Sensory-Friendly Physical Activity for Sleep in Autistic Children

Sleep problems are very common in children on the autism spectrum and can worsen daytime behaviour, learning, and family stress. Many families have limited access to specialist sleep services. This study evaluates a school-based, sensory-friendly physical activity program designed to improve sleep and wellbeing in autistic children. This multicenter, parallel-group, randomized controlled trial was conducted in special education schools in China. Classrooms of children aged 7-12 years with a diagnosis of autism spectrum disorder were randomly assigned to either: (1) a teacher-led, sensory-friendly physical activity program integrated into regular physical education lessons for 16 weeks, or (2) usual school activities without the program. The intervention emphasized predictable routines, gradual warm-up, adjusted sensory input (for example, noise and light), and calming cool-down activities to support self-regulation and readiness for sleep. The primary outcomes are children's sleep parameters measured by wrist actigraphy, including sleep efficiency, sleep onset latency, sleep duration, and wake after sleep onset. Secondary outcomes include parent-reported sleep problems, children's daily moderate-to-vigorous physical activity, and caregivers' sleep quality, mental health, parenting sense of competence, and quality of life. Outcomes are assessed at baseline, immediately after the 16-week program, and 6 months after the program ends.

Eligibility criteria Child inclusion criteria(1) Aged 7-12 years with a documented DSM-5 diagnosis of autism spectrum disorder in school records.(2) Able to understand and execute two-step instructions, as confirmed by the classroom special-education teacher.(3) Parent-reported sleep problems on the Children's Sleep Habits Questionnaire (CSHQ), operationalised as ≥ 5 nights per week of bedtime resistance, sleep onset delay, or night wakings. Caregiver inclusion criteria (1) Identified as the child's primary caregiver in daily life.(2) Fluent in Mandarin (speaking, listening, reading, and writing), as all intervention and assessments were conducted in Mandarin.(3) ≥ 18 years of age.(4) Provided written informed consent and agreed to random allocation. Exclusion criteria (1) Current or prior pharmacological or behavioural treatment specifically targeting sleep.(2) Medical conditions that preclude participation in physical activity (e.g., asthma, congenital heart disease).(3) Comorbid complex neurological disorders (e.g., epilepsy) or other medical/psychiatric conditions likely to interfere with sleep.