Barriers and Facilitators for Physical Activity Among Children and Youth With Autism—A Scoping Review

Click name to view affiliation

Ingrid Okkenhaug Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway

Search for other papers by Ingrid Okkenhaug in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0001-6644-5035 *
,
Magnus Rom Jensen Library Section for Research Support, Data and Analysis, Norwegian University of Science and Technology, Trondheim, Norway

Search for other papers by Magnus Rom Jensen in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0002-1810-2676
, and
Solvor Solhaug Library Section for Research Support, Data and Analysis, Norwegian University of Science and Technology, Trondheim, Norway

Search for other papers by Solvor Solhaug in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0009-0001-2185-3710
Free access

Background: The purpose of this scoping review was to systematically synthesize barriers and facilitators for physical activity (PA) among children and youth with autism spectrum disorders (ASD) across the socioecological model. Methods: Five electronic databases were searched in March 2022 for studies examining barriers and facilitators for PA among children and youth with ASD. An updated search was performed in April 2024. The framework synthesis method was utilized, and the socioecological model was the chosen framework. Results: Fifty-four studies published from 2008 to 2024 were included. Among the included studies, 57% included the perspectives of children and youth with ASD alone or together with proxies (eg, parents, teachers, and coaches), while 43% included only the perspectives of proxies. Barriers and facilitators on the intrapersonal and interpersonal levels were most substantial. The analysis led to 2 main categories of barriers and facilitators, those unique to children and youth with ASD, and those similar to what had been identified through research on children and youth, both typically developing and with other disabilities. Conclusions: This comprehensive scoping review shows the complexity of factors contributing to barriers and facilitators for PA among children and youth with ASD, and highlights both the factors unique to this population and more general factors affecting PA participation. The findings from this synthesis might be used to guide the development of inclusive PA in physical education, organized sports, and other community PA arenas.

Children and youth with autism spectrum disorder (ASD) display lower levels of physical activity (PA) compared to their typically developing (TD) peers.13 Additionally, several studies46 have shown that children and youth with ASD participate in significantly fewer regular activities, including both organized sports and self- or family-organized activities. Given the rising prevalence of ASD among children and youth worldwide,7,8 coupled with low PA levels, it is crucial to understand the complex factors hindering and facilitating PA to effectively promote PA in this population.

ASD is a neurodevelopmental condition, characterized by core characteristics in 2 areas, social communication and restrictive, repetitive sensory-motor behaviors.9 The condition is characterized as a spectrum, indicating significant variation in factors such as functioning and support needs.10 The global prevalence is estimated to be 1% to 2%.11 In addition to the general benefits from PA, including physical fitness and mental health,1214 studies have shown positive effects of PA on several factors closely related to the core characteristics of ASD, including social-emotional behaviors such as social interaction skills and motor control,1518 and some have shown reductions in stereotypic behaviors.15,17,19

A plethora of approaches to understanding the complex factors affecting PA behavior exist, and theoretical models exploring how individual and social-environmental factors interrelate, such as socioecological models.20,21 Socioecological models have been used to understand PA behavior in the general population,22,23 in diverse populations with disabilities,24,25 and with ASD.26,27 In the context of health behavior, such as PA, McLeroy et al21 proposed an adapted socioecological model, depicting 5 levels of influence: (1) intrapersonal factors, both modifiable (eg, attitudes and motivation) and nonmodifiable (eg, age and gender); (2) interpersonal factors, which are formal and informal social networks, social support systems, and groups (eg, family, friends, and public acceptance); (3) institutional factors, which are formal and informal contexts within social institutions (eg, physical education [PE] curriculum or content); (4) community factors, which are the relationships between and among organizations and informal networks (eg, PA programs and facilities); and (5) public policy, including local, state, and national laws, policies, and priorities. Additionally, Sallis et al,28 and Spence and Lee29 proposed a sixth level of influence, physical ecology which pertains to the physical environment (eg, climate) when studying PA behavior. Previous research has explored many levels of influence in this population,26,27 but few reviews have explored all levels of influence,2,3032 including physical ecology.

Research on PA participation among children and youth with ASD has grown in popularity, and literature reviews that systematically map the research done in this area are needed. Utilizing a socioecological model to examine barriers and facilitators for PA provides the possibility of comprehensively investigating the complex interplay between individual and social-environmental factors. Liang et al2 examined PA levels of children and adolescents with ASD, identifying factors of influence on 4 out of 5 levels, not including physical ecology. The review only included studies that quantitatively measured PA levels, excluding most qualitative studies exploring individual experiences. Similarly, the reviews by Krieger et al,31 Hickingbotham et al,30 and Askari et al32 mapped barriers and facilitators for PA, identifying factors located at the intrapersonal and interpersonal levels, and to a lesser extent the community level. Interestingly, at the intrapersonal level, Askari et al32 was the only review to discuss the findings in relation to the core characteristics of ASD, while Hickingbotham et al,30 who also included other psychiatric disorders in their review, identified only intrapersonal factors. However, to our knowledge, no previous scoping review has comprehensively examined barriers and facilitators for PA among children and youth with ASD. Considering this, the current scoping review aimed to thoroughly identify and synthesize barriers and facilitators for PA among children and youth with ASD across the socioecological model’s levels of influence.

Methods

The comprehensive nature of scoping reviews helped us to thoroughly and systematically map the existing literature regarding barriers and facilitators for PA in children and youth with ASD, regardless of the study design and the methodological quality of included studies. Scoping reviews usually do not assess the quality of the existing literature but can identify gaps in the literature.33 This review was guided by the framework for conducting scoping reviews by Arksey and O’Malley33 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews protocol (Supplementary Material S1 [available online]).34

Data Sources and Searches

The following 5 sources were searched: Web of Science, Scopus, ERIC (ProQuest), SPORTDiscus (EBSCO), and MEDLINE (Ovid). The search string was developed in close cooperation between all authors, with Jensen and Solhaug being research librarians experienced in performing systematic review studies. The search strategies for each source are provided in Supplementary Material S2 (available online). Then, a manual search of reference lists was performed.

Inclusion Criteria

To be included in this review, the research had to be (1) an original empirical study; hence, literature reviews, abstracts, commentaries, and studies developing/validating new instruments were excluded; (2) published in English; (3) focused on 6- to 21-year-old (school age) children and youth with ASD; (4) on the topic of experienced or perceived barriers and facilitators for PA (including self- or family-organized PA, PE, organized sports, etc); and (5) published in peer-reviewed journals. The methodological approach was not utilized as an exclusion criterion, and quantitative, qualitative, and mixed methods studies were included.

Data Selection

The initial search was conducted on February 3, 2022, an updated search was performed on April 9, 2024, and after the removal of duplicates, all items were screened independently and blinded based on title and abstract by Jensen and Solhaug using a specialized software, Rayyan (Rayyan Systems, Inc).35 Rayyan does not provide automatic screening and was used only to systematize the independent screening. Conflicts between the initial reviewers were independently reviewed and settled by Okkenhaug, who screened the full text of the remaining studies based on the inclusion criteria. This screening process was followed by a joint discussion between all authors in cases of uncertainty, and then final agreement was reached on which of the studies to include.

Data Extraction and Framework Synthesis

The data extraction and analysis were guided by the framework synthesis method, as this is a systematic and flexible approach to studying the complexities of influences affecting PA.36 The framework consists of 5 overlapping steps37: familiarization, framework selection, indexing, charting, and mapping and interpretation. The framework synthesis was performed by Okkenhaug.

The familiarization stage leading up to the planning of this scoping review gave the researchers specific knowledge about the research field and its complexities per both its methodological approaches and usage of theoretical frameworks. To capture these complexities, the need for a concrete framework to synthesize the reviewed literature became apparent. Through this familiarization, the socioecological model was identified and chosen as the synthesizing framework.

Indexing consisted of 2 separate processes: (1) extracting descriptive characteristics of the included studies using a standardized form, this included author names, title, year of publication, journal, country of origin, aim, methods, sample (N) including female participants, age of participants, study perspective (first person or proxy), diagnosis, theoretical perspective, and philosophical underpinning; and (2) barriers and facilitators were indexed through a codebook approach. The codebook was based on the socioecological model and developed by Okkenhaug. Initially, it included the 5 levels from McLeroy et al’s21 socioecological model and the additional physical ecology as categories for both barriers and facilitators. This initially led to deductive indexing. During the initial full-text readthrough, the codebook was further inductively developed to include subcategories grounded in the included material. All the studies, regardless of methodological approach, were indexed through coding, and text and tables regarding barriers and facilitators for PA included in the “Results” section were indexed. All indexing was done in NVivo (version 1.6.1, Lumivero), and full PDFs of the included studies were uploaded into the software. An external researcher blindly indexed 10% of the included studies using the codebook with the possibility to add new codes, and this was followed by a discussion with Okkenhaugr. Overall, the indexing showed coherent results, and the categories were interpreted similarly. The discussion centered around whether factors belonged on the intrapersonal or interpersonal levels of influence, and how the same factors are experienced as both barriers and facilitators. This is further reflected in the discussion.

After indexing, all the excerpts were inspected within each subcategory and charted based on what the specific excerpt was about. This helped to reduce the data material and start the mapping and interpretation of content within each subcategory. In this process, some subcategories were renamed to better describe the content. These subcategories together with the socioecological model guided the presentation of results.

Through mapping and interpreting, we addressed the aim of this review: to collate the findings into a whole. This was done by looking at findings across categories, how a barrier or facilitator at 1 level affected other level barriers or facilitators, and how the same factor can be perceived both as a barrier and as a facilitator. This process also led to the differentiation between barriers and facilitators unique for children and youth with ASD and that were similar across populations, identified as general barriers and facilitators. The outcomes of this process guided the writing-up and structuring of both the results and the discussion.

Results

The search identified 751 studies, excluding duplicates. Following the screening of titles and abstracts, 680 studies were eliminated, resulting in a first sample of 71 studies. See Figure 1 for a flowchart of the selection process. Following a full-text screening, 53 studies were considered eligible for inclusion. Reasons for exclusion at this stage were not exploring barriers or facilitators for PA, wrong study population, wrong publication type, and an additional duplicate. The reference lists of all the included studies were checked for additional relevant studies, and 1 additional study was included.

Figure 1
Figure 1

—Study selection process. PA indicates physical activity; WoS, Web of Science.

Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0075

Characteristics of Included Studies

Table 1 summarizes the included studies. Fifty-four studies met the inclusion criteria, including 15 quantitative, 35 qualitative, and 4 mixed methods studies (ie, integrating quantitative and qualitative data38). Additionally, most studies combining methods did so within the same tradition (either qualitative or quantitative) and were thus not categorized as mixed methods. All studies were published between 2008 and 2024, with only one study published before 2010, and 35 over the last 5 years (2019–2024). Thirty-two studies were conducted in North America, 11 in Europe, 1 in both Europe and North America, 7 in Asia, 2 in Australia, and 1 in South America. No substantial differences regarding levels of influence were identified between places of origin. Twenty-six studies utilized theoretical frameworks in developing their approaches or in analyzing their data. Of these, the most used framework was different variants of the socioecological model (9 studies). The respondents in 15 of the studies were children or youth with ASD who gave first-person accounts, 23 involved proxies (parents, coaches, instructors, teachers, and health care professionals), and 16 studies included both first-person and proxy accounts.

Table 1

Descriptive Statistics of Included Studies

Study numberAuthorsOriginMethodSample (N)Female ASDAgeTheoretical perspective
1Arkesteyn et al52BelgiumQualitative (interview)C/Y ASD: 17614.4 (1.6)Socioecological
2Arnell et al61SwedenQualitative (focus group)Stakeholders: 17n/an/aSocioecological
3Arnell et al39SwedenQualitative (interview)C/Y ASD: 24712–16n/a
4Arnell et al58SwedenQualitative (interview)Parents: 281212–16n/a
5Ayvazoglu et al64The United StatesQualitative (interview)C/Y ASD: 6

Parents: 6
24–13 (7.5)Systems theory
6Blagrave and Colombo-Dougovito75The United StatesQualitative (interview)Parents: 13n/a4–16 (11.2)n/a
7Blagrave et al78The United States, the United KingdomQualitative (interview)Y/A ASD: 23918–75 (40.45 [17.79])n/a
8Blagrave69The United StatesQualitative (drawing, observation, interview)C/Y ASD: 10110–14 (11.9)Socioecological
9Blagrave and Kemper80The United StatesQualitative (Preference Picture Scale, interview)C/Y ASD: 8

Parents: 8
39–14 (11.75)n/a
10Boucher et al50CanadaMixed methods (interview, questionnaire)C/Y ASD: 14

Caregivers: 14
18–16 (12.23 [2.51])n/a
11Bremer et al68CanadaQuantitative (questionnaire)Parents: 202416–13 (9.4 [2.1])ICF
12Brewster and Coleyshaw65The United KingdomQualitative (focus group)C/Y ASD: 2068–17n/a
13Brown et al89CanadaQuantitative (questionnaire)Parents: 201394–17 (9.42 [3.32])Multiprocess action control framework
14Columna et al50The United StatesQualitative (interview)Parents: 906–14 (10 [2.60])n/a
15Durmus and Sarol88TurkeyQualitative (interview)Parents: 1628–14 (9.31)Planned behavior

theory
16Esenturk84TurkeyQualitative (interview)Parents: 1059–16 (12.1)n/a
17Fiscella et al91The United StatesQuantitative (questionnaire)Parents: 494 ASD, 14,450 TD10612.44 (3.13)Socioecological
18Garcia et al62The United StatesMixed (questionnaire, interview)C/Y ASD: 9

Instructor: 1
016.87 (1.36)n/a
19Graham et al57CanadaMixed (questionnaire, focus group)C/Y ASD: 5

Parents: 5
n/a8–10 (9.2)n/a
20Gregor et al76CanadaQualitative (interview)Parents: 10111–19 (14.7)n/a
21Gurkan and Kocak47TurkeyQualitative (interview)Parents: 1127–16 (11.54)Leisure facilitators and hierarchical leisure constraints theory
22Gurkan and Kocak44TurkeyQualitative (interview)Parents: 17n/a10–19Socioecological
23Hamm and Yun55The United StatesQuantitative (questionnaire)C/Y ASD: 1435118–35 (25 [4.51])Self-determination theory
24Healy et al40The United StatesQuantitative (questionnaire)Y/A ASD: 25310318–50 (30.84 [7.26])n/a
25Healy and Garcia41IrelandQuantitative (questionnaire)C/Y ASD: 55

C/Y TD: 55 Parents: 110
89Youth Physical Activity Promotion model
26Healy et al90The United StatesQualitative (interview, text analysis)Parents: 1346–16 (9.38 [3.07])Social-cognitive theory
27Healy et al66IrelandQualitative (interview)C/Y ASD: 1219–13 (11)n/a
28Hillier et al42The United StatesQuantitative (questionnaire)Y/A ASD: 30

TD: 30
318–27 (22)Theory of planned behavior
29Hilton et al59The United StatesQuantitative (interview)C/Y ASD: 52

C/Y TD: 53

Parents: 105
86–12 (9.54)n/a
30Jachyra et al49CanadaQualitative (interview, digital stories)C/Y ASD: 10012–18 (14.7)Critical social science approach
31Kimber et al74The United KingdomQualitative (interview)Coaches: 10n/an/an/a
32Lamb et al67The United KingdomQualitative (interview, photovoice)C/Y ASD: 5112–16 (1.4)Bourdieu’s reflexive sociology
33Lawson et al82The United StatesQualitative (interview)C/Y ASD: 14

Parents: 14
26–18 (9.14)n/a
34Lee et al83The United StatesQualitative (interview, text analysis)Parents: 5n/a7–14Position theory
35May et al63AustraliaQualitative (interview, motor control testing)C/Y ASD: 13

Parents: 9
n/a4–11 (5.8 [1.9])n/a
36Memari et al43IranQuantitative (questionnaire, activity log)Parents: 83316–15 (9.8 [1.8])n/a
37Must et al79The United StatesQuantitative (questionnaire)Parents: 53 ASD, 58 TD93–11 (6.6 [2.1])Socioecological
38Obrusnikova and Cavalier27The United StatesQualitative (interview, photovoice, activity log, accelerometer)C/Y ASD: 1428–14 (10.64 [1.65])Socioecological
39Obrusnikova and Miccinello46The United StatesMixed (questionnaire, focus group)Parents: 103, 11 for focus group155–21 (12 [3.81])Socioecological
40Oliveira et al87BrazilQuantitative (questionnaire, motor testing)C/Y ASD: 30

Parents: 30
105–10 (6.7 [1.38])n/a
41Oriel et al51The United StatesQuantitative (questionnaire)Teachers: 121n/a3–18n/a
42Pan et al48TaiwanQuantitative (questionnaire, accelerometer)C/Y ASD: 25

C/Y TD: 75
014.26 (±0.89)Self-determination theory
43Parsons et al54The United KingdomQualitative (interview)C/Y ASD: 3

A ASD: 3

Parents: 4

Stakeholders: 5
1FP: 10–24 (16.8)

P: 9–17 (11.8)
Theoretical domains framework and capability opportunity motivation, behavior model of behavior
44Pushkarenko et al73CanadaQualitative (interview)Parents: 6n/a7–10 (8.2)Socioecological
45Rios and Benson45CanadaQualitative (interview)Caregivers: 1735–9 (7.12 [1.17])n/a
46Rosso86AustraliaQualitative (weekly reports, debrief sessions, meeting notes)C/Y ASD: 20

C/Y TD: 4

Instructors: 17
613–19 (15.33)Community development and sport theory
47Ryan et al77CanadaQuantitative (questionnaire)Parents: 120 ASD, 289 other ID2611–23 (17.20 [3.05])n/a
48Salters et al56CanadaQualitative (interview)Instructors: 9n/an/an/a
49Sarol et al70TurkeyQualitative (interview)C/Y ASD: 1

Parents: 1

Coach: 1
n/a14Expectancy-value theory
50Seguin and Fletcher71CanadaQualitative (interview, field observations)C/Y ASD: 1

TD sibling: 1

Parents: 2

Instructor: 1
19n/a
51Stanish et al60The United StatesQuantitative (interview)C/Y ASD: 35

C/Y TD: 60
613–21 (15.9)n/a
52Verret et al72FranceQualitative (interview)C/Y ASD: 4

Teacher: 1
n/a14Interest theory
53Wright et al85CanadaQualitative (interview)C/Y ASD: 4

TD siblings: 4

Parents: 4 Instructors 6
16–14 (11)n/a
54Yessick et al81The United StatesQualitative (scrapbook interview, field notes)C/Y ASD: 4n/a11–12 (11.5)n/a

Abbreviations: A ASD, adult with ASD; ASD, autism spectrum disorders; C/Y ASD, children and youth with ASD; ID, intellectual disability; FP, first person; ICF, International Classification of Functioning, Disability, and Health; P, parent; n/a, not applicable; Y/A ASD, youth and adults with ASD; TD, typically developed.

Barriers and Facilitators for PA

In line with our aim, the included studies were collated based on the socioecological model,21 and both barriers and facilitators were found on all levels of the model. Overall, the analytical process led to substantially more barriers than facilitators coded, and barriers were identified in 53 of the included studies, and facilitators in 45. As it was previously shown that children and youth with ASD are less physically active than their TD peers,1,2 this was not surprising. It was, however, interesting how the same aspects could be perceived as both facilitators and barriers, “but it depends on ... . ”39 Plus, substantially more barriers and facilitators were identified at the intrapersonal and interpersonal levels of influence than the 4 other levels, with public policy factors being the least-covered category. Syntheses of the findings can be found in Table 2.

