Getting into the Game: Evaluation of advanced movement skills of school-aged children with autism spectrum disorder

Chief Investigator: Ms Kerry Evans

Funding Amount: $49,651

Recipient: Novita Children’s Services

Overview:

Almost half of SA children receiving NDIS support have autism (ASD). These children are less physically active than peers, and movement skill issues are now known to complicate the clinical picture. The motor skill gaps widen with age, leading to less chances for participation and social interaction (i.e., circular impact on ASD impairments). However, there is no measure that fully captures the movement issues in these children. We aim to provide a tool that will. With child input we will also create a user guide for physiotherapists/coaches to inform interventions and support participation.


Research Outcomes:

Researchers: Ms Kerry Evans, Dr Annemarie Wright, Dr Virginia Wright, Ms Penny Miller

Research Completed: 2021

Research Findings: Children with an Autism Spectrum Disorder diagnosis are known to have movement difficulties but these are not well understood. Our research shows that the new Ignite Challenge measurement tool is a reliable way to measure physical ability and is well-accepted by children and physiotherapists. Study interviews with both groups supported us in refining the Ignite Challenge user guidelines which will, we hope, help children with ASD to participate more successfully in community-based physical activity programs.

Key Outcomes:

Almost half of the children receiving NDIS support live with autism spectrum disorder (ASD). These children are less physically active than their peers, and movement skill issues are now known to complicate the clinical picture. The skill gaps widen with age, leading to less chances for participation and social interaction plus negative impacts on physical and mental health. There is no measure that fully captures movement issues in these children. Our research aimed to provide a tool that will.

WHAT DID WE DO?  Children living with ASD attended a Novita office to complete a 45 minute assessment of their movement skills (the Ignite Challenge) with a trained physiotherapist assessor. The child’s parent/carer was also asked to complete two questionnaires about movement and social skills. The assessment was video-recorded and scored by a second trained physiotherapist. Children returned to the same office 1-3 weeks later to repeat the Ignite Challenge with the original physiotherapist assessor. An experienced interviewer conducted study interviews with nine children and all of the physiotherapist assessors about their experiences. 

WHO TOOK PART?

  • 47 children aged between 6-14 years old (average age of 9 years); 37 boys and 10 girls
  • 7 physiotherapists and 2 allied health assistants who assisted with set-up and filming

WHAT DID WE FIND OUT?

The Ignite Challenge assessment

Scores on the Ignite Challenge can range from 0% (unable to perform the movement skills) to 100% (perfect score). Participants scored between 22-95% on their first test, showing that the tool captures a wide range of movement abilities. All but two participants completed both assessments.

Key findings

  • The Ignite Challenge can be used by different physiotherapist assessors with very similar results (i.e., it has excellent inter-rater reliability). The scores of the physiotherapists who conducted the live assessment and those who scored from videos were almost identical.
  • The advanced motor skills of the children can be reliably measured by the Ignite Challenge (i.e., it has excellent test-retest reliability).  Participant scores were very similar for the initial test and the retest.  Thus clinicians can feel confident that any changes observed after an intervention reflect a true improvement in a child’s abilities.
  • The older the child, the higher their score on the Ignite Challenge. While this would be expected in a developing child, in these children with ASD, age only explained a quarter of the variance in scores. Analysis is ongoing to explore other personal characteristics that may contribute to this potentially important finding.
  • Ignite Challenge scores showed a positive association with other known measures of mobility, participation and socialisation (i.e., the Ignite Challenge has strong validity). There was however, no association with a participant’s sensory profile. Work is ongoing to fully understand this result.
  • Children generally responded well to the Ignite Challenge and enjoyed the chance to show their best movement skills and play ‘games’ with a physiotherapist in a positive environment.
  • Physiotherapists reported that the Ignite Challenge is a notable improvement on existing tests of physical ability used for children with ASD, and that they enjoyed using it (a sign that it was a good fit for the children they were assessing). 

WHY ARE THESE FINDINGS IMPORTANT? Movement difficulties are not currently included in an ASD diagnosis and are less well understood than other aspects of this condition. Our research shows that the Ignite Challenge measurement tool is a reliable way to measure physical ability and is well-accepted by children and physiotherapists. Child and physiotherapist interview data are being analysed to inform enhanced guidelines for how to best administer the Ignite Challenge and its use will, we hope, lead to the over-arching aim of successful participation of children with ASD in community-based physical activity programs.

UPDATE:

All children completed the full Ignite Challenge, with mean time of 46.1 minutes (SD 10.1).

PT ratings of ease of administration were 6.3/10 (SD 2.3) and child engagement 6.6/10 (SD 2.2). Test mean scores were 69.2% (SD 17.1) and 69.5% (SD 16.6) at baseline and retest with excellent interrater (n=47) and test‐retest (n=45) reliability (ICC=0.97 [95% CI=0.93, 0.99] and ICC=0.91 [95% CI 0.84, 0.95]) respectively; CoV 4.29% and 9.28% respectively; and MDC80=9.32% points). Associations between the Ignite Challenge and PEDI‐CAT (n=45) were r=0.53, 0.60 and 0.63 (p<0.0001) respectively for Social, Mobility, and Daily Activity subscale scores.

Conclusions/Significance: The favourable results overall support use of the Ignite Challenge to identify a child’s movement skills strengths and challenges. Evaluation of responsiveness to change will be an important next step. Given the possibility of a negative feedback loop between ASD‐linked impairments and motor skills limitations and children’s physical activity (PA) participation, the Ignite Challenge may aid goal setting and evaluating progress in PA‐based intervention programs for children with ASD.

Research Papers:

Getting into the Game: Evaluation of the reliability of the Ignite Challange, a measure of advanced movement skills of school-aged children with autism spectrum disorder – Paper in preparation “I’ve found it enjoyable because the kids are often enjoying themselves as well.” Refining engagement strategies and administration of a new measure advanced motor skills for children with autism spectrum disorder – Paper in preparation

Initial validation of the Ignite Challenge for children and youth with Autism Spectrum Disorder

Getting into the Game: Presented at the American Academy of Cerebral Palsy and Developmental Medicine 74th Annual Meeting (Virtual Conference): Available at https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.15004

Related Publications: The Ignite Challenge was developed prior to this research project at Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada, and as such is their intellectual property that is then licensed for free unrestricted use to paediatric physiotherapists who take the Ignite Challenge training course.

Future Outcomes:

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