A comparison of the physical fitness of individuals with intellectually disabilities autism spectrum disorders and Down syndrome diagnosis

Abstract

Introduction: This article reports the physical abilities and physical wellness of three groups of children with different neurodevelopmental disabilities: Autism, Down Syndrome and Intellectual Disability. Methods: The causal-comparative research method was implemented in this study. The participants comprised 32 students with moderate intellectual disabilities, 18 with autism spectrum disorder, and 22 with down syndrome. The body mass index (BMI), flexibility, standing long jump, sitting height, stroke length, and medicine ball throwing levels were measured for physical fitness, and the groups were compared afterward. The Kruskal Wallis-H Test and Mann-Whitney U Test were applied to determine the differences between the groups' physical fitness averages for the statistical analysis. Results: Statistically significant differences were obtained in BMI, standing long jump, stroke length, and medicine ball throwing variables (p < 0.05). However, no statistically significant difference was discovered for the flexibility and sitting height variables (p > 0.05). The BMI, sitting height, and stroke length levels for the group with autism spectrum disorder were higher than the other groups, as the flexibility levels of the group with down syndrome were higher than the other groups. Students with intellectual disabilities were demonstrated to have better values than other groups regarding standing long jump and medicine ball throwing performances. Conclusions: Objective information about the physical fitness of individuals with children with different neurodevelopmental disabilities was obtained. In addition, the data obtained with these children will contribute to future plans for movement training as well as the content and frequency of the interventions, and will guide the development of new strategies to develop physical abilities and physical wellness.

Introduction

Physical fitness can be considered a measure of most, if not all, of the body systems involved in daily physical activity or physical exercise performance. Therefore, physical fitness tests provide information about the current functional status of all relevant systems (Myers et al. 2002). Physical fitness is divided into sport-specific and health-related physical fitness (Plowman and Smith 2014). Health-related physical fitness includes body composition and aerobic and musculoskeletal functions. Revealing these physical fitness regarding health issues is important in preventing future health problems (Bilim et al. 2016). Physical fitness levels are even more important regarding children's health who fall behind in developmental areas. It is asserted that physical fitness, which is a significant health indicator (Ayán Pérez et al. 2016), is at a very low level in individuals with intellectual disabilities (Hartman et al. 2010). Children with intellectual disabilities are at high risk for chronic diseases due to inactivity (Winnick and Short 2014, Rimmer et al. 2007). Thus, adequate physical fitness regarding health is essential for the life quality of these individuals so that they can complete their daily living activities and reduce these health risks. Health-related physical fitness improves and maintains overall health and well-being and mitigates cardiovascular and metabolic health risks associated with inactivity, such as obesity (Smith et al. 2014). Obesity and metabolic diseases are some of the most critical health problems in intellectually disabled individuals (Şenlik and Atılgan 2019). Therefore, it is important to examine physical fitness (Rimmer et al. 2004), which is a health indicator, in terms of individuals with intellectual disabilities in order for these individuals to lead healthy lives.

Contemporary scholarship shows that the physical fitness of children with intellectual disabilities is generally compared with children with typical development, and the studies with internal comparisons are quite limited (Jeoung 2018, Ayan et al. 2019). The differences and similarities between the physical traits of children with Autism Spectrum Disorder (ASD), Down Syndrome (DS), and children with intellectual disabilities (ID) without a DS diagnosis were a hotbed of discussion in recent years (Cha et al. 2020, Yarımkaya et al. 2021). However, it is highlighted that the findings regarding the similarities and differences between these individuals with moderate intellectual disabilities are limited. The main reason for the deficiencies in the motor skills of these individuals and how they play a role in their incompetency is not completely grasped (Davis et al. 2018, Holloway et al. 2018).

Hocking et al. (2016) have reported a strong correlation between motor development and physical fitness levels in childhood and adolescence. Therefore, insights regarding the physical fitness traits, monitoring, and defining their development are pivotal for directing the movement training sections used in training programs (Herwegen et al. 2018). There was no consensus on the most appropriate movement training practices for these individuals among the training programs specific to individuals with moderate ASD, DS, and ID (Ferreira et al. 2018). In particular, the support education services offered to children with moderate support needs focus on daily life skills such as dressing and eating independently. (Hartman et al. 2015). Cattuzzo et al. (2016)found a strong relationship between motor development and physical fitness levels. Thus, it is worth studying the examination of the physical fitness levels of these individuals.