Table 2

Barriers and Facilitators for PA

BarriersStudy numberaFacilitatorsStudy numbera
Intrapersonal barriersIntrapersonal facilitators
    Motivation1, 2, 3, 4, 5, 10, 12, 14, 18, 19, 21, 22, 24, 27, 28, 29, 30, 35, 36, 38, 39, 41, 42, 43, 45, 48, 51    Motivation1, 3, 4, 8, 10, 11, 12, 14, 18, 19, 22, 23, 30, 32, 38, 43, 44, 49, 50, 51, 52
    Inadequate motor competence1, 3, 4, 10, 11, 20, 21, 22, 27, 29, 32, 37, 38, 39, 40, 41, 45, 46, 48, 51    Predictability and structure1, 3, 4, 12, 18, 30, 31, 39, 43, 45, 48, 54
    Overstimulating environment2, 3, 4, 6, 7, 8, 9, 10, 14, 19, 20, 27, 31, 32, 35, 37, 41, 43, 44, 45, 54    Demonstrating motor skills3, 11, 15, 22, 27, 32, 40, 45, 49, 50
    Risk behavior5, 6, 9, 10, 12, 14, 20, 22, 31, 33, 34, 35, 37, 39, 41, 43    Social competence3, 22, 30, 48
    Social competence1, 4, 5, 6, 10, 12, 20, 22, 31, 32, 35, 39, 41, 45, 47, 48
    Unpredictability3, 4, 5, 9, 12, 16, 19, 20, 31, 43, 45, 53
    Preference1, 4, 10, 14, 28, 34, 35, 38, 43, 51
Interpersonal barriersInterpersonal facilitators
    Family support1, 2, 4, 5, 9, 12, 13, 14, 15, 16, 20, 21, 22, 24, 26, 30, 33, 34, 36, 37, 38, 39, 43, 45, 48, 49, 53    Family support1, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 19, 20, 22, 26, 30, 31, 34, 35, 38, 39, 44, 45, 47, 49, 51
    Bullying and exclusion1, 3, 5, 6, 8, 10, 12, 14, 15, 20, 21, 22, 25, 27, 30, 34, 37, 38, 39, 44, 45, 47, 54    Inclusion1, 3, 6, 7, 8, 10, 14, 15, 18, 19, 21, 22, 27, 30, 38, 43, 44, 45, 48, 49, 50, 51, 54
    Teacher/coach relationship1, 2, 4, 7, 9, 14, 15, 18, 20, 27, 30, 31, 37, 41, 44, 46, 47, 48    Teacher/coach relationship1, 2, 3, 4, 8, 10, 15, 20, 31, 33, 44, 46, 47, 48, 49, 50, 52, 53, 54
    Social participation1, 3, 4, 9, 10, 27, 31, 32, 45, 46, 48, 51
Institutional barriersInstitutional facilitators
    Physical education1, 2, 3, 4, 5, 14, 16, 18, 20, 22, 30, 32, 34, 39, 41, 43, 46, 52, 53    Physical education2, 10, 18, 22, 32, 38
    Public support2, 7, 14, 20, 22, 43, 45    School support11, 15, 39, 43, 45
Community barriersCommunity facilitators
    Unavailable programs1, 2, 3, 4, 5, 6, 9, 10, 12, 14, 15, 20, 21, 22, 28, 29, 30, 33, 35, 36, 37, 38, 39, 43, 44, 45, 46, 47, 48, 53    Inclusive programs3, 5, 6, 14, 15, 20, 21, 22, 26, 31, 35, 38, 39, 43, 44, 45, 47, 53
    Inaccessible facilities1, 6, 7, 14, 21, 22, 33, 38, 39, 43, 46    Accessible facilities1, 6, 7, 17, 21, 22, 38, 39
Public policy barriersPublic policy facilitators
    Down-prioritizing PA2, 4, 14, 15, 16, 20, 22, 30, 45    Prioritizing PA22
Physical barriersPhysical facilitators
    Climate1, 3, 4, 8, 10, 14, 18, 20, 22, 38, 39, 51    Climate18, 19, 38, 39
    Surroundings1, 3, 8, 38

Abbreviation: PA, physical activity.

aSee Table 1.

Intrapersonal Factors

Motivational barriers were the most diverse and complex category of intrapersonal barriers. The participants described aspects of motivation generally as barriers for PA,27,3954 and more concretely, feelings of not belonging,48,49,55 incompetence,39,45,48,56 lack of autonomy,39,54,57 challenges with self-regulation,39,58,59 and low self-esteem.39,44,45,54,56,6063 Experiencing feelings of unsafety was highlighted in several of the included studies.53,60,6466 The emphasis on feeling unsafe shows the importance of teachers and coaches working to support their students and athletes to reduce anxiety levels and feelings of vulnerability. Conversely, motivation was also perceived as an important facilitator through descriptions of enjoyment with PA,27,39,44,49,5254,57,58,60,6772 feelings of safety,62,65 self-esteem,54,73 feeling competent,44,55,71,72 experiencing belongingness,49 experiencing the activity as meaningful,39,44,50,58,60 and the freedom of choice or autonomy.39,52,54,55

ASD is characterized by core characteristics in 2 areas, social communication and restrictive, repetitive sensory-motor behaviors,9 and at the intrapersonal level, all of the remaining intrapersonal categories found in Table 2 can be connected to these core characteristics. Pertaining to social communication, we found barriers related to deficits in social-emotional reciprocity9 presented as social competence barriers and facilitators,45,52,53,74 which included challenges with understanding social norms46,51,56,64,67,7577 and social withdrawal.56,64,65 Interestingly, developing social understanding was perceived both as a facilitator and as a barrier, a barrier to understanding specifically. At the same time, PA could give opportunities for social learning and further participation in social interactions.44,56,71 Additionally, some studies45,56,77 showed that both parents and the children and youth themselves perceived social skills as being the most important skill set for participation, and hence more important to develop than, for instance, motor skills.

Deficits in nonverbal communicative behaviors9 manifested as challenges with understanding nonverbal and verbal cues44,45,58,65,67,74 within the category of social competence, especially for nonverbal individuals.44 Regarding deficits in developing, maintaining, and understanding relationships,9 factors related to adjusting to others and how social codes and demands change were experienced as barriers for PA.63,65,75 Interestingly, PA could help to develop reciprocal relationships,44,56,71 and choosing whom to participate with could facilitate PA.39 It should be acknowledged that solving or addressing these barriers and facilitators required social support and knowledge from parents/caregivers, coaches and teachers, friends, pupils, or other athletes,40,48,78 (ie, other levels of influence in the socioecological model).

Considering the core symptoms within the second area,9 experiences of overstimulating environments in the sense of noise, people, lightning, and temperature were identified as barriers in several studies39,45,51,53,54,57,58,61,66,67,7376,7881 in addition to tactile stimuli like sweating and getting dirt on you,50,63,66,69,78 which was connected to symptoms of hyperreactivity. Similarly, behaviors described as risk behaviors, consisting of a lack of awareness of surroundings and risks,44,46,53,80,82 risk of eloping,46,50,74,75,82 and unsafe behaviors for oneself and others44,46,50,51,53,54,6365,75,76,79,82,83 were related to symptoms of hyporeactivity. Some general attempts to overcome these barriers through “disability-friendly” programs or “autistic-friendly hours”78 have been made at community and institutional levels. Unfortunately, this led to a lack of individual adaptations in some cases, and as ASD is a heterogeneous diagnosis, these measures did not have the desired effects. Additionally, Kimber et al74 found that for some individuals, communication difficulties enhanced these barriers. Taken together, this pointed to the need for coaches, teachers, support staff, and similar to have sufficient knowledge about ASD and to know the individual.

Another core symptom is related to the insistence on sameness and inflexible adherence to routines.9 Within our material, this manifested as barriers connected to unpredictability, and more specifically challenges with transitions54,64 and rigid thinking concerning structure and predictability when participating in PA.39,45,54,57,58,65,74,76,80,84,85 Interestingly, several studies,39,45,46,49,52,54,56,58,65,74,81 highlighted that when PA was organized in a predictable way it facilitated participation and that PA could contribute to routines, a predictable everyday life, and even promote healthy behaviors.62 This, in turn, was shown to add to the care demands on parents or caregivers.58,65 Restrictive fixed interests are also a symptom within this area,9 manifested by a preference for other activities not transferable to PA,27,42,50,5254,58,60,63,83 although some studies showed that this in some cases can be incorporated into the PA, and via that, be used to facilitate PA.27,46 For some individuals, PA was their preferred activity,53,54 contributing to PA participation.

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition,9 in line with previous research, does also include some associated features of ASD relevant when discussing PA, namely motor abnormalities or delays. Findings from our included studies showed that children and youth experienced inadequate motor competence, including delays in motor development and low motor competence,27,39,44,46,47,5153,56,58,59,66,68,76,79,86,87 challenges with developing motor skills,45,60,67 and clumsiness45,56 as barriers to PA. Conversely, studies also showed that participating in PA could help develop these competences, and through that further facilitate PA.39,44,45,67,68,70,71,87,88

Taken together, these findings suggest that children and youth with ASD experience barriers to PA that can be connected to the core symptoms of their diagnosis, which could lead to an argument that PA is not suitable for children and youth with autism. However, several studies showed how the same barriers can be “flipped” to become facilitators through adaptions made in the environment (ie, other levels of influence in the analytical model),40,61,73,76 emphasizing that PA is suitable for children and youth with ASD when adapted to their needs.

Interpersonal Factors

Regarding the interpersonal barriers and facilitators, parent and family support dominated the included studies. Considering barriers, parents being inactive or not prioritizing PA,44,49,89 not being able to provide direct support, such as transportation or being present,27,40,46,49,50,52,54,58,64,70,80,84,85,88 and being gatekeepers for trying new activities27,45,50,65,80,84,88 were prominent. Also, the family economy was highlighted as a potential barrier.4345,47,50,56,58,64,70,76,82,84,88 Most of these barriers could be flipped around, and having physically active parents, parents prioritizing PA as a part of family life, and viewing PA as important also for their child with ASD could facilitate PA.44,49,50,69,70,88,89 Similarly, the parents’ or extended family’s direct support was deemed crucial for PA in several studies,27,45,46,49,52,53,57,58,60,63,64,70,73,75,77,78,80,88 and could be connected to the previously mentioned themes of structure, predictability, and providing safety for the child or youth. The parents who managed to obtain financial support, access PA programs, and master their life situations seemed to be the most proactive and were to a larger degree able to contribute to their child’s PA.44,53,58,70,73,74,78,80

Regarding the social aspects of PA, bullying and exclusion were experienced by children and youth in several of the included studies, including both peer-bullying and not being asked to join activities,39,41,46,47,49,50,52,53,6466,69,76,79,83 experiencing a general intolerance toward individuals with ASD and a lack of understanding among adults.44,47,50,64,73,88 Especially, nonverbal individuals experienced other people not being willing to include them,45,74 and in some cases, simply having the diagnosis was grounds for being excluded from PA.66,75 Simultaneously, arenas for PA could be important for building friendship in this population,47,56,57,66 and having a conscious group of friends to do PA with seemed an important facilitator.27,39,44,5254,57,60,66,70,71,7375,78,81

The included studies showed several issues regarding teachers and coaches’ competences, including for teaching or coaching (eg, pedagogy and adapting activity),52,58,62,66,76,77,79,80,86,88 about ASD,4951,61,73,74,78,86,88 and dealing with exclusion and bullying,73,74 leading to difficulties with inclusion and developing the teacher-student or coach-athlete relationship.56,77 It seemed crucial for teachers and coaches to develop the relationship by getting to know the individual and building trust.52,53,56,58,6972,74,76,77,81,82,85,88 To achieve this, several studies39,52,53,71,73,74,81,85,88 highlighted personal characteristics such as understanding, competence, humor, communication, and role-modeling as aids in promoting participation and enjoyment in PA.

