Disparities in Physical Activity and Sport Participation Among Transition-Age Youth With Autism and Intellectual Disability.

Physical activity is critical for health, yet many adolescents do not engage in regular activity. Youth with autism spectrum disorder (ASD) and intellectual disability (ID) may be at heightened risk due to motor, sensory, and social barriers, but less is known about complete disengagement. Using nationally representative data from the 2021-2023 National Survey of Children's Health, this study examined disparities in (1) any weekly physical activity and (2) participation in organized sport among transition-age youth (14-17 years) with ASD only, ID only, or ASD + ID, compared with youth without ASD or ID. Survey-weighted multiple logistic regression models estimated adjusted odds ratios (aORs) for each outcome, controlling for sex, race, household poverty ratio, metropolitan residence, and age. Compared to youth without ASD or ID, all diagnostic groups had significantly lower odds of engaging in any weekly physical activity (ASD only: aOR = 0.32, 95% CI: 0.24-0.44; ID only: aOR = 0.49, 95% CI: 0.31-0.76; ASD + ID: aOR = 0.51, 95% CI: 0.30-0.88; all p ≤ 0.02) and organized sport (ASD only: aOR = 0.20, 95% CI: 0.15-0.27; ID only: aOR = 0.31, 95% CI: 0.19-0.51; ASD + ID: aOR = 0.24, 95% CI: 0.14-0.41; all p < 0.001). Across both models and diagnostic groups, female sex, lower household income, and increased age were associated with lower physical activity and sport participation (all p ≤ 0.02), whereas non-metropolitan residence was associated with higher odds of sport participation-only (p = 0.005). These findings identify substantial disengagement among youth with ASD and/or ID and highlight the need for accessible, adapted physical activity and sport opportunities during adolescence to reduce risk of long-term inactivity.