Physical Activity of Preschoolers with Developmental Disabilities and Delays

Children with developmental disabilities and delays are at greater risk for developing overweight and obesity compared to typically developing peers. Participation in regular physical activity is a modifiable behavior that is consistently associated with improved weight status and other positive health outcomes. Previous studies have identified numerous individual- and environmental-level factors that associate with physical activity among school-age children with and without disabilities. However, little is known about physical activity behaviors and related correlates among preschool-aged children with disabilities (ages 3 – 5 years), especially while they are in preschool settings. Therefore, the overall purpose of this dissertation was to describe the physical activity behaviors of preschoolers with disabilities and to identify individual- and environmental-level factors that associate with physical activity during the preschool day. This dissertation was comprised of three studies. In the first study, an observational system for assessing physical activity and related environmental contexts was developed and reliability of the instrument was evaluated. Content validity of the instrument was established through literature reviews, expert consultations, and informal observations in inclusive and special education preschool settings. To determine reliability, paired observers followed a focal child while simultaneously, but independently, recording physical activity and environmental contexts. Reliability sessions occurred during 20% of observation sessions, and interval-by-interval percent agreement and kappa statistics were calculated. The findings of this study indicated that the new instrument, the Observational System for Recording Physical Activity in Children – Developmental Disabilities (OSRAC-DD), was reliable and suitable for use in inclusive and special education preschool settings. The second study described the physical activity behaviors of children with disabilities in preschools and identified individual-level factors that associated with physical activity. Mixed linear regression analyses were used to determine the association between objectively measured physical activity and individual-level factors including age, gender, race, diagnosis, level of impairment, motor skill levels, and parent education. All models were adjusted for wear time and preschool was included as a random effect. Results of this study indicated that physical activity was significantly associated with age, race, and diagnosis. Additionally, the preschool setting accounted for nearly half of the variance in physical activity among children with disabilities. The purpose of the third study was to describe associations between physical activity of children with disabilities and features of the preschool environment. Research assistants were trained to use the OSRAC-DD to directly observe the physical activity behaviors and preschool social and physical environmental characteristics of 34 preschoolers with disabilities. Logistic regression analyses were conducted with observation intervals as the unit of analysis and child nested within school as random effects. All models were adjusted for age, gender, diagnosis, and motor skill level. Findings from this study indicated that the physical activity levels of children with disabilities were associated with features of the physical and social environment within preschool settings. For example, children with disabilities were more likely to be physically active while outdoors compared to indoors and when in solitary or small group contexts compared to in larger groups with an adult present. Overall, these three studies describe the physical activity behaviors and related factors among young children with developmental disabilities in preschools. Findings revealed that specific individual- and environmental-level factors significantly associated with physical activity, and that the preschool setting accounted for nearly half of the variability in physical activity. These findings also highlight the importance of preschools as a setting for physical activity promotion of young children with developmental disabilities and the need to create, in preschools, environments that are supportive of physical activity. Collectively, results from the studies included in this dissertation support the application of a multilevel approach to understanding physical activity behaviors of young children with developmental disabilities in preschool settings