Therefore, the research in this direction are pivotal for determining and developing the strengths and weaknesses of individuals with moderate support needs and designing motor development programs (Hartman et al. 2015).

The potential findings regarding the similar and different physical characteristics of children with ASD, DS, and ID with moderate intellectual disabilities in need of special education, developing effective teaching methods for these individuals, and guiding families and educators towards interventions were considered essential contributions to the literature. On the other hand, the study is thought to contribute to the arrangements of these children such as the content, and frequency of the applications to be made, in the educational environment in the future, and might contribute to the development of new approach strategies. Moreover, having a study sample of children with moderate intellectual disabilities is also essential for building literature on children's physical fitness in this age group. The study aimed to compare the current physical fitness of individuals with moderate autism spectrum disorder and intellectual disabilities through a diagnosis of Down syndrome and offer recommendations relying on evidence-based data and the literature.

Methodology

Research model

Studies aiming to determine the causes and consequences of the differences between the groups without any intervention of the participants are categorized as causal-comparative research (Büyüköztürk and Kılıç Çakmak 2019). The causal comparison research method was selected to measure and compare children's physical fitness levels aged 7–11 years with autism spectrum disorder and Down syndrome diagnoses as determinants. The comparisons based on the causal-comparative method enabled us to explore the differences in physical fitness levels of individuals with moderate autism spectrum disorder, moderate down syndrome, and moderate intellectual disabilities.

Participants

The research population consisted of 131 students with disabilities who received education at the 1st level and continued to Muş Special Education Application Center, Special Education Rehabilitation Centers in Muş, diagnosed with moderate down syndrome, autism spectrum disorder needing moderate support, and moderate intellectual disability. The sample included 72 students; 32 of them with ID (16 boys, 16 girls), 18 of them with ASD (14 boys, four girls, and 22), and DS (10 boys, 12 girls). A simple random sampling method was used in the sample selection. In addition, the criterion sampling method, which is one of the purposive sampling methods, was used to determine the parents. The criteria in the study were determined as follows: a) accepting to participate in the study voluntarily and b) having a diagnosis of moderate intellectual disability.

Ethical Committee approval was gained from Muş Alparslan University Scientific Research and Ethical Committee Headship with resolution number dated 25.02.2021–5138 to implement the research. Permission approval regarding the implementation was received from Muş Governorship Provincial Directorate of National Education dated 14.04.2021 and numbered 20200220368014370. Parental written consent for the participation of their children in the research was obtained. The information about the participants was collected from their respective special education classroom teachers and the school administration, and physical fitness parameter measurements of the participants were quantified and recorded in the Physical Fitness Test Information Form.

Data collection

After obtaining the approval of the ethics committee and the official permission of the Ministry of National Education, parents and teachers were informed about the measurements. The measurements were completed by taking mask and hygiene measures in March and the first week of April when schools were open due to the pandemic. All measurements were taken during the pandemic period. Everyone in the measurement area wore a mask, and the measuring devices were cleaned after each child. The researchers took the measurements by going to the institutions where the students were educated. Each measurement was explained to each student by the researchers, shown as a model, and the student was asked to do the movement. For the students who could not perform the movement in the correct form, the movement to be made with partial physical assistance was explained again, and they were asked to do it independently. Each student was given two attempts, and the best score was written.

Data collection tools

Age, height, and weigh measurement

The ages of the participants were determined by official records in educational institutions during the interview. Participants' weights were measured by using a Fakir brand electronic weighing scale with a sensitivity of 0.01 kg and a capacity of 150 kg. During the measurements, the children were weighed in their sports outfits without the shoes, socks on or off, their heads upright, the soles flat on the weighing scale, knees tense, the heels adjacent, and the body upright. The results were measured in kilograms recorded in the Physical Fitness Information Form. For the height measurements of the students, they were rendered to stand without shoes, with the heels adjacent, body and head upright, and eyes looking across. When the sliding caliper apparatus touched the head, the height value obtained was measured in centimeters and recorded in the Physical Fitness Test Information Form (http://yetenektaramasi.gsb.gov.tr. Access Date: 08.05.2020).

Body mass ındex (BMI)

Body mass index (BMI) was calculated by dividing the body weight (kg) by the square of the height (m) (Zorba and Saygın 2009).

Flexibility (sit and reach) test

In the sit-and-reach test used for flexibility measurements, the students were rendered to place their soles on the resting part of the flexibility board without shoes. Then, the students were instructed to reach forward with both arms without bending their knees, slowly push the ruler on the flexibility board with their fingertips, take it to the furthest point, and wait for 1–2 s. The test was repeated twice, and the best reaching level was recorded in the Physical Fitness Test Information Form (http://yetenektaramasi.gsb.gov.tr. Access Date: 08.05.2020).

