Introduction and context
Participation in physical activity (PA) and physical education (PE) is very important for all children and youth (C&Y) because it helps with physical, social, affective, and cognitive development (Bailey, 2006). Autistic C&Y especially gain from PA and PE as it may help develop their physical and social skills, including cooperation and personal responsibility (Lamb et al., 2016). However, they often face challenges such as exclusion, bullying, sensitivities to loud noises and bright lights, and a lack of supportive community programs and resources. These challenges make it difficult for them to take part in PA and PE (Arnell et al., 2023; Haegele & Maher, 2021). Facilitators and barriers that affect PA and PE participation among autistic C&Y have been identified. However, a full review has never been done. We conducted two scoping reviews to fill this gap. Our main research question was: What facilitators and barriers to PA and PE participation for autistic C&Y have been identified?
Methods
We used Arksey and O’Malley’s scoping review framework (2005) and the socio-ecological model (McLeroy et al., 1988) to guide these reviews. The framework involved creating research questions, selecting studies based on specific criteria, and analyzing the data from those studies. Included studies had to: (a) be in English, (b) be original peer-reviewed research, (c) focus on identifying facilitators and/or barriers to PA and PE participation, and (d) involve autistic C&Y aged 5–18 years. We summarized data descriptively with statistics and found themes according to the socio-ecological model levels. We checked the quality of the studies using the Quality Assessment with Diverse Studies tool (Harrison et al., 2021). We also consulted stakeholders to make sure our results were useful and relevant.
Key findings and implications
The PA participation of autistic C&Y was examined in 39 studies while their PE participation was examined in 22 studies. These studies were included in the scoping reviews where 96 facilitators of PA and 77 facilitators of PE were identified respectively. Additionally, 104 barriers to PA and 104 barriers to PE were reported. We identified that autistic C&Y may experience a cycle of PA and PE avoidance similar to the one observed in children with movement difficulties due to underdeveloped movement and social skills (Barnett et al., 2013; Bouffard et al., 1996). These difficulties can lead to lower achievement and negative experiences in PA and PE, which may reduce autistic C&Y’s confidence, increase feelings of helplessness, and make them more likely to avoid PA and PE (Arnell et al., 2020; Obrusnikova & Miccinello, 2012).
Parents, coaches, teachers, and healthcare professionals all played a big role in PA and PE participation. For example, parents, especially single parents, struggled with the time, energy, and money needed to support their child’s PA participation (Freedman et al., 2011; Arnell et al., 2020). This challenge was made worse by a lack of guidance from healthcare professionals and PE teachers, leaving parents feeling unsure about how to motivate their child to participate in PA and PE (Gregor et al., 2018; Durmuş & Sarol, 2023). Additionally, insufficient training for PE teachers, teaching aids, and coaches, along with a lack of resources, led to PA and PE practises that excluded autistic C&Y and made them feel isolated (Gregor et al., 2018).
Safety concerns also played a big role as a barrier to PA and PE participation. For example, autistic C&Y were worried about getting hurt or being bullied during PA and PE, leading them to avoid these activities (Obrusnikova & Cavalier, 2011; Ayvazoglu et al., 2015). Parents also restricted unsupervised outdoor PA because of safety concerns associated with nearby highways or bodies of water (Shannon et al., 2021). These worries contributed to PA and PE avoidance among autistic C&Y and hindered their movement and social skill development (Shannon et al., 2021; Ayvazoglu et al., 2015).
Access to adapted PA and PE opportunities also affected participation. For example, the availability of PA equipment at home, such as a pool or a bicycle, or the proximity of a neighbourhood playground, facilitated PA participation (Blagrave & Kemper, 2022; Obrusnikova & Cavalier, 2011). Conversely, limited access to affordable and sensory-friendly PA options in the community made it challenging for autistic C&Y to participate in PA (Gregor et al., 2018). Further, financial constraints and limited resources in community programs and schools restricted access to necessary PA and PE equipment and facilities (Columna et al., 2020; Durmuş & Sarol, 2023). This lack of accessible opportunities left fewer options for autistic C&Y to participate in PA and PE and develop their movement and social skills (Arkesteyn et al., 2023).
Our reviews highlighted the importance of focusing on what helps to improve PA and PE participation as opposed to the barriers. A strengths-based approach that emphasizes these facilitators may help reduce the avoidance of PA and PE among autistic C&Y (Warburton & Bredin, 2019). Effective facilitators included tailoring PA activities to autistic C&Y’s preferences, ensuring supportive interactions with others, using teaching methods suited to individual needs, and providing accommodating environments. For example, activities that match the child’s interests, provide familiar experiences, and include game-like elements may boost participation (Arnell et al., 2018; Obrusnikova & Cavalier, 2011). Supportive partners may also increase motivation and confidence (Arnell et al., 2023; Gregor et al., 2018). Tailored coaching methods such as personalized guidance, clear rules, and the use of technology, may enhance participation for autistic C&Y by aligning with their strengths and preferences. Familiar physical settings, like neighbourhood parks or backyards, can create a sense of security and comfort for autistic C&Y and help them overcome their reluctance to participate. Thus, we should create positive experiences that help break the cycle of avoidance by integrating such facilitators into PA and PE planning (Bouffard et al., 1996; Warburton & Bredin, 2019).
Strengths and limitations
These scoping reviews offered new insights into what helps or hinders the PA and PE participation of autistic C&Y. This comprehensive review is unique and provides information for autistic C&Y, their families, teachers, community leaders, and healthcare professionals. However, there are two key limitations. First, some studies included participants older than 18 years, even though the average age was between 5 and 18 years. Second, one reviewer screened the entire data set for both reviews, with only a partial screening by a second reviewer. The method was considered suitable due to the primary reviewer’s expertise.
Conclusions and next steps
In conclusion, these two scoping reviews highlighted the considerable PA and PE barriers faced by autistic C&Y. These barriers may contribute to a cycle of PA and PE avoidance among these C&Y. While it is important to identify barriers, focusing on what helps promote PA and PE participation might be more effective. Interventions that create inclusive and supportive PA and PE opportunities can be developed by evaluating which facilitators promote PA and PE participation. This approach is key to fostering movement and social skill development to break the hypothesized cycle of avoidance and encourage lifelong engagement in PA and PE for autistic C&Y.
Future research should explore how past and current PA and PE experiences affect participation, while also considering differences in age, sex, gender, and socio-demographic factors. Additionally, studies should primarily involve autistic C&Y, their families, and teachers to find ways to improve PA and PE participation at home, school, and in the community.