Autism and exergaming: effects on repetitive behaviors and cognition

Effects of aquatic exercise intervention on executive function and brain-derived neurotrophic factor of children with autism spectrum disorder

BACKGROUND

Limited knowledge exists regarding the effectiveness of aquatic exercise intervention for improving executive function (EF) in children with autism spectrum disorder (ASD). Additionally, the impact of aquatic exercise on brain-derived neurotrophic factor (BDNF) in children with ASD requires further investigation.

AIMS

This study aimed to explore the effects of a 12-week aquatic exercise intervention on core EF and BDNF levels in children with ASD.

METHODS AND PROCEDURES

Thirty children with ASD were assigned to an experimental or control group. The experimental group underwent a 12-week aquatic exercise intervention, while the control group engaged in supervised free activities. Pre- and post-intervention assessments measured EF and BDNF levels.

OUTCOMES AND RESULTS

The experimental group showed significant improvements (p < 0.05) in inhibition control, cognitive flexibility, and BDNF levels. However, working memory did not significantly improve. The control group exhibited no significant changes in EF or BDNF levels.

CONCLUSIONS AND IMPLICATIONS

Aquatic exercise appears to be a beneficial intervention for cognitive development in children with ASD, as it enhances inhibition control, cognitive flexibility, and BDNF levels in children with ASD. Furthermore, the observed improvements in EF following aquatic exercise intervention in children with ASD may be associated with increased BDNF levels.

Brief Report: A Specialized Fitness Program for Individuals with Autism Spectrum Disorder Benefits Physical, Behavioral, and Emotional Outcomes

Individuals with autism spectrum disorder (ASD) engage in less physical activity than typically-developing peers. This can result in serious negative consequences for individual well-being and may contribute to the physical, behavioral, and emotional challenges associated with ASD. This study explored the potential benefits of trainer-led, individualized, physical fitness sessions specialized for ASD. Eleven individuals (ages 7-24 years) with ASD were assessed at baseline and following 15 fitness sessions. Participants demonstrated improvements in core and lower-body strength and reductions in restricted and repetitive patterns of behavior, along with non-significant but marked reductions in issues with daytime sleepiness. Results suggest the merit of specialized fitness programs and emphasize the need for larger and more rigorous research studies on this topic.

Effects of Physical Activity on Cognition, Behavior, and Motor Skills in Youth with Autism Spectrum Disorder: A Systematic Review of Intervention Studies

The aim of this paper was to analyze the acute and chronic effects of physical activity (PA) on cognition, behavior, and motor skill in youth with autism spectrum disorder (ASD), taking into account potential confounders. In addition, it was intended to elaborate a guide of educational applications with strategies for PA use. Studies were identified in four databases from January 2010 to June 2023. A total of 19 interventional studies met the inclusion criteria. PA programs ranged from two weeks to one year in duration, with a frequency of one to five sessions per week. More than 58% of the studies showed positive effects of PA on cognition, and 45.5% on behavior and motor skill. Moderate-vigorous PA for 15-30 min has shown acute effects on cognition, general behavior, and stereotypic/repetitive behaviors in youth with ASD. A total of 9 out of 14 studies showed chronic effects on general behavior and stereotypic behaviors, and only 6 on motor skills.

Engagnition: A multi-dimensional dataset for engagement recognition of children with autism spectrum disorder

Engagement plays a key role in improving the cognitive and motor development of children with autism spectrum disorder (ASD). Sensing and recognizing their engagement is crucial before sustaining and improving the engagement. Engaging technologies involving interactive and multi-sensory stimuli have improved engagement and alleviated hyperactive and stereotyped behaviors. However, due to the scarcity of data on engagement recognition for children with ASD, limited access to and small pools of participants, and the prohibitive application requirements such as robots, high cost, and expertise, implementation in real world is challenging. However, serious games have the potential to overcome those drawbacks and are suitable for practical use in the field. This study proposes Engagnition, a dataset for engagement recognition of children with ASD (N = 57) using a serious game, "Defeat the Monster," based on enhancing recognition and classification skills. The dataset consists of physiological and behavioral responses, annotated by experts. For technical validation, we report the distributions of engagement and intervention, and the signal-to-noise ratio of physiological signals.

[Motor intervention strategies on postural control in children and youth with autism spectrum disorder: A systematic review]

Autism spectrum disorder (ASD) has varied characteristics with an impact at the social, communicative and sensorimotor (SM) level. An SM feature is postural control (PC) problems. There are various motor intervention strategies (MIS), but the benefit over LC is something that has been analyzed less extensively. The objective was to describe the MIS and its results on the PC of children and adolescents with ASD. A search of PubMed, Scopus, Web of Science and Cochrane was performed. A total of eight articles met the eligibility criteria. All MIS showed beneficial results on the improvement of PC. The MIS were of a varied nature (dance practice, personalized physical activity, video games, Tai Chi Chuan, Taekwondo and virtual reality). It is necessary to improve the designs and consider the risks of bias, since they limit the scope of the results.

A Literature Review on the Effects of Exergames on Executive Function in Youth

Exergames (video games that promote cognitive and physical activity simultaneously) benefit executive function in elderly populations. It has been suggested that exergames may induce larger effects than cognitive or exercise training alone, but few reviews have synthesized the causal factors of exergames on executive function from experimental research with youth. This review investigates (1) the various types of exergames and associated comparison conditions (2) the executive function outcome assessments commonly utilized in exergame research with youth (3) the efficacy of exergames by evaluating experimental studies that compared exergaming to cognitive, exercise, and passive control conditions inclusive of effect sizes and (4) the potential mechanisms underlying the changes in executive function induced from exergames. Eligible outcome data were available from 607 participants across ten studies, with the age of participants ranging from 4-21 (M age = 10.46 ). The findings indicate that exergames improve aspects of executive function from both acute and chronic studies. Despite the high variability of exergame contexts, dosage, populations, and outcome assessments, improvements in executive function comparing exergaming to passive control conditions were exhibited across all studies. While there is evidence of exergaming demonstrating advantages over passive control conditions, evidence is mixed when comparing exergaming to sedentary cognitive and exercise comparison conditions. Potential sources of these mixed results and future directions to address current gaps in the field are identified. As video game and technology use grows exponentially and concerns of childhood sedentary behavior and play deprivation increase, evidence-based practices that promote both physical and cognitive activity are needed.

