Sage Journals: Discover world-class research

Abstract

Motor interventions are commonplace for children with neurodevelopmental disabilities, as motor skills such as walking, balancing and using one's hands functionally are instrumental for early exploration and developing a sense of agency and independence in later life. This review explores the use of non-pharmacological interventions for motor delays in children with neurodevelopmental disabilities, specifically looking at the characteristics of effective and ineffective interventions, what skills were targeted, and the transferability of interventions to non-clinical settings. From the 119 reports included in the final sample, the findings demonstrated that gross motor skills were most frequently targeted for intervention. These skills were most often assessed using standardised measures. Characteristics of effective interventions involved twice weekly implementation and unfamiliar environments. Transferability of interventions varied drastically from home-based yoga and parent-implemented massage therapy to interventions requiring virtual reality, treadmills and specialised interventionists.

Lay Abstract

Many children with neurodevelopmental disabilities receive motor interventions for delays with skills such as walking, crawling and using one's hands functionally. This is important for children to explore their environment and develop skills for independence later in life. This review worked to understand behavioural and psychological interventions for motor delays in these children. This article specifically examined what characteristics make an intervention effective or ineffective, what skills were targeted, and the transferability of these interventions beyond a research or medical setting. From the 119 reports included in the final review, findings showed that gross motor skills, including walking and coordination, were most often targeted for intervention. Motor skills were most often assessed using standardised measures. Characteristics of effective interventions involved twice weekly sessions and unfamiliar environments. Some interventions were transferable, including home-based yoga and massage therapy done by parents. Other interventions were not transferable as they required virtual reality, treadmills and specialised professionals to conduct the intervention.

Keywords

neurodiversity motor intervention systematic review Down syndrome autism attention-deficit hyperactivity disorder

Proficient motor skills are critical for early childhood development as they allow young children to actively explore and engage with the world around them (Oudgenoeg-Paz, 2014). In addition, motor development is related to other developmental domains such as social and cognitive abilities (DeLuca et al., 2013), and academic success (Murrah, 2010). For children with neurodevelopmental disabilities including autism, attention deficit hyperactivity disorder (ADHD) and Down syndrome, motor skill development can be challenging and can greatly benefit from early intervention. While motor delays are not a diagnostic criterion for autism and ADHD, these difficulties have been reported in nearly 80% of autistic children (Green et al., 2009) and 50% of children with ADHD (Gillberg, 1998; Goulardins et al., 2016). This exemplifies both the need for appropriate motor intervention and a better understanding of the populations from which we can understand the standards of current interventions. For rarer neurodevelopmental disabilities such as Pitt–Hopkins syndrome, Fragile X syndrome and Williams syndrome, motor delays frequently present in early childhood (Kau et al., 2002; Mayall et al., 2021; Van Balkom et al., 2012). For some diagnoses, motor delays are primary characteristics of the presentation, as in the case of Rett syndrome (Brunetti & Lumdsen, 2020) and Angelman syndrome (Duca et al., 2013), although these diagnoses are rare, making it challenging to draw conclusions about the broader populations. Given the inextricable link between developmental domains, specifically in more plastic periods of early childhood, non-pharmacological motor interventions have led to positive outcomes in areas such as executive function (Schurink et al., 2012; Westendorp et al., 2014), academic success (Flores et al., 2023; Jelle Veijk et al., 2011) and language development (Duncan et al., 2019; Odeh et al., 2020) while potentially minimising the risks associated with some pharmaceutical interventions (Catalá-López et al., 2017). While pharmaceuticals can be incredibly effective for children with ADHD (van der Oord et al., 2008), there are high rates of discontinuation (Habel et al., 2005; Toomey et al., 2012) which can impact their long-term efficacy. Parents and their children have mixed opinions on medication use (Charach et al., 2014) with some feeling positive (McElearney et al., 2005) while others do not (Hart et al., 2018). As such, it is beneficial to understand the non-pharmacological options to give families the opportunity to explore what best suits their respective needs. Pharmacological interventions can vary from stimulant medication for ADHD (Carolan, 2021) to psychotropic medication for children with Down syndrome (Weas et al., 2024) which impact the chemical balance in the brain. Alternatively, non-pharmacological interventions can include occupational therapy, physical therapy and many others which address developmental domains behaviourally. Additionally, there is a wealth of literature that exemplifies the efficacy of motor interventions for children with Down syndrome (Ku & Sung, 2022; Rodríguez-Grande et al., 2022), ADHD (Kleeren et al., 2023, Xie et al., 2021) and autism (Colombo-Dougovito & Block, 2019; Ruggeri et al., 2020) from which researchers can deduce features of effective interventions. While neurodiversity ranges broadly from those with a unique chromosomal difference to those with an unclear genetic underpinning, by looking across diagnoses rather than investigating them independently, we can determine potential effective interventions that can benefit children who were not in the respective sample.

Other reviews have explored the use of interventions for motor delays in the past, ranging from autistic children (Ruggeri et al., 2020) to children with Down syndrome (Maïano et al., 2019), though they are diagnosis-specific. Although the experiences of children with neurodevelopmental disabilities differ broadly, consolidating these findings is beneficial to determine what interventions could benefit children across populations. As autism and ADHD are more common, research within these groups can provide a broader sample from which one can inform motor interventions for other populations with similar presentations. Phenotypes differ for syndromes with a genetic basis, but these reports can be used as a jumping-off point for researchers and practitioners. While there have been efforts to consolidate input from those with lived experience through institutions such as the James Lind Alliance (James Lind Alliance, 2017), it would be beneficial to present intervention research as a parallel to understanding disability intervention experience holistically and transdiagnostically (Astle et al., 2022).

Early intervention has been shown to improve motor skills, in addition to adaptive functioning (Connolly et al., 1993). The options for interventions range from aquatic physical therapy (Milligan et al., 2022) and animal-assisted therapies (Zoccante et al., 2021) to traditional physical therapy (Guivarch et al., 2021; Young, 2017) and virtual reality (Mraz et al., 2016), making it difficult for both parents and clinicians to decide what intervention is best and what makes it so. This systematic review aims to provide a detailed account of current non-pharmacological motor interventions for children with neurodevelopmental disabilities including how their progress is operationalised, the characteristics of effective and ineffective interventions and the transferability of these interventions to non-clinical settings in an effort to enable accessibility and agency for families of children with neurodevelopmental disabilities. We specifically explored non-pharmacological interventions in this report as pharmacological interventions function differently (Cope & Mohn-Johnsen, 2017; Gomathi et al., 2020) compared to behavioural interventions such as occupational and physical therapies. Similarly, we explored how interventions may be transferable to non-clinical settings which would not be possible with pharmacological methods.

Objectives

Before beginning this systematic review, research questions were laid out and refined to ensure that only the relevant studies were included and assessed. Additional information was included beneath each question to ensure transparency and clarity of what the research questions were asking. The research questions asked are as follows:

a) What are the common characteristics of effective interventions? And those of ineffective interventions?

Category Classification

Intervention frequency Number of times the intervention was implemented in a given week.

Location Where the intervention was implemented, including, but not limited to therapy offices, hospitals, schools and within the home.

Parent involvement Parents are involved in the intervention in any capacity, such as being present, implementing the intervention themselves, providing verbal support, etc.

Intervention type - Exercise-based: Includes sports therapies, aquatic therapies, treadmill training, etc.
- Animal therapy: Includes hippotherapy, therapy animals, etc.
- Task-based therapy: Includes therapies involving games, completing certain motor tasks, handwriting, etc.
- Massage therapy: Includes parent-administered or therapist-administered massage therapies.
- Sensory-based: Includes vestibular stimulation, tactile stimulation, vibration therapy, sensorimotor stimulation, etc.
- Technology-based: Includes virtual reality, video games and audio-visual feedback systems.
- Equipment-based: Includes any objects adapted for accessibility, orthoses and supplementary support systems; does not include unmodified equipment such as treadmills, video games and virtual reality headsets.
- Adapted physical and occupational therapies: Includes any adaptation of traditional physical and occupational therapies

Effective interventions Interventions were classified as effective if a child met motor milestones, completed certain motor behaviours more frequently, engaged in unfavourable motor behaviours (i.e. illegible handwriting and dropping objects) less frequently, or scored higher on a standardized motor measure, etc. Interventions were classified as ‘declined’ if motor skills worsened, ‘no change’ if there was no directional change, and ‘similar’ if outcomes were similar to a comparison group that also received a form of motor intervention i.e. traditional occupational or physiotherapy. In instances where multiple evaluations were used, if one evaluation showed improvement while another showed a decline, improvement was classified as ‘mixed’. If all evaluations showed improvement, it was classified as ‘improved’. If some evaluations showed improvement and others showed no change, it was classified as ‘improved’. If some evaluations showed no change and others showed a decline, it was classified as ‘declined’.

b) What skills are targeted in interventions?

We defined skills as motor skills broadly divided into three categories including fine motor skills, gross motor skills, or both fine and gross motor skills. Skills were kept broad as some studies focused more specifically on skills such as balance, handwriting, sports-related skills and motor control. Other studies explored motor skills more broadly using standardised measures, and this categorisation allowed us to group studies with varying targeted skills together.

c) How is motor delay assessed prior to intervention?

We have defined motor delay broadly as any reference to a delay in one's ability to complete motor-related tasks or reach motor milestones later than the typical age expected.

d) Which skills demonstrate improvement?

As per research question b), motor skills were categorised as fine motor skills, gross motor skills, or both. Given the broad scope of studies that were included in this review, we did not look into specific skills such as walking, bimanual coordination and handwriting. Additionally, we did not require a certain effect size given the variability in sample sizes. Rather, skills were classified as ‘improved’ if the results section of a paper mentioned a distinct improvement in skills, compared to either a control group or participants at an earlier time point while ‘declined’ was a distinct decline in motor skills. Motor improvements were classified as ‘mixed’ if some skills showed improvement while others showed a decline. Skills were classified as having ‘no change’ if the intervention resulted in no reported change in outcome. Additionally, skills were classified as ‘similar’ if different groups showed similar outcomes, including groups receiving interventions for different amounts of time.

e) Are these interventions transferrable for non-clinical persons to use outside of a laboratory setting, if effective?

This question was answered by contextualising the features of effective interventions to determine if they would be transferrable to settings outside of a hospital, clinic, or therapy centre. This included understanding the potential specialised training needed for the therapy, associated costs and the equipment needed for implementation.

Methodology

Pre-registration

To ensure transparency in conducting our review, our study was preregistered to PROSPERO, the international prospective register of systematic reviews through the National Institute for Health and Care Research. This review was registered under the title ‘Interventions targeting motor delays in neurodivergent children’, with the registration number CRD42022367465. This preregistration detailed the intentions for the review including initial guiding research questions, and inclusion and exclusion criteria. To maximise the quality and reach of this review, adjustments were made to the preregistration criteria, including expanding database searches to include the Cochrane Library and PsycInfo. Additionally, we decided to include interventions from all contexts to expand the scope to include any potentially informative interventions. To focus our attention fully on motor development, we excluded discussions surrounding other developmental domains targeted by the included interventions.

Inclusion criteria and study selection

Following PRISMA guidelines, all studies were required to have a specified population, intervention, comparator and outcome. Participants included in the review consisted of children diagnosed with a neurodevelopmental disability with a genetic component or attention-deficit hyperactivity disorder (ADHD) or autism. ‘Children’ was defined as anyone under the age of 18, excluding studies that investigated prenatal or foetal intervention. ADHD and autism were included in the review as there is extensive literature on motor interventions. Though motor delays are not symptoms required for diagnosis, researchers are seeing more evidence of motor atypicalities that warrant intervention (Johnson et al., 2015). The intervention criterion was specified as any non-pharmaceutical, behavioural intervention focused on improving fine or gross motor skills. The comparator criterion was specified as a point of comparison either with time or population. Studies could meet this criterion if they included pre- and post-intervention measures to fulfil the time comparator or could have a separate control group entirely to fulfil the population comparator. The outcome was defined as any change – or lack thereof – in motor skills measured by standardized assessments, frequency of skill use, or measures specific to an intervention.

