The current study examined the feasibility of both a family-based judo class and a child-only class in youth with ASD. It was hypothesized that, while both the family and child-only classes would be both feasible and acceptable to participants and their families, the family class would have a higher attendance rate and lower attrition rate compared to the child-only class. Our findings primarily support our hypothesis with the family class having a significantly higher attendance rate and a lower attrition rate compared to the child-only class. Additionally, parents from both classes reported the program as being a positive experience for their child and themselves. The child-only class, however, did not meet the attendance and attrition benchmarks.
The attendance rate was over 20% greater in the family-based class compared to the child-only class, with all nine children in the family class attending 88% (13 out of 15) classes. Although the exact reasons for the difference in attendance between the two classes cannot be derived from the results of this study, there are few possible explanations. First, the direct involvement of parents in the family class may have increased parent engagement and interest in attending the sessions. Second, one of the primary reasons for registration in the family class was to participate in an activity together as a family, thus the classes may be viewed as a high priority for families, thus increasing their level of commitment to the program. This finding is supported in a review by Karst and Van Hecke  who reported that direct family involvement may increase both parent and child engagement in an intervention for children with ASD.
A surprising finding was the greater interest in the family class compared to the child-only class during the registration period. The family-class was filled within two weeks, while the child-only class required nearly the full eight-week registration period before it was full. Additionally, not only did the family class have a waitlist in case any child dropped out before the start of the program, several of the parents in the child-only class had initially attempted to register for the family class, but decided to enroll their child in the child-only class when they were informed it was full. Furthermore, even though parents of children in the child-only class expressed satisfaction with the class following the end of the program, several parents did request to have the option to join their child in future judo classes.
This novel study is the first to include the addition of the family into a martial arts program for youth with ASD. In addition to the benefits of family involvement in the program, the logistical advantages are important to note as well. For example, the judo instructors remarked that they were able to focus on the class as a whole, even if a child was being disruptive as the accompanying family member could tend to the child while the class continues. Another advantage of the family class was the ability for the parents to model the judo techniques for their children and assist them when they struggled with an exercise. Thus, the judo instructors commented on the further progression the family class achieved in the program compared to the child-only class. It should be noted, however, that the child-only class was significantly shorter than the family class despite both classes adopting the same curriculum. Based on input from observation notes and the instructor input, participants in the child-only class had more difficulty with focus and concentration during class, especially at the beginning of the 15-week program, which may account for the shorter duration of some of the sessions. Prior research has shown that parent involvement and modeling of behavior may be linked with increased focus and engagement in children with ASD during a PA intervention .
The parents in the family class reported that there was an increase in social interaction, not just with their children, but with parents as well. In fact, a suggestion was made to include more opportunities for families to socialize with one another. The benefits of a family class for not only children with ASD, but parents/caregivers as well is of importance to note, given the increase stress and pressures often reported by parents of children with ASD . Furthermore, there is evidence to suggest that a bidirectional relationship exists between parent/caregiver stress and child ASD symptoms. In other words, increased stress levels of the parent/caregiver may exacerbate child ASD symptoms, which in turn, may further worsen parent/caregiver stress [20, 29]. Given the additional strain on families of children with ASD, future research should examine the effects of a family judo class on parent/caregiver physical and psychosocial outcomes.
Both the family and child-only classes had small sample sizes, however, the current study was not intended to demonstrate efficacy, but rather feasibility. Therefore, a large sample size was not essential to the study question. Nonetheless, larger sample sizes of youth with ASD of varying severity levels would be necessary to determine the effectiveness of the family judo class, and whether there are differences between the family and child-only classes. Another limitation was the lack of randomization between the family and child-only classes. Parents of participants could select whether they wanted their child to participate in the family or child-only class. While attempts to limit bias were made by requiring parents of the child-only class to remain at the study site during sessions, future research should consider random assignment into either the family or child-only judo class in order to more accurately compared the differences between the two classes.
While prior studies have demonstrated the feasibility and benefits of child only martial arts programs, these samples have been limited to children with level 1 ASD who need minimal support. As the current study demonstrated, the inclusion of the family unit allows for children who may require additional support to participate in the program. Thus, future martial arts programs can potentially include children with greater ASD severity by adopting a family-based model. Additionally, while prior research has demonstrated the benefits of martial arts programs, such as judo, on physical and psychosocial outcomes in children with ASD, the benefits of a family-based class may extend to parents/caregivers and positively impact family relationships.