Standing long jump

The student's feet were kept even, tiptoes behind the starting line, and the point of closest contact to the starting line was marked after a strong jump with the arms forward horizontally. The test was repeated twice, and the longest jump was recorded in the Physical Fitness Test Information Form (Zorba 2001).

Arm span measurement

The students were seated on the measuring bench, and their backs were allowed to lean against the measuring scale in an upright position. The students' arms were stretched out to the sides, parallel to the floor. The distance between the middle fingertips of both arms was measured in centimeters and recorded in the Physical Fitness Test Information Form (Mınıstry of Youth and Sports, 2019 http://yetenektaramasi.gsb.gov.tr. Access Date: 08.05.2020).

Sitting height measurement

The students were seated, resting on the measuring bench, with their backs upright and eyes were looking across. The sliding measuring apparatus on the bench and the foot level was adjusted after the desired sitting position was achieved on the bench. The distance between the bench ground and the top of the head is measured in centimeters and recorded in the Physical Fitness Test Information Form (http://yetenektaramasi.gsb.gov.tr. Access Date: 08.05.2020).

Medicine ball throwing

After the subjects took their positions behind the starting line with their feet parallel, they were asked to throw a 1-kilogram medicine ball with both hands to the furthest possible distance by taking their arms back above the head. The distance between the starting line and where the medicine ball first touched the ground is measured as centimeters. The test was repeated twice by allowing the required resting interval, and the longest throws were recorded in the Physical Fitness Test Information Form (Ongül et al. 2017).

Data analysis

SPSS 22.0 package program was used to analyze the research data. First, percentage and frequency values were calculated to evaluate participants' demographic characteristics. Moreover, since the participants' age, height, weight, and body index values had ordinal characteristics, and our data did not show normal distribution, median values, and quartile deviation values were preferred. Then, comparing the physical fitness levels of the three groups, The Kruskal Wallis-H Test, one of the non-parametric tests, was applied to determine the difference between the groups. Furthermore, the Mann-Whitney U test was used to determine the directions of these differences between the groups. Finally, the statistical significance was accepted as p < 0.05, and the findings were presented in Table 1.

Table 1.

Statistical distribution of participants' demographic characteristics.

Variables		n	%
Gender	Male	40	55,6
	Female	32	44,4
	Total	72	100,0
Types of disability	ID	32	44,4
	ASD	18	25,0
	DS	22	30,6
	Total	72	100,0

ID = intellectual disabilities, ASD = autism spectrum disorder, DS = Down syndrome.

Findings

Table 2 illustrates the descriptive statistics regarding the age, height, weight, and physical fitness levels of the participants with intellectual disabilities.

Table 2.

Statistical distribution of participants with intellectual disabilities.

Variables	Min.	Max.	Xmean	quarter deviation
Age	7	11	9	1
Height (cm)	110	147	124.5	5.88
Weight (kg)	17	41	25.5	3
*BMI	13.15	23.53	15.88	1.77
Flexibility	1	28	15	3
Standing long jump	2	115	53	29.5
Sitting height	56	74	64,5	3.75
Arm span length	101	133	121.5	8.5
Medicine ball throwing	10	360	172	63.13

^*body mass index.

Table 3 summarizes the descriptive statistics regarding the age, height, weight, and physical fitness levels of individuals with an autism spectrum disorder.

Table 3.

Statistical distributions of participants with autism spectrum disorder.

Variables	Min.	Max.	Xmean	quarter deviation
Age	7	11	8	1.13
Height (cm)	109	150	126	12
Weight (kg)	18	60	30	10.63
*BMI	14.62	26.67	17.90	2.53
Flexibility	2	25	15.5	6.75
Standing long jump	1	97	13	21
Sitting height	55	80	66	6
Arm span length	104	146	121	11.38
Medicine ball throwing	5	350	115	66.25

^*body mass index.

Table 4 presents the descriptive statistics regarding the age, height, weight, and physical fitness levels of individuals with Down Syndrome

Table 4.

Statistical distributions of participants with down syndrome.

