beta testing, the intervention was shortened to a 4-week trial with 5 parent/child dyads. Children completed exit surveys and parents and children were interviewed about intervention feasibility, accessibility, and engagement. Exit survey data were summarized with descriptive statistics. Qualitative data were analyzed using a modified grounded-theory approach.

Results

All participants (n = 5; ages 10-14 years) attended all 4 planned coaching sessions and completed an average of 9 of 12 planned exergame challenges for a weekly average of 50 min. All participants reported enjoying coaching sessions, 4 of 5 reported enjoying exergames, and 3 of 5 reported enjoying on-demand exercise videos. In interviews, children generally reported finding participation feasible, exergaming challenges active and fun, and coaches friendly and helpful. Parents reported high feasibility of supporting their children's involvement and valued child goal-setting and intervention flexibility; however, some found telehealth sessions overly scripted. Several adaptations to coaching scripts, coach training, and parent materials were made for the larger demonstration pilot, including changes to reduce scriptedness of coaching sessions, to provide parents with more information specific to autism, and to make video content more appropriate to children's needs/preferences.

Discussion

A telehealth coaching and exergaming intervention appears feasible, accessible, and engaging for autistic youth aged 10-15. Future studies with larger, more diverse samples, longer study durations and/or follow-up periods, and more rigorous study designs are needed to advance understanding of the appropriateness and effectiveness of this type of intervention for this population.

Presenting a New Framework to Improve Engagement in Physical Activity Programs for Children and Adolescents With Social, Emotional, and Behavioral Disabilities

Children and adolescents with psychiatric and neurodevelopmental diagnoses such as anxiety, depression, autism, and attention-deficit/hyperactivity disorder (ADHD) face enormous health disparities, and the prevalence of these disorders is increasing. Social, emotional, and behavioral disabilities (SEBD) often co-occur with each other and are associated with unique barriers to engaging in free-living physical activity (PA), community-based exercise and sports programming, and school-based physical education. Some examples of these barriers include the significantly depleted parental reserve capacity associated with SEBD in children, child dysregulation, and previous negative experiences with PA programming and/or exclusion. Importantly, most SEBD are "invisible," so these parents and children may face more stigma, have less support, and fewer inclusive programming opportunities than are typically available for children with physical or intellectual disabilities. Children's challenging behavioral characteristics are not visibly attributable to a medical or physical condition, and thus are not often viewed empathetically, and cannot easily be managed in the context of programming. Existing research into PA engagement barriers and facilitators shows significant gaps in existing health behavior change (HBC) theories and implementation frameworks that result in a failure to address unique needs of youth with SEBD and their parents. Addressing these gaps necessitates the creation of a simple but comprehensive framework that can better guide the development and implementation of engaging, effective, and scalable PA programming for these youth and their families. Therefore, the aim of this article is to: (1) summarize existing research into SEBD-related child and parent-level barriers and facilitators of PA evidence-based program engagement; (2) review the application of the most commonly used HBC and disability health theories used in the development of evidence-based PA programs, and implementation science frameworks used in adaptation and dissemination efforts; (3) review the SEBD-related gaps that may negatively affect engagement; and (4) describe the new Pediatric Physical Activity Engagement for Invisible Social, Emotional, and Behavioral Disabilities (PAID) Framework, a comprehensive adapted PA intervention development and implementation adaptation framework that we created specifically for youth with SEBD and their parents.

Barriers and facilitators to physical education, sport, and physical activity program participation among children and adolescents with psychiatric disorders: a systematic review

Children and adolescents with heterogeneous psychiatric disorders, of whom over 50% have a second psychiatric comorbidity, have low rates of physical activity and experience unique challenges to engaging in community-based exercise programming, school-based physical education programming, and targeted physical activity interventions. This contributes to elevated rates of gross and fine motor delays, lower mood and self-regulation, and increased risk of chronic diseases such as obesity and type 2 diabetes. Perform a systematic scoping review of the literature to assess known barriers to and facilitators of engaging in physical activity programming among children and adolescents with heterogeneous and/or comorbid psychiatric disorders, in order to improve engagement among this population in real world intervention settings. Systematic Boolean diagnostic and physical activity search terms were entered into PubMed, MEDLINE, PsycINFO and Web of Science for English-language studies published between 2005 and 2020, examining barriers and facilitators for common psychiatric diagnoses and general psychiatric population's engagement in physical activity, physical education, sports, or exercise interventions. Two reviewers independently reviewed titles, abstracts and full articles to determine inclusion. A total of 5,198 articles were returned; 39 relating to children and adolescents were qualified for full-text review. After review, 24 studies were included addressing barriers and facilitators across multiple diagnoses; 7 studies were quantitative, 10 were qualitative, and 7 were mixed methods. Major barriers included low motivation, low self-efficacy, depleted parental reserve capacity, social isolation, lack of staff training, and safety concerns. Major facilitators included peer support/engagement, exergames, supportive parental behaviors, and inclusive/adaptive programming. Numerous barriers and facilitators to physical activity have been identified which should inform community, school, clinical, and research intervention program design. Further research is needed to develop effective strategies that address the challenges to inclusion that children and adolescents with heterogeneous and/or comorbid psychiatric disorders face.