Considering social participation, individuals with ASD experienced challenges with understanding both verbal and nonverbal communication and communicating their own needs,39,45,52,86 leading to difficulties understanding instructions, feedback, etcetera. Similarly, 5 studies highlighted challenges with understanding social codes and demands and how these change between settings.39,52,56,58,67 Furthermore, challenges with adjusting to others in team or group activities led to clear preferences around whom to be active with, which in turn could lead to barriers to participating in organized forms of PA or preferring solitary activities.39,53,58,60,67,74,80

Institutional Factors

Regarding the institutional factors, most findings were related to PE. Barriers to participating in PE were related to PE being perceived as loud, chaotic, or competitive with little room for adaptation in line with the parents’ or children’s wishes,39,49,52,54,58,67,72 being actively excluded,44,46,50,51,61,83,84 low teacher competence in adapting and inclusion,39,44,50,58,64,76 and low teacher-to-student ratios.51,61,62,85,86 On the other hand, having PE as a mandatory subject was reported to be positive27,44,53,61 and appeared to also predict out-of-school participation in PA,46,68 especially when teachers were competent in adapting PE with the aim of participation for all.62,67,72 Also on the institutional level, a lack of information on why and how to do PA was described as a barrier,54,76,78 together with a lack of support from school and too much time spent in school and on homework.44,45,50,61 Further, different kinds of support during school hours were perceived as positive for PA, such as having educational assistants to support the student45 and general support and recommendations for PA from teachers.54,88

Community Factors

Similar to PE, competitive environments with rigid performance standards appeared to be a potential barrier to participation in organized sports.39,49,54,58,63,73,75,76 An additional challenge for children and youth with ASD was that the availability of adapted programs was low, participation was expensive, and there were long waitlists.27,39,4244,46,47,49,50,5254,58,59,61,64,65,73,75,76,79,82,85,88 As previously stated, coaches lacked competence in adapting and including children and youth with ASD, and low staff-to-participant ratios further inhibited participation.4447,49,50,53,54,56,58,61,64,73,75,76,80,85,86,88 Regarding facilitators, having available and inclusive PA programs,27,46,47,63,70,74,75,77,85,88 with competent coaches willing to adapt and include children and youth with ASD,39,44,47,63,73,76,77,85,88 and a physically and socially supportive environment were essential.54,77,90

PA facilities and their structure could constitute an additional barrier for PA, by not being open, not allowing children and youth with ASD access or enforcing strict rules for behavior,27,44,47,50,75 location and equipment being perceived as unsafe,46,75 and lighting and noise contributing to overstimulation.52,54,78,82,86 Some parents also reported avoiding PA in public spaces to avoid public embarrassment,50,64,75 leading to not having access to PA facilities. Parents in several studies27,44,46,47,52,75,78,91 highlighted the importance of having available and safe PA facilities in their neighborhood as an important facilitator.

Public Policy Factors

This was the least-covered category, with only 9 studies showing results at this level of the socioecological model. Considering barriers, both caregivers and stakeholders (teachers, support staff, health care workers, etc) expressed that public policy providers did not give enough importance to PA and did not prioritize it.45,58,61,84,88 In practical terms, this could lead to more importance and time given to other subjects in school and to different forms of therapy.44,49 This also included public funding and financial support for behavioral therapy and educational matters, which were more available than funding for PA.44,45,49,76,88 On the other hand, parents in Gurkan and Kocak44 expressed increased public prioritization for PA, which further facilitated increased PA in their families and for their children with autism.

Physical Factors

Considering the physical factors, both climate and the weather constituted the most frequently mentioned barrier and facilitator. Barriers included temperature (ie, “too hot” or “too cold”) and varying weather conditions, bugs or animals, or allergies.27,39,44,46,50,52,53,58,60,62,69,76 At the same time as the weather could inhibit PA, good weather conditions, a comfortable temperature, or no insects could facilitate PA in some cases.27,46,57,62 Additionally, the surroundings could inhibit PA if there were too many distractions, such as cars, other people, noises, and the location in itself.27,39,52,69 Calmer or quieter surroundings and available equipment were on the other hand reported to facilitate PA.27,52

Discussion

The first study identified in this scoping review was published in 2008,59 and with 35 (65%) of the 54 included studies published after 2019, the field of study can be characterized as growing popularity. The included studies utilized a variety of methodological and theoretical approaches, with findings being somewhat consistent. The primary study perspective in 23 (42.6%) studies came only from proxies (parents, teachers, coaches, etc), whereas 31 (57.4%) included either only the perspectives of children and youth or the perspectives of both proxies and the children and youth with ASD themselves. This contrasts with what previous reviews on children and youth with disabilities had found24,92 and shows that the research field is shifting to include the perspectives of children and youth to a significant degree. One reason for this shift might be an increased focus on children’s and youths’ rights to be heard in matters affecting their everyday lives,93,94 resulting in a shift moving professionals and researchers toward incorporating first-person perspectives in their work and research.

The synthesis of studies based on the perspectives included also showed that the emphasis on different forms of barriers and facilitators differed between different perspectives. Like Shields et al,24 we found that the children and youth with ASD mostly identified both barriers and facilitators on intra- and interpersonal levels, while parents and support staff additionally identified factors on institutional, community, and public policy levels. The exception was community-level factors where children and youth in our included studies reported similarly to proxies, which could be explained by the individuals’ feelings of exclusion when not being welcomed into a PA program.

Furthermore, although both the children and youth and proxies reported similar numbers of intrapersonal level barriers, the content of the barriers varied. The children and youth themselves highlighted motivational barriers, while parents to a larger degree highlighted the barriers that can be connected to the core characteristics of ASD. This difference is interesting for several reasons: First, the children and youth themselves might not experience the characteristics of their diagnosis as limiting to the same extent that their parents do, which could indicate that parents or others around the children and youth can underestimate them and their possibilities, contributing to barriers. Second, this could indicate that the group of children and youth with ASD studied differs when proxies are invited to participate and when the children and youth themselves are invited. For example, nonverbal individuals were rarely included themselves, but their parents/caregivers, teachers, or coaches were. This points to within-group differences in who on the autism spectrum is being heard from.95 At the same time, it is important to acknowledge the parents’ role in voicing their children’s views or needs. In line with this, it is important to also acknowledge the large heterogeneity within the autism spectrum, with factors influencing one individual’s PA participation that might not influence another’s. This was also shown in how proxies expressed family support both as an important barrier and as a facilitator, while children and youth themselves to a lesser degree highlighted the role of the family. Two of the included and recently published studies53,80 utilized diverse qualitative methods to ensure the inclusion of individuals with complex communication needs and intellectual disabilities, showing possibilities for hearing the voices of diverse groups in research.

Interestingly, at the community level, first-person and proxy accounts viewed barriers similarly per experiences of unavailable PA programs. However, when looking at facilitators, the proxies highlighted inclusive or adapted PA programs, and this was to a much lesser degree covered by the children and youth themselves. This could indicate that parents stress the accessibility of adapted or specialized programs, whereas the children and youth themselves might prefer participating on the same grounds as their peers. Taken together, one could argue that children and adults experience the world differently,96 and hence perceive both different and similar barriers and facilitators. This underlines the importance of including the perspectives of both the children and youth with ASD and proxies such as parents, teachers, and coaches to further understand the complex factors influencing PA participation.

Some previous research on TD children and youth had shown boys to have higher levels of PA participation23,97 and PA levels98 compared to girls. Interestingly, the number of barriers and facilitators and the levels of influence were similar for boys and girls when reported,40,60,79 and only 2 of the included studies indicated that boys were more physically active.43,87 One reason for the lack of gender differences could be the skewed gender ratio in individuals diagnosed with ASD, with a proposed ratio of 4 boys to every 1 girl,99 the proportion reflected in the included studies.

The complexities of PA behavior are highlighted through several findings; first, as shown in Figure 2, some factors are perceived as both facilitators and barriers, often dependent on the quality of interaction. An example of such a factor is parent support for PA. This underscores the complexity, contextuality, and subjectivity of the PA experiences as well as the heterogeneity within the autism spectrum. Further, what level of influence a factor is located at is not always apparent. For example, experiencing unpredictability as a barrier to participation could be interpreted as an intrapersonal factor, but it can also be interpreted as an interpersonal factor related to how PA is organized, or the pedagogical approaches of the coach or teacher. Similarly, family finance can be understood as an interpersonal factor, and an issue concerning the availability of PA through the institutional, community, or public policy levels of influence.

Figure 2
Figure 2

—Socioecological model, adapted from McLeroy et al.21 PA indicates physical activity.

Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0075

Throughout our conceptual mapping and interpretation, 2 main categories of barriers and facilitators across the socioecological model’s levels of influence were identified: the factors unique to children and youth with ASD, and factors influencing children and youth in general. Unique to children and youth with ASD were all the intrapersonal factors except motivation, which was related to the diagnosis. While acknowledging the unique challenges children and youth with ASD experience, most of the identified barriers and facilitators for PA were the same as previous studies had identified for TD children and youth, and children and youth with other disabilities.14,24,97,100103 This points to some more general challenges PA providers face with regard to the support of inclusive PA environments and overreaching goals such as “participation for all.”

Different aspects of motivation have repeatedly been shown to be associated with PA,24,97,100,103,104 indicating similar needs to feel competent, experience belongingness, safety, and moreover, a feeling of self-esteem from performing activities. Interestingly, feelings of unsafety as a barrier for PA among children and youth with ASD could be related to the preference or need for predictability and structure connected to the core characteristic of insistence on sameness and inflexible adherence to routines.9 Increased knowledge of the individual athletes with ASD needs might help teachers and coaches in their efforts to support inclusive PA environments and thus help facilitate feelings of safety. Family support dominated the interpersonal factors in the included studies; similarly, Martins et al105 and Bloemen et al103 found positive associations between having physically active parents and child or youth PA. This also included family finances and possibilities to support PA, which was identified as a potentially stronger barrier for children and youth with disabilities.103

With difficulties in social competence leading to social withdrawal in some cases, it is interesting how developing social skills and participating with friends were important facilitators also for this population, in line with findings from TD children and youth.100102,106 This contributes to the knowledge about the importance of belongingness, and how this is important for the drive to participate in PA in this population as well. The additional risk of bullying highlighted in the included studies points to this potentially being a strong barrier to participation in organized forms of PA for this population, which further indicates the importance of working actively with inclusion and anti-bullying in PA arenas.

The importance of a good teacher-student or coach-athlete relationship is prominent across the literature100,107 and supported in the included studies. Within this also lays the importance of getting to know the individual, which was obviously highlighted in the included studies. This also includes general knowledge about ASD, as the heterogeneity of the diagnosis predicts individual differences in the expression of ASD. Also related is the teacher’s or coach’s role in contributing to structure and predictability and using understandable (eg, adapted) communication.

