Unpacking the relationship between autism, sport participation, and adolescent health: A causal mediation analysis

Autistic children are less likely to participate in sport than non-autistic children, and sport participation may improve health and health related quality of life. It is therefore possible that sport participation may partially mediate the association between autism and adolescent health and health related quality of life. Sport participation may have distinct effects for autistic and non-autistic children, and these effects may also differ between team and individual sports.

The study had two objectives. First, to estimate cumulative effects of sport participation (team or individual) between ages 8-15 on adolescent health and health related quality of life and determine whether effects of sport participation differed for autistic children compared to non-autistic children. Second, to determine whether sport participation (team or individual) mediated the relationship between autism and adolescent health and health related quality of life.

Methods for causal mediation analysis were used to analyse data from a representative cohort of Australian children (n = 313 autistic; 6346 non-autistic) between ages 8-15. Sport participation was reported by parents from ages 8-15. Outcomes at age 14-15 included body mass index, the Pediatric Quality of Life Inventory, the Strengths and Difficulties Questionnaire, and the Short Moods and Feelings Questionnaire.

Non-autistic children's health benefited from all forms of sport. For autistic children, however, team sport participation was linked to worse mental health and no benefit in physical health. Individual sport improved physical health related quality of life, but not body mass index or mental health for autistic children. The mediation hypothesis was not supported.

Our findings suggest that greater efforts are needed to adapt community sport to encourage equitable participation and ensure that participation benefits autistic children's health and health-related quality of life equally.