The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study

Background

The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences.

Objective

This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs.

Methods

Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA.

Results

Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (−58.8 min; P=.04) but not for the intervention group (−5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames.

Conclusions

AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing.

Trial Registration

ClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415.

Do ADHD-impulsivity and BMI have shared polygenic and neural correlates?

There is an extensive body of literature linking ADHD to overweight and obesity. Research indicates that impulsivity features of ADHD account for a degree of this overlap. The neural and polygenic correlates of this association have not been thoroughly examined. In participants of the IMAGEN study, we found that impulsivity symptoms and body mass index (BMI) were associated (r = 0.10, n = 874, p = 0.014 FWE corrected), as were their respective polygenic risk scores (PRS) (r = 0.17, n = 874, p = 6.5 × 10-6 FWE corrected). We then examined whether the phenotypes of impulsivity and BMI, and the PRS scores of ADHD and BMI, shared common associations with whole-brain grey matter and the Monetary Incentive Delay fMRI task, which associates with reward-related impulsivity. A sparse partial least squared analysis (sPLS) revealed a shared neural substrate that associated with both the phenotypes and PRS scores. In a last step, we conducted a bias corrected bootstrapped mediation analysis with the neural substrate score from the sPLS as the mediator. The ADHD PRS associated with impulsivity symptoms (b = 0.006, 90% CIs = 0.001, 0.019) and BMI (b = 0.009, 90% CIs = 0.001, 0.025) via the neuroimaging substrate. The BMI PRS associated with BMI (b = 0.014, 95% CIs = 0.003, 0.033) and impulsivity symptoms (b = 0.009, 90% CIs = 0.001, 0.025) via the neuroimaging substrate. A common neural substrate may (in part) underpin shared genetic liability for ADHD and BMI and the manifestation of their (observable) phenotypic association.

ADHD symptoms and body composition changes in childhood: a longitudinal study evaluating directionality of associations

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is linked to increased risk of overweight/obesity among children and adults. Studies have also implicated obesity as a risk factor for ADHD. However, no studies have evaluated bidirectional, longitudinal associations between childhood fat mass and ADHD symptom severity.

OBJECTIVES

We investigate bidirectional associations between ADHD symptoms and measures of body composition between ages 1.5 and 9. We further examine effects of specific eating patterns linked to ADHD on associations between symptom severity and body composition.

METHODS

The study utilized data from children (N = 3903) participating in the Generation R cohort (Netherlands). Children were enrolled at birth and retained regardless of ADHD symptoms over time. Cross-lagged and change models examined bidirectional associations between body composition (body mass index/dual-energy X-ray absorptiometry) and ADHD symptoms at four time points in childhood.

RESULTS

A child with a clinically concerning ADHD symptom z-score two standard deviations above the mean at age 6 would be expected to experience about 0.22 kg greater fat mass gain measured via dual-energy x-ray absorptiometry between ages 6 and 9, even if they displayed healthy eating patterns (95% CI: 0.11 - 0.28, p < 0.001). Conversely, fat mass at any age did not predict worse ADHD symptoms later.

CONCLUSIONS

Beginning in early childhood, more ADHD symptoms predict higher fat mass at later ages. We did not find evidence of a reverse association. Based on these and prior findings, lifestyle counselling during treatment for children with a diagnosis of ADHD should be considered, even if they are diagnosed in early childhood and do not yet have a body mass index of clinical concern.

Healthy Foods, Healthy Families: combining incentives and exposure interventions at urban farmers' markets to improve nutrition among recipients of US federal food assistance

BACKGROUND

Healthy Foods, Healthy Families (HFHF) is a fruit and vegetable (F&V) exposure/incentive program implemented at farmers' markets in low-income neighborhoods, targeting families receiving US federal food assistance. We examined program effects on participants' diet and associations between attendance, demographics and dietary change.

METHODS

Exposure activities included F&V tastings and cooking demonstrations. Incentives included 40% F&V bonus for electronic benefit transfer (EBT) card users and $20 for use purchasing F&V at every third market visit. Self-report surveys measuring nutritional behaviors/literacy were administered to participants upon enrollment (n = 425, 46.2% Hispanic, 94.8%female). Participants were sampled for follow-up at markets during mid-season (n = 186) and at season end (n = 146). Attendance was tracked over 16 weeks.

RESULTS

Participants post-intervention reported significantly higher vegetable consumption(P = 0.005) and lower soda consumption (P = 0.005). Participants reporting largest F&V increases attended the market 6-8 times and received $40 in incentives. No change in food assistance spent on F&V (P = 0.94); 70% reported significant increases in family consumption of F&V,indicating subsidies increased overall F&V purchasing. Participants reported exposure activities and incentives similarly affected program attendance.

CONCLUSION

Interventions combining exposure activities and modest financial incentives at farmers' markets in low-income neighborhoods show strong potential to improve diet quality of families receiving federal food assistance.