Effects of Physical Exercise and Virtual Training on Visual Attention Levels in Children with Autism Spectrum Disorders

Unit of analysis error in a meta-analysis

In this correspondence, we raised concerns about methodological issues in a recent network meta-analysis by Wang et al. As meta-analysis forms the basis of most guidelines and clinical decisions, a sound methodology with a correct conclusion is paramount.

The effectiveness and sustained effects of exercise therapy to improve executive function in children and adolescents with autism: a systematic review and meta-analysis

This study rigorously examines the efficacy and sustained impact of exercise therapy on enhancing executive function among children and adolescents diagnosed with autism spectrum disorder (ASD). Furthermore, it conducts a comprehensive analysis of five distinct subgroups, categorized by variations in school age, exercise cycles, exercise characteristics, dimensions of executive function, and the administration of medication. A systematic search was conducted across the PubMed, EmBase, Cochrane Library, Web of Science, and SPORTDiscus databases to identify randomized controlled trials published from the inception of the library until October 20, 2024, focusing on the effects of exercise therapy on the enhancement of executive function in children and adolescents with ASD. Sixteen studies were systematically evaluated and included in the meta-analysis, revealing that exercise therapy led to a significant improvement in executive function among children and adolescents with ASD (SMD = 0.41, 95% CI [0.30, 0.52], P = 0.00), along with some evidence of sustained improvement (SMD = 0.74, 95% CI [0.29, 1.20], P = 0.00). Subgroup analyses indicated that exercise did not significantly enhance executive functioning in preschool-aged patients with ASD, and working memory did not exhibit a significant improvement across various dimensions of executive functioning. Furthermore, no differences were observed in analyses of different exercise cycles, exercise characteristics, or the use of medication among subjects.

CONCLUSION

Exercise interventions improve executive function in children and adolescents with ASD, with sustained post-intervention effects. Limited impact on working memory and observed heterogeneity highlights the need for more precise intervention designs and rigorous research.

WHAT IS KNOWN

• Exercise therapy is widely considered a promising non-pharmacological intervention for improving cognitive functions in children and adolescents with autism spectrum disorder (ASD). • Prior studies suggest exercise benefits executive function in ASD, but evidence on sustained effects and subgroup differences remains limited.

WHAT IS NEW

• This meta-analysis confirms that exercise therapy significantly and sustainably improves executive function in children and adolescents with ASD, with greater benefits observed in school-aged participants. • For the first time, subgroup analyses reveal age-dependent effects and confirm that working memory shows limited responsiveness to exercise, regardless of medication use or exercise characteristics.

Comparative effectiveness of physical activity interventions on cognitive functions in children and adolescents with Neurodevelopmental Disorders: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Physical activity (PA) interventions have been shown to yield positive effects on cognitive functions. However, it is unclear which type of PA intervention is the most effective in children and adolescents with Neurodevelopmental Disorders (NDDs). This study aimed to compare the effectiveness of different types of PA interventions on cognitive functions in children and adolescents with NDDs, with additional analyses examining intervention effects across specific NDD types including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

METHODS

In this systematic review and network meta-analysis, seven databases (Web of Science, PubMed, Medline, APA PsycINFO, Embase, CINAHL, and SPORTDiscus) for randomized controlled trials from database inception to September 2023 were searched. Randomized controlled trials comparing the effectiveness of PA intervention with any non-pharmacological treatment or control group on cognitive functions in children and adolescents diagnosed with NDDs aged 5-17 years were included. Frequentist network meta-analyses were performed based on standardized mean differences (SMD) using random effects models to examine post-intervention differences in cognitive functions, including attention, memory, and executive functions. Intervention dropout was assessed as a measure of treatment acceptability.

RESULTS

Thirty-one randomized controlled trials (n = 1,403, mean age 10.0 ± 1.9 years) with 66 arms were included in the network. Mind-body exercise (MBE; SMD = 1.91 for attention; 0.92 for executive functions), exergaming (SMD = 1.58 for attention; 0.97 for memory; 0.94 for executive functions), and multi-component physical activity (MPA; SMD = 0.79 for executive functions) were associated with moderate to substantial cognitive improvements compared with usual care, whereas the effectiveness of aerobic exercise (AE) was non-significant. Exergaming (SMD = 0.78, 95%CI 0.12 to 1.45) and MPA (SMD = 0.64, 95%CI 0.11 to 1.18) were more effective than AE for executive functions. When analyzing specific NDD types, exergaming lost its superiority over usual care for attention and memory in ADHD, nor for executive functions in ASD. Instead, MPA demonstrated significant benefits across these domains and populations. The certainty of evidence for these comparisons was very low to low. No significant differences in acceptability were observed among MBE, exergaming, and MPA.

CONCLUSIONS

The findings in this study suggest that MBE, exergaming, and MPA were effective interventions for improving domain-specific cognitive functions in children and adolescents with NDDs. AE demonstrated non-significant effectiveness for all outcomes. MBE emerges as particularly advantageous for attention. MPA yielded consistent improvements in memory and executive functions across NDD types. Further high-quality randomized controlled trials of direct comparisons are needed to confirm and expand on the findings from this NMA.

