Author Identifier (ORCID)
Abstract
Background Difficulties in gross and fine motor skills negatively affect the healthy development of children with autism spectrum disorder (ASD), yet evidence for physical activity interventions (PAIs) remains limited and inconsistent. Therefore, this study aimed to investigate the differential effects of PAIs on gross and fine motor difficulties in children with ASD and to explore potential moderators. Methods Following PRISMA guidelines, empirical studies published from inception to April 21, 2026 were systematically searched across PubMed, Web of Science, Embase, the Cochrane Library, and SPORTDiscus. Effect sizes were synthesized using a three-level random-effects model and were expressed as Hedges’ g (g). Moderator effects were examined using subgroup and meta-regression analyses. Results Forty-four studies (1311 children aged 2–16 years) were included. PAIs significantly improved gross motor skills (g = 0.87, I² = 66.3%), with significant effects observed for locomotor (g = 0.92), manipulation (g = 0.83), balance (g = 0.80), and coordination (g = 0.52). Improvements in fine motor skills were not significant (g = 0.26, I² = 63.9%), including manual dexterity (g = 0.44) and fine motor integration (g = 0.09). Organized form, intervention setting and providers significantly moderated effects on overall and gross motor skills (p < 0.05). Group-based interventions delivered by educators or coaches in inclusive settings showed greater effects. Meta-regression revealed a positive association between improvements in locomotor and total sessions (β = 0.017, p < 0.05). Conclusions PAIs improve gross motor skills and related outcomes in children with ASD. Group-based interventions delivered by educators or coaches in inclusive settings may be particularly effective. Further rigorous studies are needed to clarify effects on fine motor skills and determine the optimal intervention dose.
Keywords
ASD, motor difficulties, multilevel meta-analysis, physical activity interventions
Document Type
Journal Article
Date of Publication
8-1-2026
Article Number
105335
ISSN
08914222
Volume
175
Publication Title
Research in Developmental Disabilities
Publisher
Elsevier
School
Centre for Human Performance / School of Medical and Health Sciences
Funding Information
This work was supported by the National Education Scientific Planning Projects (No. BLA230105) and the Shanghai Oriental Excellence Programme for Teachers.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Recommended Citation
Peng, C., He, J., Xu, K., Wu, X., Wang, D., & Zhang, L. (2026). Differential effects of physical activity interventions on gross and fine motor difficulties in children with autism spectrum disorder: Insights from a multilevel meta-analysis with moderator analyses. Research in Developmental Disabilities, 175, Article 105335. https://doi.org/10.1016/j.ridd.2026.105335