Variables	Min.	Max.	Xmean	quarter deviation
Age	7	11	8	1
Height (cm)	105	143	117	5.25
Weight (kg)	16	57	23.5	4.25
*BMI	14.51	27.87	17.47	1.95
Flexibility	9	29	17.5	1.5
Standing long jump	5	88	50.5	15.5
Sitting height	52	82	65.5	4.63
Arm span length	96	140	110	7.13
Medicine ball throwing	10	220	117.5	45

^*body mass index.

Table 5 indicates a statistically significant difference in the participants' BMI, standing long jump, stroke length, and medicine ball throwing values (p < 0.05). It was found that this difference was between the ASD group and the ID group for the BMI variable. The mean BMI rank of the ASD group was higher than the DS group, and the DS group had higher values than the ID group. The standing long jump variable revealed that the difference favors the ID group between the ID group and the ASD group and DS between the DS group and the ASD groups. The stroke length parameter showed a statistical difference between the ID and the DS group, favoring the ME, and between the ASD and the DS group in favor of the ASD. Moreover, the medicine ball throwing tests revealed that the ID group had statistically significant advantages against the ASD and the DS group. There was no statistically significant difference in flexibility and sitting height variables by disability types (p > 0.05).

Table 5.

Comparison of participants' physical fitness levels by disability type.

Variables	Disability type	n	Rank Avg.	X2	sd	p	Significant Difference
*BMI	ID (A)	32	28,61	9,447	2	0,009*	B > A
	ASD (B)	18	46,92
	DS (C)	22	39,45
	Total	72
Flexibility	ID (A)	32	32,20	5,898	2	0,052
	ASD (B)	18	33,17
	DS (C)	22	45,48
	Total	72
Standing long jump	ID (A)	32	42,53	9,296	2	0,010*	A > B C > B
	ASD (B)	18	23,92
	DS (C)	22	38,02
	Total	72
Sitting height	ID (A)	32	34,59	0,488	2	0,783
	ASD (B)	18	38,36
	DS (C)	22	37,75
	Total	72
Arm span length	ID (A)	32	40,84	11,271	2	0,004*	A > C B > C
	ASD (B)	18	43,86
	DS (C)	22	24,16
	Total	72
Medicine ball throwing	ID (A)	32	44,73	8,931	2	0,011*	A > B A > C
	ASD (B)	18	30,08
	DS (C)	22	29,77
	Total	72

^*body mass index.

Discussion

This study on the physical fitness of children with autism spectrum disorder and children with and without Down syndrome revealed a statistically significant difference in BMI values (p < 0.05). It was understood that this difference is between the ASD group and ID as the mean rank of the children with ASD was higher than the children with DS. Moreover, children with DS had higher values than those with ID without DS diagnosis in the same context. These results indicate that children with ASD have a higher mean BMI than children with ID, regardless of a DS diagnosis. Previous studies demonstrated that children with ASD are less active than the research population, and obesity is more prevalent in this group (Ptomey et al. 2020, Bremer and Cairney 2020). Thus, it is asserted that individuals with ASD are exposed to more diseases and health problems due to their sedentary lifestyles (Ferreira et al. 2018, Sansi and Nalbant 2019). Furthermore, several studies found that individuals with DS and ASD are more sedentary than other individuals with ID. Thus, they have higher exposure to obesity, overweight problems, and low physical fitness (Collins and Staples 2017). Therefore, it can be argued that the findings on BMI coincide with the contemporary literature.

This study revealed no statistically significant difference in flexibility values (p > 0.05). However, the mean rank of children with DS was higher than those with ASD, while children with ASD had higher than those with ID without a DS diagnosis. A cross-check with the literature on the flexibility findings revealed that the joints and ligaments of children with DS have a very flexible structure, so excessive flexion and extension are common (Nalbant 2011) and that their muscle structures are more flexible (Aydın 2016). Furthermore, previous attempts discovered that individuals with ID without an ASD diagnosis have problems with the flexibility (Kara et al. 2019), while those with an ASD diagnosis and ID have similar flexibility skills (Cha et al. 2020). Therefore, it can be argued that the findings on flexibility are in accord with the literature.