We ran searches on the following databases: Medline, Embase, Web of Science, Scopus, ClinicalTrials.gov, Cochrane Library and PsycInfo in November 2022, totalling 19.041 abstracts. The search terms were as follows:
Neurodivergent: gene* (delay OR disability OR disorder OR condition OR dysfunction OR neurodiver* OR impair* OR neurodev) autis OR asperger* OR prader-willi OR Tourette* OR Down OR Downs OR Fragile X OR attention-deficit OR adhd OR dyspraxia

Motor: motor* OR fine motor OR fine-motor OR gross motor OR gross-motor OR walk* OR climb* OR grasp* OR dress* OR fasten*

Intervention: interven* OR therap* OR treat*

Child: child* OR infan* OR baby OR toddler* OR teen* OR adolescen* OR boy* OR girl* OR kid OR kids OR youth* OR kindergarten* OR juvenil* OR preschool* OR pre-school* OR pediatric* OR peadiatric* OR paediatric* OR pubescen*

Following deduplication, abstract screening, full-text screening and quality assessment detailed in the PRISMA flow diagram in Figure 1, a total of 119 reports were included in the final review (Page et al., 2021). Initial abstract screening was conducted by three members of the research team. Inter-rater reliability was established by having all three raters screen the same thirty studies, selected at random. These studies were rated, and any discrepancies were discussed in detail prior to further screening. All study abstracts were screened by the principal investigator, and 28% of abstracts were screened by an additional rater. With a total of 143 rating discrepancies, there was an inter-rater reliability of 96.2% when scoring abstracts. A total of 552 studies were included in the full-text screening. During full-text screening, all texts were double-screened to ensure that any potential studies were reviewed in detail. From the 552 studies that were reviewed, a total of 157 studies were included in the final review for critical appraisal with an inter-rater reliability of 93%. An additional 38 studies were excluded further during the study quality assessment informed by the Critical Appraisal Skills Program: Randomised Controlled Trial Checklist (CASP, 2020), as detailed in Figure 1, yielding a final total of 119 studies. For the purposes of this review, the following criteria were used: participant information, intervention details, intervention frequency, findings, data analysis and measures. Of the studies that were excluded, six were excluded for not meeting the participant criterion; 11 were excluded for having insufficient details on the intervention; eight were excluded for insufficient information on the frequency of implementation; two were excluded for not meeting the criterion for findings, eight were excluded for not meeting the criterion for measures; one was excluded for unethical practice. While the final exclusion was not listed under the critical appraisal criteria, the purpose of this systematic review is to better understand the attributes of motor interventions for children with neurodevelopmental disabilities so practitioners can implement those that are most beneficial for these respective populations. If an intervention is unethical and uses methods that cause physical or emotional harm to a child at any point, these will not be considered as these practices will not be tolerated in a research community that aspires towards neurodiversity-affirming care. Any discrepancies between raters were discussed in detail before determining which studies would be included in the final review.

Figure 1.
PRISMA Flow Diagram.

Results

In the final review, there were a total of 60 quasi-experimental studies, 21 case studies and 38 randomized controlled trials. While neurodevelopmental disabilities were broadly represented in this systematic review, Down syndrome (N = 78), autism (N = 49) and ADHD (N = 13) were the most commonly investigated diagnoses. Less common diagnoses included Rett syndrome (N = 4: Drobnyk et al., 2019; Lotan et al., 2004, 2021; Mraz et al., 2016), Prader-Willi syndrome (N = 1; Rubin et al., 2021), Williams syndrome (N = 1; Conklin & Simonds, 2021), Angelman syndrome (N = 1; Han et al., 2022), Joubert syndrome (N = 1; Ipek et al., 2017), Pitt–Hopkins syndrome (N = 1; Casey et al., 2018) and CASK mutation (N = 1; DeLuca et al., 2017). For ease of reference, these included studies are all listed in Table 1, with quasi-experimental studies in pink, case studies in blue and randomized controlled trials in green. Improvements were classified as improved, declined, mixed, no change and similar. ‘Improved’ meant that at least one motor skill showed improvement, even if other skills showed no change. ‘Declined’ meant that at least one motor skill declined, even if other skills showed no change. ‘Mixed’ meant that some skills may have improved while others declined. ‘No change’ meant that there was no significant change in motor skills between the start and end of the intervention. ‘Similar’ meant that motor skills improved for the intervention group, but they were not significantly different from those of the control group.

Table 1.
Extraction table.

Study N Diagnoses Average age Weekly frequency Intervention location Motor skill Intervention type Intervention outcome Parent involvement Measures

Drobnyk et al., 2019 5 Rett syndrome 7.50 years 3x School Fine Sensory-based no change No Reaches and grasps (N) in play sessions

Wentz, 2017 19 Down syndrome 66 days 7x Home Both Task-based Declined Yes BSID

Schleien et al., 1988 6 Autism 8.7 years 2x School Both Exercise-based; task-based Declined No Study specific motor checklist

Guivarch et al., 2021 10 Autism Median: 8.35 1x Hospital Gross Exercise-based Improved No MABC, VABS

Helsel et al., 2021 20 Autism 13.2 years 3x Home Gross Exercise-based Improved Yes TGMD, hand dynamometer, leg press, Stork Balance Test, Star Excursion Balance Test, Sit and Reach Test

Salgueiro et al., 2012 10 Autism 6.75 years 1x Artificial lagoon Both Animal therapy Improved No Psychoeducational Profile Revised

Kaur & Bhat, 2019 21 Autism 7.8 years 4x Home and school Both Exercise-based Improved Yes BOTMP, imitation test

Hospodar et al., 2021 8 Down syndrome 8.6 years 7x Home Gross Equipment-based; task-based Improved Yes BSID

Pan et al., 2016 32 ADHD 8.9 years 2x Table tennis centre Both Task-based Improved No BOTMP

Majorek et al., 2004 5 ADHD Not reported 1x Clinic Both Exercise-based; sensory-based Improved Yes Lincoln-Oserretzky-Scala

Caputo et al., 2018 26 Autism 7.99 years 1x Pool Gross Exercise-based; task-based Improved No VABS, HAAR

Hadadi, 2018 26 Autism 4.18 years 2x School and clinic Gross Task-based Improved No Correct trials (N) after demonstration

Arlsan et al., 2022 14 Autism 10.07 years 3x Unclear Gross Exercise-based Improved No BOTMP, Sit and Reach Test

Clark et al., 2020 34 ADHD 10.21 years 2x Unclear Gross Exercise-based Improved No PANESS

Angulo-Barroso et al., 2008 30 Down syndrome 10 months 5x Home Gross Exercise-based Improved Yes BSID

Martin, 2004 17 Down syndrome 5 years 7x Home and clinic Gross Equipment-based Improved Yes GMFM, BOTMP

Pan et al., 2019 30 ADHD 9.14 years 2x Gym Gross Task-based Improved No TGMD

Jang et al., 2015 20 ADHD 8.4 years 2x Stables Both Animal therapy Improved No BOTMP

Lotan et al., 2021 5 Rett syndrome 9 years <1x Home Both Adapted PT Or OT Improved Yes Goal Attainment Scale

Hawks et al., 2020 15 Autism Unclear 5x Summer camp Gross Exercise-based Improved Yes Cycling 70ft unsupported

Habib-Hasan et al., 2020 48 Down syndrome 16.2 months 7x Home Gross Adapted PT or OT Improved Yes GMFM

Kokkoni, 2016 5 Down syndrome 17 months 2x Lab Gross Equipment-based Improved Yes Stair climbing speed and success, leg movement frequency

Rubin et al., 2021 42 Prader-Willi syndrome 10.9 years 4x Home Both Exercise-based; technology-based Improved Yes BOTMP

Fiss et al., 2009 10 down syndrome 18.4 months 1x Clinic Both Sensory-based Improved Yes GMFM

Gusso et al., 2021 14 Down syndrome 15.5 years 4x School; home Gross Sensory-based Improved Yes 6 min walk test, mechanography ground reaction force plate

Wuang et al., 2011 155 Down syndrome Unclear 2x Lab Both Technology-based; task-based Improved No BOTMP

Karanth et al., 2010 30 autism 41 months 5x Clinic Both Task-based Improved No Communication DEALL Developmental Checklist

Mahoney et al., 2001 27 Down syndrome 14 months <1x Clinic Gross Exercise-based; task based Improved No PDMS

Connolly et al., 1993 73 Down syndrome 4.6 years 1x Clinic, home Both Task-based Improved Yes Age at developmental milestones

Chang et al., 2014 30 ADHD 8.44 years 2x Pool Gross Exercise-based; task based Improved No Basic Motor Ability Test

Okada et al., 2019 40 Down syndrome Median: 7 months (avg not given) 3x Clinic; home Gross Task-based Improved Yes Onset of independent walking

Silva et al., 2012 14 Down syndrome Unclear 7x Home Both Massage therapy Improved Yes PDMS

Fiss et al., 2007 10 Down syndrome 18.4 months 1x Unclear Gross Sensory-based; task-based Improved No GMFM

Hernandez-Reif et al., 2006 21 Down syndrome 2 years 2x Preschool Both Massage therapy Improved No Developmental Programming for Infants and Young Children

Fidler et al., 2021 42 Down syndrome 7 months 7x Home Fine Task-based Improved Yes Reaching and grasping task with rubber ball

Barros et al., 2020 7 Down syndrome 10.8 years 2x Pool Gross Exercise-based; task based Improved No Body Coordination Test

McGuire et al., 2019 5 Down syndrome 6.5 years 1x Ballet studio Gross Exercise-based; task based Improved Yes GMFM, Canadian Occupational Performance Measure

Amini et al., 2016 16 Down syndrome 8.75 years 2x Unclear Gross Exercise-based Improved No Biodex Stability System

Steiner & Kertesz, 2012 26 Autism unclear 1x Stables Gross Animal therapy Improved No Ariel Performance Analysis System

Pan, 2011 15 Autism 9 years 2x Pool Gross Exercise-based Improved Yes HAAR

Rahman & Shaheen, 2010 26 Down syndrome 4.2 years 7x Clinic; home Gross Exercise-based; task based Improved Yes BOTMP

Lafferty, 2005 7 Down syndrome 9.27 years <1x Unclear Gross Exercise-based Improved No Left and right hip and knee angles

Wang & Ju, 2002 20 Down syndrome 4.6 years 3x Intervention centre Gross Task-based Improved No BOTMP, Motor Proficiency and Motor Skill Inventory

Weber & Thorpe, 1989 12 Autism Unclear 5x School Gross task-based Improved No I Can Assessment of Gross Motor Skills

Ketcheson et al., 2023s 25 Autism 4.7 years 1x Gym Both Task-based Improved No TGMD, MSEL

Panigrahy & Dandekar, 2021 20 Autism 13.7 years 3x School Fine Task-based Improved No Pegboard reaction time

Cawand, 2014 28 Down syndrome 15 months 2x Home Both Equipment-based Improved No Developmental Assessment Scale for Indian Infant

DeLuca et al., 2017 3 CASK mutation 56 months 7x Unclear Both Task-based Mixed No PDMS

Lotan et al., 2004 4 Rett syndrome 10 years Variable Unclear Gross Exercise-based Mixed Yes 31-item motor functioning assessment

Harris, 1981 20 Down syndrome 10.18 months 3x Home Both Task-based No change Yes PDMS, BSID

Edwards et al., 2017 11 Autism 7.64 year 3x Home Both Task-based; technology-based No change Yes TGMD, object control skills, golf swing, golf putt

Satiansukpong et al., 2016 16 Down syndrome 10.39 years 2x Animal sanctuary Gross Animal therapy No change Yes BOTMP, Beery VMI, postural control record form

Martinez & Antón, 2018 10 down syndrome 12.5 years 1x Lab Both Task-based No change No Imitate 8 motor commands

Fragala-Pinkham et al., 2008 6 Autism and Down syndrome 8.6 years 2x Pool Gross Exercise-based No change Yes Multidimensional pediatric evaluation of disability, swimming classification scale, Floor to Stand Test

Marcus et al., 2010 3 Autism Unclear Variable School Gross Technology-based; task-based No change No Percent of 10 min walk without toe walking

Hayward et al., 2009 44 Autism 35 months Variable Home Both Task-based Similar Yes VABS

Sanz Aparicio, 1988 48 Down syndrome 8.5 months 2x Home; clinic Both Task-based Similar Yes Brunet-Lezine's First Childhood Scale

Lydic et al., 1985 18 Down syndrome Unclear 3x Lab Both Sensory-based Similar No Movement Assessment of Infants, PDMS

Karimi et al., 2010 18 Down syndrome Unclear 3x Clinic Gross Adapted PT or OT Similar Yes GMFM

Hyun et al., 2016 12 ADHD 10.8 years 3x Stables Gross Animal therapy Similar No MatScan Floor system mat

Logan et al., 2014 1 Down syndrome 1.1 7x Home Fine Equipment-based; task-based Declined Yes Reaches for toy (N)

Casey et al., 2018 1 Pitt–Hopkins syndrome 4 5x Daycare Both Equipment-based Improved No Mobility Ability Participation Assessment

Colombo-Dougovito et al., 2019 2 Autism 7.5 2x School Both Exercise-based Improved No TGMD

Alesi et al., 2014 3 Down syndrome 12.97 2x Unclear Gross Exercise-based Improved Yes TGMD

Hodges et al., 2019 1 Autism 4 Unclear Hospital Gross Sensory-based Improved Yes Percent of 100 steps without toe walking

Rodger & Brandenburg, 2009 2 Autism 10.46 1x Clinic, home Fine Adapted pt or ot Improved Yes MABC, VABS, Canadian Occupational Performance Measure

Battaglia et al., 2019 (1) 3 Autism 14.3 1x Pool Both Exercise-based; task-based Improved No TGMD

Colebourn et al., 2017 1 Autism 9 3x School Both Exercise-based; task-based Improved No TGMD, BOTMP

Lewis & Fragala-Pinkham, 2005 1 Down syndrome 10.5 5x Home Gross Exercise-based; task-based Improved Yes BOTMP