TRIAL REGISTRATION

PROSPERO CRD42023409606.

Effects of different exercise modalities on pediatric and adolescent populations with developmental disorders: a network meta-analysis of randomized controlled trials

To investigate the impact of different types of exercise modalities on children and adolescents with developmental disorders. Data were obtained from randomized controlled trials retrieved from five databases. Following the PRISMA NMA guidelines, a Bayesian framework-based Markov chain Monte Carlo simulation was used for aggregation and analysis. The included studies were assessed for risk of bias and quality evaluation. A total of 68 studies were included. Moderate-quality evidence suggests that combative sports may be the best exercise for enhancing gross motor skills, ball sports are the most effective for improving executive function, neurodevelopmental motor training is the most effective for improving social skills, and aquatic exercise is the most effective for improving behavioral problems.

CONCLUSIONS

Combat sports, ball sports, neurodevelopmental motor training, and aquatic exercise may be effective exercise modalities for improving symptoms in children and adolescents with developmental disorders. However, the degree of improvement can vary among individuals with specific developmental disorders. Therefore, precise assessment of the individual symptoms of children or adolescents is crucial before selecting specific exercise interventions.

TRIAL REGISTRATION

PROSPERO (CRD42024545673).

WHAT IS KNOWN

• Many studies indicate that exercise as an intervention can have positive effects on individuals with developmental disorders, such as ADHD and autism. However, reported effects vary, and there is no clear consensus on the optimal exercise intervention method yet.

WHAT IS NEW

• Through a comprehensive network meta-analysis, various exercise interventions for children and adolescents with developmental disorders were compared to determine the optimal approach. The study found that combat sports, ball sports, neurodevelopmental motor training, and aquatic exercise could potentially be effective modalities for improving symptoms in this population.

Benefits of exercise for children and adolescents with autism spectrum disorder: a systematic review and meta-analysis

Background

Numerous experimental studies have shown that exercise can serve as an intervention with beneficial effects on children and adolescents with autism. However, a systematic review on the specific areas affected has not been conducted.

Methods

Preliminary research sources were obtained by searching four databases, and two researchers independently screened the literature that met the study criteria. The study was conducted under the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions.

Results

37 studies were included in the final analysis, of which 9 studies were quantitatively synthesized and 28 studies were qualitatively analyzed. Exercise interventions have positive effects on motor performance, cognitive function, individual and social relationships, behavioral problems, physical health, and brain function in children and adolescents with autism. The results of the meta-analysis indicate that exercise can effectively improve social skills [SMD=-0.53, 95%CI (-0.76, -0.3), P=0.000].

Conclusions

Long-term, regular, chronic exercise is beneficial for children and adolescents with autism, particularly in the area of social skills.

Systematic review registration

https://www.crd.york.ac.uk/prospero PROSPERO, identifier CRD42024554530.

Sport and Autism: What Do We Know so Far? A Review

Autism, or autism spectrum disorders, is a neurodevelopmental condition characterized by limitations in social interaction, communication skills, and repetitive behaviors. Although motor disorders were previously considered marginal in autism, recent research has highlighted their significance. Numerous studies have underscored the positive impact of sports on autistic individuals. This article presents a comprehensive overview of the literature regarding the effects of sport interventions on autistic individuals and aims to extract general and practical recommendations. Initially, the article reviews the various characteristics of autism that are positively impacted by sports, ranging from psycho-social skills to motor behavior. Subsequently, it examines how different configurations of sports practice (individual/collective, indoor/outdoor, etc.) may be suitable for autistic individuals. Literature research was conducted in two databases, resulting in the inclusion of 92 articles meeting longitudinal criteria (i.e., containing full sport/physical activity programs with pre-to-post analyses) out of 1665 initially identified articles. The findings suggest that individuals with autism can benefit from sports across a wide range of physical, psychological, and social factors. Importantly, there is no full contraindication for any activity, although some may require specific step-by-step preparation. Each activity has the potential to provide benefits in specific areas, as discussed in the article. In conclusion, further research is needed to explore the most effective strategies for implementing sports programs and maximizing their benefits for individuals across the autism spectrum.

Physical Activity and Mental Health in Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis

Importance

Children and adolescents with neurodevelopmental disorders experience mental health issues and are encouraged to be brought together in real-life treatment. However, physical activity, which is a promising method for boosting mental health, has only been examined in children and adolescents with certain types of neurodevelopmental disorders.

Objective

To examine the association of physical activity interventions with mental health (ie, cognitive function, psychological well-being, internalizing, and externalizing problems) in children and adolescents with neurodevelopmental disorders and to identify possible moderators.

Data Sources

Studies were searched from inception to May 2023 through Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC.

Study Selection

Randomized clinical trials or nonrandomized designs applying physical activity interventions and reporting at least 1 mental health outcome in children and adolescents aged 5 to 17 years with neurodevelopmental disorders were included. Two independent reviewers selected and assessed the studies.