PE and sport were previously shown to be characterized by normative performance standards100,103,107 and competitive environments,22 which could both facilitate PA and function as a barrier. These issues were prominent in the included studies and were highlighted only as barriers. This contributes to our understanding of how traditional sports or of PE providers themselves might reduce barriers to participation for some groups, in this case, children and youth with ASD. This might be partly explained by how the normative performance standards might inhibit the possibilities for inclusion or willingness to adapt for participation for all. In line with this, it is important to remember that this also constitutes a barrier for TD children and youth and shows how sports organizations’ goals of participation for all, etcetera, might not cohere with normative performance standards.

Thus, the active exclusion of children and youth with disabilities in general,103,107 and in this case, ASD, constitutes another big challenge for schools, sport organizers, and other PA organizers. Knowing that children and youth with ASD and other disabilities achieve less PA than their TD peers (who also achieve less than recommended PA) and participate in fewer activities constitutes a large problem. When the organized forms of PA are not available in the same manner, the possibilities for increasing PA levels also appear to be limited. This might find support on another level of the socioecological model, the public policy level, but as the included studies showed, parents and stakeholders reported little public support for PA. Instead, the parents experienced more support for other kinds of therapy (eg, behavioral or speech), whereas funding for PA participation was scarce. This further led to the need for increased financial resources to participate in cases where parents needed to cover the costs for assistants or other support staff for PA or sports.

Limitations and Strengths

This scoping review had both limitations and strengths. The systematic and broad search for all relevant peer-reviewed studies published in academic journals was a strength of this research. We also applied rigorous review methods and did not exclude studies based on time of publication or methodological approach. Also, as this review was restricted to published studies, publication bias cannot be discounted. Due to the large number of studies found and included, we did not search the gray literature. Moreover, there is a possibility that our search and selection processes led to us missing relevant studies. Still, as discussed in the “Methods” section, the current scoping review followed a structured search protocol in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews protocol.34 Finally, we did not complete a quality assessment of the included studies since this is not recommended with scoping reviews.33

The choice to utilize a framework synthesis method36,37 to structure the analysis of included studies might be considered a strength that helps move an analysis from only synthesizing to an integrated discussion. On the other hand, the choice of a predefined theoretical framework can contribute to confirmation bias, leading to findings not “fitting” the theoretical model being overlooked. To avoid this, the choice of a framework that included all levels of influence was important to capture more of the whole picture. Furthermore, describing how the analysis was performed was important to enhance transparency. When compiling research findings from different studies, it is important to remember that children and youth with ASD are as heterogeneous as other children and youth and that grouping results can lead to important distinctions and dimensions being lost. Conversely, it can be argued that regardless of methodological approach, theoretical framework, level of functioning, and country of origin, the included studies showed markedly similar findings.

Implications

This scoping review has highlighted both unique and general barriers and facilitators for PA among children and youth with ASD. From this comprehensive synthesis, we make the following recommendations to enhance PA in this population, and these recommendations might also be used to inform the development of future interventions:

  1. 1.To be able to respond to the diverse needs of individuals with autism, teachers, and coaches should set aside time to get to know the individual and their needs. In line with this, it is important to enhance teachers’ and coaches’ knowledge about inclusive pedagogy, specific conditions, such as ASD, and developing relationships with diverse groups of students or athletes. This also implies that teachers or coaches must have the time and resources available to prioritize this, which needs to be supported at institutional, community, and public policy levels.
  2. 2.PA providers should prioritize providing safety through predictability, structure, and an inclusive environment. Moreover, building inclusive PA environments free of bullying and exclusion should be prioritized. This would involve working with policy makers, PA providers, teachers, coaches, and peers both at schools and in sports.
  3. 3.Enhancing the availability of diverse PAs, both competitive and noncompetitive, is important to further enhance PA participation.
  4. 4.To enhance PA participation, political prioritizing is needed, including economic support for PA as leisure and to ensure PE or adapted PE participation. Support should also be directed toward parents, like further enhancing stakeholders’ knowledge about PA and autism.

Conclusions

This comprehensive scoping review showed the complexity of factors contributing to barriers and facilitators for PA among children and youth with ASD, and how the perspectives included frame what type of facilitators and barriers are identified in the studies. ASD-specific barriers and facilitators must be viewed in light of the heterogenous diagnosis, requiring that teachers, coaches, and caretakers know each individual with ASD in order to facilitate PA. With social skills being reported as the most important skill set, findings in this review highlighted social support as a key to promoting PA. General barriers and facilitators included normative performance standards in PE and organized sports. A competitive environment seemed to function as a barrier for many children and youth with ASD and TD children and youth alike, highlighting the importance of making a variety of PAs available. The synthesis of ASD-specific and general barriers and facilitators highlights the need for both individual adaptations and more general measures that facilitate PA, not only for children and youth with ASD. To facilitate PA for children and youth with ASD, specific measures should be taken at interpersonal, institutional, community, and especially public policy levels of influence. Future research might elaborate on the motivational aspects of the intrapersonal level of influence to identify measures to enhance individual motivation. Also, the included studies were prominently from high-income countries, and research from other parts of the world is needed.

Acknowledgment

The authors would like to express their gratitude to Ingar Mehus and Terese Wilhelmsen for their valuable comments in developing this article.

References

  • 1.

    Jones RA, Downing K, Rinehart NJ, et al. Physical activity, sedentary behavior and their correlates in children with autism spectrum disorder: a systematic review. PLoS One. 2017;12(2):e0172482. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Liang X, Li R, Wong SHS, Sum RKW, Sit CHP. Accelerometer-measured physical activity levels in children and adolescents with autism spectrum disorder: a systematic review. Prev Med Rep. 2020;19:101147. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Rech JP, Irwin JM, Rosen AB, Baldwin J, Schenkelberg M. Comparison of physical activity between children with and without autism spectrum disorder: a systematic review and meta-analysis. Adapt Phys Activ Q. 2022;39(4):456481. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Stanish HI, Curtin C, Must A, Phillips S, Maslin M, Bandini LG. Physical activity levels, frequency, and type among adolescents with and without autism spectrum disorder. J Autism Dev Disord. 2017;47(3):785794. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Mangerud WL, Bjerkeset O, Lydersen S, Indredavik MS. Physical activity in adolescents with psychiatric disorders and in the general population. Child Adolesc Psychiatry Ment Health. 2014;8(1):2. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Healy S, Haegele JA, Grenier M, Garcia JM. Physical activity, screen-time behavior, and obesity among 13-year olds in ireland with and without autism spectrum disorder. J Autism Dev Disord. 2017;47(1):4957. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Atladottir HO, Gyllenberg D, Langridge A, et al. The increasing prevalence of reported diagnoses of childhood psychiatric disorders: a descriptive multinational comparison. Eur Child Adolesc Psychiatry. 2015;24(2):173183. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Bougeard C, Picarel-Blanchot F, Schmid R, Campbell R, Buitelaar J. Prevalence of autism spectrum disorder and co-morbidities in children and adolescents: a systematic literature review. systematic review. Front Psychol. 2021;12:709. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    American Psychiatric Association. Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders (DSM). 5th ed. American Psychiatric Association; 2013:50–59.

    • Search Google Scholar
    • Export Citation
  • 10.

    Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet. 2018;392(10146):508520. doi:

  • 11.

    Lord C, Charman T, Havdahl A, et al. The Lancet commission on the future of care and clinical research in autism. Lancet. 2022;399(10321):271334. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):14511462. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Hansen BH, Anderssen SA, Andersen LB, et al. Cross-sectional associations of reallocating time between sedentary and active behaviours on cardiometabolic risk factors in young people: an International Children’s Accelerometry Database (ICAD) analysis. Sports Med. 2018;48(10):24012412. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Biddle SJH, Ciaccioni S, Thomas G, Vergeer I. Physical activity and mental health in children and adolescents: an updated review of reviews and an analysis of causality. Psychol Sport Exerc. 2019;42:146155. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Bremer E, Crozier M, Lloyd M. A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism. 2016;20(8):899915. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Huang J, Du C, Liu J, Tan G. Meta-analysis on intervention effects of physical activities on children and adolescents with autism. Int J Environ Res Public Health. 2020;17(6):1950. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Sorensen C, Zarrett N. Benefits of physical activity for adolescents with autism spectrum disorders: a comprehensive review. Rev J Autism Dev Disord. 2014;1(4):344353. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Colombo-Dougovito AM, Lee J. Social skill outcomes following physical activity–based interventions for individuals on the autism spectrum: a scoping review spanning young childhood through young adulthood. Adapt Phys Activ Q. 2021;38(1):138169. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Lang R, Koegel LK, Ashbaugh K, Regester A, Ence W, Smith W. Physical exercise and individuals with autism spectrum disorders: a systematic review. Res Autism Spectr Disord. 2010;4(4):565576. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Bronfenbrenner U. The Ecology of Human Development: Experiments by Nature and Design. Harvard University Press; 1979.

  • 21.

    McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351377. doi:

  • 22.

    Duffey K, Barbosa A, Whiting S, et al. Barriers and facilitators of physical activity participation in adolescent girls: a systematic review of systematic reviews. Front Public Health. 2021;9:743935. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Hu D, Zhou S, Crowley-McHattan ZJ, Liu Z. Factors that influence participation in physical activity in school-aged children and adolescents: a systematic review from the social ecological model perspective. Int J Environ Res Public Health. 2021;18(6):3147. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Shields N, Synnot AJ, Barr M. Perceived barriers and facilitators to physical activity for children with disability: a systematic review. Br J Sports Med. 2012;46(14):989997. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Úbeda-Colomer J, Devís-Devís J, Sit CHP. Barriers to physical activity in university students with disabilities: differences by sociodemographic variables. Disabil Health J. 2019;12(2):278286. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Buchanan AM, Miedema B. Parents’ perspectives of physical activity in their adult children with autism spectrum disorder: a social-ecological approach. Adapt Phys Activ Q. 2017;34(4):401420. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Obrusnikova I, Cavalier AR. Perceived barriers and facilitators of participation in after-school physical activity by children with autism spectrum disorders. J Dev Phys Disabil. 2011;23(3):195211. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Sallis JF, Owen N, Fisher EBEcological models of health behavior. In: Glanz K, Rimer BK, Viswanath K, eds. Health Behavior and Health Education: Theory, Research, and Practice. 4th ed. Jossey-Bass; 2008:465486.

    • Search Google Scholar
    • Export Citation
  • 29.

    Spence JC, Lee RE. Toward a comprehensive model of physical activity. Psychol Sport Exerc. 2003;4(1):724. doi:

  • 30.

