Pub Date : 2026-01-01DOI: 10.1016/j.ridd.2025.105201
Md Roungu Ahmmad , Md Tareq Ferdous Khan , Sahil Hareshbhai Kothiya , Mohammed Rashid , Christina McCrae
Background
Sleep behavior is closely linked to autism spectrum disorder (ASD) and may influence behavioral and neurological development. This study examined the association between sleep pattern consistency (SPC) and ASD among children aged 6–17 years.
Methods
This study used data from 63,866 children from the 2022–2023 National Survey of Children’s Health (NSCH). ASD status was based on parent-reported provider diagnoses. SPC was constructed from sleep duration and bedtime regularity. Associations between SPC and ASD were examined using relative risks and multivariable logistic regression. Machine learning methods predicted individualized ASD profiles and identified high-risk subgroups. Model performance was evaluated using discrimination and calibration metrics.
Results
The cohort showed 4.41 % ASD prevalence, mean age 11.9 years, 51.8 % male, 62.4 % healthy weight, 28.9 % poor sleep routines, 28.8 % lower income, 40.5 % co-occurring disorders, and 42.4 % with medication. Children with poor sleep routines (PSR) demonstrated a significantly higher likelihood of ASD (aOR: 1.92; 95 % CI: 1.64–2.25), whereas long sleep with regularity (LSR) was associated with a lower likelihood (aOR: 0.81; 95 % CI: 0.70–0.94). Other correlated factors included male sex (aOR: 3.83, p < 0.001), underweight (aOR: 1.28, p < 0.001), and overweight (aOR: 1.39, p < 0.001). Among female children from low-income households with co-occurring conditions, PSR patterns were associated with higher predicted ASD probability (∼12 %, p = 0.002), whereas healthy sleep routine (HSR) showed substantially lower predicted probabilities.
Conclusion
SPC was significantly associated with ASD. These findings highlight the potential relevance of sleep health in relation to developmental outcomes and ASD screening, particularly among higher-risk subgroups.
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Pub Date : 2026-01-01DOI: 10.1016/j.ridd.2025.105202
Pei Zhang , Gang Zhao , Junru Li , Xian Tian , Lingrong Xiao , Hongzhu Diao , Xiaoqing Xu , Yisi Jin , Hongmei Wu
<div><h3>Background</h3><div>Despite documented benefits of exercise for children with attention deficit hyperactivity disorder (ADHD), poor adherence to exercise programs limits therapeutic effectiveness. While existing research focuses on symptom outcomes, the behavioral processes and contextual factors influencing sustained exercise participation remain underexplored.</div></div><div><h3>Aims</h3><div>This study systematically explored facilitators and barriers to exercise compliance—operationally defined as the degree to which a child's actual exercise behavior (frequency, intensity, duration) aligns with prescribed recommendations—in children with ADHD from parental perspectives, using the Capability-Opportunity-Motivation-Behavior (COM-B) model.</div></div><div><h3>Methods and procedures</h3><div>A qualitative descriptive study was conducted with 16 parents (13 mothers, 3 fathers; child age range: 6–12 years) of children diagnosed with ADHD, purposively sampled from a home-based exercise intervention program at a tertiary hospital in China (June–September 2024). Sampling considered child characteristics (age, ADHD subtype) and family socioeconomic status to ensure diverse perspectives. Semi-structured interviews (20–40 min) explored parents' experiences with their children's exercise participation. Data were analyzed using directed content analysis, whereby transcripts were systematically coded line-by-line within the COM-B framework while remaining open to inductive subtheme emergence. Data saturation was achieved at 16 interviews.</div></div><div><h3>Outcomes and results</h3><div>Analysis identified 12 distinct subthemes across three COM-B domains. Capability barriers included motor skill deficits, attention difficulties, emotional dysregulation, and limited self-management, collectively undermining children's confidence and willingness to exercise. Opportunity factors functioned bidirectionally: parental knowledge, companionship, peer support, and facility accessibility enhanced adherence; financial constraints, lack of parental time, and excessive academic workload—particularly salient in China's high-pressure educational context—significantly impeded participation. Motivation evolved dynamically, with external rewards initially driving engagement but intrinsic interest and perceived symptom improvement sustaining long-term adherence.</div></div><div><h3>Conclusions and implications</h3><div>This study provides the first theoretically grounded, qualitative examination of exercise adherence processes (rather than solely outcomes) in pediatric ADHD. Findings reveal culture-specific barriers and the dynamic interplay among capability, opportunity, and motivation. Clinicians should conduct individualized capability assessments before prescribing exercise and tailor programs to children's motor abilities. Educators can adjust homework loads and integrate movement breaks. Parents should prioritize exercise companionship and employ structured
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