Data Extraction and Synthesis

Random multilevel meta-analysis using Hedges g was performed. Data extraction and risk-of-bias assessment were conducted by multiple reviewers. Heterogeneity, publication bias, sensitivity analysis, and moderator analysis were examined to substantiate the results.

Main Outcomes and Measures

The main outcomes were mental health related to cognitive function, psychological well-being, internalizing, or externalizing problems measured by neurocognitive tasks or subjective questionnaires.

Results

A total of 76 studies involving 3007 participants were included in systematic review, 59 of which were used for meta-analysis. The findings indicated that physical activity interventions were associated with significant benefits for overall mental health (g, 0.67; 95% CI, 0.50-0.85), cognitive function (g, 0.74; 95% CI, 0.53-0.95), psychological well-being (g, 0.56; 95% CI, 0.16-0.96), internalizing (g, 0.72; 95% CI, 0.34-1.10), and externalizing problems (g, 0.58; 95% CI, 0.28-0.89). Moderators were also identified: frequency, total sessions, and total duration for overall mental health; total sessions, and total duration for cognitive function; session duration and frequency for psychological well-being; physical activity type for internalizing problems; and session duration for externalizing problems. Moderator analyses showed that type of neurodevelopmental disorder did not modify the associations between physical activity and overall mental health or its subgroups.

Conclusions and Relevance

The findings in this study suggest that children and adolescents with different types of neurodevelopmental disorders may be grouped together when performing physical activity interventions, which were confirmed to be beneficial to overall mental health and its subgroups in this new diagnostic population, but that physical activity interventions should be tailored when targeting different mental health domains.

Psychosocial interventions for autistic children and adolescents delivered by non-specialists in low- and middle-income countries: a scoping review

Background

Most autistic individuals reside in low- and middle-income countries (LMIC) and have limited access to medical providers and specialists. Support for delivery of psychosocial interventions by non-specialists is growing to address this mental health care gap. This scoping review involved a systematic analysis of studies of non-specialist delivered psychosocial interventions for children and adolescents diagnosed with autism and living in low- and middle-income countries.

Methods

The primary objective of this review was to identify psychosocial interventions for autistic children and adolescents in LMIC delivered by non-specialists (parent, teacher, peer, community, multi-level) and to summarize resulting effects on targeted outcomes. The search strategy was completed in four databases with predetermined inclusion and exclusion criteria. The systematic search generated 3,601 articles. A total of 18 studies met inclusion/exclusion criteria. Data extraction was completed, and results summarized by; (1) participant sample; (2) intervention procedures; (3) implementation by non-specialists; (4) effect on evaluated outcomes; and (5) assessment of risk of bias. Studies examined a range of child and adolescent outcomes including assessment of communication skills, social skills, motor skills, functional and adaptive behaviors, emotional regulation, attention and engagement, sensory challenges, depression, anxiety, and quality of life. Several studies also evaluated intervention effects on family relationships, parent/caregiver stress and parent/caregiver mental health.

Results

Collectively, the 18 studies included a total of 952 ASC participants ranging in age from 2 to 16 years. Of the included studies, 8 studies were parent/caregiver-mediated, 1 study was peer-mediated, 2 studies were teacher-mediated, and 7 studies included multi-level non-specialist mediated components. Effects on evaluated outcomes are reported.

Conclusion

Non-specialist delivered interventions for autistic children and adolescents are effective for an array of outcomes and are particularly well suited for low- and middle-income countries. Implications for future research are discussed.

Features and effects of computer-based games on cognitive impairments in children with autism spectrum disorder: an evidence-based systematic literature review

INTRODUCTION

Children with Autism Spectrum Disorder (ASD) have different cognitive and intelligence profiles than typical developing individuals. Some of these children need cognitive rehabilitation. This study's main purpose is to provide a systematic review about applying computerized cognitive games for autistic children and to determine the effectiveness of such interventions.

MATERIAL AND METHODS

A thorough search of the ISI Web of Science, Medline (through PubMed), Scopus, IEEE Xplore, and APA PsycInfo databases was performed for articles published from inception to May 17, 2022.

RESULTS

Of 1746 papers, 28 studies were found to be eligible in this systematic review. Fifteen studies (53.57%) compared a Control Group (CG) with Experimental Groups (EGs), while 13 papers (46.42%) evaluated only the impact of the applied intervention in an experimental group. Major domains of cognitive functions are divided into five main categories: 1. Executive functions, 2. Social cognition/emotions, 3. Attention/concentration, 4. Learning and memory, and 5. Language. In 42.85% (12 studies) of the screened papers, social cognition and emotions were assessed after cognitive rehabilitation. The highest rate of effects reported by studies were related to social cognition enhancement. Of the total number of included studies, 17 studies reported a positive effect at all scales, of which nine were quasi-experimental, and seven were fully experimental.

CONCLUSION

Using suitable computerized game-based solutions could enhance cognition indexes in autistic children. Hence, further investigation is needed to determine the real effectiveness of these novel technologies.