Ipek et al., 2017 1 Joubert syndrome 1.6 5x Clinic Gross Adapted pt or ot, sensory-based Improved No GMFM

Han et al., 2022 1 Angelman syndrome 15 2x Lab Gross Technology-based; equipment- based; task-based Improved No Tinetti Performance-Oriented Mobility Assessment

Battaglia et al., 2019 (2) 1 Autism 4.2 Variable Pool Gross Exercise-based Improved No VABS, Psycho-educational profile

Moriello et al., 2020 4 Down syndrome 3.83 1x Stables Gross Animal therapy Improved No GMFM, gait analysis

Champagne & Dugas, 2010 2 Down syndrome 2.75 1x Stables Gross Animal therapy Improved No GMFM

Edwards & Yuen, 1990 1 Down syndrome 0.92 1x Home Both sensory-based Improved Yes BSID

Conklin & Simonds, 2021 1 Williams syndrome 1.5 Variable Gym Gross Exercise-based Improved No GMFM

Yilmaz et al., 2004 1 autism 9 3x Pool Gross Exercise-based Improved No Thrust test, balancing on one foot, Aquatic Orientation Checklist

Winchester et al., 2002 3 Down syndrome 6.33 1x Stables Gross Animal therapy Improved No GMFM, timed 10 meter walk

Berg et al., 2012 1 Down syndrome 12 4x Home Both Task-based; technology-based Mixed Yes BOTMP

Mraz et al., 2016 1 Rett syndrome 9 3x Home Gross Task-based; technology-based Mixed Yes Functional reach test, Pediatric Evaluation of Disability Inventory

Gerritsen, 2010 11 autism unclear 5x Unclear Both Task-based; sensory-based No change No VABS

Gupta et al., 2011 23 Down syndrome 13.26 years 3x School Gross Exercise-based; task-based Improved No Handheld dynamometer

Marzouki et al., 2022 22 autism 6.33 2x Pool Gross Exercise-based; task-based Improved No TGMD

Ulrich et al., 2001 30 Down syndrome 307.4 days 5x Home Gross Exercise-based Improved Yes BSID

Eid et al., 2017 31 Down syndrome 10.16 3x Clinic Gross Exercise-based Improved No Biodex Stability System

El Shemy & El-Sayed, 2018 30 autism 9.29 years 3x Clinic Gross sensory-based Improved No BOTMP

Sarabzadeh et al., 2019 18 autism 8.2 years 3x Unclear Both Equipment-based; task based Improved No MABC

Peric et al., 2022 25 Down syndrome 15.7 years 2x Football pitch Gross Exercise-based; task-based Improved No Football skill proficiency scored 1–5

Shaffer et al., 2001 56 ADHD unclear variable Unclear Both Task-based; sensory-based Improved No BOTMP

Pan et al., 2017 24 ADHD 9.52 years 1x Gym, lab Both Task-based Improved Yes BOTMP, Brockport Physical Fitness Test

Najafabadi et al., 2018 28 autism 7.1 years 3x Gymnasium Both Exercise-based Improved No BOTMP

Wu et al., 2007 30 Down syndrome 10 months 5x Home Gross Exercise-based Improved Yes BSID

Wu et al., 2010 26 Down syndrome 10 months 5x Home Gross Exercise-based Improved Yes BSID

Uyanik et al., 2003 45 down syndrome 8.93 years 3x Clinic Both sensory-based Improved No Ayres Southern California Sensory Integration

Bremer et al., 2015 9 autism 4 years variable Clinic Both Task-based Improved No PDMS, MABC

Looper & Ulrich, 2010 17 Down syndrome 1.69 years 5x Home Gross Exercise-based; equipment-based Improved Yes GMFM

Pan, 2010 16 autism 7.24 years 2x Pool Gross Exercise-based Improved No HAAR

Lin & Wuang, 2012 92 Down syndrome 15.25 years 3x Lab Gross Exercise-based; technology-based Improved No BOTMP

Ulrich et al., 2008 30 Down syndrome 10 months 5x Home Gross Exercise-based; equipment-based Improved Yes BSID

Alsakhawi & Elshafey, 2019 45 Down syndrome 4.59 years 3x Clinic Gross Exercise-based Improved No Berg Balance Scale, Biodex Balance System

Ozbeser et al., 2022 12 Down syndrome 12.6 years 2x Clinic Fine Adapted pt or ot Improved Yes Canadian Occupation Performance Measure, BOTMP

Pinero-Pino et al., 2020 32 Down syndrome 5.1 months 7x Home Both Massage therapy Improved Yes Brunet-Lezine Early Childhood Psychomotor Development

Jankowicz-Szymanska et al., 2012 40 Down syndrome 16.8 years 2x Gym Gross Exercise-based Improved No Emi Duo Balance

Raghupathy et al., 2022 36 Down syndrome 8.1 years 3x Unclear Gross Exercise-based Improved No TGMD, Four Square Step Test, Pediatric Balance Scale

El-Sayed & Ragaa, 2022 30 Down syndrome 8.3 years 3x Unclear Gross Exercise-based; sensory-based Improved No Biodex Balance System

Norouzi et al., 2022 40 Down syndrome 8.3 years 3x Hospital Fine Task-based Improved No Potentiometers during bimanual coordination

Álvareza et al., 2018 16 Down syndrome 8.4 years 2x School Gross Technology-based; task-based Improved No TGMD, Wii Balance Board

Barkin et al., 2022 58 ADHD 8.8 years 2x Clinic Both Adapted pt or ot Improved No BOTMP

Lee, 2022 34 Autism 47 months 2x Unclear Fine Technology-based Improved No Wide Range Assessment of Visual Motor Abilities

Gabriels et al., 2012 42 Autism 8.7 years 1x Stables Gross Animal therapy Improved No BOTMP

Noghondar et al., 2021 27 Down syndrome 11.1 years 3x Unclear Gross Exercise-based; task-based Improved No SIMI motion analysis

Weerdmeester et al., 2016 73 ADHD 9.77 years 2x School Both Technology-based, exercise-based No change No MABC

Columna et al., 2021 15 autism 7.4 years <1x Home, gym, school Both Exercise-based; task-based No change Yes TGMD

Ulrich et al., 2011 62 Down syndrome 12 years 5x Training facility Gross Exercise-based; equipment-based No change No Standing on one foot for one minute

Gabriels et al., 2015 116 Autism unclear 1x Stables Both Animal therapy No change No BOTMP, VABS

Young, 2017 19 Down syndrome 4.42 5x Preschool Gross Exercise-based; task-based Similar Yes TGMD

Wu et al., 2008 30 Down syndrome 10.03 months variable Home Gross Exercise-based Similar Yes Computerized GAITrie mat

Ghafoor et al., 2021 30 Down syndrome 8.8 years 2x Clinic Gross Exercise-based Similar No Dynamic Gait Analysis, Wisconsin Gait Scale for Child

Kavlak et al., 2022 23 Down syndrome 12 months 2x Unclear Gross Task-based Similar No Alberta Infant Motor Scale

Objective 1: What are the common characteristics of effective interventions focused on motor skills? And what are the common characteristics of ineffective interventions?

To address the first objective (i.e. to identify the characteristics of successful and ineffective interventions), we examined intervention settings, frequency, parent involvement and the nature of the intervention. With respect to settings, these were divided into two subgroups: familiar (school, home and daycare) and unfamiliar (clinic, lab, intervention-specific i.e. horse stables, swimming pool and ballet studio). There were 50 studies conducted in familiar environments, 63 conducted in unfamiliar environments, seven which were done in both familiar and unfamiliar environments, and 14 where the setting was unclear. Of the interventions implemented in unfamiliar environments, 56 showed some level of improvement in children's motor skills compared to the control, three showed improvements similar to those of the control (Fragala-Pinkham et al., 2008; Ketcheson et al., 2023; Martinez & Antón, 2018) group, and four showed no reported improvement, but no measured decline (Aparicló, 1988; Hyun et al., 2016; Karimi et al., 2010; Lydic et al., 1985). However, there was significant variability in outcomes for interventions implemented in familiar environments. Thirty-eight of the studies showed reported improvements for interventions; four showed improvements equal to those of comparators (Harris, 1981; Hayward et al., 2009; Weerdmeester et al., 2016; Young, 2017); three showed no improvement (Edwards et al., 2017; Gerritsen, 2010; Marcus et al., 2010), six showed mixed results involving some improvement and some regression (Berg et al., 2012; DeLuca et al., 2017; Lotan et al., 2004; Mraz et al., 2016; Wentz, 2017) and only two showed reported reductions in motor abilities (Logan et al., 2014; Schleien et al., 1988). Thus, the familiarity and implied control of an intervention's setting may have an influence on how a child with a neurodevelopmental disability responds to an intervention.

Another element we explored was the frequency of intervention implementation which ranged broadly from less than once per week (N = 4), weekly (N = 20), twice weekly (N = 30), three times a week (N = 27), four times per week (N = 4), five times per week (N = 15), six times per week (N = 0) and daily (N = 10). There were eight studies that had variable frequencies. Of those implemented less than once per week, one article showed both positive and negative results (Columna et al., 2021) while the remaining three showed positive results (Lotan et al., 2021; Mahoney et al., 2001; Lafferty, 2005). Of those implemented once per week, only three showed no improvements while the remaining had positive outcomes (Gabriels et al., 2018; Ketcheson et al., 2023; Martinez & Anton, 2018). Only one intervention that was conducted twice a week had a negative outcome with a minor regression in jumping ability (Schleien et al., 1988). Similarly, only one intervention conducted three times a week had mixed findings (Mraz et al., 2016) and one intervention had a small but not statistically significant impact on motor skills (Drobnyk et al., 2019). One of the studies that was intended to be implemented four times per week (Berg et al., 2012) indicated that the family could not meet the time requirements of the intervention and the child was easily distracted.

Interventions were classified under a number of categories: exercise-based (N = 52), animal therapy (N = 10), technology-based (N = 11), equipment-based (N = 11), sensory stimulation (N = 14), adapted physical or occupational therapies (N = 7), task-based (N = 51) and massage therapy (N = 3). Some interventions fell into multiple categories. Of those task-based interventions that resulted in mixed findings, two of them were also technology-based (Berg et al., 2012; Mraz et al., 2016). One of these technology-based studies (Berg et al., 2012) did indicate that the family was not able to meet the time requirements of the intervention and that the child was easily distracted. Similarly, another study involving technology (Weerdmeester et al., 2016) which showed no significant improvement, noted that the non-significant improvements were likely from the exercise component of the intervention, rather than the virtual reality portion.

The final element we examined as a factor that could influence intervention efficacy was parent involvement. For a total of 71 interventions, there was no parent involvement at all. For the remaining 49 studies, parents were involved in some capacity of either observational, supporting, or implementing the intervention themselves. For some interventions, parent involvement was critical for children to feel comfortable enough for the intervention to be effective, such as massage therapy (Hernandez-Reif et al., 2006; Pinero-Pinto et al., 2020; Silva et al., 2012). For some task-based interventions, parents have the potential to serve as a distractor for the child, rather than an attentional support.

Objective 2: What skills are targeted in these interventions?

Examining skills broadly for the second objective, 70 of the studies examined only gross motor skills, seven examined only fine motor skills, and 38 examined both fine and gross motor skills. Of the studies that measured only gross motor skills, 56 showed improvements generally, six of these demonstrated no significant changes following the intervention, six showed improvements similar to those of controls, and two showed mixed findings (Lotan et al., 2004; Mraz et al., 2016). No studies showed only declines. Of the studies that focused on fine motor skills, six showed improvements, while one resulted in declines (Logan et al., 2014). Of those that measured both fine and gross motor skills, two showed declines (Schleien et al., 1988; Wentz, 2017), three showed improvements similar to controls (Hayward et al., 2009; Lydic et al., 1985; Sanz Aparicló, 1988), seven showed no changes and two showed mixed findings (Berg et al., 2012; DeLuca et al., 2017). As gross motor skills develop first and are critical to exploring one's environment and moving independently, it is understandable that these skills are the primary focus of many interventions. It is also possible that since fine motor skills require the coordination of many small muscles, it may be more difficult for interventions to target these.

Objective 3: How is motor delay assessed prior to intervention?

With respect to the third listed objective, motor skills were assessed in a number of ways, though standardized assessments were used most across all study types. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP, Bruininks, 1978) was used in 22 of the studies, followed by the Test of Gross Motor Development (TGMD, Ulrich & Sanford, 1985) used in 14 of the studies, the Gross Motor Function Measure (GMFM, Russel et al., 2002) in 12 of the studies, the Bayley Scales of Infant and Toddler Development (BSID, Bayley, 2006) in nine of the studies and Peabody Developmental Motor Scales (PDMS, Folio & Fewell, 2000) in six.

Objective 4: Which skills demonstrate improvement?

As summarized under Objective 2, gross motor skills showed the most improvement with 80% of the interventions reporting overall positive outcomes. With only seven studies focusing on fine motor skills alone, five of these showed significant improvements though these findings do not carry the same weight because of the smaller sample size. For interventions that examined fine and gross motor skills, 63% showed significant improvements. It is possible that interventions that examined both motor skill domains were attempting to address too many delays at a time, which resulted in dampened efficacy.