A randomized cross-over trial investigating the neurocognitive effects of acute exercise on face recognition in children with autism spectrum disorder

Difficulties in face recognition contribute to social-cognitive problems in autistic children. Evidence on behavioral interventions targeting this cognitive domain is limited. In non-autistic individuals, a single exercise session is known to elicit temporary benefits for several cognitive functions. Our study investigates whether acute aerobic exercise influences face recognition in autistic children. In a randomized order, 29 participants completed a 20-min moderately-intense cycling bout on an ergometer and a control condition. Before and after each condition, participants categorized Mooney faces and instruments during a computerized cognitive task. Simultaneously, the N170 component of event-related potentials and pupil size were recorded using electroencephalography and eyetracking, respectively. As indicated by a greater increase of reaction time in the exercise compared to the control condition, the results revealed impaired face recognition following aerobic exercise. This effect was accompanied by a lower decrease of the positive N170 amplitude and a trend towards a greater constriction of the pupil size in the exercise compared to the control condition. Our findings highlight the interplay of the physiological state and face recognition in autistic children. Exercise-induced impairments in this social-cognitive ability may be due to an interference with the learning effect that is typically seen for the structural encoding of faces.

Exergaming and education: a relational model for games selection and evaluation

Exergaming, or technology-driven physical exercise, has gained popularity in recent years. Its applications include physical education, health promotion, and rehabilitation. Although studies have obtained promising results regarding the positive effects of exergaming, the outcomes of exergaming for different populations remain undetermined. Inconsistencies in the literature on this topic have multiple potential explanations, including the content and demand of the exergames and the capability of the exergamer. A model with a sound theoretical framework is required to facilitate matching between games and gamers. This article proposes a relational model based on a matrix of Bloom's taxonomy of learning domains and the performance components of exergames. Appropriate matching of the physical demands of an exergame and the ability of the exergamer would enhance the effective usage of exergaming for individuals with various needs. This theory-based exergame model is developed to promote the general development, physical status, and psychosocial well-being of students, older adults, and individuals with rehabilitation needs. This model may provide a resource for future research on the application, effectiveness, and design of exergaming.

Serious Games in the new era of digital-health interventions: A narrative review of their therapeutic applications to manage neurobehavior in neurodevelopmental disorders

Children and adolescents with neurodevelopmental disorders generally show adaptive, cognitive and motor skills impairments associated with behavioral problems, i.e., alterations in attention, anxiety and stress regulation, emotional and social relationships, which strongly limit their quality of life. This narrative review aims at providing a critical overview of the current knowledge in the field of serious games (SGs), known as digital instructional interactive videogames, applied to neurodevelopmental disorders. Indeed, a growing number of studies is drawing attention to SGs as innovative and promising interventions in managing neurobehavioral and cognitive disturbs in children with neurodevelopmental disorders. Accordingly, we provide a literature overview of the current evidence regarding the actions and the effects of SGs. In addition, we describe neurobehavioral alterations occurring in some specific neurodevelopmental disorders for which a possible therapeutic use of SGs has been suggested. Finally, we discuss findings obtained in clinical trials using SGs as digital therapeutics in neurodevelopment disorders and suggest new directions and hypotheses for future studies to bridge the gaps between clinical research and clinical practice.

Acute Effects of Exergaming on Students' Executive Functions and Situational Interest in Elementary Physical Education

Two studies were conducted to examine the acute effects of exergaming on students' executive functions and to explore their situational interest regarding these games in elementary physical education. The first study involved a two-group, repeated measures, cross-over quasi-experimental design. Participants were 74 (36 boys) fourth- and fifth-grade students who were assigned to the experimental (38 students) and the waiting list control (36 students) group. The single physical education session with exergames was first implemented with the initial experimental group and after the post-test, the waiting list control group received the intervention. In the second study, a pre-test post-test, within-subjects design was involved with the experimental group students (48 fourth- and fifth-grade students, 27 boys) who participated in a booster single physical education session with exergames two months after their involvement in a four-week intervention with cognitively challenging physical activity games. Both studies involved pre- and post-intervention measures for executive functions using the design fluency test and a post-test measure for situational interest. During the acute session, students had to follow the movements of an on-screen dancing character in time to a chosen song of the Just Dance 2015 exergame. The results of the first study showed that experimental group students improved significantly from pre- to post-test their scores in design fluency and in cognitive flexibility and in the total score of the design fluency test and their improvements were higher compared to the waiting list control group. The waiting list control group students, after receiving the acute session with exergames, significantly improved their scores in design fluency, inhibition, and cognitive flexibility and in the total score of the design fluency test compared to their pre-intervention scores. Moreover, the second study showed that students' total score in the design fluency test improved significantly from pre- to post-intervention. In both studies, students reported generally high scores in all subscales of the situational interest questionnaire. These results suggested that an acute exergame-based physical education session attracted students' interest and positively triggered their executive functions.

Inclusive physical education program of schoolchildren with autism spectrum disorders

Purpose: The purpose was to develop an inclusive physical education program for schoolchildren with ASD and experimentally test its effectiveness. Materials and methods: An inclusive physical education curriculum for children with ASD was made up and incorporated into the process of physical education in secondary schools. At the beginning and the end of the pedagogical experiment, 12-year-old children were tested in the experimental (involved in the author's program, n=9) and control groups (involved in the traditional curriculum, n=11). The indicators of psychophysical fitness of children were determined according to the results of 19 test exercises. The reliability of the differences was determined by the Mann-Whitney U test.  Results: Under the influence of the author's program, physical fitness of children of the experimental group improved significantly. Whereas the trend towards improving almost all indicators of the physical fitness of children with ASD in the traditional program has not been confirmed statistically. The traditional physical education program was most effective in promoting flexibility (inclinations forward) and coordination (passing and catching a ball against a wall) in children with ASD. Conclusions: The author's program was proven to be significantly more effective than the traditional ones in the formation of the strength of shoulder extensors and hand flexors, fine coordination of hand muscles, the speed-strength of leg muscles, and balance. This allows us to recommend it for use in physical education lessons in institutions of general secondary education.