    Hickingbotham MR, Wong CJ, Bowling AB. Barriers and facilitators to physical education, sport, and physical activity program participation among children and adolescents with psychiatric disorders: a systematic review. Transl Behav Med. 2021;11(9):17391750. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Krieger B, Piškur B, Schulze C, Jakobs U, Beurskens A, Moser A. Supporting and hindering environments for participation of adolescents diagnosed with autism spectrum disorder: a scoping review. PLoS One. 2018;13(8):e0202071. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Askari S, Anaby D, Bergthorson M, Majnemer A, Elsabbagh M, Zwaigenbaum L. Participation of children and youth with autism spectrum disorder: a scoping review. Rev J Autism Dev Disord. 2015;2(1):103114. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):1932. doi:

  • 34.

    Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467473. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. doi:

  • 36.

    Brunton G, Oliver S, Thomas J. Innovations in framework synthesis as a systematic review method. Res Synth Methods. 2020;11(3):316330. doi:

  • 37.

    Gough DA, Oliver S, Thomas J. An Introduction to Systematic Reviews. 2nd ed. Sage; 2017.

  • 38.

    Creswell JW. A Concise Introduction to Mixed Methods Research. Sage; 2015.

  • 39.

    Arnell S, Jerlinder K, Lundqvist LO. Perceptions of physical activity participation among adolescents with autism spectrum disorders: a conceptual model of conditional participation. J Autism Dev Disord. 2018;48(5):17921802. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Healy FS, Brewer B, Laxton P, et al. Brief report: perceived barriers to physical activity among a national sample of autistic adults. J Autism Dev Disord. 2022;52:45834591. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Healy S, Garcia JM. Psychosocial correlates of physical activity participation and screen-time in typically developing children and children on the autism spectrum. J Dev Phys Disabil. 2019;31(3):313328. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Hillier A, Buckingham A, Schena D. Physical activity among adults with autism: participation, attitudes, and barriers. Percept Mot Skills. 2020;127(5):874890. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Memari AH, Panahi N, Ranjbar E, et al. Children with autism spectrum disorder and patterns of participation in daily physical and play activities. Neurol Res Int. 2015;2015:531906. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Gurkan RK, Kocak F. Double punch to the better than nothing: physical activity participation of adolescents with autism spectrum disorder. Int J Dev Disabil. 2021;69(5):697709. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Rios PC, Benson SMS. Exploring caregiver perspectives of social and motor skills in children with autism spectrum disorder and the impact on participation. Front Psychol. 2020;11:1260. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Obrusnikova I, Miccinello DL. Parent perceptions of factors influencing after-school physical activity of children with autism spectrum disorders. Adapt Phys Activ Q. 2012;29(1):6380. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Gurkan RK, Kocak F. Perceived constraints and facilitators of participation in physical activity by individuals with autism spectrum disorders. Phys Act Rev. 2020;8(1):5163. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48.

    Pan CY, Tsai CL, Chu CH, Hsieh KW. Physical activity and self-determined motivation of adolescents with and without autism spectrum disorders in inclusive physical education. Res Autism Spectr Disord. 2011;5(2):733741. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Jachyra P, Renwick R, Gladstone B, Anagnostou E, Gibson BE. Physical activity participation among adolescents with autism spectrum disorder. Autism. 2021;25(3):613626. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50.

    Columna L, Felizola G, Prieto L, Myers B, Streete D, Lightburn A. The experiences of Hispanic families of children with autism spectrum disorder regarding physical activity. Res Dev Disabil. 2020;107:103785. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    Oriel KN, Wetzel E, Reed T, Wilt C, Saufley R. Utilization of physical activity in school-based settings for children with autism spectrum disorder. Palaestra. 2020;34(4):4449.

    • Search Google Scholar
    • Export Citation
  • 52.

    Arkesteyn A, Cornelissen V, Steyaert J, Vancampfort D, Van Damme T. Barriers and facilitators of physical activity participation in adolescents with autism. Children’s Health Care. 2023;10:693. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53.

    Boucher TQ, McIntyre CL, Iarocci G. Facilitators and barriers to physical activity involvement as described by autistic youth with mild intellectual disability. Adv Neurodev Disord. 2023;7:512524. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Parsons K, Payne S, Holt N, Wallace J. A qualitative study of physical activity drivers in autistic individuals using COM-B. Autistic and non-autistic perspectives. Res Autism Spectr Disord. 2024;111:331. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 55.

    Hamm J, Yun J. The motivational process for physical activity in young adults with autism spectrum disorder. Disabil Health J. 2018;11(4):644649. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 56.

    Salters D, Rios PC, Benson SSM. Instructors’ perspectives of social and motor influences on participation in children with autism spectrum disorder. Res Q Exerc Sport. 2022;93(3):467478. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 57.

    Graham TCN, King N, Coo H, Zabojnikova P, Gurd BJ, Samdup D. Design and evaluation of an exergaming system for children with autism spectrum disorder: the children’s and families’ perspective. Front Virtual Real. 2022;3:303. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 58.

    Arnell S, Jerlinder K, Lundqvist LO. Parents’ perceptions and concerns about physical activity participation among adolescents with autism spectrum disorder. Autism. 2020;24(8):22432255. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 59.

    Hilton CL, Crouch MC, Israel H. Out-of-school participation patterns in children with high-functioning autism spectrum disorders. Am J Occup Ther. 2008;62(5):554563. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60.

    Stanish H, Curtin C, Must A, Phillips S, Maslin M, Bandini L. Enjoyment, barriers, and beliefs about physical activity in adolescents with and without autism spectrum disorder. Adapt Phys Activ Q. 2015;32(4):307317. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 61.

    Arnell S, Jerlinder K, Geidne S, Lundqvist L-O. Experiences of stakeholder collaboration when promoting participation in physical activity among adolescents with autism spectrum disorder. Disabil Rehabil. 2022;44(9):17281736. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 62.

    Garcia JM, Cathy BS, Garcia AV, et al. Transition of a judo program from in-person to remote delivery during COVID-19 for youth with autism spectrum disorder. Adv Neurodev Disord. 2021;5(2):227232. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 63.

    May T, Rinehart N, Barnett L, et al. “We’re doing AFL auskick as well”: experiences of an adapted football program for children with autism. J Mot Learn Dev. 2018;6(1):130146. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 64.

    Ayvazoglu NR, Kozub FM, Butera G, Murray MJ. Determinants and challenges in physical activity participation in families with children with high functioning autism spectrum disorders from a family systems perspective. Res Dev Disabil. 2015;47:93105. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 65.

    Brewster S, Coleyshaw L. Participation or exclusion? Perspectives of pupils with autistic spectrum disorders on their participation in leisure activities. Br J Learn Disabil. 2011;39(4):284291. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 66.

    Healy S, Msetfi R, Gallagher S. ‘Happy and a bit Nervous’: the experiences of children with autism in physical education. Br J Learn Disabil. 2013;41(3):222228. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 67.

    Lamb P, Firbank D, Aldous D. Capturing the world of physical education through the eyes of children with autism spectrum disorders. Sport Educ Soc. 2016;21(5):698722. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 68.

    Bremer E, Ginis KAM, Bassett-Gunter RL, Arbour-Nicitopoulos KP. Factors associated with participation in physical activity among Canadian school-aged children with autism spectrum disorder: an application of the international classification of functioning, disability and health. Int J Environ Res Public Health. 2020;17(16):5925. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 69.

    Blagrave J. Experiences of children with autism spectrum disorders in adapted physical education. Eur J Adapt Phys Act. 2017;10(1):1727. doi:

  • 70.

    Sarol H, Gürkan RK, Gürbüz B. The road to championship: an example of an individual with autism spectrum disorder. Balt J Health Phys Act. 2022;14:2. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 71.

    Seguin I, Fletcher PC. “Home away from home”: examining the lived experiences of a child with ASD in a recreational dance setting. Res Dance Educ. 2024;25:316. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 72.

    Verret C, Roure C, Ouellet C, Massé L, Grenier J, Bergeron G. Situational interest of students with autism spectrum disorder using context personalization in physical education. Eur J Adapt Phys Act. 2022;15:8. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 73.

    Pushkarenko K, Causgrove Dunn J, Goodwin DL. Physical literacy for children labeled with autism spectrum disorder: mothers’ experiences of ableism, exclusion, and trauma. Adapt Phys Activ Q. 2021;38(4):525545. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 74.

    Kimber A, Burns J, Murphy M. “It’s all about knowing the young person”: best practice in coaching autistic athletes. Sports Coach Rev. 2023;12(2):166186. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 75.

    Blagrave AJ, Colombo-Dougovito AM. Experiences participating in community physical activity by families with a child on the autism spectrum: a phenomenological inquiry. Adv Neurodev Disord. 2019;3(1):7284. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 76.

    Gregor S, Bruni N, Grkinic P, et al. Parents’ perspectives of physical activity participation among Canadian adolescents with autism spectrum disorder. Res Autism Spectr Disord. 2018;48:5362. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 77.

    Ryan S, Fraser-Thomas J, Weiss JA. Patterns of sport participation for youth with autism spectrum disorder and intellectual disability. J Appl Res Intell Disab. 2018;31(3):369378. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 78.

    Blagrave AJ, Colombo-Dougovito AM, Healy S. “Just invite us”: autistic adults’ recommendations for developing more accessible physical activity opportunities. Autism Adulthood. 2021;3(2):179186. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 79.

    Must A, Phillips S, Curtin C, Bandini LG. Barriers to physical activity in children with autism spectrum disorders: relationship to physical activity and screen time. J Phys Act Health. 2015;12(4):529534. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 80.

    Blagrave AJ, Kemper T. Physical activity preference and parent report of experiences for children on the autism spectrum with complex communication need. Adv Neurodev Disord. 2023;7:213221. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 81.

    Yessick AB, Haegele JA, Zhu X, Bobzien J. Exploring the experiences of children with asd in self-contained physical education: a modified scrapbooking study. Adv Neurodev Disord. 2020;4(1):5158. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 82.

    Lawson LM, D’Adamo J, Campbell K, et al. A qualitative investigation of swimming experiences of children with autism spectrum disorders and their families. Clin Med Insights Pediatr. 2019;13:214. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 83.

    Lee SH, Hodge SR, Dillon SR, Stewart M, Picariello M. Korean immigrant parents of children with autism and physical education. Int J Disabil Dev Educ. 2022;69(3):751769. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 84.

    Esenturk OK. Parents’ perceptions on physical activity for their children with autism spectrum disorders during the novel Coronavirus outbreak. Int J Dev Disabil. 2021;67(6):446457. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 85.