Objective 5: Are these interventions transferrable for non-clinical persons to use outside of a laboratory setting, if effective?

Many studies conducted in the home were shown to have positive outcomes following the interventions and could then easily be continued following the intervention completion. However, other interventions involved technology or equipment that is not accessible to most families. Studies using virtual reality showed promising results (Wuang et al., 2011), but this equipment may be too expensive to be recommended to families broadly. Similarly, some animal therapies were shown to be effective (Salgueiro et al., 2012; Steiner & Kertesz, 2012), but dolphin-assisted therapy is likely to be expensive, rarely available and inaccessible for most. Other interventions are highly transferrable to a non-clinical environment, such as massage therapy. Of the three massage therapy interventions that were included in the review, all showed improvement and two were implemented by parents (Pinero-Pinto et al., 2020; Silva et al., 2012). This could easily be continued following intervention completion and has no associated cost. Many studies involved physical activity such as yoga programs (Guivarch et al., 2021; Kaur & Bhat, 2019) or aquatic therapy (Chang et al., 2014; Marzouki et al., 2022), they demonstrated improvements and are feasible for many families. Yoga could be carried out within the home through online videos, and many local pools would have options for group classes or free swim if parents wanted to engage in the activity beyond a research setting.

Discussion

Evidence synthesis

There are promising findings resulting from this review paper from the attributes of effective and ineffective interventions, the transferability of interventions to non-clinical settings, and what skills are targeted for improvement. The results show that there is a level of transferability to non-clinical settings for interventions that are affordable, effective and require minimal equipment. Interventions involving yoga, massage, or swimming are accessible for many families and entail a level of adaptability for families to schedule sessions when it suits them best. While some interventions did show positive outcomes, animal-based interventions (Jang et al., 2015; Salguiero et al., 2012; Steiner & Kertesz, 2012) are not easily transferable, typically requiring an intervention-specific space and a trained professional. Similarly, equipment-based interventions that were found to be effective (Hospodar et al., 2021; Kokkoni, 2016; Martin, 2004) require the specific equipment provided by researchers. This means that families not involved in that unique study may not be able to access the same means of intervention. It is helpful to understand what aspects of an intervention made them effective. Similarly, it is beneficial to understand the limitations of transferability. Other interventions showed promising results as well, but the time commitment and location demands can decrease intervention fidelity, thereby decreasing its efficacy. As supporting a child with a disability can include physiotherapy, speech and language pathology appointments, and potential other time commitments, it is important that interventions empower families to work on their unique goals for their child, including operating on their own timelines. Regarding time commitments, the results show that interventions were most effective when implemented twice a week while interventions were less effective if they were too frequent or infrequent. If an intervention requires an unreasonable time commitment, a family is likely unable to attend the number of sessions necessary for the intervention to be fully effective. On the opposite side, therapies that were too short or didn’t occur as often were ineffective. It is possible that there wasn’t sufficient time for the intervention to properly take effect.

The role of parents in intervention implementation was variable, highlighting the differences between individual children and disabilities, broadly. While some children improved when their parent was present, which could demonstrate potential scaffolding or emotional support for the child, other studies did not show changes or a decrease in motor skills, potentially resulting from distractibility or an inclination to familiar motor skills rather than new ones.

Regarding the motor skills targeted by interventions, gross motor skills were most frequent. Given that gross motor skills precede fine motor skills in development (Department of Education, n.d.), it is understandable that this developmental domain would be a priority for intervention work. Additionally, this finding exemplifies the importance placed on improving certain motor skills over others. One's ability to walk and balance while standing would have more of an immediate impact on a child's life given that gross motor skills are often a pre-requisite to attaining fine motor milestones.

Additionally, this review provided valuable insights regarding what could make an intervention effective including implementing the intervention in an unfamiliar environment. While previous literature has provided evidence to suggest that placing a child in a novel environment interferes with their ability to learn a new task (Falk et al., 1978), it is possible that learned play routines (Vygotsky, 1967) can be changed when moved to a new environment. This could potentially allow children to engage in motor behaviours they had not engaged in previously. As such, this aspect of intervention work could be explored by future researchers.

Limitations

A limitation of this review is that it is influenced by publication bias because studies had to be published to be included. Most interventions showed improvements, though it is possible that other motor interventions have been investigated and have not been published on the basis of null findings. Additionally, there is a gap in the literature resulting from the rarity of certain diagnoses, such as Rett syndrome and Pitt–Hopkins syndrome. Some studies showed negative outcomes, although they consisted of a single participant, making it difficult to draw conclusions based on intervention rather than diagnosis or individual differences.

Another limitation is that this is a narrative systematic review, meaning that the various studies are not weighted according to sample size or effect size. This is a beneficial first step to developing a transdiagnostic understanding of interventions for neurodevelopmental disabilities, as this review was able to identify characteristics of interventions that may promote or prevent efficacy. While a meta-analysis could be beneficial for future research, some studies did not provide an effect size or the data necessary for calculating effect size. Additionally, this review sought to explore more contextual factors and diverse outcome measures that are not suitable for meta-analysis.

Future directions

Further directions could include exploring the mechanisms of interventions being effective or ineffective within the home, such as distractibility, parent scaffolding and proclivity for established behaviours. It would be beneficial for researchers to understand why familiarity with the environment may be beneficial for some children while it promotes pre-established behaviours for others. In a similar vein, practitioners could focus on providing resources to families that allow them to implement interventions within the home and that do not require professional support. Whilst this review was inclined to avoid precluding the inclusion of small-scale studies with valuable information regarding contextual factors, further research that explores randomised controlled trials with larger sample sizes could be beneficial in making more generalisable claims. However, as our research wanted to include rare aetiologies such as Rett syndrome and Pitt–Hopkins syndrome, some studies did not include effect sizes and sufficient sample sizes necessary for a meta-analysis, though this could be informative in studies to come. Though our review was not designed to target narrower age groups, diagnoses, or intervention methods, it would be beneficial for future research to narrow the focus to explore intervention efficacy within these respective groups. This would be beneficial as it would allow researchers to determine what aspects of an intervention make it effective for some children while it may not be effective for others. As research has been progressing and making great strides with each passing month, new future reviews could include the most recent evidence surrounding motor interventions and include the aforementioned research questions.

As the goal of motor interventions is to optimise outcomes and improve the quality of life for children with neurodevelopmental disabilities, this review provided a better understanding of the characteristics of effective and ineffective interventions, transferability to non-clinical settings and the various measures used to assess motor skills. This will inform practitioners and researchers as they explore motor interventions for their respective populations.

Category	Classification
Intervention frequency	Number of times the intervention was implemented in a given week.
Location	Where the intervention was implemented, including, but not limited to therapy offices, hospitals, schools and within the home.
Parent involvement	Parents are involved in the intervention in any capacity, such as being present, implementing the intervention themselves, providing verbal support, etc.
Intervention type	- Exercise-based: Includes sports therapies, aquatic therapies, treadmill training, etc. - Animal therapy: Includes hippotherapy, therapy animals, etc. - Task-based therapy: Includes therapies involving games, completing certain motor tasks, handwriting, etc. - Massage therapy: Includes parent-administered or therapist-administered massage therapies. - Sensory-based: Includes vestibular stimulation, tactile stimulation, vibration therapy, sensorimotor stimulation, etc. - Technology-based: Includes virtual reality, video games and audio-visual feedback systems. - Equipment-based: Includes any objects adapted for accessibility, orthoses and supplementary support systems; does not include unmodified equipment such as treadmills, video games and virtual reality headsets. - Adapted physical and occupational therapies: Includes any adaptation of traditional physical and occupational therapies
Effective interventions	Interventions were classified as effective if a child met motor milestones, completed certain motor behaviours more frequently, engaged in unfavourable motor behaviours (i.e. illegible handwriting and dropping objects) less frequently, or scored higher on a standardized motor measure, etc. Interventions were classified as ‘declined’ if motor skills worsened, ‘no change’ if there was no directional change, and ‘similar’ if outcomes were similar to a comparison group that also received a form of motor intervention i.e. traditional occupational or physiotherapy. In instances where multiple evaluations were used, if one evaluation showed improvement while another showed a decline, improvement was classified as ‘mixed’. If all evaluations showed improvement, it was classified as ‘improved’. If some evaluations showed improvement and others showed no change, it was classified as ‘improved’. If some evaluations showed no change and others showed a decline, it was classified as ‘declined’.

