P2.059: Effect of structured sport interventions on motor outcomes of children diagnosed with autism spectrum disorder - A systematic review

Background: Motor deficits are common in children with autism spectrum disorder (ASD). The effect of participation in structured sport interventions on motor skills of children with autism remains unclear. In this review, we synthesized randomized clinical trials (RCTs) and non-randomized controlled trials (NRCTs) to study the effectiveness of sports-based interventions on motor outcomes in children with ASD.

Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on PROSPERO (CRD42025641088). Five databases: PubMed, Web of Science, CINAHL, Cochrane Library, and Clinical Trials were searched from inception to November 2024. Gray literature was sourced from Google Scholar and ProQuest Dissertations and Theses. Articles were included if: (1) they were published in English; (2) participants were under 18 years with a diagnosis of ASD; (3) interventions included participation in a supervised organized sports program; (4) outcome measures were based on validated measures of motor development. Studies were excluded if participants were over 18, born preterm, or diagnosed with motor delay unrelated to autism. Two reviewers independently completed screening and data extraction. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for RCTs (RoB 2) and Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I v2) for NRCTs.

Results: Initial database searches retrieved 3197 studies. After full text screening, nine studies (RCTs, n= 5; NRCTs, n= 4) were included in the final review. These studies evaluated the efficacy of diverse sports-based interventions including martial arts, aquatics, gymnastics, trampoline, table tennis, and football on motor outcomes of ASD. Five out of these nine reported significant improvement in static and/or dynamic balance domains, two reported improvement in locomotion, two reported improvement in aiming and catching. Overall motor score was higher in 4 studies and none of the studies reported improvement in fine motor outcomes. Seven out of these nine studies utilized motor assessment batteries, such as Movement Assessment Battery for Children-2, Bruininks-Oseretsky Test of Motor Proficiency-2, and Test of Gross Motor Development-3. One study used specific tasks such as heel-to-toe walking and single leg stance, and another study utilized a NeuroCom Balance Master. All studies exhibited a high risk of bias (Table 1).

Conclusion: The results of this review suggest that participation in sports-based interventions may improve balance, locomotion, aiming and catching, and overall motor skills in children with ASD. There was no improvement in fine motor skills. However, caution is warranted in interpreting these findings as all studies had high risk of bias and there was a lot of heterogeneity in the outcome measures and intervention framework. Future intervention studies with blinding of outcome assessors are needed to reduce risk of bias and strengthen the evidence for these interventions.