Modified Sports Intervention Combined With Context-Focused Intervention in Adolescents With Autism Spectrum Disorder: Protocol for a Mixed Methods Study

Adolescents exhibit higher levels of sedentary behavior compared to other age groups. This situation is even more evident among adolescents with Autism Spectrum Disorder (ASD), who show significantly lower levels of physical activity than typically developing adolescents. Studies have revealed that most adolescents with ASD did not meet the three components of the Canadian 24-Hour Movement Guidelines, which include physical activity, sedentary time, and sleep. Low levels of physical activity may contribute to high rates of physical or mental health problems among young people with ASD, including a higher prevalence of overweight and obesity.

Intrinsic factors, such as mobility limitations and difficulties with social interaction, may restrict the participation of children and adolescents with ASD in physical activities. Despite these challenges, evidence suggests that including these young people in physical activity programs can yield significant benefits, such as increased peer social interaction and improvements in motor and communication skills. However, participation in physical activities tends to decline with age, resulting in less engagement from adolescents with ASD compared to younger children with the same diagnosis. Therefore, it is crucial to develop effective strategies to promote the participation of these individuals in physical activities.

Several interventions aim to promote the participation of children and adolescents with ASD in physical activities, including modified sports programs. These programs are defined as recreational activities where rules, equipment, or spaces are modified to enhance sports inclusion and develop fundamental motor skills. Despite the recognition of the importance of modified sports for children's preparation for sports and physical activity, there is still a lack of such interventions for individuals with disabilities, especially in low- and middle-income countries. To address this gap, the Sports Stars program was developed in Australia. This intervention involves modified sports activities led by professionals and delivered in peer groups. Sports Stars focuses on supporting the development of intrinsic factors, such as physical, social, cognitive, and psychological competence in children, or their physical literacy. The program was adapted to the Brazilian context to promote the participation of children and adolescents with cerebral palsy and ASD in physical activities.

A quasi-experimental study assessed the acceptability and initial outcomes of this modified sports intervention for Brazilian adolescents with ASD. Sports Stars proved to be feasible, and the preliminary results were positive for promoting participation and improving gross motor skills (such as locomotion and object control), physical conditioning, and physical literacy (social, psychological, cognitive, and physical) in these individuals. However, no planned clinical trials have yet been conducted specifically for this population. Although adolescents improved their participation in the Sports Stars program, these individuals and their families still report barriers to participation in sports and community recreational activities.

Modified sports interventions promote participation in physical activities in individuals with ASD by addressing intrinsic factors; however, they do not address contextual barriers, such as environmental and interpersonal factors, which also influence participation. Factors such as bullying, parents' perceptions often prioritizing therapeutic intervention, and challenges faced in community programs (such as the lack of adaptations in existing programs to meet their needs) are still prevalent.