Whole-body movement play shows promise for children with autism

A new pilot study suggests that play-based, whole-body movement activities may help children with autism spectrum disorder improve their self-control and reduce certain negative behaviors. The findings, published in the journal Disability and Rehabilitation, show that a movement-focused intervention led to faster responses on a test of inhibitory control and fewer sensory and disruptive behaviors, while a more traditional sedentary play program had no such effects.

Autism spectrum disorder is a neurodevelopmental condition that affects how a person communicates, interacts socially, and processes the world. Children with autism often experience co-occurring challenges beyond the core symptoms, including difficulty regulating their emotions and behaviors, unusual sensory responses, and problems with executive functioning. Executive functions are the mental skills that allow people to plan, focus attention, and control impulses. One important aspect of executive functioning is inhibitory control—the ability to stop oneself from acting impulsively or to ignore distracting information.

In children with autism, impaired inhibitory control has been linked to a range of behavioral difficulties, including repetitive actions, difficulty transitioning between tasks, and problems with aggression or self-regulation. However, traditional interventions often focus on sedentary, desk-based activities and may not fully address these overlapping challenges. The research team behind this study wanted to test whether a more dynamic, physically active intervention could produce benefits across cognitive and behavioral domains.

“Standard autism interventions do not always incorporate gross-motor activities during therapy, and mainly focus on sedentary play to improve speech and fine motor skills,” said study author Anjana Bhat, a professor at the University of Delaware. “Hence, as a pediatric physical therapist, my research focuses on understanding how whole-body movements through creative movement or general exercise facilitate motor, social, and cognitive skills in autistic children.”

To explore this, the researchers recruited 40 children diagnosed with autism spectrum disorder. The children ranged in age from 5 to 14 years, with an average age of about 8.5. Participants were matched in pairs based on their age and verbal abilities and then randomly assigned to one of two groups: a Movement group or a Sedentary Play group.

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Children in the Movement group participated in whole-body, play-based activities designed to be engaging and physically active. These included yoga, obstacle courses, dance, and games that involved throwing, catching, or navigating space. Meanwhile, children in the Sedentary Play group engaged in activities like arts and crafts, building with blocks, or reading—activities that required fine motor skills but did not involve large physical movement. Both groups received 16 sessions across eight weeks, delivered either in person or via telehealth, depending on family preference and pandemic-related constraints.

Before and after the intervention, all participants completed a computerized version of the Flanker task, a test commonly used to measure inhibitory control. In this task, children were shown rows of cartoon fish and asked to quickly identify the direction that the middle fish was pointing, even when the surrounding fish pointed in the opposite direction. The researchers measured both how fast and how accurately the children responded.

In addition, the team videotaped early and late training sessions and coded how often the children displayed sensory-seeking behaviors (such as sniffing objects or covering their ears), repetitive behaviors (like hand-flapping or rocking), and negative behaviors (such as aggression, noncompliance, or tantrums).

At the beginning of the study, the researchers found a moderate link between children’s performance on the Flanker task and their behavior during the sessions. Specifically, children who took longer to respond during the task tended to show more negative behaviors during play. This suggested that difficulties with inhibitory control may be associated with real-world behavior problems in autistic children.

After the intervention, children in the Movement group showed meaningful improvements in their performance on the Flanker task. Their reaction times became significantly faster, indicating improved inhibitory control, even though their accuracy had already been high and remained steady. In contrast, children in the Sedentary Play group showed no change in reaction times or accuracy after the intervention.

The behavioral observations also revealed important differences between the two groups. Children in the Movement group showed a significant drop in negative behaviors from the beginning to the end of the training period. They also showed a trend toward fewer sensory-seeking behaviors. However, there was no change in the frequency of repetitive behaviors, possibly because these behaviors were harder to distinguish from typical movement patterns in an active, music-filled play setting. In the Sedentary Play group, no changes were observed across any of the behavior categories.

These findings suggest that physically engaging, playful activities may support both cognitive and emotional development in children with autism. The improvements in inhibitory control were not only measurable on a standardized task but also seemed to translate into fewer disruptive behaviors during the sessions. This supports the idea that executive functioning and behavioral regulation are interconnected, and that interventions targeting one may influence the other.

“Parents of autistic children/youth should provide their child opportunities for regular creative movement (e.g., dance/music and movement, martial arts, yoga) or general exercise (e.g., walk, jog, tag, outdoor play, or sport) around 1 to 1.5 hours,” Bhat told PsyPost. “Such regular physical activity has the potential to improve their child’s attentional focus, executive functioning, socialization, and would give them a sense of belonging/achievement, when done solo at home or in a small group format in the community.”

The researchers speculate that physical activity may enhance executive functioning by increasing blood flow and brain chemicals associated with attention and arousal. Movement-based play may also offer emotional and sensory benefits by helping children self-regulate through rhythmic motion and creative expression. While the current study focused on whole-body movement in a structured yet playful format, the team notes that these activities could be easily adapted for home and school settings.

However, there are limitations to the study that should be considered. The sample size was relatively small, and although it reflected the higher prevalence of autism in boys, it included only a few girls. This makes it difficult to know whether the same benefits would be seen in autistic girls or in children with different levels of support needs.

“This is a pilot study that requires further validation through large sample studies in the future,” Bhat noted.

Moving forward, the researchers plan to expand their work with a larger, community-based trial. They aim to investigate how movement-based play can be integrated into everyday routines to support the motor, social, and emotional development of children with autism. They also hope to explore whether such interventions offer long-term benefits for mental and physical health.

“Upon receiving funding, we would like to conduct a large-scale, randomized controlled trial to evaluate the effects of community-based, whole-body movement interventions offered to autistic children,” Bhat explained. “Creative movement capitalizes on autistic children’s predilection for creativity and makes movement fun. Engaging children in fun and moderate intensity physical activity will improve their overall motor, social and cognitive development as well as long-term mental and physical fitness.”

The study, “Effects of Movement and Sedentary Play interventions on executive functioning and their relationships with sensory, repetitive, and negative behaviors of children with ASD – a pilot RCT,” was authored by W. C. Su, S. Srinivasan, and A. N. Bhat.