"Children are getting weaker, study finds"

The title of this post - "Children are getting weaker, study finds" - comes from one of the media headlines covering the study findings presented by Gavin Sandercock & Daniel Cohen [1]. In their study, the authors detail results derived from the Chelmsford Children's Fitness and Activity Survey, an initiative that has been monitoring the fitness of local children (local to Chelmsford) for about 20 years. Their results for the most recent cohort (2014) compared with previous study cohorts (2008, 1998) make for worrying reading: children are getting weaker alongside "a decrease in self-reported physical activity concurrent with the accelerated declines in fitness from 2008 to 2014."

So: "We measured; height, weight, standing broad-jump, handgrip, sit-ups and bent-arm hang in 10-year-old boys and girls from Chelmsford, England in: 2014 (n = 306), 2008 (n = 304) and 1998 (n = 310)." Researchers also asked about recent physical activity among their cohort using the Physical Activity Questionnaire for Children/Adolescents (PAQ-C), a self-report questionnaire. The collected results were analysed and among other analyses, authors "compared percentage change per year 1998–2008 with 2008–2014" across the variables being studied.

As per the headline, the results were worrying: "Pairwise comparisons showed muscular fitness of both sexes was significantly lower in 2014 than in 1998." They also observed that self-reported physical activity was lower in the later cohort. Obviously, I need to stress that this was self-reported physical activity information, so not exactly objective actigraphic data for example. Out of the several results reported relating to specific aspects of fitness across the cohorts, the issue of handgrip strength stuck out for me in light of some still emerging research suggesting that handgrip strength might have "prognostic value for mortality" according to some studies. Without wishing to make connection when none might exist, I do wonder whether such data might one day eventually tally with some other quite worrying statistics on longevity recently published?

Another detail discussed by Sandercock & Cohen is their finding that "Ten-year-olds in 2014 were taller and heavier than in 2008 and 1998 but there were no differences in BMI [body mass index]." They authors talk about this more in their media interviews: "As today's ten-year-olds are taller and heavier than the children measured six and 16 years ago we expect them to be stronger and more powerful, but this was not the case." Worrying. And it also appears that the declines in strength were increasing more rapidly in the later cohort than compared with the earlier ones, as the authors mention that from 1998 to 2008, strength (group strength) fell by just over half a percent per year, whereas from 2008 to 2014 this decline increased to 1.6% per year.

So what does this all mean for the health and well being of the next generation, and what can be done to reverse such trends? Well, health in childhood is often a good indicator of what health will look like in adulthood. I say this not only from a physiological point of view but also bearing in mind that habits bred in childhood tend to persist into adulthood. Low levels of physical activity probably also follow that pattern.

The possible reasons to account for the cohort disparities? Minus any sweeping generalisations I don't think it would be out of place to mention that things have changed quite a bit when it comes to hobbies and pastimes for at least some parts of the paediatric population. More time spent playing video games or on the Internet have perhaps replaced previous scenarios when kids would meet (in person), play out, run around, climb trees, play football and the like. I don't say that to demonise such digital pastimes (see here) but rather to point out a shifting pattern in activities that also have been noted in other relevant studies [2]. It's perhaps also worthwhile pointing out that opportunities for physical activity have also perhaps changed as a function of the environment we now live in. Why else would schools have had to implement strategies such as the daily mile for example?

Possible solutions? When I first tweeted about the publication of the Sandercock & Cohen article I added in the idea that physical activity specifically along the lines of strength and conditioning could perhaps be added to the learning curriculum. So, alongside maths and English (here in Blighty), there is also a focus on physical education too. Yes, I know physical ed(ucation) is part of the school agenda, but I actually meant something like getting kids into a gym and doing something akin to circuit training at least a few times a week. I know this is ambitious and I know that not every kid is going to be able to do this. But surely in these days of adaption and flexibility in teaching and learning, there are also ways to make such exercise open to all. And you never know, start children young with the mindset that exercise is fun and good for physical (and mental) health, and it might just serve them for a lifetime...

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[1] Sandercock GRH. & Cohen DD. Temporal trends in muscular fitness of English 10-year-olds 1998–2014: An allometric approach. Journal of Science and Medicine in Sport. 2018. Aug 1.

[2] Walsh JJ. et al. Associations between 24 hour movement behaviours and global cognition in US children: a cross-sectional observational study. The Lancet Child & Adolescent Health. 2018. Set 26.

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On "socially successful elementary school-aged children with autism"

"School-based interventions should address malleable factors such as the number of peer connections and received friendships that predict the best social outcomes for children with ASD [autism spectrum disorder]."

So said the study findings reported by Jill Locke and colleagues [1] looking at "the stable (unlikely to change) and malleable (changeable) characteristics of socially successful children with ASD."