Study	N	Diagnoses	Average age	Weekly frequency	Intervention location	Motor skill	Intervention type	Intervention outcome	Parent involvement	Measures
Drobnyk et al., 2019	5	Rett syndrome	7.50 years	3x	School	Fine	Sensory-based	no change	No	Reaches and grasps (N) in play sessions
Wentz, 2017	19	Down syndrome	66 days	7x	Home	Both	Task-based	Declined	Yes	BSID
Schleien et al., 1988	6	Autism	8.7 years	2x	School	Both	Exercise-based; task-based	Declined	No	Study specific motor checklist
Guivarch et al., 2021	10	Autism	Median: 8.35	1x	Hospital	Gross	Exercise-based	Improved	No	MABC, VABS
Helsel et al., 2021	20	Autism	13.2 years	3x	Home	Gross	Exercise-based	Improved	Yes	TGMD, hand dynamometer, leg press, Stork Balance Test, Star Excursion Balance Test, Sit and Reach Test
Salgueiro et al., 2012	10	Autism	6.75 years	1x	Artificial lagoon	Both	Animal therapy	Improved	No	Psychoeducational Profile Revised
Kaur & Bhat, 2019	21	Autism	7.8 years	4x	Home and school	Both	Exercise-based	Improved	Yes	BOTMP, imitation test
Hospodar et al., 2021	8	Down syndrome	8.6 years	7x	Home	Gross	Equipment-based; task-based	Improved	Yes	BSID
Pan et al., 2016	32	ADHD	8.9 years	2x	Table tennis centre	Both	Task-based	Improved	No	BOTMP
Majorek et al., 2004	5	ADHD	Not reported	1x	Clinic	Both	Exercise-based; sensory-based	Improved	Yes	Lincoln-Oserretzky-Scala
Caputo et al., 2018	26	Autism	7.99 years	1x	Pool	Gross	Exercise-based; task-based	Improved	No	VABS, HAAR
Hadadi, 2018	26	Autism	4.18 years	2x	School and clinic	Gross	Task-based	Improved	No	Correct trials (N) after demonstration
Arlsan et al., 2022	14	Autism	10.07 years	3x	Unclear	Gross	Exercise-based	Improved	No	BOTMP, Sit and Reach Test
Clark et al., 2020	34	ADHD	10.21 years	2x	Unclear	Gross	Exercise-based	Improved	No	PANESS
Angulo-Barroso et al., 2008	30	Down syndrome	10 months	5x	Home	Gross	Exercise-based	Improved	Yes	BSID
Martin, 2004	17	Down syndrome	5 years	7x	Home and clinic	Gross	Equipment-based	Improved	Yes	GMFM, BOTMP
Pan et al., 2019	30	ADHD	9.14 years	2x	Gym	Gross	Task-based	Improved	No	TGMD
Jang et al., 2015	20	ADHD	8.4 years	2x	Stables	Both	Animal therapy	Improved	No	BOTMP
Lotan et al., 2021	5	Rett syndrome	9 years	<1x	Home	Both	Adapted PT Or OT	Improved	Yes	Goal Attainment Scale
Hawks et al., 2020	15	Autism	Unclear	5x	Summer camp	Gross	Exercise-based	Improved	Yes	Cycling 70ft unsupported
Habib-Hasan et al., 2020	48	Down syndrome	16.2 months	7x	Home	Gross	Adapted PT or OT	Improved	Yes	GMFM
Kokkoni, 2016	5	Down syndrome	17 months	2x	Lab	Gross	Equipment-based	Improved	Yes	Stair climbing speed and success, leg movement frequency
Rubin et al., 2021	42	Prader-Willi syndrome	10.9 years	4x	Home	Both	Exercise-based; technology-based	Improved	Yes	BOTMP
Fiss et al., 2009	10	down syndrome	18.4 months	1x	Clinic	Both	Sensory-based	Improved	Yes	GMFM
Gusso et al., 2021	14	Down syndrome	15.5 years	4x	School; home	Gross	Sensory-based	Improved	Yes	6 min walk test, mechanography ground reaction force plate
Wuang et al., 2011	155	Down syndrome	Unclear	2x	Lab	Both	Technology-based; task-based	Improved	No	BOTMP
Karanth et al., 2010	30	autism	41 months	5x	Clinic	Both	Task-based	Improved	No	Communication DEALL Developmental Checklist
Mahoney et al., 2001	27	Down syndrome	14 months	<1x	Clinic	Gross	Exercise-based; task based	Improved	No	PDMS
Connolly et al., 1993	73	Down syndrome	4.6 years	1x	Clinic, home	Both	Task-based	Improved	Yes	Age at developmental milestones
Chang et al., 2014	30	ADHD	8.44 years	2x	Pool	Gross	Exercise-based; task based	Improved	No	Basic Motor Ability Test
Okada et al., 2019	40	Down syndrome	Median: 7 months (avg not given)	3x	Clinic; home	Gross	Task-based	Improved	Yes	Onset of independent walking
Silva et al., 2012	14	Down syndrome	Unclear	7x	Home	Both	Massage therapy	Improved	Yes	PDMS
Fiss et al., 2007	10	Down syndrome	18.4 months	1x	Unclear	Gross	Sensory-based; task-based	Improved	No	GMFM
Hernandez-Reif et al., 2006	21	Down syndrome	2 years	2x	Preschool	Both	Massage therapy	Improved	No	Developmental Programming for Infants and Young Children
Fidler et al., 2021	42	Down syndrome	7 months	7x	Home	Fine	Task-based	Improved	Yes	Reaching and grasping task with rubber ball
Barros et al., 2020	7	Down syndrome	10.8 years	2x	Pool	Gross	Exercise-based; task based	Improved	No	Body Coordination Test
McGuire et al., 2019	5	Down syndrome	6.5 years	1x	Ballet studio	Gross	Exercise-based; task based	Improved	Yes	GMFM, Canadian Occupational Performance Measure
Amini et al., 2016	16	Down syndrome	8.75 years	2x	Unclear	Gross	Exercise-based	Improved	No	Biodex Stability System
Steiner & Kertesz, 2012	26	Autism	unclear	1x	Stables	Gross	Animal therapy	Improved	No	Ariel Performance Analysis System
Pan, 2011	15	Autism	9 years	2x	Pool	Gross	Exercise-based	Improved	Yes	HAAR
Rahman & Shaheen, 2010	26	Down syndrome	4.2 years	7x	Clinic; home	Gross	Exercise-based; task based	Improved	Yes	BOTMP
Lafferty, 2005	7	Down syndrome	9.27 years	<1x	Unclear	Gross	Exercise-based	Improved	No	Left and right hip and knee angles
Wang & Ju, 2002	20	Down syndrome	4.6 years	3x	Intervention centre	Gross	Task-based	Improved	No	BOTMP, Motor Proficiency and Motor Skill Inventory
Weber & Thorpe, 1989	12	Autism	Unclear	5x	School	Gross	task-based	Improved	No	I Can Assessment of Gross Motor Skills
Ketcheson et al., 2023s	25	Autism	4.7 years	1x	Gym	Both	Task-based	Improved	No	TGMD, MSEL
Panigrahy & Dandekar, 2021	20	Autism	13.7 years	3x	School	Fine	Task-based	Improved	No	Pegboard reaction time
Cawand, 2014	28	Down syndrome	15 months	2x	Home	Both	Equipment-based	Improved	No	Developmental Assessment Scale for Indian Infant
DeLuca et al., 2017	3	CASK mutation	56 months	7x	Unclear	Both	Task-based	Mixed	No	PDMS
Lotan et al., 2004	4	Rett syndrome	10 years	Variable	Unclear	Gross	Exercise-based	Mixed	Yes	31-item motor functioning assessment
Harris, 1981	20	Down syndrome	10.18 months	3x	Home	Both	Task-based	No change	Yes	PDMS, BSID
Edwards et al., 2017	11	Autism	7.64 year	3x	Home	Both	Task-based; technology-based	No change	Yes	TGMD, object control skills, golf swing, golf putt
Satiansukpong et al., 2016	16	Down syndrome	10.39 years	2x	Animal sanctuary	Gross	Animal therapy	No change	Yes	BOTMP, Beery VMI, postural control record form
Martinez & Antón, 2018	10	down syndrome	12.5 years	1x	Lab	Both	Task-based	No change	No	Imitate 8 motor commands
Fragala-Pinkham et al., 2008	6	Autism and Down syndrome	8.6 years	2x	Pool	Gross	Exercise-based	No change	Yes	Multidimensional pediatric evaluation of disability, swimming classification scale, Floor to Stand Test
Marcus et al., 2010	3	Autism	Unclear	Variable	School	Gross	Technology-based; task-based	No change	No	Percent of 10 min walk without toe walking
Hayward et al., 2009	44	Autism	35 months	Variable	Home	Both	Task-based	Similar	Yes	VABS
Sanz Aparicio, 1988	48	Down syndrome	8.5 months	2x	Home; clinic	Both	Task-based	Similar	Yes	Brunet-Lezine's First Childhood Scale
Lydic et al., 1985	18	Down syndrome	Unclear	3x	Lab	Both	Sensory-based	Similar	No	Movement Assessment of Infants, PDMS
Karimi et al., 2010	18	Down syndrome	Unclear	3x	Clinic	Gross	Adapted PT or OT	Similar	Yes	GMFM
Hyun et al., 2016	12	ADHD	10.8 years	3x	Stables	Gross	Animal therapy	Similar	No	MatScan Floor system mat
Logan et al., 2014	1	Down syndrome	1.1	7x	Home	Fine	Equipment-based; task-based	Declined	Yes	Reaches for toy (N)
Casey et al., 2018	1	Pitt–Hopkins syndrome	4	5x	Daycare	Both	Equipment-based	Improved	No	Mobility Ability Participation Assessment
Colombo-Dougovito et al., 2019	2	Autism	7.5	2x	School	Both	Exercise-based	Improved	No	TGMD
Alesi et al., 2014	3	Down syndrome	12.97	2x	Unclear	Gross	Exercise-based	Improved	Yes	TGMD
Hodges et al., 2019	1	Autism	4	Unclear	Hospital	Gross	Sensory-based	Improved	Yes	Percent of 100 steps without toe walking
Rodger & Brandenburg, 2009	2	Autism	10.46	1x	Clinic, home	Fine	Adapted pt or ot	Improved	Yes	MABC, VABS, Canadian Occupational Performance Measure
Battaglia et al., 2019 (1)	3	Autism	14.3	1x	Pool	Both	Exercise-based; task-based	Improved	No	TGMD
Colebourn et al., 2017	1	Autism	9	3x	School	Both	Exercise-based; task-based	Improved	No	TGMD, BOTMP
Lewis & Fragala-Pinkham, 2005	1	Down syndrome	10.5	5x	Home	Gross	Exercise-based; task-based	Improved	Yes	BOTMP
Ipek et al., 2017	1	Joubert syndrome	1.6	5x	Clinic	Gross	Adapted pt or ot, sensory-based	Improved	No	GMFM
Han et al., 2022	1	Angelman syndrome	15	2x	Lab	Gross	Technology-based; equipment- based; task-based	Improved	No	Tinetti Performance-Oriented Mobility Assessment
Battaglia et al., 2019 (2)	1	Autism	4.2	Variable	Pool	Gross	Exercise-based	Improved	No	VABS, Psycho-educational profile
Moriello et al., 2020	4	Down syndrome	3.83	1x	Stables	Gross	Animal therapy	Improved	No	GMFM, gait analysis
Champagne & Dugas, 2010	2	Down syndrome	2.75	1x	Stables	Gross	Animal therapy	Improved	No	GMFM
Edwards & Yuen, 1990	1	Down syndrome	0.92	1x	Home	Both	sensory-based	Improved	Yes	BSID
Conklin & Simonds, 2021	1	Williams syndrome	1.5	Variable	Gym	Gross	Exercise-based	Improved	No	GMFM
Yilmaz et al., 2004	1	autism	9	3x	Pool	Gross	Exercise-based	Improved	No	Thrust test, balancing on one foot, Aquatic Orientation Checklist
Winchester et al., 2002	3	Down syndrome	6.33	1x	Stables	Gross	Animal therapy	Improved	No	GMFM, timed 10 meter walk
Berg et al., 2012	1	Down syndrome	12	4x	Home	Both	Task-based; technology-based	Mixed	Yes	BOTMP
Mraz et al., 2016	1	Rett syndrome	9	3x	Home	Gross	Task-based; technology-based	Mixed	Yes	Functional reach test, Pediatric Evaluation of Disability Inventory
Gerritsen, 2010	11	autism	unclear	5x	Unclear	Both	Task-based; sensory-based	No change	No	VABS
Gupta et al., 2011	23	Down syndrome	13.26 years	3x	School	Gross	Exercise-based; task-based	Improved	No	Handheld dynamometer
Marzouki et al., 2022	22	autism	6.33	2x	Pool	Gross	Exercise-based; task-based	Improved	No	TGMD
Ulrich et al., 2001	30	Down syndrome	307.4 days	5x	Home	Gross	Exercise-based	Improved	Yes	BSID
Eid et al., 2017	31	Down syndrome	10.16	3x	Clinic	Gross	Exercise-based	Improved	No	Biodex Stability System
El Shemy & El-Sayed, 2018	30	autism	9.29 years	3x	Clinic	Gross	sensory-based	Improved	No	BOTMP
Sarabzadeh et al., 2019	18	autism	8.2 years	3x	Unclear	Both	Equipment-based; task based	Improved	No	MABC
Peric et al., 2022	25	Down syndrome	15.7 years	2x	Football pitch	Gross	Exercise-based; task-based	Improved	No	Football skill proficiency scored 1–5
Shaffer et al., 2001	56	ADHD	unclear	variable	Unclear	Both	Task-based; sensory-based	Improved	No	BOTMP
Pan et al., 2017	24	ADHD	9.52 years	1x	Gym, lab	Both	Task-based	Improved	Yes	BOTMP, Brockport Physical Fitness Test
Najafabadi et al., 2018	28	autism	7.1 years	3x	Gymnasium	Both	Exercise-based	Improved	No	BOTMP
Wu et al., 2007	30	Down syndrome	10 months	5x	Home	Gross	Exercise-based	Improved	Yes	BSID
Wu et al., 2010	26	Down syndrome	10 months	5x	Home	Gross	Exercise-based	Improved	Yes	BSID
Uyanik et al., 2003	45	down syndrome	8.93 years	3x	Clinic	Both	sensory-based	Improved	No	Ayres Southern California Sensory Integration
Bremer et al., 2015	9	autism	4 years	variable	Clinic	Both	Task-based	Improved	No	PDMS, MABC
Looper & Ulrich, 2010	17	Down syndrome	1.69 years	5x	Home	Gross	Exercise-based; equipment-based	Improved	Yes	GMFM
Pan, 2010	16	autism	7.24 years	2x	Pool	Gross	Exercise-based	Improved	No	HAAR
Lin & Wuang, 2012	92	Down syndrome	15.25 years	3x	Lab	Gross	Exercise-based; technology-based	Improved	No	BOTMP
Ulrich et al., 2008	30	Down syndrome	10 months	5x	Home	Gross	Exercise-based; equipment-based	Improved	Yes	BSID
Alsakhawi & Elshafey, 2019	45	Down syndrome	4.59 years	3x	Clinic	Gross	Exercise-based	Improved	No	Berg Balance Scale, Biodex Balance System
Ozbeser et al., 2022	12	Down syndrome	12.6 years	2x	Clinic	Fine	Adapted pt or ot	Improved	Yes	Canadian Occupation Performance Measure, BOTMP
Pinero-Pino et al., 2020	32	Down syndrome	5.1 months	7x	Home	Both	Massage therapy	Improved	Yes	Brunet-Lezine Early Childhood Psychomotor Development
Jankowicz-Szymanska et al., 2012	40	Down syndrome	16.8 years	2x	Gym	Gross	Exercise-based	Improved	No	Emi Duo Balance
Raghupathy et al., 2022	36	Down syndrome	8.1 years	3x	Unclear	Gross	Exercise-based	Improved	No	TGMD, Four Square Step Test, Pediatric Balance Scale
El-Sayed & Ragaa, 2022	30	Down syndrome	8.3 years	3x	Unclear	Gross	Exercise-based; sensory-based	Improved	No	Biodex Balance System
Norouzi et al., 2022	40	Down syndrome	8.3 years	3x	Hospital	Fine	Task-based	Improved	No	Potentiometers during bimanual coordination
Álvareza et al., 2018	16	Down syndrome	8.4 years	2x	School	Gross	Technology-based; task-based	Improved	No	TGMD, Wii Balance Board
Barkin et al., 2022	58	ADHD	8.8 years	2x	Clinic	Both	Adapted pt or ot	Improved	No	BOTMP
Lee, 2022	34	Autism	47 months	2x	Unclear	Fine	Technology-based	Improved	No	Wide Range Assessment of Visual Motor Abilities
Gabriels et al., 2012	42	Autism	8.7 years	1x	Stables	Gross	Animal therapy	Improved	No	BOTMP
Noghondar et al., 2021	27	Down syndrome	11.1 years	3x	Unclear	Gross	Exercise-based; task-based	Improved	No	SIMI motion analysis
Weerdmeester et al., 2016	73	ADHD	9.77 years	2x	School	Both	Technology-based, exercise-based	No change	No	MABC
Columna et al., 2021	15	autism	7.4 years	<1x	Home, gym, school	Both	Exercise-based; task-based	No change	Yes	TGMD
Ulrich et al., 2011	62	Down syndrome	12 years	5x	Training facility	Gross	Exercise-based; equipment-based	No change	No	Standing on one foot for one minute
Gabriels et al., 2015	116	Autism	unclear	1x	Stables	Both	Animal therapy	No change	No	BOTMP, VABS
Young, 2017	19	Down syndrome	4.42	5x	Preschool	Gross	Exercise-based; task-based	Similar	Yes	TGMD
Wu et al., 2008	30	Down syndrome	10.03 months	variable	Home	Gross	Exercise-based	Similar	Yes	Computerized GAITrie mat
Ghafoor et al., 2021	30	Down syndrome	8.8 years	2x	Clinic	Gross	Exercise-based	Similar	No	Dynamic Gait Analysis, Wisconsin Gait Scale for Child
Kavlak et al., 2022	23	Down syndrome	12 months	2x	Unclear	Gross	Task-based	Similar	No	Alberta Infant Motor Scale