Effects of Augmented Reality Game-Based Cognitive-Motor Training on Restricted and Repetitive Behaviors and Executive Function in Patients with Autism Spectrum Disorder

Restricted and repetitive behaviors (RRBs) and executive dysfunction are widely acknowledged as core features and hallmarks in patients with autism spectrum disorder (ASD). This study aimed to investigate the effects of augmented reality (AR) using motivational games with cognitive–motor exercises on RRBs, executive function (EF), attention, and reaction time in patients with ASD. Twenty-four patients (range from 6 to 18 years) diagnosed with ASD were recruited from local social welfare centers and randomly allocated to the AR game-based cognitive–motor training group (study group) or the conventional cognitive training group (control group). Both groups completed 30 min training sessions, twice a week for four weeks. Outcome measures were conducted before and after the intervention. As a result, improvements were observed in all the subscales of the RRBs in the study group except for self-injurious and ritualistic behavior. Significant improvements were observed in EF and reaction time in the study group, which was significantly higher compared to the control group. With the present findings, we can suggest that cognitive–motor training using AR game-based content generates positive effects on improving executive function reaction time and accuracy of responses and has a limited effect on RRBs in patients with ASD. This can be proposed as a complementary intervention associated with individualized daily management.

Cognitive rehabilitation in people with autism spectrum disorder: a systematic review of emerging virtual reality-based approaches

Introduction

Emerging virtual technologies and cognitive rehabilitation methods are two new treatment approaches that can be used to strengthen cognitive functions in Autism Spectrum Disorder (ASD). The main aim of this study was to examine the effect of using virtual reality-based approaches on cognitive disorders of children and adults with ASD.

Methods

This systematic review was conducted on scientific papers to determine the effects of virtual reality-based technologies on the cognitive functions of children and adults with ASD. We identified 688 studies related to this topic and filtered them down to 17 articles, and then extracted the effects of interventions on cognitive outcomes.

Results

A total of 17 studies met the inclusion criteria, in which 226 persons with ASD had taken place. The sample size in the selected studies ranged from 1 to 56 participants (Median: 8, Q1: 3.5, Q3: 15.5). Four of the studies were case–control studies, ten were pre-test/post-test studies, and three were Randomized Control Trials (RCTs). Results of 16 studies showed significant progress in various cognitive indexes, such as task learning, attention, executive functioning, and daily skills in people with ASD. In most studies, virtual technologies had beneficial effects on reducing cognitive problems, but existing limitations could reduce their effectiveness. These limitations included the cost of virtual reality devices, inappropriate size of software, the weight of devices, potential addiction, intolerance of wearing glasses or headsets by people with autism (especially in children), and the possibility of eye injury.

Conclusion

Applying appropriate virtual-based approaches could improve cognitive indexes in people with ASD. However, further studies are needed to investigate the real effects of these technologies in the long run.

Physical Activity Design for Balance Rehabilitation in Children with Autism Spectrum Disorder

One of the characteristics of autism spectrum disorder (ASD) subjects is postural control deficit, which is significant when somatosensory perception is affected. This study analyzed postural stability evolution after physical therapy exercises based on balance training. The study included 28 children with ASD (average age 8 years, average weight 32.18 kg). The rehabilitation program involved performing balance exercises twice a week for three months. Subject assessment was carried out using the RSScan platform. The parameters were the surface of the confidence ellipse (A) and the length of the curve (L) described by the pressure center, which were evaluated before and after the rehabilitation program. Following data processing, we observed a significant decrease in the surface of the confidence ellipse by 92% from EV1 to EV2. Additionally, a decrease of 42% in the curve length was observed from EV1 to EV2. A t test applied to the ellipse surface showed a p = 0.021 and a Cohen’s coefficient of 0.8 (very large effect size). A t test applied to the length L showed p = 0.029 and Cohen’s coefficient of 1.27 mm. Thus, the results show a significant improvement in the two parameters. The application of the program based on physical exercise led to an improvement in the balance of children with autism under complex evaluation conditions.

Global Trends in Physical-Activity Research of Autism: Bibliometric Analysis Based on the Web of Science Database (1980-2021)

The World Health Organization has identified nervous system diseases as one of the biggest public health problems, including autism spectrum disorder (ASD). Considering the extensive benefits of physical activity (PA), the literature on the PA research of ASD has increased each year, but there is a lack of bibliometric analyses in this field. To investigate the research achievements worldwide, this paper adopts bibliometrics to analyze the trend in the academic literature on the PA research of ASD published from 1980 to 2021. The documents were retrieved from the Web of Science database, and the search strategy was to combine the keywords related to “physical activity” and “autism spectrum disorder” by using the Boolean operator tools “OR” and “AND” in the title. A total of 359 English documents were retrieved. Microsoft Excel, Data Wrapper, VOSviewer, and Biblioshiny were used for the visual analysis. We found that the number of published documents increased the fastest from 2017 to 2021, which may be due to the promulgation of the Global Action Plan for Physical Activity 2018–2030 and the influence of COVID-19 on the world. The United States and the University of California systems are in the leading position in this field. Cooperation among countries with different levels of development will help to jointly promote the PA research progress on ASD. The focus themes include “individual effect”, “social support” and “activity dose”. The analysis of the frontier topic points out that researchers are paying increasing attention to how to improve the health and physical fitness of this group through PA. This research clearly puts forward a comprehensive overview, theme focus, and future trends in this field, which may be helpful to guide future research.

A Qualitative Exploration of Parental Views When Comparing Individual to Group Sports in Children with Autism Spectrum Disorder—A Pilot Study

(1) Background: Physical activity is important for children with autism spectrum disorder. This study aimed to analyse autistic children’s and their parents’ preferences between group and individual physical activity, while exploring potential social barriers that they might encounter. (2) Methods: Retrospective analysis identified 701 new referrals received by the Maltese national child and adolescent mental health service, between 2016 and 2017. Of them, 24 received a sole diagnosis of autism and 10 were chosen via purposive sampling. A semi-structured interview guide was created, including readability testing, translation/back-translation, inter-rater agreements, and focus group testing. Parents were informed, consented, interviewed and thematic analysis carried out. Further quantitative data were tabled accordingly. (3) Results: Only one child met World Health Organisation recommendations for physical activity. More children preferred individual sports while parents described more benefits with group sports. Parents’ perceived benefits with group sports included better socialization, while improved levels of self-esteem and coping with anxiety were highlighted benefits for individual sports. Parents felt misunderstood, burnt out, and described a lack of autism-friendly sports facilities, including geographical disproportionation of adequate facilities on the island. Too much screen time was a major parental concern. (4) Conclusion: Recommendations aim to develop sport therapy systems and well-resourced services in Malta. Staff training is recommended to improve service quality.