Mindful that the phrase 'socially successful children' is perhaps not one that I'm particularly enamoured with, and certainly not one that necessarily opens the doors to 'successful' academic outcomes in childhood for example (see here), the Locke paper makes for interesting reading.

Looking at nearly 150 "elementary-aged children with ASD" authors listed a number of factors linked to 'playground peer engagement' and 'social network salience ' a.k.a playing with other children in the school yard and "inclusion in informal peer groups." The severity of autistic symptoms was unsurprisingly a key feature as was those numbers of 'peer connections' and 'received friendships'.

What do these results mean? Well, minus sweeping generalisations, there may be some pretty easy ways that 'social outcomes' can be positively influenced for at least some children on the autism spectrum; not least one important variable: friends. Yes, a shocker I know.

I've used the term 'easy ways' and 'friends' in that previous sentence to denote how [sometimes] complicated and expensive/resource intensive interventions to 'increase social outcomes' when it comes to the label of autism really might not be the most effective use of resources. I however understand that friends, real friends, are not just something that can be magically produced on demand and that also friendships, whilst in the end generally worthwhile, are not without their own stresses and strains (some of which might be even more stressful and strainful(!) for a child on the autism spectrum).

One approach that does seem to be finding some favour in the peer-reviewed domain at least is that of employing a buddy system. The findings reported by Laushey & Heflin [2] whilst not without their methodological issues, provide some important assertions that a peer buddy approach might be something for schools to consider for some pupils with autism. I know some people might argue that a buddy is not the same as a friend but I'm not one of the them: opportunity (not necessity) is the mother of invention. Visit most schools (at least in here in the UK) and you will see similar arrangements being made for pupils whether diagnosed with autism or not. That and use of 'buddy/friendship stops' in certain parts of the playground and you'll see how important socialisation is viewed for all school pupils.

I'm also a greater believer that sport and exercise can be an important part of inclusion practices when it comes to autism - something equally applicable to school. Y'know, those team games that help build and forge important bonds between children particularly when it comes to competitive team games, also introducing the important concept of 'belonging'. I appreciate that finding the right sport is important in terms of likes/dislikes and ability but there are quite a few options out there. Indeed, drilling further down into the concept of 'belonging', one can perhaps see how even at elementary school age, finding your social niche can open up a whole world of new friends/associates thus implying that school clubs (e.g. Lego club, ICT club) might also be an important intervention tool too.

I don't want to come across too formulaic or mechanical when it comes to how to improve social outcomes for children on the autism spectrum because there is not one-size-fits-all 'flowchart' to this issue. Appreciating also that some children on the autism spectrum might not necessarily want to be 'social butterflies' there has to be some indication from the child as to the extent of their wants and wishes when it comes to social interaction also taken into account.

I should also remind readers that when it comes to friendships, children can be a rather fickle bunch...

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[1] Locke J. et al. Characteristics of socially successful elementary school-aged children with autism. J Child Psychol Psychiatry. 2016 Sep 13.

[2] Laushey KM. & Heflin LJ. Enhancing social skills of kindergarten children with autism through the training of multiple peers as tutors. J Autism Dev Disord. 2000 Jun;30(3):183-93.

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Locke J, Williams J, Shih W, & Kasari C (2016). Characteristics of socially successful elementary school-aged children with autism. Journal of child psychology and psychiatry, and allied disciplines PMID: 27620949

Physical activity in children and youth: themes and consensus

'Physical activity boosts kids' brain power and academic prowess' went the press release accompanying the consensus statement published by Jens Bangsbo and colleagues [1] (open-access).

The consensus statement brought together researchers from around the world "and from a variety of academic disciplines" to emphasise how undertaking all-manner of different kinds of exercise "are still a good investment in academic achievement" when it comes to children aged between 6-18 years of age.

The statement is open-access but a few choice passages are particularly worthy of highlighting including the idea that there are various positive physical effects from exercise (as if you needed telling): "Frequent moderate-intensity and, to a lesser extent, low-intensity exercise improves cardiometabolic fitness in children and youth." I might at this point also refer you to the findings by Ekelund and colleagues [2] that made some headlines recently suggesting that about 65-70 minutes of "moderate intensity physical activity" a day might be something to aim for across different age groups. Yes, move more.

Perhaps just as important are the various associations being made between exercise and other important areas of health and well-being including that: "Physical activity before, during and after school promotes scholastic performance in children and youth" and: "Mastery of fundamental movement skills is beneficial to cognition and scholastic performance in children and youth." Being careful not to fall into the trap that is 'those who exercise are more 'smarter' than those who don't' the idea that mastering movement skills might be another positive from exercise is an important point to make. As I've said before on this blog (see here) one particular pastime ticks a lot of boxes in terms of exercise and a particular focus on fine and gross motor skills: the martial arts. Added to the fact that some important life skills can be gained from disciplines such as karate (e.g. self-confidence) and I'd be the first to advocate more children and young adults getting involved in such activities. Indeed, this is something else covered in the Bangsbo article: "Physical activity-based positive youth development programmes that have an intentional curriculum and deliberate training are effective at promoting life skills (eg, interpersonal, self-regulation skills) and core values (eg, respect and social responsibility) in children and youth."