    Wright KT, Bryden PJ, Fletcher PC. Moving and improving: investigating programming and familial influences on physical activity for children with Autism Spectrum Disorder (ASD). Phys Act Health. 2019;3(1):4556. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 86.

    Rosso EGF. Brief report: coaching adolescents with autism spectrum disorder in a school-based multi-sport program. J Autism Dev Disord. 2016;46(7):25262531. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 87.

    Oliveira KSC, Fontes DE, Longo E, Leite HR, Camargos ACR. Motor skills are associated with participation of children with autism spectrum disorder. J Autism Dev Disord. 2023;53:14031412. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 88.

    Durmus K, Sarol H. Investigation of the intentions of children on the autism spectrum to participate in physical activity according to the planned behavior theory. Int J Dev Disabil. 2023;10:844. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 89.

    Brown DM, Arbour-Nicitopoulos KP, Ginis KAM, Latimer-Cheung AE, Bassett-Gunter RL. Examining the relationship between parent physical activity support behaviour and physical activity among children and youth with autism spectrum disorder. Autism. 2020;24(7):17831794. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 90.

    Healy S, March G, Williams E. “I’m not in this alone” the perspective of parents mediating a physical activity intervention for their children with autism spectrum disorder. Res Dev Disabil. 2018;83:160167. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 91.

    Fiscella NA, Case LK, Jung J, Yun J. Influence of neighborhood environment on physical activity participation among children with autism spectrum disorder. Autism Res. 2021;14(3):560570. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 92.

    Wilhelmsen T, Sørensen M. Inclusion of children with disabilities in physical education: a systematic review of literature from 2009 to 2015. Adapt Phys Activ Q. 2017;34(3):311337. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 93.

    UNCRC. Convention on the rights of the child. 1989. Accessed September 14, 2023. https://www.unicef.org/child-rights-convention/convention-text

    • Search Google Scholar
    • Export Citation
  • 94.

    UNCRPD. Convention on the rights of persons with disabilities. 2006. Accessed October 4, 2023. https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities

    • Search Google Scholar
    • Export Citation
  • 95.

    Taneja-Johansson S. Whose voices are being heard? A scoping review of research on school experiences among persons with autism and attention deficit/hyperactivity disorder. Emot Behav Difficul. 2023;28(1):3251. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 96.

    Garth B, Aroni R. “I value what you have to say”. Seeking the perspective of children with a disability, not just their parents. Disabil Soc. 2003;18(5):561576. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 97.

    Biddle SJH, Atkin AJ, Cavill N, Foster C. Correlates of physical activity in youth: a review of quantitative systematic reviews. Int Rev Sport Exerc Psychol. 2011;4(1):2549. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 98.

    Steene-Johannessen J, Hansen BH, Dalene KE, et al. Variations in accelerometry measured physical activity and sedentary time across Europe—harmonized analyses of 47,497 children and adolescents. Int J Behav Nutr Phys Act. 2020;17(1):1738. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 99.

    Maenner MJ, Shaw KA, Baio J, et al. Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2016. MMWR Surveill Summ. 2020;69(4):904. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 100.

    Martins J, Costa J, Sarmento H, et al. Adolescents’ perspectives on the barriers and facilitators of physical activity: an updated systematic review of qualitative studies. Int J Environ Res Public Health. 2021;18(9):4954. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 101.

    Allender S, Cowburn G, Foster C. Understanding participation in sport and physical activity among children and adults: a review of qualitative studies. Health Educ Res. 2006;21(6):826835. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 102.

    Back J, Johnson U, Svedberg P, McCall A, Ivarsson A. Drop-out from team sport among adolescents: a systematic review and meta-analysis of prospective studies. Psychol Sport Exerc. 2022;61:102205. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 103.

    Bloemen MAT, Backx FJG, Takken T, et al. Factors associated with physical activity in children and adolescents with a physical disability: a systematic review. Dev Med Child Neurol. 2015;57(2):137148. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 104.

    Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380(9838):258271. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 105.

    Martins J, Marques A, Sarmento H, Carreiro da Costa F. Adolescents’ perspectives on the barriers and facilitators of physical activity: a systematic review of qualitative studies. Health Educ Res. 2015;30(5):742755. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 106.

    Nally S, Ridgers ND, Gallagher AM, Murphy MH, Salmon J, Carlin A. “When you move you have fun”: perceived barriers, and facilitators of physical activity from a child’s perspective. Front Sports Act Living. 2022;4:789259. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 107.

    Holland K, Haegele JA. Perspectives of students with disabilities toward physical education: a review update 2014–2019. Kinesiol Rev. 2021;10(1):7887. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation

This scoping review comprehensively synthesizes findings across all levels of influence in the socioecological model and differentiates between barriers and facilitators unique to children and youth with ASD and typically developing children and youth, and with other disabilities.

This is significant to further inform practitioners and interventions to enhance PA in the autistic population.

  • Collapse
  • Expand
  • Figure 1

    —Study selection process. PA indicates physical activity; WoS, Web of Science.

  • Figure 2

    —Socioecological model, adapted from McLeroy et al.21 PA indicates physical activity.

  • 1.

    Jones RA, Downing K, Rinehart NJ, et al. Physical activity, sedentary behavior and their correlates in children with autism spectrum disorder: a systematic review. PLoS One. 2017;12(2):e0172482. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Liang X, Li R, Wong SHS, Sum RKW, Sit CHP. Accelerometer-measured physical activity levels in children and adolescents with autism spectrum disorder: a systematic review. Prev Med Rep. 2020;19:101147. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Rech JP, Irwin JM, Rosen AB, Baldwin J, Schenkelberg M. Comparison of physical activity between children with and without autism spectrum disorder: a systematic review and meta-analysis. Adapt Phys Activ Q. 2022;39(4):456481. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Stanish HI, Curtin C, Must A, Phillips S, Maslin M, Bandini LG. Physical activity levels, frequency, and type among adolescents with and without autism spectrum disorder. J Autism Dev Disord. 2017;47(3):785794. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Mangerud WL, Bjerkeset O, Lydersen S, Indredavik MS. Physical activity in adolescents with psychiatric disorders and in the general population. Child Adolesc Psychiatry Ment Health. 2014;8(1):2. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Healy S, Haegele JA, Grenier M, Garcia JM. Physical activity, screen-time behavior, and obesity among 13-year olds in ireland with and without autism spectrum disorder. J Autism Dev Disord. 2017;47(1):4957. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Atladottir HO, Gyllenberg D, Langridge A, et al. The increasing prevalence of reported diagnoses of childhood psychiatric disorders: a descriptive multinational comparison. Eur Child Adolesc Psychiatry. 2015;24(2):173183. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Bougeard C, Picarel-Blanchot F, Schmid R, Campbell R, Buitelaar J. Prevalence of autism spectrum disorder and co-morbidities in children and adolescents: a systematic literature review. systematic review. Front Psychol. 2021;12:709. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    American Psychiatric Association. Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders (DSM). 5th ed. American Psychiatric Association; 2013:50–59.

    • Search Google Scholar
    • Export Citation
  • 10.

    Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet. 2018;392(10146):508520. doi:

  • 11.

    Lord C, Charman T, Havdahl A, et al. The Lancet commission on the future of care and clinical research in autism. Lancet. 2022;399(10321):271334. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):14511462. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Hansen BH, Anderssen SA, Andersen LB, et al. Cross-sectional associations of reallocating time between sedentary and active behaviours on cardiometabolic risk factors in young people: an International Children’s Accelerometry Database (ICAD) analysis. Sports Med. 2018;48(10):24012412. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Biddle SJH, Ciaccioni S, Thomas G, Vergeer I. Physical activity and mental health in children and adolescents: an updated review of reviews and an analysis of causality. Psychol Sport Exerc. 2019;42:146155. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Bremer E, Crozier M, Lloyd M. A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism. 2016;20(8):899915. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Huang J, Du C, Liu J, Tan G. Meta-analysis on intervention effects of physical activities on children and adolescents with autism. Int J Environ Res Public Health. 2020;17(6):1950. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Sorensen C, Zarrett N. Benefits of physical activity for adolescents with autism spectrum disorders: a comprehensive review. Rev J Autism Dev Disord. 2014;1(4):344353. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Colombo-Dougovito AM, Lee J. Social skill outcomes following physical activity–based interventions for individuals on the autism spectrum: a scoping review spanning young childhood through young adulthood. Adapt Phys Activ Q. 2021;38(1):138169. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Lang R, Koegel LK, Ashbaugh K, Regester A, Ence W, Smith W. Physical exercise and individuals with autism spectrum disorders: a systematic review. Res Autism Spectr Disord. 2010;4(4):565576. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Bronfenbrenner U. The Ecology of Human Development: Experiments by Nature and Design. Harvard University Press; 1979.

  • 21.

    McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351377. doi:

  • 22.

    Duffey K, Barbosa A, Whiting S, et al. Barriers and facilitators of physical activity participation in adolescent girls: a systematic review of systematic reviews. Front Public Health. 2021;9:743935. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Hu D, Zhou S, Crowley-McHattan ZJ, Liu Z. Factors that influence participation in physical activity in school-aged children and adolescents: a systematic review from the social ecological model perspective. Int J Environ Res Public Health. 2021;18(6):3147. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Shields N, Synnot AJ, Barr M. Perceived barriers and facilitators to physical activity for children with disability: a systematic review. Br J Sports Med. 2012;46(14):989997. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Úbeda-Colomer J, Devís-Devís J, Sit CHP. Barriers to physical activity in university students with disabilities: differences by sociodemographic variables. Disabil Health J. 2019;12(2):278286. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Buchanan AM, Miedema B. Parents’ perspectives of physical activity in their adult children with autism spectrum disorder: a social-ecological approach. Adapt Phys Activ Q. 2017;34(4):401420. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Obrusnikova I, Cavalier AR. Perceived barriers and facilitators of participation in after-school physical activity by children with autism spectrum disorders. J Dev Phys Disabil. 2011;23(3):195211. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Sallis JF, Owen N, Fisher EBEcological models of health behavior. In: Glanz K, Rimer BK, Viswanath K, eds. Health Behavior and Health Education: Theory, Research, and Practice. 4th ed. Jossey-Bass; 2008:465486.

    • Search Google Scholar
    • Export Citation
  • 29.

    Spence JC, Lee RE. Toward a comprehensive model of physical activity. Psychol Sport Exerc. 2003;4(1):724. doi:

  • 30.