Those in the shadow of the pandemic: impacts of the COVID-19 outbreak on the mental health of children with neurodevelopmental disorders and their parents

This study aimed to investigate the emotional and behavioral responses of children with neurodevelopmental disorders and their parents during the recent novel coronavirus disease (COVID-19) pandemic and the associated factors. Our study included 299 children and adolescents with neurodevelopmental disorders and 299 mothers or fathers. Participant groups were as follows: autism spectrum disorder (n = 131, 43.8%); intellectual disability (n = 103, 34.4%); specific learning disorder (n = 46, 15.4%); and communication disorder (n = 19, 6.4%). A data form was created to investigate the emotional, behavioral, sleep problems, and appetite changes of the cases, and it was adapted for online application and conveyed to the parents in the form of emails. Our study indicated that children and adolescents' emotional problems were 44.5%, behavioral problems 33.4%, sleep problems 65.2%, and appetite problems 32.4%. Irritability (35.5%), hyperactivity (37.8%), stereotyped behavior (29.8%), delayed sleep phase (51.5%) were the most common problems reported by the parents. The frequencies of emotional and behavioral problems in the ASD group were higher than in the other groups (p < .05). In addition, the Hospital Anxiety Depression Scale (HADS) was used to determine the parents' anxiety and depression symptoms. Mean HADS anxiety and depression scores of parents were 8.5 ± 4.3 and 7.8 ± 4.2, respectively. Our study demonstrated that the COVID-19 pandemic and lockdown negatively affected children with neurodevelopmental disorders and their parents in many areas. It is necessary that these children and their families are evaluated and supported by local professionals, as the ongoing pandemic can exacerbate the current challenges. The findings of our study reflect the early period of the pandemic. For this reason, longitudinal studies about the long-term consequences of the pandemic are needed.

The efficacy of executive function interventions in children with autism spectrum disorder: a systematic review and meta-analysis

INTRODUCTION

Children with Autism Spectrum Disorder (ASD) experience difficulties in Executive Functions (EFs) performance. However, the efficacy of EF intervention needs to be further investigated.

OBJECTIVE

To evaluate the efficacy of different EF interventions in children and adolescents with ASD.

METHODS

A systematic review and meta-analysis were carried out according to PRISMA guidelines. Relevant databases including PubMed, PsycINFO, Scopus, and Web of Science were searched up to November 2019. Papers included in the study have the following characteristics: randomized controlled trial or quasi-experimental design and published in English or Spanish.

RESULTS

After the elimination of duplicates, 949 were screened. Among these, six were included in the systematic review. The main approaches for EF in ASD were computer-based interventions, cognitive-behavioral therapy, and assisted-animal therapy. Statistically significant results (p = 0.003) were found in using exergames.

CONCLUSION

Different approaches can be used for improving EF intervention, with positive effects on working memory, behavior, and flexibility.

Interventions with Serious Games and Entertainment Games in Autism Spectrum Disorder: A Systematic Review

The use of serious games and entertainment games was compared as adjuvant tools for intervention in Autism Spectrum Disorder (ASD). A comprehensive search was performed in the MEDLINE, PsycINFO, Scopus, and Web of Science databases. From 295 studies, 53 studies were selected and included in this review. Overall, studies showed improvement after intervention, regardless of the type of video games, mostly for social skills and behavior. However, these changes should be regarded with caution, as they are limited to the tests applied. Furthermore, neither the entertainment nor the serious approach had a therapeutic impact on emotional resilience, representing the current gap in the field. Thus, even considering the limitations, our study is important because it shows that both categories have strengths.

Effects of Cognitive Training Programs on Executive Function in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review

BACKGROUND

Autism Spectrum Disorder is often associated with deficits in executive functions (EFs), which is contributing significantly to individuals with ASD's difficulties in conducting an independent life, particularly considering social skills. Technologies offer promising opportunities to structure EF intervention programs for children on the autistic spectrum.

METHODS

This study aimed to review the effectiveness of randomized controlled trials or quasi-experimental studies of EF interventions delivered to children and young people (up to 23 years old) with a diagnosis of ASD. A special focus was dedicated to document the effectiveness of computerized and non-computerized cognitive training on (1) EFs and on (2) ASD symptomatology and social skills. Of 2601 studies retrieved, 19 fulfilled the inclusion criteria.

RESULTS

Most of the interventions identified were effective in enhancing EFs and reducing symptoms in children and young people with ASD. Limited evidence is available on their generalization to untrained skills (i.e., social abilities) as well as long-term effects.

CONCLUSIONS

There is growing evidence for overall effectiveness of EF training, particularly when computerized. However, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, and a small samples of included studies.

Spontaneous emergence of leadership patterns drives synchronization in complex human networks

Synchronization of human networks is fundamental in many aspects of human endeavour. Recently, much research effort has been spent on analyzing how motor coordination emerges in human groups (from rocking chairs to violin players) and how it is affected by coupling structure and strength. Here we uncover the spontaneous emergence of leadership (based on physical signaling during group interaction) as a crucial factor steering the occurrence of synchronization in complex human networks where individuals perform a joint motor task. In two experiments engaging participants in an arm movement synchronization task, in the physical world as well as in the digital world, we found that specific patterns of leadership emerged and increased synchronization performance. Precisely, three patterns were found, involving a subtle interaction between phase of the motion and amount of influence. Such patterns were independent of the presence or absence of physical interaction, and persisted across manipulated spatial configurations. Our results shed light on the mechanisms that drive coordination and leadership in human groups, and are consequential for the design of interactions with artificial agents, avatars or robots, where social roles can be determinant for a successful interaction.

