Sensory-Friendly Physical Activity for Sleep in Autistic Children

This study is a multicenter, parallel-group, randomized controlled trial conducted in special education schools in China. Classrooms are the unit of randomization to minimize contamination between children in the same class. Eligible participants are children aged 7-12 years with a documented diagnosis of autism spectrum disorder who attend participating special schools, have at least one sleep difficulty (such as bedtime resistance, prolonged sleep onset, or night wakings), and live with a primary caregiver who can complete questionnaires in Mandarin and provide informed consent.

Classes are randomly assigned in a 1:1 ratio to either the sensory-friendly Physical Activity Program (PAP) or a control condition. The PAP is delivered by trained physical education teachers during scheduled lessons, three times per week for 16 weeks. Each session includes a structured warm-up, multi-component physical activities adapted for motor and sensory needs, and a cool-down segment with breathing and relaxation exercises in a low-arousal environment. Teachers receive manuals and on-site coaching to support fidelity. The control group follows usual school routines and physical education without the PAP.

The primary outcomes are actigraphy-derived sleep parameters: sleep efficiency, sleep onset latency, total sleep time, and wake after sleep onset. Secondary outcomes include accelerometer-measured daily physical activity; parent-reported sleep problems; and caregiver-reported sleep quality, anxiety and depressive symptoms, parenting sense of competence, and health-related quality of life. Data are collected at three time points: baseline (before randomization), immediately after the 16-week intervention, and 6-month follow-up. Linear mixed-effects models with random intercepts for classroom and child are used to estimate intervention effects while accounting for clustering and prespecified covariates.

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.