Finally, I leave you with another important point raised in the consensus statement: "Social inclusion can be promoted by providing equal access to opportunities within physical activity and sports settings regardless of children and young people's social, cultural, physical and demographic characteristics." Wearing my autism research hat, I might agree with the tenets of this point (see here) applied to the autism spectrum and how participation in sports and exercise can be a really important part of social inclusion strategies.

Now, added to exercise potentially improving academic outcomes, how about some outdoor learning too and importantly, making sure that children and young people get enough [quality] sleep?

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[1] Bangsbo J. et al. The Copenhagen Consensus Conference 2016: children, youth, and physical activity in schools and during leisure time. Br J Sports Med. 2016 Jun 27. pii: bjsports-2016-096325.

[2] Ekelund U. et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016. July 27.

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Bangsbo J, Krustrup P, Duda J, Hillman C, Andersen LB, Weiss M, Williams CA, Lintunen T, Green K, Hansen PR, Naylor PJ, Ericsson I, Nielsen G, Froberg K, Bugge A, Lundbye-Jensen J, Schipperijn J, Dagkas S, Agergaard S, von Seelen J, Østergaard C, Skovgaard T, Busch H, & Elbe AM (2016). The Copenhagen Consensus Conference 2016: children, youth, and physical activity in schools and during leisure time. British journal of sports medicine PMID: 27354718

Behavioural outcomes in autism following exercise

It's our birthday today (this blog I mean). We've reached the ripe old age of 5. Many happy returns Questioning Answers. According to some people (one person anyway) "Those who can, publish. Those who can't, blog". Personally, I enjoy doing a bit of both and when it comes to peer-reviewed science, quantity does not always trump quality. That's my excuse anyway.

And onwards...

Today I'm talking about the paper by Emily Bremer and colleagues [1] who set out to "systematically search and critically analyse the literature pertaining to behavioural outcomes of exercise interventions for individuals with autism spectrum disorder aged ⩽16 years."

Researchers concluded that pretty consistently, various exercise interventions "can result in improvements to numerous behavioural outcomes including stereotypic behaviours, social-emotional functioning, cognition and attention." At the very least, adverse side-effects and harms were minimal and it goes without saying that any sort of physical activity is normally quite a good thing anyway. The sorts of activity included in the review ranged from swimming to yoga/dance and quite a bit in-between. Further: "Horseback riding and martial arts interventions may produce the greatest results with moderate to large effect sizes, respectively."

Martial arts in particular cutting the scientific mustard? Well, I'm impressed. Indeed I've said as much about the use of martial arts such as karate for autism before (see here and see here) realising that certain aspects of the discipline such as kumite might not initially be to everyone's taste. That being said, karate and other martial arts might tend to instil a degree of confidence in their practitioners [2], so even those who might not be natural-born 'fighters' might eventually develop a liking (and talent) for this side of the activity. A sprinkling of competition can also sometimes be a good thing (head to 2m36s to see how kata can translate into action)...

Of course the authors are correct in their assertion that further: "well-controlled designs, standardized assessments, larger sample sizes and longitudinal follow-ups is necessary". I might add that a focus on the biology associated with using particular exercise regimes as well as the behavioural effects might also be a good idea so as to potentially ascertain what it is about particular sports/pastimes that seem to produce the behavioural outcomes noted.

I think more people are cottoning on to the idea that sports and physical activity might hold lots of different promises for many people with autism. Most people on the autism spectrum do not lack the capacity to engage in sports and exercise (see here) but again, it tends to be about the provision of opportunities and putting forward a good case as to why taking up a physical activity might be a good thing (see here). I say this keeping in mind individual tastes.

Finally, with again the martial arts in mind, at least one of the governing bodies here in Blighty is starting to open doors. The question is: what's stopping you? Kiai!

Music to close, and given some enthusiasm from some of my brood for Ferris Bueller's Day Off, Yello and Oh Yeah...

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[1] Bremer E. et al. A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism. 2016. Jan 28.

[2] Chen MA. & Cheesman DJ. Mental toughness of mixed martial arts athletes at different levels of competition. Percept Mot Skills. 2013 Jun;116(3):905-17.

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Bremer, E., Crozier, M., & Lloyd, M. (2016). A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder Autism DOI: 10.1177/1362361315616002