The Effects of Exercise Interventions on Executive Functions in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review and Meta-analysis

BACKGROUND

Both chronic and acute exercise interventions have reported positive effects on executive functions (EFs) in general populations. However, data on changes in EFs in children and adolescents with autism spectrum disorder (ASD) in response to exercise interventions are still unclear.

OBJECTIVE

This systematic review and meta-analysis aimed to synthesize available empirical studies concerning the effects of exercise interventions on EFs in children and adolescents with ASD.

METHODS

In accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, the electronic databases CINAHL Complete (via EBSCOhost), SPORTDiscus with Full Text (via EBSCOhost), MEDLINE (via EBSCOhost), Web of Science, ProQuest, and Education Resources Information Center (ERIC; via EBSCOhost) were searched from inception to January 2021. Two authors independently extracted data and conducted a risk-of-bias analysis using the Physiotherapy Evidence Database scale. Randomized controlled trials/quasi-experimental designs that used acute or chronic exercise interventions and assessed EFs through neurocognitive tasks or questionnaires among children and adolescents with ASD were included. In total, 259 articles were identified, of which 15 full texts were independently assessed for eligibility by two authors. In total, 14 articles underwent systematic review, and seven were selected for meta-analysis.

RESULTS

Overall, chronic exercise interventions had a small to moderate positive effect on overall EFs in children and adolescents with ASD (g = 0.342; 95% confidence interval [CI] 0.084-0.600; p < 0.01). Regarding domain-specific EFs, chronic exercise interventions had a small to moderate positive effect on cognitive flexibility (g = 0.312; 95% CI 0.053-0.570; p < 0.01) and inhibitory control (g = 0.492; 95% CI 0.188-0.796; p < 0.01). However, our review found a non-significant effect size (g = 0.212; 95% CI - 0.088 to 0.512) on working memory.

CONCLUSIONS

Chronic exercise interventions appear to have beneficial effects on overall EFs in children and adolescents with ASD, particularly in relation to cognitive flexibility and inhibitory control.

Behavioural Improvements in Children with Autism Spectrum Disorder after Participation in an Adapted Judo Programme Followed by Deleterious Effects during the COVID-19 Lockdown

The public health lockdown prompted by the novel coronavirus (COVID-19) pandemic, which included school closures that may have potentially serious consequences for people with disabilities or special educational needs, disrupted an ongoing adapted judo training intervention in children with Autism Spectrum Disorder (ASD). The purpose of this study was to compare repetitive behaviours, social interaction, social communication, emotional responses, cognitive style and maladaptive speech scores across four time-points: baseline, after an eight-week control period, after an eight-week judo intervention and after an eight-week lockdown period due to COVID-19. The sample consisted of 11 children diagnosed with ASD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V), with an intelligence quotient (IQ) range between 60 and 70. Significant improvements were shown following the judo intervention period compared to the baseline and control periods. However, the same values significantly declined during the COVID-19 lockdown period resulting in values lower than those recorded at baseline, and following the control period and the judo intervention. The decline in psychosocial and behavioural scores are likely due to the stress caused by the sudden halt in activity and the increase in sedentary practices associated with the lockdown.

Effects of Physical Exercise Interventions on Stereotyped Motor Behaviours in Children with ASD: A Meta-Analysis

Studies have reported that physical exercise reduces maladaptive stereotyped motor behaviours (SMB) in children with ASD, but these intervention studies vary in design and outcome. The present systematic review and meta-analysis included 22 studies, involving 274 children with ASD, to quantify the effect of exercise on SMB and its potential moderators. Multi-level modelling revealed a large overall effect, Hedges' g = 1.16, with significant heterogeneity across participant, treatment, and study levels. Further, a more appropriate model using between-case estimation for within-subject effects to improve comparability between single-case and group-design studies, yielded a smaller but still significant effect, g = 0.51. Lastly, higher exercise intensity, but not age, exercise duration or settings, reliably predicted treatment effectiveness. Implications for clinical practice and research are discussed.

Parent-reported social-communication changes in children diagnosed with autism spectrum disorder during the COVID-19 pandemic in the UK

Introduction: The coronavirus pandemic has swept across the United Kingdom (UK). Given the ever-evolving situation, little is known about the repercussions of coronavirus and the subsequent lockdowns for children diagnosed with Autism Spectrum Disorder (ASD). Therefore, this study explores the social-communicative impact of the first lockdown (March 2020 - July 2020) in the UK and the return to school period (September 2020 - October 2020), following prolonged disruption to routine, in children diagnosed with ASD. Methods : Parents of autistic children completed 2 separate online surveys following the first lockdown in the UK (n = 176) and also when children returned to school following the summer break (n = 54). Results : The results suggested that self-regulation skills (p < .05) and co-operation skills (p < .05) were most affected over the course of the lockdown. Children's physical activity levels were perceived to significantly increase during the return to school (p < .0001), which was associated with better social-communication outcomes (p < .05). Conclusion : Future work is needed to confirm and explore the findings. Such work could be implemented to protect and improve the social-communicative outcomes of autistic children.

The Effect of Physical Activity Interventions on Executive Function Among People with Neurodevelopmental Disorders: A Meta-Analysis

The current meta-analysis comprehensively examined the effects of physical activity interventions on executive function among people with neurodevelopmental disorders. The meta-analysis included 34 studies with 1058 participants aged 5-33 years. Results indicated an overall significant medium effect of physical activity interventions on improving executive function in people with neurodevelopmental disorders under the random-effect model (Hedges' g = 0.56, p < .001). Significant moderators of the effects of physical activity intervention on executive function included age, intervention length and session time, executive function subdomains, and intervention dose (total minutes in the intervention). This meta-analysis provides support for the effectiveness of physical activity interventions on executive function among people with neurodevelopmental disorders. Future studies and limitations are discussed.

Video Games for the Treatment of Autism Spectrum Disorder: A Systematic Review

Video games are a promising area of intervention for children diagnosed with Autism Spectrum Disorders (ASD). However, reviews on this topic are scarce. This review on studies exploring video games for the treatment of ASD followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and its protocol was registered in PROSPERO. PubMed, PsycInfo, Embase, WebOfScience and clinicaltrials.gov databases were searched. Twenty-four articles were included in the review. Video game-based interventions were effective for alleviating ASD symptoms, albeit with small effect sizes. High rates of acceptability and adherence to treatment were obtained. Conclusion: Video games are a promising area for improving the treatment of children with ASD. Exploring commercial video games is one of the lines for future research.

