Perception of patients with temporomandibular disorders of the effects of botulinum toxin application: a retrospective cross-sectional observational study.

Physical activity, screen time, and sleep are key health-determining behaviors in children that influence many health outcomes, such as adiposity, cardiometabolic health, social-cognitive development, and quality of life (). The American Academy of Pediatrics (AAP) has endorsed guidelines for daily levels of physical activity, screen time, and sleep, recommending at least 1 hour of physical activity, no more than1 hour of screen time in ages 2–5 years or 2 hours of screen time in older children, and age-specific sleep duration guidelines (; ; ; ). These guidelines do not differ for children with and without developmental differences; however, prior research has suggested that children diagnosed with autism spectrum disorder (ASD) meet guidelines at a lower rate than nonautistic children (). Additionally, autistic children have higher prevalences of obesity and obesity-related medical conditions, such as hypertension and type-II diabetes, compared with nonautistic children (; ). To address these health disparities, it is important to understand the differences between autistic and nonautistic children in physical activity, screen time, sleep, and their determinants. While researchers and clinicians have traditionally addressed physical activity, screen time, and sleep as separate domains of behavior, it is becoming increasingly recognized that they often produce similar influences on health and may benefit from combined consideration. For example, meeting guidelines for these behaviors as a whole is associated with a large variety of positive health effects across the life-span in social-cognitive development, physical fitness, emotional health, quality of life, and cardiometabolic health (lower body mass index, systolic blood pressure, triglycerides and higher HDL cholesterol) (; ; ). While data looking specifically at children with developmental differences is limited, it is known that meeting all three guidelines is associated with more favorable social and emotional function among children diagnosed with ASD or Attention-deficit/hyperactivity disorder (ADHD) (). Despite the importance, the prevalence of meeting guidelines for physical activity, screen time, and sleep in children is generally low (). Healy et al. analyzed data from the 2016 National Survey of Children’s Health (NSCH), finding the prevalence of meeting all guidelines among nonautistic school-age children and adolescents to be 12.9% and 10.7%, respectively, while the prevalence among autistic school-age children and adolescents was even lower at 6.5% and 4.4%, respectively (). Regarding physical activity, Healy et al. found that autistic school-age children and adolescents were respectively 39% and 59% less likely to meet guidelines compared with nonautistic peers (). Other studies have produced mixed results, inconsistently finding associations between autism and physical activity, with notably large heterogeneity between study designs regarding factors such as sample size, the physical activity measure used, limitation to clinically confirmed autism diagnosis, and age-group stratification (; ; ).