Footnotes

Acknowledgements

We would like to extend our gratitude to Alexandra Hendry for her guidance and support as we prepared this review.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Aunnika D Short

References

Alesi

Battaglia

Roccella

Testa

Palma

Pepi

(2014). Improvement of gross motor and cognitive abilities by an exercise training program: Three case reports. Neuropsychiatric Disease and Treatment, 2014(10), 479–485. https://doi.org/10.2147/NDT.S58455

Alsakhawi

R. S.

Elshafey

M. A.

(2019). Effect of core stability exercises and treadmill training on balance in children with down syndrome: Randomized controlled trial. Advances in Therapy, 2019(36), 2364–2373. https://doi.org/10.1007/s12325-019-01024-2

Álvareza

N. G.

Mortecinosb

A. V.

Rodríguezb

V. Z.

Fontanillab

M. L.

Vásquezb

M. M.

Pavez-Adasmea

Hernández-Mosqueiraa

(2018). Effect of an intervention based on virtual reality on motor development and postural control in children with Down syndrome. Revista Chilena de Pediatria, 89(6), 747–752. https://doi.org/10.4067/S0370-41062018005001202

Amini

H. A.

Fazel Kalkhoran

Salehi

Jazini

(2016). Effect of backward walking training on improves postural stability in children with down syndrome. International Journal of Pediatrics, 4(7), 2171–2181. https://doi.org/10.22038/ijp.2016.7103

Angulo-Barroso

R. M.

Ulrich

D. A.

(2008). Long-term effect of different treadmill interventions on gait development in new walkers with Down syndrome. Gait & Posture, 27(2), 231–238. https://doi.org/10.1016/j.gaitpost.2007.03.014

Arslan

Ince

Akyüz

(2022). Effects of a 12-week structured circuit exercise program on physical fitness levels of children with autism spectrum condition and typically developing children. International Journal Of Developmental Disabilities, 68(4), 500–510. https://doi.org/10.1080/20473869.2020.1819943

Astle

D. E.

Holmes

Kievit

Gathercole

S. E.

(2022). Annual research review: The transdiagnostic revolution in neurodevelopmental disorders. Journal of Child Psychology and Psychiatry, 63(4), 397–417. https://doi.org/10.1111/jcpp.13481

Barkın

KÖSE

Temizkan

Özgün

K. A. Y. A.

Koray

K. A. R. A.

Şahin

(2022). How does visual praxis based occupational therapy program effect motor skills in children with hyperactivity and attention disorder?: Single blind randomised study design. Journal of Experimental and Clinical Medicine, 39(3), 803–808. https://doi.org/10.52142/omujecm.39.3.40

Barros

N. P.

Araújo

D. D. S.

Lima

E. B. D.

Carvalho

I. P. D.

Lima

S. D. S.

Costa

L. G. T.

(2020). Effects of kayaking on motor skills in children and adolescents with Down syndrome. Revista Brasileira de Medicina do Esporte, 26(4), 302–306. https://doi.org/10.1590/1517-869220202604220312 .

10.

Battaglia

Agrò

Cataldo

Palma

Alesi

(2019a). Influence of a specific aquatic adapted physical acitivty in a child with autism spectrum disorders: A case study. Life Span and Disability, 12(2), 155–172.

11.

Battaglia

Agrò

Cataldo

Palma

Alesi

(2019b). Influence of a specific aquatic program on social and gross motor skills in adolescents with autism spectrum disorders: Three case reports. Journal of Functional Morphology and Kinesiology, 4(2), 27. https://doi.org/10.3390/jfmk4020027

12.

Bayley

(2006). Bayley scales of infant and toddler development.

13.

Berg

Becker

Martian

Danielle

P. K.

Wingen

(2012). Motor control outcomes following Nintendo Wii use by a child with Down syndrome. Pediatric Physical Therapy, 24(1), 78–84. https://doi.org/10.1097/PEP.0b013e31823e05e6

14.

Bremer

Balogh

Lloyd

(2015). Effectiveness of a fundamental motor skill intervention for 4-year-old children with autism spectrum disorder: A pilot study. Autism, 19(8), 980–991. https://doi.org/10.1177/1362361314557548

15.

Bruininks

(1978). Bruininks-Oseretsky Test of Motor Proficiency: Examiners Manual. American Guidance Service.

16.

Brunetti

Lumsden

D. E.

(2020). Rett syndrome as a movement and motor disorder–A narrative review. European Journal of Paediatric Neurology, 28, 29–37. https://doi.org/10.1016/j.ejpn.2020.06.020

17.

Caputo

Ippolito

Mazzotta

Sentenza

Muzio

M. R.

Salzano

Conson

(2018). Effectiveness of a multisystem aquatic therapy for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 48, 1945–1956. https://doi.org/10.1007/s10803-017-3456-y

18.

Carolan

(2021). ADHD Stimulant medication misuse and considerations for current prescribing practice: A literature review. Irish Journal of Medical Science, 191(1971), 1–8. https://doi.org/10.1007/s11845-020-02502-1

19.

Casey

A. F.

Pickard

Ullrich

MacNeil

(2018). An adapted walking intervention for a child with Pitt Hopkins syndrome. Disability and Rehabilitation: Assistive Technology, 13(1), 25–30. https://doi.org/10.1080/17483107.2016.1278469

20.

Catalá-López

Hutton

Núñez-Beltrán

Page

M. J.

Ridao

Macías Saint-Gerons

Moher

(2017). The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PloS One, 12(7), e0180355. https://doi.org/10.1371/journal.pone.0180355

21.

Cawand

N. S.

(2014). To study the effectiveness of” D” chair on fine motor skills in children with Down's syndrome-A comparative study. Indian Journal of Occupational Therapy (Indian Journal of Occupational Therapy), 46(3), 77–82. https://doi.org/10.1016/j.jaci.2021.04.020

22.

Champagne

Dugas

(2010). Improving gross motor function and postural control with hippotherapy in children with Down syndrome. Physiotherapy Theory and Practice, 26(8), 564–571. https://doi.org/10.3109/09593981003623659

23.

Chang

Y. K.

Hung

C. L.

Huang

C. J.

Hatfield

B. D.

Hung

T. M.

(2014). Effects of an aquatic exercise program on inhibitory control in children with ADHD: A preliminary study. Archives of Clinical Neuropsychology, 29(3), 217–223. https://doi.org/10.1093/arclin/acu003

24.

Charach

Yeung

Volpe

Goodale

Dosreis

(2014). Exploring stimulant treatment in ADHD: Narratives of young adolescents and their parents. BMC Psychiatry, 14(110), 1–11. https://doi.org/10.1186/1471-244X-14-110

25.

Clark

Seymour

K. E.

Findling

R. L.

Mostofsky

S. H.

(2020). Subtle motor signs as a biomarker for mindful movement intervention in children with ADHD. Journal of Developmental and Behavioral Pediatrics: JDBP, 41(5), 349. https://doi.org/10.1097/DBP.0000000000000795

26.

Colebourn

J. A.

Golub-Victor

A. C.

Paez

(2017). Developing overhand throwing skills for a child with autism with a collaborative approach in school-based therapy. Pediatric Physical Therapy, 29(3), 262–269. https://doi.org/10.1097/PEP.0000000000000405

27.

Colombo-Dougovito

A. M.

Block

M. E.

(2019). Fundamental motor skill interventions for children and adolescents on the autism spectrum: A literature review. Review Journal of Autism and Developmental Disorders, 2019(6), 159–171. https://doi.org/10.1007/s40489-019-00161-2

28.

Colombo-Dougovito

A. M.

Kelly

L. E.

Block

M. E.

(2019). The effect of task modifications on the fundamental motor skills of boys on the autism spectrum: A pilot study. Journal of Developmental and Physical Disabilities, 2019(31), 653–668. https://doi.org/10.1007/s10882-019-09666-4

29.

Columna

Prieto

L. A.

Beach

Russo

Foley

J. T.

(2021). A randomized feasibility trial of a fundamental motor skill parent-mediated intervention for children with autism spectrum disorders. International Journal of Environmental Research and Public Health, 18(23), 12398. https://doi.org/10.3390/ijerph182312398

30.

Conklin

Simonds

A. H.

(2021). Outcomes of an 8-week treadmill training program for a toddler with Williams syndrome: A case report. Pediatric Physical Therapy, 33(1), E10–E14. https://doi.org/10.1097/PEP.0000000000000770

31.

Connolly

B. H.

Morgan

S. B.

Russell

F. F.

Fulliton

W. L.

(1993). A longitudinal study of children with Down syndrome who experienced early intervention programming. Physical Therapy, 73(3), 170–179. https://doi.org/10.1093/ptj/73.3.170

32.

Cope

Mohn-Johnsen

(2017). The effects of dosage time and frequency on motor outcomes in children with cerebral palsy: A systematic review. Developmental Neurorehabilitation, 20(6), 376–387. https://doi.org/10.1080/17518423.2017.1282053

33.

Critical Appraisal Skills Programme. (2020). CASP (Randomised Controlled Trial) Checklist. [online] Available at https://casp-uk.net/images/checklist/documents/CASP-Randomised-Controlled-Trial-Checklist/CASP-RCT-Checklist-PDF-Fillable-Form.pdf Accessed: 30 April, 2023

34.

DeLuca

S. C.

Wallace

D. A.

Trucks

M. R.

Mukherjee

(2017). A clinical series using intensive neurorehabilitation to promote functional motor and cognitive skills in three girls with CASK mutation. BMC Research Notes, 10(1), 1–6. https://doi.org/10.1186/s13104-016-2345-3

35.

De Luca

C. R.

McCarthy

Galvin

Green

J. L.

Murphy

Knight

Williams

(2013). Gross and fine motor skills in children treat.

36.

Drobnyk

Rocco

Davidson

Bruce

Zhang

Soumerai

S. B.

(2019). Sensory integration and functional reaching in children with Rett syndrome/rett-related disorders. Clinical Medicine Insights: Pediatrics, 13(1), 1179556519871952. https://doi.org/10.1177/1179556519871952

37.

Duca

D. G.

Craiu

Monica

B. O. E. R.

Chirieac

S. M.

Arghir

Tutulan-Cunita

Budisteanu

(2013). Diagnostic approach of Angelman syndrome. Maedica, 8(4), 321. https://doi.org/10.26574/maedica.2013.8.4.321

38.

Duncan

Cunningham

Eyre

(2019). A combined movement and story-telling intervention enhances motor competence and language ability in pre-schoolers to a greater extent than movement or story-telling alone. European Physical Education Review, 25(1), 221–235. https://doi.org/10.1177/1356336X17715772

39.

Edwards

Jeffrey

May

Rinehart

N. J.

Barnett

L. M.

(2017). Does playing a sports active video game improve object control skills of children with autism spectrum disorder? Journal of Sport and Health Science, 6(1), 17–24. https://doi.org/10.1016/j.jshs.2016.09.004

40.

Edwards

S. J.

Yuen

H. K.

(1990). An intervention program for a fraternal twin with Down syndrome. American Journal of Occupational Therapy, 44(5), 454–458. https://doi.org/10.5014/ajot.44.5.454

41.

Eid

M. A.

Aly

S. M.

Huneif

M. A.

Ismail

D. K.

(2017). Effect of isokinetic training on muscle strength and postural balance in children with Down’s syndrome. International Journal of Rehabilitation Research, 40(2), 127–133. https://doi.org/10.1097/MRR.0000000000000218

42.

El-Sayed

S. E.

Ragaa

A. E. E.

(2022). Mechanical vestibular stimulation versus traditional balance exercises in children with Down syndrome. African Health Sciences, 22(1), 377–383. https://doi.org/10.4314/ahs.v22i1.46

43.

El Shemy

S. A.

El-Sayed

M. S.

(2018). The impact of auditory rhythmic cueing on gross motor skills in children with autism. Journal of Physical Therapy Science, 30(8), 1063–1068. https://doi.org/10.1589/jpts.30.1063

44.

Falk

J. H.

Martin

W. W.

Balling

J. D.

(1978). The novel field-trip phenomenon: Adjustment to novel settings interferes with task learning. Journal of Research in Science Teaching, 15(2), 127–134. https://doi.org/10.1002/tea.3660150207

45.

Fidler

D. J.

Schworer

E. K.

Needham

Prince

M. A.

Patel

Will

E. A.

Daunhauer

L. A.

(2021). Feasibility of a syndrome-informed micro-intervention for infants with Down syndrome. Journal of Intellectual Disability Research, 65(4), 320–339. https://doi.org/10.1111/jir.12814

46.

