Youth with Autism Spectrum Disorder Experience Less Physical Activity and More Sleep Issues


Children and adolescents with autism spectrum disorder have less physical activity, longer sleep latency, shorter total sleep time, and lower sleep efficiency than their peers without autism.

A new meta-analysis study found that children and adolescents with autism spectrum disorder (ASD) experience less physical activity and sleep than those without ASD. What’s more, investigators observed that age affected physical activity among those with ASD, but not sleep.

Investigators, led by Xiao Liang, PhD, of the department of rehabilitation sciences at the Hong Kong Polytechnic University, wanted to access levels of physical activity and sleep parameters, comparing youth with ASD and without ASD, as well as children versus adolescents.

The investigators identified 1757 studies, but after evaluating them, they only included 28 studies in their analysis. In total, Liang and colleagues had a sample of 803 children and adolescents with ASD and 1573 without ASD. The youth were between the ages of 5.1 – 16.9 years.

For physical activity, the investigators looked at the length of moderate-to-vigorous physical activity (MVPA) levels.

“The recently developed 24-hour Movement Behavior Framework recommends at least 60

minutes of MVPA per day, as well as 540 - 660 minutes of sleep hours per night, for school-aged children and adolescents,” the investigators wrote. “It has been shown that the specific combinations of movement behaviors (eg, high MVPA and long sleep time) are associated with lower odds ratios for developing physiological health issues, such as overweight and obesity and unfavorable body mass index scores, among children with ASD.”

Sure enough, the team observed a significant small-to-moderate group difference in MVPA for children and adolescents with ASD versus without (κ = 12; g = −0.450; 95% CI, −0.622 to −0.277).

Children and adolescents with ASD had less physical activity (mean [SD], 58.73 [39.09] min/d) than peers without ASD (77.03 [52.03] min/d).

“Our findings confirmed that children and adolescents with ASD (aged 5.5 to 15.9 years) experienced age-related reductions in MVPA,” the team wrote. “A plausible mechanism for these observed MVPA differences could be that because of early abnormal sensory sensitivity to stimuli, children with ASD demonstrate difficulties in participating in activities with physical demands and social communication as they age.”

The investigators added how youth with ASD may avoid physical activities with “higher social demands,” such as basketball, football, and volleyball.

“Indeed, physical inactivity is a global pandemic, contributing to a range of chronic diseases and premature deaths,” investigators wrote.

Age also played a significant part in physical activity levels between children and adolescents with and without ASD (β = −0.049 [95% CI, −0.097 to −0.001]; P = .045), demonstrating how physical activity levels rose with age.

Age, however, was not observed to affect sleep. The study examined sleep latency, referring to the time in minutes from going to bed and falling asleep, total sleep time, referring to the total amount of time spent asleep per night per time awake after sleep onset (WASO), and sleep efficiency per the percentage of total sleep time divided by the time in bed between sleep onset and sleep offset.

Staring with sleep latency, the team found a significant moderate-to-large group difference observed in youth with ASD and without (κ = 17; g = 0.514; 95% CI, 0.351 – 0.677). In other words, youth with ASD had a longer sleep latency duration (mean, 32.57 minutes) than peers without ASD (mean, 7.65 minutes).

Yet, age did not significantly affect sleep latency (β = 0.025; 95% CI, −0.036 – 0.885; P = .42).

With sleep time, children and adolescents with ASD slept for significantly less (461 minutes) than their peers without ASD (474.54 minutes).

Age also did not significantly affect sleep time for youth with or without ASD (β = 0.037; 95% CI, −0.054 to 0.128; P = .43).

For sleep efficiency, there was nonsignificant differences between youth with or without ASD, as well as with age β = 0.060; 95% CI, −0.033 to 0.153; P = .209).

As for WASO, group differences also were not statistically significant (κ = 7; g = 0.324; 95% CI,

−0.002 to 0.650), but WASO was slightly longer in children with ASD than without (62.34 minutes vs 54.55 minutes).

“Findings from accelerometer-assessed sleep parameters suggest that, on average, children and

adolescents with ASD had longer sleep latency, shorter total sleep time, and lower sleep efficiency than their peers without ASD,” the team wrote. “These results were inconsistent with the findings of a previous meta-analysis, which reported that children with ASD had increased sleep onset latency as compared with children without ASD, but there were no differences in total sleep time and sleep efficiency between groups as measured by actigraphy.”


Liang, Xiao, Haegele, J, Healy Sean, et al. Age-Related Differences in Accelerometer-Assessed Physical Activity and Sleep Parameters Among Children and Adolescents With and Without Autism Spectrum Disorder. JAMA Network Open. 2023;6(10):e2336129. doi:10.1001.2023.36129

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