Physical and Sedentary Activity Patterns in Youths with Autism Spectrum Disorder

Little is known about the patterns of sedentary behavior and physical activity (PA) within different school levels (i.e., primary school and secondary school) and on different day types (i.e., weekdays and weekend days) among youths with autism spectrum disorder (ASD). The sample was recruited from one city in Taiwan. A total of 68 male youths with ASD, aged 6–17 years, participated in the study. PA was assessed using an ActiGraph accelerometer, and sedentary behaviors (i.e., TV viewing, computer use, and reading time) were determined using a self-report log. The main findings were that (a) primary school youths with ASD were more active than secondary school youths with ASD on both weekdays and weekend days, but primary school youths with ASD also had more sedentary time than did secondary school youths with ASD on both weekdays and weekend days; (b) secondary school youths with ASD were more active but also more sedentary on weekdays compared with weekend days, but they had more screen use on weekend days compared with on weekdays. Future interventions are required to decrease sedentary behavior and increase PA to improve the health of these youths according to school level and day of the week.

The Effects of Physical Activity and Exergaming on Motor Skills and Executive Functions in Children with Autism Spectrum Disorder

Objective: This study aims at investigating the effects of two types of interventions, Sports, Play and Active Recreation for Kids (SPARK) and exergaming (Kinect), on motor skills (MS) and executive functions (EF) in children with autism spectrum disorder (ASD). Materials and Methods: Sixty children, aged 6-10 years were randomly assigned to SPARK (n = 20), Kinect (n = 20), or a control group (n = 20). Children's MS and EF were assessed before and after the intervention. The SPARK and Kinect groups participated in an 8-week intervention; the control group received treatment as usual. Intention-to-treat repeated-measures ANOVA was used to examine the effects of the intervention. Results: For MS, a significant group X time interaction was observed for aiming and catching skills [F(2, 53) = 4.12, P < 0.05]; the SPARK group improved significantly from pre- to post-test compared with the other groups. For EF, a main effect of group was found for correct responses [F(2, 53) = 5.43, P < 0.01]. The Kinect group showed more correct responses than the SPARK and control groups. A main effect of time was significant for conceptual responses [F(1, 53) = 10.61, P < 0.01] and perseverative errors [F(1, 53) = 14.31, P < 0.01]. Conclusion: This study suggests that structured physical activity (PA) interventions that target specific MS improve motor function in children with ASD and exergaming could be effective for improving EF. Future research is needed to untangle the interaction between the type of exercise, traditional PA versus exergaming, and the dose associated with improvements in MS and EF in children with ASD.

The role of BMI on cognition following acute physical activity in preadolescent children

BACKGROUND

There is an increasing prevalence of physical inactivity during childhood, concurrent with a rise in obesity rates, which is associated with a variety of health problems. However, the extent to which increased body mass index (BMI) influences acute physical activity (PA) benefits on cognition in childhood remains unknown. The aim of this study was to examine whether BMI influences the effects of acute PA on inhibitory control task performance.

METHODS

In a sample of 116 children pooled from four prior studies (ages 8-11; 51 females), demographic measures of age, sex, IQ, socioeconomic status, and aerobic fitness were considered along with BMI. Children participated in a counterbalanced, randomized crossover study, whereby they completed two different interventions; 20 minutes of treadmill walking (60-70% heart rate max) and restful reading (non-exercise control). Following each intervention, children performed a modified flanker task that manipulates inhibitory control demands. Correlations were conducted to determine the influence of demographic variables, fitness, and BMI on inhibitory control following each intervention. Subsequent hierarchical regression analyses were performed with significant demographic factors in the first step, aerobic fitness in the second step when significant, and BMI in the final step.

RESULTS

Analyses indicated that children exhibited improved task performance (p's ≤ 0.001) and decreased interference (p = 0.04) following the walking intervention compared to the restful reading control condition, indicating greater benefits following acute PA across task condition, with selectively greater benefits for the task condition requiring greater inhibitory control. Regression analyses revealed that greater BMI was related to decreased performance following acute PA (p = 0.001); an association not observed following restful reading (p's ≥ 0.11). These results suggest that BMI negatively influences the effect of acute exercise on performance.

CONCLUSION

Confirming previous studies, these findings indicate beneficial effects of acute PA on a flanker task that modulates inhibitory control requirements, but the effects are significantly greater for task conditions requiring greater amounts of inhibitory control. Further, these beneficial effects of PA appear to be blunted in children with higher BMI. These findings suggest that the acute benefits of PA on cognition may not be fully realized in children with higher BMI.

Exercise Intervention in Treatment of Neuropsychological Diseases: A Review

Faced with a constant inundation of information and increasing pressures brought by the continuous development of modern civilization, people are increasingly faced with mental health challenges that are only now being actively researched. Mental illness is caused by brain dysfunction due to internal and external pathogenic factors that destroy the integrity of the human brain and alter its function. Regular participation in physical exercise can stimulate the cerebral cortex and simultaneously increase the supply of oxygen and nutrients, helping to preserve or restore normal functioning of the nervous system. In conjunction with other systems of the body, the nervous system constitutes the neuro-humoral regulation system responsible for maintaining the stable state of the human body. This paper is a systematic review of studies investigating the effects of exercise intervention on several common neuropsychological diseases, including depression, anxiety disorder, autism, and attention-deficit/hyperactivity disorder. Furthermore, we discuss possible physiological mechanisms underlying exercise-induced benefits and study limitations that must be addressed by future research. In many cases, drug therapy is ineffective and brings unwanted side effects. Based on the literature, we conclude that exercise intervention plays a positive role and that certain standards must be established in the field to make physical activity consistently effective.