The study indicates a statistically significant difference between the groups in standing long jump values (p < 0.05). It was indicated that there is a difference between the ID having statistically significant advantages against the ASD group. The group with a DS diagnosis had better results than the ASD group. These findings indicate that the group with ID has better long jump abilities than those with DS, while the ASD group has the least capability. Contemporary scholarship revealed that people with ID perform better in leaps, jumping, and sliding actions (Jeoung 2018), while those with ASD have postural disorders such as increased swinging and abnormal weight distribution (Pace and Bricout 2015). It is found that they have problems in maintaining balance and movement planning (Sowa and Meulenbroek 2012) due to their incompetence in coordination (Bhat et al. 2011), so they may exhibit poor performance in muscle strength, endurance, and gross motor skills (Sarabzadeh et al. 2019). Furthermore, the group with ASD has the weakest motor coordination skills among individuals with intellectual disabilities (Colombo-Dougovito and Block 2019). Children with ASD experience more skill deficits than those with DS (Töret and Acarlar 2011). It was also stated that the motor skills of children with DS might be better than those with ASD during childhood (Herwegen et al. 2018). Since children with DS have low knee and leg strength capacity (Shields et al. 2017), they are more disadvantaged regarding motor skills than their peers with ID without a DS diagnosis (Sansi and Özer 2019). These results imply that our findings are in parallel with the literature. Previous studies indicate that standing long jump ability is associated with lower extremity muscle strength, and muscle strength is associated with the body's oxygen capacity. Therefore, individuals with DS have limited muscle performance as they have lower oxygen capacity, weak lower extremity strength, and joint mobility than their peers with ID but no DS diagnosis (Baynard et al. 2008, Silva et al. 2017). Thus, it can be propounded that the standing long jump values of the DS group were lower than the group with ID in our study. Previous studies also found that leg strength and BMI values of individuals with ID might be inversely proportional (Fernhall 2001) and obesity and excess weight might negatively affect specific motor skills such as aerobic performance and muscle strength (Frey and Chow 2006). The findings regarding the group with ASD having the highest average BMI and the group with ID with the lowest average values, while the group with ASD averaging the lowest values in standing long jump skills, and the group with ID having the highest averages confirm previous findings.

The sitting height values proved no statistically significant difference between the groups (p > 0.05). Accordingly, it can be asserted that the participants exhibited similar developmental characteristics regarding sitting height. Moreover, a statistically significant difference was found regarding the stroke length (p < 0.05). It was found that there is a difference between the ID had higher averages than the DS group. The two-paired comparison between ASD and the DS group favored the latter. The mean rank values of the ASD group were higher than the group with ID, and it had higher averages than the group with DS. The previous findings on sitting height and stroke length parameters hint at arguments such as individuals with DS and no DS diagnosis and those with ASD in the studied age group have similar developmental levels. Especially children with ID and ASD may have similar physical characteristics. Therefore, it is frequently asserted that they cannot be distinguished (Marchal et al. 2016). Furthermore, the physical development of children with ASD is not regressed substantially, while children with ID may experience severe regressions due to various factors (Er 2018). It was also discussed that the bone mineral density and muscle strength of individuals with DS might be lower than those with ID but with no DS diagnosis ((Angelopoulou et al. 2000, Silva et al. 2017). Moreover, low bone mineral density and insufficient bone development are prevalent in individuals with DS (Matute-Llorente et al. 2017). These individuals are negatively affected by their anthropometric characteristics and body composition (García-Hoyos et al. 2017). This might cause the arms, lower and upper extremities, and stature to be short (Winnick and Porretta 2016, Ilkım 2017). Therefore, it might be argued that the findings regarding sitting height and stroke length are in line with the literature.

This study also revealed a statistically significant difference in medicine ball throwing skills (p < 0.05). In addition, it was observed that the ID group had better capabilities than the ASD group and the DS group. These findings indicate that the medicine ball throwing skills of children with ID with no DS diagnosis were higher than children with ASD and DS, while children with ASD had higher capabilities than those with DS. Previous findings revealed that individuals with ASD could perform better in throwing, pushing, and throwing an object than individuals with DS and developmental disabilities (Bentenuto et al. 2016), but balance, arm, and leg performances may be weak due to deficiencies in social functions (Sarabzadeh et al. 2019). Skills such as throwing balls may be affected by the limitations in these social functions (Holloway et al. 2018). Furthermore, it was argued that the short arms, small hands, and fingers of individuals with DS (Uzuner 2016) might cause poor ball-handling skills and motor planning (Marchal et al. 2016). Therefore, it can be argued that the factors stated in this study might be why the medicine ball throwing skill of the ASD group was higher than the group with DS and the ID group's superiority in this regard. In this sense, it can be asserted that our study is in accord with the literature. However, some studies also claimed no significant difference was found in the ball throwing skills of individuals with ASD and ID (Cha et al. 2020). Furthermore, individuals with moderate ID perform lower than individuals with ASD in motor skills such as dexterity, and body coordination (Jeoung 2018) contradicts the research findings.

