Effect of Combined Music and Taekwondo Training for Children with Autism Spectrum Disorder

Participants will wear an optical heart rate monitor on their forearm to measure their exercise heart rate as a reflection of the physical activity level during the training. Continuous heart rate data will be recorded for every record and expressed as the mean heart rate per min.

The Children's Emotional Manifestation Scale (CEMS) will be used to assess the children's emotional state. It classifies observable emotional behaviours into five categories: 'Facial expression', 'Vocalization', 'Activity', 'Interaction', and 'Level of cooperation'. Each category is scored from 1 to 5. The numbers obtained for each category are added together to obtain the total score, which will be between 5 and 25. High scores indicate the manifestation of more negative emotional behavior.

Children will be asked to rate their exertion level using the Borg 6-to-20 Scale, in which "6" indicates "no exertion at all" and "20" indicates "maximal exertion".

A scoring system was modified for use in this project with reference to the international Taekwondo referee scoring standard. Children's performance for a set of selected Taekwondo moves and kicks will be observed and scored by two qualified referees. The performance will be scored out of 8 marks, with 3 marks for presentation, 2 marks for cognitive ability, 2 marks for basic skills, and 1 mark for social interaction. Higher scores indicate better performance.

This test will be used to measure the children's selective attention, that is, their ability to maintain a consistent focus on some continuous stimuli.

The test consists of five visual search and sequencing tasks that are heavily influenced by attention, concentration, resistance to distraction, and cognitive flexibility (or set-shifting). The child is required to connect a series of stimuli (numbers, expressed as numerals or in word form, and letters) in a specified order as fast as possible in each trial. The time scores for the five CTMT trials will be converted to standardized T-scores according to the reference tables in the testing manual, and be summed up to produce a global performance level score, the CTMT Composite Index (CI), which can then be converted into a percentile score according to the participant's chronological age. Higher T score and CTMT CI correspond to better performance.

This scale will be completed by the parents. It is a 65-item autism rating scale widely use to identify a spectrum of deficits in reciprocal social behavior, ranging from absent to severe, based on observations of a child's behavior in various social settings. Scoring is on a four-point Likert Scale with five subscales (social awareness, social cognition, social communication, social motivation, and autistic mannerism). Higher T-scores correspond to poorer social functioning.

This is a 39-item, yes-or-no questionnaire of children's social behavior and communication tendencies as reported by their parents. The questionnaire has been translated into Chinese and is being validated. The cut-off score of 15 marks indicates possible autism spectrum disorder (ASD) or related social-communication difficulties.

The questionnaire will be completed by parents. There are 25 items in the SDQ, which consists of five scales, each with five items, for assessing children's mental health status in terms of emotional, conduct, hyperactivity, peer problems, and prosocial behavior.

The CGI-I will be completed by parents to evaluate children's functional changes in daily life after completion of the 10-week program, and at 2-month follow-up. The CGI-I consisted of 12 questions developed by our research team, which are focused on all core symptoms of ASD and covered the following aspects: (1) motor functioning; (2) children's capability to follow instructions; (3) social, communication, and language understanding and expression; and (4) children's capabilities for attention shifting, attention to complete a task, attention to details, and imagination.