    Hickingbotham MR, Wong CJ, Bowling AB. Barriers and facilitators to physical education, sport, and physical activity program participation among children and adolescents with psychiatric disorders: a systematic review. Transl Behav Med. 2021;11(9):17391750. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Krieger B, Piškur B, Schulze C, Jakobs U, Beurskens A, Moser A. Supporting and hindering environments for participation of adolescents diagnosed with autism spectrum disorder: a scoping review. PLoS One. 2018;13(8):e0202071. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Askari S, Anaby D, Bergthorson M, Majnemer A, Elsabbagh M, Zwaigenbaum L. Participation of children and youth with autism spectrum disorder: a scoping review. Rev J Autism Dev Disord. 2015;2(1):103114. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):1932. doi:

  • 34.

    Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467473. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. doi:

  • 36.

    Brunton G, Oliver S, Thomas J. Innovations in framework synthesis as a systematic review method. Res Synth Methods. 2020;11(3):316330. doi:

  • 37.

    Gough DA, Oliver S, Thomas J. An Introduction to Systematic Reviews. 2nd ed. Sage; 2017.

  • 38.

    Creswell JW. A Concise Introduction to Mixed Methods Research. Sage; 2015.

  • 39.

    Arnell S, Jerlinder K, Lundqvist LO. Perceptions of physical activity participation among adolescents with autism spectrum disorders: a conceptual model of conditional participation. J Autism Dev Disord. 2018;48(5):17921802. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Healy FS, Brewer B, Laxton P, et al. Brief report: perceived barriers to physical activity among a national sample of autistic adults. J Autism Dev Disord. 2022;52:45834591. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Healy S, Garcia JM. Psychosocial correlates of physical activity participation and screen-time in typically developing children and children on the autism spectrum. J Dev Phys Disabil. 2019;31(3):313328. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Hillier A, Buckingham A, Schena D. Physical activity among adults with autism: participation, attitudes, and barriers. Percept Mot Skills. 2020;127(5):874890. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Memari AH, Panahi N, Ranjbar E, et al. Children with autism spectrum disorder and patterns of participation in daily physical and play activities. Neurol Res Int. 2015;2015:531906. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Gurkan RK, Kocak F. Double punch to the better than nothing: physical activity participation of adolescents with autism spectrum disorder. Int J Dev Disabil. 2021;69(5):697709. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Rios PC, Benson SMS. Exploring caregiver perspectives of social and motor skills in children with autism spectrum disorder and the impact on participation. Front Psychol. 2020;11:1260. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Obrusnikova I, Miccinello DL. Parent perceptions of factors influencing after-school physical activity of children with autism spectrum disorders. Adapt Phys Activ Q. 2012;29(1):6380. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Gurkan RK, Kocak F. Perceived constraints and facilitators of participation in physical activity by individuals with autism spectrum disorders. Phys Act Rev. 2020;8(1):5163. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48.

    Pan CY, Tsai CL, Chu CH, Hsieh KW. Physical activity and self-determined motivation of adolescents with and without autism spectrum disorders in inclusive physical education. Res Autism Spectr Disord. 2011;5(2):733741. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Jachyra P, Renwick R, Gladstone B, Anagnostou E, Gibson BE. Physical activity participation among adolescents with autism spectrum disorder. Autism. 2021;25(3):613626. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50.

    Columna L, Felizola G, Prieto L, Myers B, Streete D, Lightburn A. The experiences of Hispanic families of children with autism spectrum disorder regarding physical activity. Res Dev Disabil. 2020;107:103785. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    Oriel KN, Wetzel E, Reed T, Wilt C, Saufley R. Utilization of physical activity in school-based settings for children with autism spectrum disorder. Palaestra. 2020;34(4):4449.

    • Search Google Scholar
    • Export Citation
  • 52.

    Arkesteyn A, Cornelissen V, Steyaert J, Vancampfort D, Van Damme T. Barriers and facilitators of physical activity participation in adolescents with autism. Children’s Health Care. 2023;10:693. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53.

    Boucher TQ, McIntyre CL, Iarocci G. Facilitators and barriers to physical activity involvement as described by autistic youth with mild intellectual disability. Adv Neurodev Disord. 2023;7:512524. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Parsons K, Payne S, Holt N, Wallace J. A qualitative study of physical activity drivers in autistic individuals using COM-B. Autistic and non-autistic perspectives. Res Autism Spectr Disord. 2024;111:331. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 55.

    Hamm J, Yun J. The motivational process for physical activity in young adults with autism spectrum disorder. Disabil Health J. 2018;11(4):644649. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 56.

    Salters D, Rios PC, Benson SSM. Instructors’ perspectives of social and motor influences on participation in children with autism spectrum disorder. Res Q Exerc Sport. 2022;93(3):467478. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 57.

    Graham TCN, King N, Coo H, Zabojnikova P, Gurd BJ, Samdup D. Design and evaluation of an exergaming system for children with autism spectrum disorder: the children’s and families’ perspective. Front Virtual Real. 2022;3:303. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 58.

    Arnell S, Jerlinder K, Lundqvist LO. Parents’ perceptions and concerns about physical activity participation among adolescents with autism spectrum disorder. Autism. 2020;24(8):22432255. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 59.

    Hilton CL, Crouch MC, Israel H. Out-of-school participation patterns in children with high-functioning autism spectrum disorders. Am J Occup Ther. 2008;62(5):554563. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60.

    Stanish H, Curtin C, Must A, Phillips S, Maslin M, Bandini L. Enjoyment, barriers, and beliefs about physical activity in adolescents with and without autism spectrum disorder. Adapt Phys Activ Q. 2015;32(4):307317. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 61.

    Arnell S, Jerlinder K, Geidne S, Lundqvist L-O. Experiences of stakeholder collaboration when promoting participation in physical activity among adolescents with autism spectrum disorder. Disabil Rehabil. 2022;44(9):17281736. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 62.

    Garcia JM, Cathy BS, Garcia AV, et al. Transition of a judo program from in-person to remote delivery during COVID-19 for youth with autism spectrum disorder. Adv Neurodev Disord. 2021;5(2):227232. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 63.

    May T, Rinehart N, Barnett L, et al. “We’re doing AFL auskick as well”: experiences of an adapted football program for children with autism. J Mot Learn Dev. 2018;6(1):130146. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 64.

    Ayvazoglu NR, Kozub FM, Butera G, Murray MJ. Determinants and challenges in physical activity participation in families with children with high functioning autism spectrum disorders from a family systems perspective. Res Dev Disabil. 2015;47:93105. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 65.

    Brewster S, Coleyshaw L. Participation or exclusion? Perspectives of pupils with autistic spectrum disorders on their participation in leisure activities. Br J Learn Disabil. 2011;39(4):284291. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 66.

    Healy S, Msetfi R, Gallagher S. ‘Happy and a bit Nervous’: the experiences of children with autism in physical education. Br J Learn Disabil. 2013;41(3):222228. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 67.

    Lamb P, Firbank D, Aldous D. Capturing the world of physical education through the eyes of children with autism spectrum disorders. Sport Educ Soc. 2016;21(5):698722. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 68.

    Bremer E, Ginis KAM, Bassett-Gunter RL, Arbour-Nicitopoulos KP. Factors associated with participation in physical activity among Canadian school-aged children with autism spectrum disorder: an application of the international classification of functioning, disability and health. Int J Environ Res Public Health. 2020;17(16):5925. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 69.

    Blagrave J. Experiences of children with autism spectrum disorders in adapted physical education. Eur J Adapt Phys Act. 2017;10(1):1727. doi:

  • 70.

    Sarol H, Gürkan RK, Gürbüz B. The road to championship: an example of an individual with autism spectrum disorder. Balt J Health Phys Act. 2022;14:2. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 71.

    Seguin I, Fletcher PC. “Home away from home”: examining the lived experiences of a child with ASD in a recreational dance setting. Res Dance Educ. 2024;25:316. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 72.

    Verret C, Roure C, Ouellet C, Massé L, Grenier J, Bergeron G. Situational interest of students with autism spectrum disorder using context personalization in physical education. Eur J Adapt Phys Act. 2022;15:8. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 73.

    Pushkarenko K, Causgrove Dunn J, Goodwin DL. Physical literacy for children labeled with autism spectrum disorder: mothers’ experiences of ableism, exclusion, and trauma. Adapt Phys Activ Q. 2021;38(4):525545. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 74.

    Kimber A, Burns J, Murphy M. “It’s all about knowing the young person”: best practice in coaching autistic athletes. Sports Coach Rev. 2023;12(2):166186. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 75.

    Blagrave AJ, Colombo-Dougovito AM. Experiences participating in community physical activity by families with a child on the autism spectrum: a phenomenological inquiry. Adv Neurodev Disord. 2019;3(1):7284. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 76.

    Gregor S, Bruni N, Grkinic P, et al. Parents’ perspectives of physical activity participation among Canadian adolescents with autism spectrum disorder. Res Autism Spectr Disord. 2018;48:5362. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 77.

    Ryan S, Fraser-Thomas J, Weiss JA. Patterns of sport participation for youth with autism spectrum disorder and intellectual disability. J Appl Res Intell Disab. 2018;31(3):369378. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 78.

    Blagrave AJ, Colombo-Dougovito AM, Healy S. “Just invite us”: autistic adults’ recommendations for developing more accessible physical activity opportunities. Autism Adulthood. 2021;3(2):179186. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 79.

    Must A, Phillips S, Curtin C, Bandini LG. Barriers to physical activity in children with autism spectrum disorders: relationship to physical activity and screen time. J Phys Act Health. 2015;12(4):529534. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 80.

    Blagrave AJ, Kemper T. Physical activity preference and parent report of experiences for children on the autism spectrum with complex communication need. Adv Neurodev Disord. 2023;7:213221. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 81.

    Yessick AB, Haegele JA, Zhu X, Bobzien J. Exploring the experiences of children with asd in self-contained physical education: a modified scrapbooking study. Adv Neurodev Disord. 2020;4(1):5158. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 82.

    Lawson LM, D’Adamo J, Campbell K, et al. A qualitative investigation of swimming experiences of children with autism spectrum disorders and their families. Clin Med Insights Pediatr. 2019;13:214. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 83.

    Lee SH, Hodge SR, Dillon SR, Stewart M, Picariello M. Korean immigrant parents of children with autism and physical education. Int J Disabil Dev Educ. 2022;69(3):751769. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 84.

    Esenturk OK. Parents’ perceptions on physical activity for their children with autism spectrum disorders during the novel Coronavirus outbreak. Int J Dev Disabil. 2021;67(6):446457. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 85.

    Wright KT, Bryden PJ, Fletcher PC. Moving and improving: investigating programming and familial influences on physical activity for children with Autism Spectrum Disorder (ASD). Phys Act Health. 2019;3(1):4556. doi:

    • Crossref