Our findings, in general, imply that children with ASD have higher averages in physiological factors such as BMI, sitting height, stroke length, and lower performance in motor skills. These are consistent with the previous findings, such as individuals with ASD exhibit regression regarding their physical development and cannot be distinguished from individuals with normal physical development (Er 2018), they are weaker in gross and fine motor skills compared to other disability groups (Collins and Staples 2017, Sansi and Nalbant 2019), and obesity is prevalent in this group (Clare et al. 2018, Bremer and Cairney 2020). In addition, it was determined that children with Down syndrome had higher flexibility than the other groups. These findings are in line with previous findings such as children with DS have slower growth and development than other disability groups, and in children with ID with no DS diagnosis, their physical fitness and motor skills are lower than other disability groups due to their weak muscle structure (Esposito et al. 2012, Silva et al. 2017), while their flexibility is at a very good level thanks to their muscle structure (Nalbant 2011). This study revealed that children with ID with no Down syndrome have better motor skills such as standing long jumps, throwing medicine balls, and fewer physical advantages. Contemporary researchers assert that individuals with moderate ID might acquire specific motor skills for their basic needs (Şenlik and Atılgan 2019), and individuals with ID who are not obese or overweight can perform well in skills such as leaping and jumping (Fang et al. 2017, Jeoung 2018). Furthermore, the motor skills of individuals with ID who adequately and regularly perform physical activities may improve (Colombo-Dougovito and Block 2019) with a combination of physical activity and adequate-proper nutrition. It is stated that physical development relies on bone development (Modlesky and Zhang 2020). Therefore, it can be argued that the higher performance of children with ID in motor skills might stem from their physical activity levels, and the lesser physical advantages might be due to nutrition and environmental factors.

Conclusion and recommendations

This study on the physical fitness of children with autism spectrum disorder and children with Down syndrome with no such diagnosis revealed a statistically significant difference in BMI, standing long jump, stroke length, and medicine ball throw (p < 0.05). However, no statistically significant difference was discovered for the flexibility and sitting height variables (p > 0.05). The findings regarding mean rank values indicate that the mean BMI rank of the ASD group was higher than the DS group and the ID group, respectively. The flexibility parameter shows that the DS group had higher mean rank values than the ASD and ID groups. In addition, it was found that the ID group had a higher mean rank than the DS and ASD groups in the standing long jump variable. The sitting height parameter also indicates that the group with ASD had higher mean rank values than the DS and ID groups. Moreover, the stroke length parameter revealed that the group with ID had higher mean rank values than the ASD and DS groups. Finally, the medicine ball throwing parameter shows that the ID group had higher mean rank values than the ASD and DS groups.

There may be several alternative factors such as genealogy, environment, nutrition, and socioeconomic factors affecting the physical fitness of the participants (Hinckson et al. 2013). Therefore, the findings may not be reduced to a single factor. However, the participants were individuals attending the same educational institutions. These organizations provided special education services as each element affects these individuals' physical fitness. Maximizing the performance of motor development levels, which have a significant correlation with the physical fitness level, depends on increasing physical activity opportunities (Santos et al. 2018, Nişli et al. 2019). The development of an educational approach that includes the developmental differences of different disability groups brings along the necessity of implementing a training program according to the disability type and characteristics. As it is certain that the physical fitness development of individuals with intellectual disabilities cannot be under their control. Field experts assert that intervention is a necessity, and individuals with ASD, DS, and mental incompetence with no DS diagnosis should be enrolled in different training programs because they exhibit distinct developmental characteristics (Colombo-Dougovito and Block 2019). The development of approaches that appropriately address daily practice needs requires a better understanding of the factors that hinder or facilitate physical activity (Ptomey et al. 2016). In qualitative studies, especially family members supporting physical activity, providing community-based services other than educational environments, implementing home-based programs, eliminating the lack of information about these individuals (Downs et al. 2014, Bossink et al. 2017) identifying the deficiencies in future qualitative studies will support all development areas of individuals in the holistic education approach.

Therefore, we propose that further research on physical education or development of individuals with special educational needs should be aware of the differences and similarities between people with ID, ASD, and DS while applying a work practice involving these characteristics. It is thought that these findings shall be beneficial for teachers, academics, families, and policymakers in physical education and sports, and these children will contribute to the arrangements in the educational environment, the content, and the frequency of the applications to be made.

Disclosure statement

No potential conflict of interest was reported by the authors.