Document Type


Publication Date




Publication Title

JAMA Network Open






e2336129 (1-16)


Importance: Physical inactivity and sleep disorders are health-related concerns of youth with autism spectrum disorder (ASD) that can persist from childhood and exacerbate core symptoms. However, evidence on group differences in accelerometer-assessed physical activity and sleep parameters among youth with and without ASD is inconclusive and age-specific effects remain unclear.

Objective: To synthesize evidence on group differences in accelerometer-assessed physical activity and sleep parameters and examine the moderating effects of age between children and adolescents with and without ASD.

Data Sources: American Psychological Association PsychInfo, CINAHL Ultimate, ERIC, MEDLINE, SPORTDiscus with Full Text, and Web of Science from inception to February 2023.

Study Selection: Two independent reviewers screened articles for observational research comparing accelerometer-assessed physical activity levels and sleep parameters in children and adolescents with and without ASD.

Data Extraction and Synthesis: After developing a standardized form, relevant data were extracted. Quality was assessed using the McMaster Critical Review Form and rated based on sample, measurement, and analyses. The Preferring Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed.

Main Outcomes and Measures: The primary outcomes were actigraphy-measured MVPA, sleep latency, sleep efficiency, total sleep time, and wake after sleep onset. Data were pooled using a random-effects model. Hedges g was used to express the effect size index. Meta-regression on age was also performed to investigate the potential moderating effects.

Results: Collectively, 1757 studies were initially identified. Among 104 articles that were assessed, 28 were included, comprising moderate-to-vigorous physical activity (MVPA), 4 sleep parameters, and 73 independent effect sizes. A total of 28 studies were included in analysis, comprising 805 children and adolescents with ASD and 1573 without ASD (age range, 5.1-16.9 years). Compared with peers without ASD, children and adolescents with ASD had a small-to-moderate difference in MVPA (g = −0.450; 95% CI, −0.622 to −0.277), total sleep time (g = −0.332; 95% CI, −0.574 to −0.090), sleep efficiency (g = −0.424; 95% CI, −0.645 to −0.203), and a moderate difference in sleep latency (g = 0.514; 95% CI, 0.351 to 0.677) measured by actigraphy. Children and adolescents with ASD experienced an age-related decline in moderate-to-vigorous physical activity (β = −0.049 [95% CI, −0.097 to −0.001]; P = .045), indicating that younger children with ASD showed a smaller difference in MVPA compared with their peers without ASD. Moderating effects of age on sleep parameters were not significant.

Conclusions and Relevance: The findings of this meta-analysis suggested that children and adolescents with ASD had lower MVPA and worse sleep than peers without ASD, and the difference in MVPA varied with age. These findings reinforce the need for public health initiatives aimed at reducing these group disparities.


© 2023 Liang X et al. (The Authors)

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC-BY 4.0) License.

Data Availability

Article states: "See Supplement 2."

Original Publication Citation

Liang, X., Haegele, J. A., Healy, S., Tse, A. C.-Y., Qiu, H., Zhao, S., & Li, C. (2023). Age-related differences in accelerometer-assessed physical activity and sleep parameters among children and adolescents with and without autism spectrum disorder: A meta-analysis. JAMA Network Open, 6(10), 1-16, Article e2336129.


0000-0002-8580-4782 (Haegele)