The goal of this clinical trial is to learn if an 8-week, community-based pickleball program can improve sensory-motor function and reduce the severity of core autism symptoms in adults ages 18-45 with autism spectrum disorder (ASD) who can participate independently without a caregiver.
The main questions it aims to answer are:
1. Does participating in the pickleball program improve sensory-motor function (including visual-motor integration and proprioceptive bias), measured using the HaptiKart task and a pickleball skill assessment? 2. Does participating in the pickleball program reduce core autism symptom severity, measured by the Social Responsiveness Scale, 2nd edition (SRS-2)?
Researchers will compare an early-start pickleball group to a delayed-start control group (who continues usual activities at first) to see if the pickleball program leads to greater improvements in sensory-motor outcomes and ASD symptom severity.
Participants will:
* Complete an in-person baseline visit at a local public library to provide written consent, complete surveys (SRS-2, PROMIS Depression and Sleep measures, and WHOQOL-BREF), and complete a video game-based sensory-motor assessment (HaptiKart). * Be randomly assigned to either start pickleball classes immediately or after an initial delay period. * Attend pickleball classes twice per week for 8 weeks (90 minutes per class; 16 sessions total), led by trained instructors at community indoor court facilities. * Continue their usual activities during periods when they are not assigned to pickleball classes. * Complete a brief pickleball skill assessment during the intervention period at their first and last class. * Complete follow-up assessments after each phase of the study to repeat surveys and sensory-motor testing. * Participants will also wear a small activity monitor (ActiGraph) during pickleball sessions to measure in-class physical activity levels, and complete brief online check-ins about safety/injury and program feedback during the intervention period.
Aged 18-45 years
Clinical diagnosis of autism spectrum disorder (ASD)
Able to participate in group-based activities without caregiver support
Able to understand English and independently communicate without assistance
Clinical diagnosis of intellectual disability (ID)
Does not have normal or corrected-to-normal vision
Actively participating in a racquet sport ≥1 time per week
Use of mobility aids
Parallel
Pickleball Program (Community-Based)
BehavioralGroup-based beginner-friendly pickleball classes delivered in community indoor court facilities. Sessions occur twice per week for 8 weeks (16 sessions total), approximately 90 minutes per session, led by trained instructors.
Sensory-Motor Function (HaptiKart task outcomes)
Sensory-motor integration and proprioceptive bias measured using the HaptiKart videogame task.
Autism Symptom Severity (SRS-2 Total Score)
Core autism symptom severity measured by the Social Responsiveness Scale, 2nd edition (SRS-2), adult self-report, total score. The SRS-2 consists of 65 items rated on a 4-point Likert scale (1 = not true; 4 = almost always true). Raw total scores range from 0 to 195. Higher scores indicate greater severity of autism-related social impairment.
Depression Symptoms (PROMIS Depression)
Self-reported depressive symptoms measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Depression-Short Form. (8-item version). Items are rated on a 5-point Likert scale (1 = never to 5 = always). Raw summed scores range from 8 to 40. Raw scores are converted to standardized PROMIS T-scores (mean = 50, standard deviation = 10) using established scoring tables. Higher T-scores indicate greater depressive symptom severity. T-scores will be used for primary analyses.
Sleep-Related Impairment
Self-reported sleep disturbance and sleep-related impairment measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep-Related Impairment - Short Form 8a. The instrument includes 8 items rated on a 5-point Likert scale. Raw summed scores range from 8 to 40. Raw scores are converted to standardized PROMIS T-scores (mean = 50, standard deviation = 10) using published scoring tables. Higher T-scores indicate greater sleep-related impairment (worse daytime functioning related to poor sleep). T-scores will be used for primary analyses.
Sleep Disturbance
Sleep disturbance will be measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance-Short Form 8b. The instrument includes 8 items rated on a 5-point Likert scale. Raw summed scores range from 8 to 40. Raw scores are converted to standardized PROMIS T-scores (mean = 50, standard deviation = 10) using published scoring tables. Higher T-scores indicate greater sleep disturbance (worse perceived sleep quality). T-scores will be used for primary analyses.
Quality of Life (WHOQOL-BREF)
Quality of life will be measured using the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The WHOQOL-BREF contains 26 items rated on a 5-point Likert scale and yields four domain scores: Physical Health, Psychological Health, Social Relationships, and Environment. Raw domain scores are transformed to a 0-100 scale according to WHO scoring guidelines. Higher scores indicate better quality of life. Domain scores will be analyzed as continuous outcomes.
Pickleball Skill Performance
Pickleball performance measured using a structured ball-return assessment with coach fed-ball trials and scored for accuracy and paddle contact quality.
Physical Activity During Sessions (ActiGraph)
Physical activity level during pickleball sessions measured using wearable accelerometry (ActiGraph).
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