Fiss

A. C. L.

(2007). Effect of Increased Practice Time Using Sensorimotor Groups on Gross Motor Skill Acquisition for Children with Down Syndrome. Doctoral dissertation. University of Kentucky.

47.

Fiss

A. C. L.

Effgen

S. K.

Page

Shasby

(2009). Effect of sensorimotor groups on gross motor acquisition for young children with Down syndrome. Pediatric Physical Therapy, 21(2), 158–166. https://doi.org/10.1097/PEP.0b013e3181a3dec7

48.

Flores

Coelho

Mourão-Carvalhal

M. I.

Forte

(2023). Association between motor and math skills in preschool children with typical development: Systematic review. Frontiers in Psychology, 14(1105391), 1–23. https://doi.org/10.3389/fpsyg.2023.1105391

49.

Folio

Fewell

R. F.

(2000). Peabody Developmental Motor Scales (2nd Edition). Pro-Ed.

50.

Fragala-Pinkham

Haley

S. M.

O’Neil

M. E.

(2008). Group aquatic aerobic exercise for children with disabilities. Developmental Medicine & Child Neurology, 50(11), 822–827. https://doi.org/10.1111/j.1469-8749.2008.03086.x

51.

Gabriels

R. L.

Agnew

J. A.

Holt

K. D.

Shoffner

Zhaoxing

Ruzzano

Mesibov

(2012). Pilot study measuring the effects of therapeutic horseback riding on school-age children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 6(2), 578–588. https://doi.org/10.1016/j.rasd.2011.09.007

52.

Gabriels

R. L.

Pan

Dechant

Agnew

J. A.

Brim

Mesibov

(2015). Randomized controlled trial of therapeutic horseback riding in children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(7), 541–549. https://doi.org/10.1016/j.jaac.2015.04.007

53.

Gabriels

R. L.

Pan

Guérin

N. A.

Dechant

Mesibov

(2018). Long-term effect of therapeutic horseback riding in youth with autism spectrum disorder: a randomized trial. Frontiers in Veterinary Science, 5, 156.

54.

Gerritsen

(2010). The effect of Tomatis therapy on children with autism: Eleven case studies. The International Journal of Listening, 24(1), 50–68. https://doi.org/10.1080/10904010903466378

55.

Ghafoor

Hassan

Zulqernain

Hassan

M. S.

Javaid

H. M. W.

Saeed

(2021, October). Comparison of static cycle and treadmill training on gait parameters in the children with Down syndrome. In Medical Forum, 32(10), 215.

56.

Gillberg

(1998). Hyperactivity, inattention and motor control problems: Prevalence, comorbidity and background factors. Folia Phoniatrica et Logopaedica, 50(3), 107–117. https://doi.org/10.1159/000021456

57.

Gomathi

Padmapriya

Balachandar

(2020). Drug studies on Rett syndrome: From bench to bedside. Journal of Autism and Developmental Disorders, 50(8), 2740–2764. https://doi.org/10.1007/s10803-020-04381-y

58.

Goulardins

J. B.

Rigoli

Piek

J. P.

Kane

Palacio

S. G.

Casella

E. B.

Nascimento

R. O.

Hasue

R.H.

Oliveira

J. A.

(2016). The relationship between motor skills, ADHD symptoms, and childhood body weight. Research in Developmental Disabilities, 55, 279–286.

59.

Green

Charman

Pickles

Chandler

Loucas

Simonoff

Baird

(2009). Impairment in movement skills of children with autistic spectrum disorders. Developmental Medicine and Child Neurology, 51(4), 311–316. https://doi.org/10.1111/j.1469-8749.2008.03242.x

60.

Guivarch

Jouve

Avenel

Poinso

Conforti-Roussel

(2021). Effect of physical therapy on 7-to 10-year-old children with autism spectrum disorder: A retrospective study in a university day hospital. Bulletin of the Menninger Clinic, 85(4), 385–404. https://doi.org/10.1521/bumc.2021.85.4.385

61.

Gupta

Rao

B. K.

Kumaran

S. D.

(2011). Effect of strength and balance training in children with Down’s syndrome: A randomized controlled trial. Clinical Rehabilitation, 25(5), 425–432. https://doi.org/10.1177/0269215510382929

62.

Gusso

Vesey

R. M.

Derraik

J. G.

Munns

C. F.

Colle

Biggs

J. B.

Hofman

P. L.

(2021). The effects of 20 weeks of side-alternating vibration therapy on physical function, bone and muscle health in adolescents with Down syndrome. Physical & Occupational Therapy In Pediatrics, 41(1), 44–55. https://doi.org/10.1080/01942638.2020.1758983

63.

Habel

L. A.

Schaefer

C. A.

Levine

Bhat

A. K.

Elliott

(2005). Treatment with stimulants among youths in a large California health plan. Journal of Child & Adolescent Psychopharmacology, 15(1), 62–67. https://doi.org/10.1089/cap.2005.15.62

64.

Habib-Hasan

Sheikh

M. S.

Hoodbhoy

Azam

O’Neil

(2020). Early intervention physical therapy using “parent empowerment program” for children with Down syndrome in Pakistan: A feasibility study. Journal of Pediatric Rehabilitation Medicine, 13(3), 233–240. https://doi.org/10.3233/PRM-190605

65.

Hadadi

(2018). The Effectiveness of Using Video Modeling Techniques to Improve Motor Skills for Preschool Children with Autism Spectrum Disorders. University of Arkansas.

66.

Han

Park

You

J. S. H.

(2022). Effects of robotic interactive gait training combined with virtual reality and augmented reality on balance, gross motor function, gait kinetic, and kinematic characteristics in angelman syndrome: A case report. Children, 9(4), 544. https://doi.org/10.3390/children9040544

67.

Harris

S. R.

(1981). Effects of neurodevelopmental therapy on motor performance of infants with Down's syndrome. Developmental Medicine & Child Neurology, 23(5), 477–483. https://doi.org/10.1111/j.1469-8749.1981.tb02021.x

68.

Hart

K. C.

Ros

Gonzalez

Graziano

P. A.

(2018). Parent perceptions of medication treatment for preschool children with ADHD. Child Psychiatry & Human Development, 49(1), 155–162. https://doi.org/10.1007/s10578-017-0737-9

69.

Hawks

Constantino

J. N.

Weichselbaum

Marrus

(2020). Accelerating motor skill acquisition for bicycle riding in children with ASD: A pilot study. Journal of Autism and Developmental Disorders, 50(1), 342–348. https://doi.org/10.1007/s10803-019-04224-5

70.

Hayward

Eikeseth

Gale

Morgan

(2009). Assessing progress during treatment for young children with autism receiving intensive behavioural interventions. Autism, 13(6), 613–633. https://doi.org/10.1177/1362361309340029

71.

Helsel

B. C.

Foster

R. N.

Sherman

Ptomey

L. T.

Montgomery

R. N.

Washburn

R. A.

Donnelly

J. E.

(2023). A remotely delivered yoga intervention for adolescents with autism Spectrum disorder: Feasibility and effectiveness for improving skills related to physical activity. Journal of Autism and Developmental Disorders, 53(10), 3958–3967. https://doi.org/10.1007/s10803-022-05702-z

72.

Hernandez-Reif

Field

Largie

Mora

Bornstein

Waldman

(2006). Children with down syndrome improved in motor functioning and muscle tone following massage therapy. Early Child Development and Care, 176(3–4), 395–410. https://doi.org/10.1080/03004430500105233

73.

Hodges

A. C.

Betz

A. M.

Wilder

D. A.

Antia

(2019). The use of contingent acoustical feedback to decrease toe walking in a child with autism. Education and Treatment of Children, 42(2), 151–160. https://doi.org/10.1353/etc.2019.0007

74.

Hospodar

C. M.

Sabet

Logan

S. W.

Catena

M. A.

Galloway

J. C.

(2021). Exploratory analysis of a developmentally progressive modified ride-on car intervention for young children with Down syndrome. Disability and Rehabilitation: Assistive Technology, 16(7), 749–757. https://doi.org/10.1080/17483107.2019.1710773

75.

Hyun

G. J.

Jung

T. W.

Park

J. H.

Kang

K. D.

Kim

S. M.

Son

Y. D.

Han

D. H.

(2016). Changes in gait balance and brain connectivity in response to equine-assisted activity and training in children with attention deficit hyperactivity disorder. The Journal of Alternative and Complementary Medicine, 22(4), 286–293. https://doi.org/10.1089/acm.2015.0299

76.

İpek

Akyolcu

Bayar

(2017). Physiotherapy and rehabilitation in a child with joubert syndrome. Case Reports in Pediatrics, 2017(8076494), 1–7. https://doi.org/10.1155/2017/8076494

77.

James Lind Alliance. (2017, October). Neurodevelopmental Disorders (Canada), Priority Setting Partnerships, https://www.jla.nihr.ac.uk/priority-setting-partnerships/neurodevelopmental-disorders-canada/

78.

Jang

Song

Kim

Lee

Shin

H. Y.

Joung

Y. S.

(2015). Equine-assisted activities and therapy for treating children with attention-deficit/hyperactivity disorder. The Journal of Alternative and Complementary Medicine, 21(9), 546–553. https://doi.org/10.1089/acm.2015.0067

79.

Jankowicz-Szymanska

Mikolajczyk

Wojtanowski

(2012). The effect of physical training on static balance in young people with intellectual disability. Research In Developmental Disabilities, 33(2), 675–681. https://doi.org/10.1016/j.ridd.2011.11.015

80.

Jelle Vuijk

Hartman

Mombarg

Scherder

Visscher

(2011). Associations between academic and motor performance in a heterogeneous sample of children with learning disabilities. Journal of Learning Disabilities, 44(3), 276–282. https://doi.org/10.1177/0022219410378446

81.

Johnson

M. H.

Gliga

Jones

Charman

(2015). Annual research review: Infant development, autism, and ADHD–early pathways to emerging disorders. Journal of Child Psychology and Psychiatry, 56(3), 228–247. https://doi.org/10.1111/jcpp.12328

82.

Karanth

Shaista

Srikanth

(2010). Efficacy of communication DEALL—an indigenous early intervention program for children with autism spectrum disorders. The Indian Journal of Pediatrics, 77(1), 957–962. https://doi.org/10.1007/s12098-010-0144-8

83.

Karimi

Nazi

Sajedi

AKBAR

F. N.

Karimloo

(2010). Comparison the effect of simultaneous sensory stimulation and current occupational therapy approaches on motor development of the infants with Down syndrome. Iranian Journal of Child Neurology, 4(3), 39–44.

84.

Kau

A. S.

Meyer

W. A.

Kaufmann

W. E.

(2002). Early development in males with Fragile X syndrome: A review of the literature. Microscopy Research and Technique, 57(3), 174–178. https://doi.org/10.1002/jemt.10069

85.

Kaur

Bhat

(2019). Creative yoga intervention improves motor and imitation skills of children with autism spectrum disorder. Physical Therapy, 99(11), 1520–1534. https://doi.org/10.1093/ptj/pzz115

86.

Kavlak

Unal

Tekin

Al Sakkaf

A. A. H.

(2022). Comparison of the effectiveness of Bobath and Vojta techniques in babies with Down syndrome: Randomized controlled study. Annals of Clinical and Analytical Medicine, 13(1), 35–39. https://doi.org/10.4328/ACAM.20830

87.

Ketcheson

Staples

Pitchford

E. A.

Loetzner

(2023). Promoting positive health outcomes in an urban community-based physical activity intervention for preschool aged children on the autism spectrum. Journal Of Autism And Developmental Disorders, 53(2), 633–647. https://doi.org/10.1007/s10803-021-04871-7

88.

Kleeren

Hallemans

Hoskens

Klingels

Smits-Engelsman

Verbecque

(2023). A critical view on motor-based interventions to improve motor skill performance in children with ADHD: A systematic review and meta-analysis. Journal of Attention Disorders, 27(4), 354–367. https://doi.org/10.1177/10870547221146244

89.

Kokkoni

(2016). Immediate effects of early environmental enrichment on infant motor behavior through the use of an open-area body-weight support system . Doctoral dissertation. University of Delaware.

90.

Sung

M. C.

(2022). The effects of interventions on motor skills in individuals with down syndrome: A meta-analysis. Journal of Developmental and Physical Disabilities, 34(5), 775–793. https://doi.org/10.1007/s10882-021-09827-4

91.

Lafferty

M. E.

(2005). A stair-walking intervention strategy for children with Down's syndrome. Journal of Bodywork and Movement Therapies, 9(1), 65–74. https://doi.org/10.1016/j.jbmt.2004.01.003

92.

Lee

S. C.

(2022). Comparison of computer-based and therapeutic activity interventions for improving visual motor abilities of preschoolers with autism: A randomized control study. The Open Journal of Occupational Therapy, 10(2), 1–11. https://doi.org/10.15453/2168-6408.1856

93.