Environmental Factors Associated with Physical Activity and Screen Time Among Children With and Without Autism Spectrum Disorder

This study aimed to examine how environmental factors are associated with physical activity (PA) and screen-time (ST) among children with and without ASD (n = 1380 and 1411, respectively). For TD children, the absence of a bedroom television and neighborhood support were associated with PA. For children with ASD, no environmental factors were associated with PA. Regarding ST, the presence of a bedroom television, absence of limits on ST, lack of neighborhood amenities and support, and adverse neighborhood factors were all associated with ST among TD children. For children with ASD, the presence of a bedroom television and the absence of limits on ST were associated with ST. Potential explanations for this dichotomy and suggestions for future research are discussed.

Effectiveness of active video game usage on body composition, physical activity level and motor proficiency in children with intellectual disability

BACKGROUND

Interventions with active video games (AVGs) can promote physical activity (PA) and health and are compatible with a school setting. The needs of children with intellectual disability (ID) in this area have been neglected.

METHODS

A two-arm trial was conducted among 203 students with intellectual disability. The intervention group was prescribed a 12-week intervention with AVG. The control group continued with usual PA.

RESULTS

Children's BOT-2 short-form score increased in both the intervention and control groups. However, the AVG intervention had no statistically significant effect on children's body composition, PA and motor proficiency overall, or in analyses of subgroups based on age, body weight and comorbid autism.

CONCLUSION

Active video game intervention had no marked effect on body composition, PA and motor proficiency in children with intellectual disability. The reasons for the lack of effectivity of the intervention are discussed; these may provide better guidelines for future AVG intervention in children with intellectual disability.

Exercise Reverses Behavioral and Synaptic Abnormalities after Maternal Inflammation

Abnormal behaviors in individuals with neurodevelopmental disorders are generally believed to be irreversible. Here, we show that voluntary wheel running ameliorates the abnormalities in sociability, repetitiveness, and anxiety observed in a mouse model of a neurodevelopmental disorder induced by maternal immune activation (MIA). Exercise activates a portion of dentate granule cells, normalizing the density of hippocampal CA3 synapses, which is excessive in the MIA-affected offspring. The synaptic surplus in the MIA offspring is induced by deficits in synapse engulfment by microglia, which is normalized by exercise through microglial activation. Finally, chemogenetically induced activation of granule cells promotes the engulfment of CA3 synapses. Thus, our study proposes a role of voluntary exercise in the modulation of behavioral and synaptic abnormalities in neurodevelopmental disorders.

Effect of Acute Exercise on Prefrontal Oxygenation and Inhibitory Control Among Male Children With Autism Spectrum Disorder: An Exploratory Study

Objective: Children with autism spectrum disorder (ASD) experience significant challenges in executive functioning. Emerging evidence suggests exercise may improve executive functioning among children; however, these effects and their mechanisms have not been fully explored among children with ASD. The purpose of this study was to explore the acute effect of exercise on cerebral oxygenation within the prefrontal cortex and inhibitory control among male children with ASD.

Method: Participants (N = 12) were 8–12 years of age with a diagnosis of ASD. A within-subject crossover design was employed. Participants completed three 20-min conditions on separate days: circuit-based workout, treadmill walking, and sedentary control. Pre- and post- each condition participants completed a cancellation task (Leiter-3) as a measure of inhibitory control and cerebral oxygenation was concurrently assessed using functional near-infrared spectroscopy (fNIRS). Heart rate, affect, perceived exertion, motivation, and self-efficacy were measured throughout the experiment as manipulation checks and potential psychological mechanisms. A series of repeated measures ANOVAs were conducted to examine intervention effects.

Results: Results demonstrated medium-to-large interaction effects (time by condition) for cerebral oxygenation (ηp2 = 0.237) and inhibitory control (ηp2 = 0.118). Post hoc analyses revealed that the circuit exercise condition elicited the largest changes in both outcomes. The manipulation checks indicated that the exercises were completed as intended.

Conclusion: These findings suggest that exercise may be a feasible intervention for enhancing executive functioning in children with ASD. More research with larger samples is needed to replicate these findings.

Effects of Mini-Basketball Training Program on Executive Functions and Core Symptoms among Preschool Children with Autism Spectrum Disorders

This study examined the effects of a 12-week mini-basketball training program (MBTP) on executive functions and core symptoms among preschoolers with autism spectrum disorder (ASD). In this quasi-experimental pilot study, 33 ASD preschoolers who received their conventional rehabilitation program were assigned to either a MBTP group (n = 18) or control group (n = 15). Specifically, the experimental group was required to take an additional 12-week MBTP (five days per week, one session per day, and forty minutes per session), while the control group was instructed to maintain their daily activities. Executive functions and core symptoms (social communication impairment and repetitive behavior) were evaluated by the Childhood Executive Functioning Inventory (CHEXI), the Social Responsiveness Scale-Second Edition (SRS-2), and the Repetitive Behavior Scale-Revised (RBS-R), respectively. After the 12-week intervention period, the MBTP group exhibited significantly better performances in working memory (F = 7.51, p < 0.01, partial η² = 0.195) and regulation (F = 4.23, p < 0.05, partial η² = 0.12) as compared to the control group. Moreover, the MBTP significantly improved core symptoms of ASD preschoolers, including the social communication impairment (F = 6.02, p < 0.05, partial η² = 0.020) and repetitive behavior (F = 5.79, p < 0.05, partial η² = 0.016). Based on our findings, we concluded that the 12-week MBTP may improve executive functions and core symptoms in preschoolers with ASD, and we provide new evidence that regular physical exercise in the form of a MBTP is a promising alternative to treat ASD.

Exergames for Children and Adolescents with Autism Spectrum Disorder: An Overview

Autistic Spectrum Disorder (ASD) is a complex neurodevelopmental disorder associated with various etiologies and characterized by deficits in social interaction, emotional reciprocity, communication, motor skills and cognitive functions. Studies have proposed that limited levels of physical activity and late motor skills and fitness, particularly in children and adolescents with ASD, may accentuate social and emotional deficits. In view of this, exergames, which are active video-games, can be considered a low-cost and safe type of exercise for children and adolescents with ASD, since they are more enjoyable than ordinary physical activities, influencing on treatment adherence. Thus, our study aims to evidence the effects of exergames on physical fitness, cognitive functions, and repetitive behaviors in children and adolescents with ASD. Despite the small number of studies investigating the effects of exergames as new strategy in children and adolescents with ASD, results suggest exergames as potential tool for the treatment of children and adolescents with ASD for improvement in physical fitness, cognitive functions and repetitive behavior. Our review pointed towards the importance of exergames for children and adolescents with ASD. Despite few studies conducted about this issue, we can consider exergames a potential tool to increase physical fitness, cognitive functions and to decrease repetitive behavior in children and adolescents with ASD. Moreover, health professionals should be careful when attempting to help this population, because the current literature is unclear yet about the improvement of ASD features through exergames.

Microglia as possible therapeutic targets for autism spectrum disorders

Malfunctions of the nervous and immune systems are now recognized to be fundamental causes of autism spectrum disorders (ASDs). Studies have suggested that the brain's resident immune cells, microglia are possible key players in ASDs. Specifically, deficits in synaptic pruning by microglia may underlie the pathogenesis of ASDs, in which excess synapses are occasionally reported. This idea has driven researchers to investigate causal links between microglial dysfunction and ASDs. In this review, we first introduce the characteristics of microglia in ASD brains and discuss their possible roles in the pathogenesis of ASDs. We also refer to immunomodulatory agents that could be potentially used as symptomatic therapies for ASDs in light of their ability to modify microglial functions. Finally, we will mention a possible strategy to radically cure some of the symptoms reported in ASDs through reorganizing neural circuits via microglia-dependent synaptic pruning.

The impact of sport activities on basic motor skills of children with autism

Background and Study Aim: This study aims to investigate the impact of sports training on basic motor skills of children with autism. Material and Methods: The study included sixteen children with autism who were aged between 12-16 years. The study aims to present the difference between basic motor skills of children with autism before sports training and after taking sports training for 12 weeks. The study was conducted in experimental design and compared values before and after sports training. SPSS 23.0 statistics program was used to perform statistical assessment of the data. The non-parametric Wilcoxon test was used for intragroup changes of fine and gross motor development, balance, life skills and self-care test data in the test battery. Results: At the end of a 12-week study, positive developments were observed in balance, catching, skipping, basic gymnastics, and some psychomotor and life skills, while no significant difference was observed in throwing skills. Based on daily life generalization, it can be said that the learned skills positively contribute to life standards of individuals with autism. Conclusions: The study results show that exercise programs also develop the physical fitness levels of children with autism. At the end of a 12-week sports training, a positive development was seen in basic motor skills and life skills. It is thought that useful results can be obtained with such exercise programs.

A Game-Based Repeated Assessment for Cognitive Monitoring: Initial Usability and Adherence Study in a Summer Camp Setting

The current feasibility study examined the adherence, reliability, and assessment potential of an evidence-based game-like mobile Monitoring Tool (Akili Interactive Labs), to monitor 100 participants' cognition for eight sessions at a summer camp for children with special needs. A validated measure of attention was administered at baseline. In the last session, participants completed an exit questionnaire. The Monitoring Tool was found to be enjoyable, and showed a high rate of adherence. No Monitor-related adverse events were reported. Monitor metrics showed good reliability across repeated measurements, indicating it is stable over long-term cognitive monitoring. There was evidence that the Monitoring Tool was able to detect differences in cognition between the children diagnosed with attention deficit hyperactivity disorder and autism spectrum disorders.

Moderating effect of social interaction on enjoyment and perception of physical activity in young adults with autism spectrum disorders

Background: Young adults with autism spectrum disorder (ASD) are at increased risk for a sedentary lifestyle and its associated health problems. In neurotypical (NT) individuals, social participation and enjoyment are related to physical activity engagement. Exergaming has been shown to increase energy expenditure compared to traditional video games and is an effective option for community-based recreation. Methods: We measured physiological and psychological responses of young adults with ASD to exergaming under varying conditions and sought to determine whether playing alone versus with a partner influenced physical activity level and/or experience in NT young adults (n = 18) and those with ASD (n = 18). Results: Both ASD and NT groups experienced high enjoyment and perceived exertion while exergaming. Perceived exertion was moderated by enjoyment when young adults with ASD played with a partner, reporting less effort despite actually expending more energy. Conclusion: Social interaction may lead to increased intensity and duration of physical activity for individuals with ASD. Exergaming is a socially acceptable and age-appropriate exercise modality for this group and likely represents a cost-effective and accessible way to incorporate physical activity and social interaction into their daily lives.

Examining the impact of physical activity on sleep quality and executive functions in children with autism spectrum disorder: A randomized controlled trial

Sleep disturbance and executive dysfunction have been widely reported in children with autism spectrum disorder. While the positive impacts of physical activity on sleep quality and cognition are documented in children with typical development, similar studies in children with autism spectrum disorder are scarce. The objective of this study was to examine the impact of physical activity on sleep quality and cognition in children with autism spectrum disorder. A total of 40 children diagnosed with autism spectrum disorder (mean age = 9.95 years) were randomly assigned into two groups: physical activity intervention and control. Four sleep parameters (sleep efficiency, sleep onset latency, sleep duration, and wake after sleep onset) and two executive functions (inhibition control and working memory) were assessed. Results revealed a significant improvement in sleep efficiency, sleep onset latency, and sleep duration in the intervention group but not in the control group during weekdays. Moreover, a significant improvement in inhibitory control was shown in the intervention group but not in the control group. No significant improvement in working memory capacity was documented in either group (ps > 0.05). Our findings highlight the value of physical activity in improving sleep quality and cognition among children with autism spectrum disorder, but specific physical activity may be required to benefit individual executive functions.

Relations among activity participation, friendship, and internalizing problems in children with autism spectrum disorder

Social interaction difficulties in children with autism spectrum disorder can be challenging, especially during adolescence. In addition, high rates of comorbid internalizing disorders in autism spectrum disorder can lead to social isolation. With limited social activity participation, social deficits and internalizing problems in autism spectrum disorder may be related to participation, exposure, and practice with friends. The purpose of this study was to evaluate the relations among friendship, activity participation, and internalizing problems. Participants included 129 children with autism spectrum disorder between the ages of 6 and 18 years. Measures of friendship, sport, hobby, and club participation, and internalizing problems were assessed. Results showed that activity participation was related to more friendships, even after controlling for intelligence quotient. This study sheds light on the impact of social engagement with peers in developing and maintaining friendships as well as managing internalizing problems.