Lewis

C. L.

Fragala-Pinkham

M. A.

(2005). Effects of aerobic conditioning and strength training on a child with Down syndrome: A case study. Pediatric Physical Therapy, 17(1), 30–36. https://doi.org/10.1097/01.PEP.0000154185.55735.A0

94.

Lin

H. C.

Wuang

Y. P.

(2012). Strength and agility training in adolescents with Down syndrome: A randomized controlled trial. Research in Developmental Disabilities, 33(6), 2236–2244. https://doi.org/10.1016/j.ridd.2012.06.017

95.

Logan

S. W.

Huang

H. H.

Stahlin

Galloway

J. C.

(2014). Modified ride-on car for mobility and socialization: Single-case study of an infant with Down syndrome. Pediatric Physical Therapy, 26(4), 418–426. https://doi.org/10.1097/PEP.0000000000000070

96.

Looper

Ulrich

D. A.

(2010). Effect of treadmill training and supramalleolar orthosis use on motor skill development in infants with Down syndrome: A randomized clinical trial. Physical Therapy, 90(3), 382–390. https://doi.org/10.2522/ptj.20090021

97.

Lotan

Downs

Elefant

(2021). A pilot study delivering physiotherapy support for Rett syndrome using a telehealth framework suitable for COVID-19 lockdown. Developmental Neurorehabilitation, 24(6), 429–434. https://doi.org/10.1080/17518423.2021.1914762

98.

Lotan

Isakov

Merrick

(2004). Improving functional skills and physical fitness in children with Rett syndrome. Journal of Intellectual Disability Research, 48(8), 730–735. https://doi.org/10.1111/j.1365-2788.2003.00589.x

99.

Lydic

J. S.

Windsor

M. M.

Short

M. A.

Ellis

T. A.

(1985). Effects of controlled rotary vestibular stimulation on the motor performance of infants with Down syndrome. Physical & Occupational Therapy In Pediatrics, 5(2–3), 93–118. https://doi.org/10.1300/J006v05n02_07

100.

Mahoney

Robinson

Fewell

R. R.

(2001). The effects of early motor intervention on children with Down syndrome or cerebral palsy: A field-based study. Journal of Developmental & Behavioral Pediatrics, 22(3), 153–162. https://doi.org/10.1097/00004703-200106000-00001

101.

Maïano

Hue

Lepage

Morin

A. J.

Tracey

Moullec

(2019). Do exercise interventions improve balance for children and adolescents with Down syndrome? A systematic review. Physical Therapy, 99(5), 507–518. https://doi.org/10.1093/ptj/pzz012

102.

Majorek

Tüchelmann

Heusser

(2004). Therapeutic eurythmy—movement therapy for children with attention deficit hyperactivity disorder (ADHD): A pilot study. Complementary Therapies in Nursing and Midwifery, 10(1), 46–53. https://doi.org/10.1016/S1353-6117(03)00087-8

103.

Marcus

Sinnott

Bradley

Grey

(2010). Treatment of idiopathic toe-walking in children with autism using GaitSpot auditory speakers and simplified habit reversal. Research in Autism Spectrum Disorders, 4(2), 260–267. https://doi.org/10.1016/j.rasd.2009.09.012

104.

Martin

(2004). Effects of supramalleolar orthoses on postural stability in children with Down syndrome. Developmental Medicine And Child Neurology, 46(6), 406–411. https://doi.org/10.1017/S0012162204000659

105.

Martínez

Antón

(2018). Effects of a psychomotor intervention programme in preadolescents with Down syndrome/efectos de un programa de intervención psicomotriz en preadolescentes con síndrome de down. Infancia y Aprendizaje, 41(1), 165–199. https://doi.org/10.1080/02103702.2017.1401301

106.

Marzouki

Soussi

Selmi

Hajji

Marsigliante

Bouhlel

Knechtle

(2022). Effects of aquatic training in children with autism spectrum disorder. Biology, 11(5), 657. https://doi.org/10.3390/biology11050657

107.

Mayall

L. A.

D’Souza

Hill

E. L.

Karmiloff-Smith

Tolmie

Farran

E. K.

(2021). Motor abilities and the motor profile in individuals with Williams syndrome. Advances in Neurodevelopmental Disorders, 5(1), 46–60. https://doi.org/10.1007/s41252-020-00173-8

108.

McElearney

Fitzpatrick

Farrell

King

Lynch

(2005). Stimulant medication in ADHD: What do children and their parents say? Irish Journal of Psychological Medicine, 22(1), 5–9. https://doi.org/10.1017/S0790966700008715

109.

McGuire

Long

Esbensen

A. J.

Bailes

A. F.

(2019). Adapted dance improves motor abilities and participation in children with Down syndrome: A pilot study. Pediatric Physical Therapy, 31(1), 76–82. https://doi.org/10.1097/PEP.0000000000000559

110.

Milligan

Glanzman

Waasdorp

Kinslow

Hagenbaugh

Pipan

Palombaro

(2022). The benefits of group aquatic therapy for young children with down syndrome. The Journal of Aquatic Physical Therapy, 30(1), 12–21. https://doi.org/10.1097/PXT.0000000000000011

111.

Moriello

Terpstra

M. E.

Earl

(2020). Outcomes following physical therapy incorporating hippotherapy on neuromotor function and bladder control in children with Down syndrome: A case series. Physical & Occupational Therapy in Pediatrics, 40(3), 247–260. https://doi.org/10.1080/01942638.2019.1615601

112.

Mraz

Eisenberg

Diener

Amadio

Foreman

M. H.

Engsberg

J. R.

(2016). The effects of virtual reality on the upper extremity skills of girls with Rett syndrome: A single case study. Journal of Intellectual Disability-Diagnosis and Treatment, 4(3), 152–159. https://doi.org/10.6000/2292-2598.2016.04.03.2

113.

Murrah

W. M.

(2010). Comparing self-regulatory and early academic skills as predictors of later math, Reading, and science elementary school achievement. In Dissertation abstracts international section A: Humanities and social sciences (pp. 53–61). ProQuest Information & Learning.

114.

Najafabadi

M. G.

Sheikh

Hemayattalab

Memari

A. H.

Aderyani

M. R.

Hafizi

(2018). The effect of SPARK on social and motor skills of children with autism. Pediatrics & Neonatology, 59(5), 481–487. https://doi.org/10.1016/j.pedneo.2017.12.005

115.

Norouzi

Soleymani

Abedanzadeh

(2022). Dohsa-hou training improves bimanual coordination among children with Down syndrome. International Journal of Developmental Disabilities, 69(6), 926–935.

116.

Odeh

C. E.

Martell

Griffin

Johnson

E. R.

Gladfelter

A. L.

Odeh

C. E.

Gladfelter

A. L.

(2020). Motor-based interventions improve language outcomes in children with autism: A systematic review. Clinical Archives of Communication Disorders, 5(1), 1–7. https://doi.org/10.21849/cacd.2020.00192

117.

Okada

Uejo

Hirano

Nishi

Matsuno

Muramatsu

Ishikawa

(2019). Assessing the efficacy of very early motor rehabilitation in children with down syndrome. The Journal of Pediatrics, 213(1), 227–231. https://doi.org/10.1016/j.jpeds.2019.05.038

118.

Oudgenoeg-Paz

(2014). Walk this way, Talk this way. Motor skills, spatial exploration, and the development of spatial cognition and language . Doctoral dissertation. Utrecht University.

119.

Özbeşer

Tüzün

E. H.

Dericioğlu

Övgün

ÇD

(2022). Effects of cognitive orientation to daily occupational performance and conductive education treatment approaches on fine motor skills, activity and participation limitations in children with Down syndrome: A randomised controlled trial. Journal of Autism and Developmental Disorders, 54(1), 168–181. https://doi.org/10.1007/s10803-022-05781-y

120.

Page

M J

Mckenzie

J E

Bossuyt

P M

Boutron

Hoffmann

T C

Mulrow

C D

Shamseer

Tetzlaff

J. M.

Akl

E. A.

Brennan

S. E.

Chou

Glanville

Grimshaw

J. M.

Hróbjartsson

Lalu

M. M.

Loder

E. W.

Mayo-Wilson

, ... Moher

(2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372(71), 1–9.

121.

Pan

C. Y.

(2010). Effects of water exercise swimming program on aquatic skills and social behaviors in children with autism spectrum disorders. Autism, 14(1), 9–28. https://doi.org/10.1177/1362361309339496

122.

Pan

C. Y.

(2011). The efficacy of an aquatic program on physical fitness and aquatic skills in children with and without autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 657–665. https://doi.org/10.1016/j.rasd.2010.08.001

123.

Pan

C. Y.

Chang

Y. K.

Tsai

C. L.

Chu

C. H.

Cheng

Y. W.

Sung

M. C.

(2017). Effects of physical activity intervention on motor proficiency and physical fitness in children with ADHD: An exploratory study. Journal Of Attention Disorders, 21(9), 783–795. https://doi.org/10.1177/1087054714533192

124.

Pan

C. Y.

Chu

C. H.

Tsai

C. L.

S. Y.

Cheng

Y. W.

Liu

Y. J.

(2016). A racket-sport intervention improves behavioral and cognitive performance in children with attention-deficit/hyperactivity disorder. Research in Developmental Disabilities, 57(1), 1–10. https://doi.org/10.1016/j.ridd.2016.06.009

125.

Pan

C. Y.

Tsai

C. L.

Chu

C. H.

Sung

M. C.

Huang

C. Y.

W. Y.

(2019). Effects of physical exercise intervention on motor skills and executive functions in children with ADHD: A pilot study. Journal of Attention Disorders, 23(4), 384–397. https://doi.org/10.1177/1087054715569282

126.

Panigrahy

C. N.

Dandekar

R. V.

(2021). Effect of bimanual activities on hand and proprioception in autism spectrum disorder. Indian Journal of Public Health Research & Development, 12(2), 80–83. https://doi.org/10.37506/ijphrd.v12i2.14098

127.

Perić

D. B.

Milićević-Marinković

Djurović

(2022). The effect of the adapted soccer programme on motor learning and psychosocial behaviour in adolescents with Down syndrome. Journal of Intellectual Disability Research, 66(6), 533–544. https://doi.org/10.1111/jir.12881

128.

Pinero-Pinto

Benítez-Lugo

M. L.

Chillón-Martínez

Rebollo-Salas

Bellido-Fernández

L. M.

Jiménez-Rejano

J. J.

(2020). Effects of massage therapy on the development of babies born with Down syndrome. Evidence-Based Complementary and Alternative Medicine, 2020(1), 1–9. https://doi.org/10.1155/2020/4912625

129.

Raghupathy

M. K.

Divya

Karthikbabu

(2022). Effects of traditional Indian dance on motor skills and balance in children with Down syndrome. Journal of Motor Behavior, 54(2), 212–221. https://doi.org/10.1080/00222895.2021.1941736

130.

Rahman

S. A. A.

Shaheen

A. A.

(2010). Efficacy of weight bearing exercises on balance in children with Down syndrome. Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 47(1), 37–42.

131.

Rodger

Brandenburg

(2009). Cognitive orientation to (daily) occupational performance (CO-OP) with children with Asperger's syndrome who have motor-based occupational performance goals. Australian Occupational Therapy Journal, 56(1), 41–50. https://doi.org/10.1111/j.1440-1630.2008.00739.x

132.

Rodríguez-Grande

E. I.

Buitrago-López

Torres-Narváez

M. R.

Serrano-Villar

Verdugo-Paiva

Ávila

(2022). Therapeutic exercise to improve motor function among children with Down syndrome aged 0 to 3 years: A systematic literature review and meta-analysis. Scientific Reports, 12(1), 13051. https://doi.org/10.1038/s41598-022-16332-x

133.

Rubin

D. A.

Wilson

K. S.

Tucker

J. M.

Castner

D. M.

Dumont-Driscoll

M. C.

Rose

D. J.

(2021). Improved motor proficiency and quality of life in youth with prader–willi syndrome and obesity 6 months after completing a parent-led, game-based intervention. Pediatric Exercise Science, 33(4), 177–185. https://doi.org/10.1123/pes.2020-0160

134.

Ruggeri

Dancel

Johnson

Sargent

(2020). The effect of motor and physical activity intervention on motor outcomes of children with autism spectrum disorder: A systematic review. Autism, 24(3), 544–568. https://doi.org/10.1177/1362361319885215

135.

Russell

D. J.

Rosenbaum

Wright

Avery

L. M.

(2002). Gross motor function measure (GMFM-66 & GMFM-88) Users Manual. Mac Keith Press.

136.

Salgueiro

Nunes

Barros

Maroco

Salgueiro

A. I.

Dos Santos

M. E.

(2012). Effects of a dolphin interaction program on children with autism spectrum disorders–an exploratory research. BMC Research Notes, 5(1), 1–8. https://doi.org/10.1186/1756-0500-5-199

137.

Sanz Aparicló

M. T

. (1988). Effect of observational training of parents in the early stimulation of trisomy-21 babies. Early Child Development and Care, 41(1), 89–101. https://doi.org/10.1080/0300443880410108

138.

Sarabzadeh

Azari

B. B.

Helalizadeh

(2019). The effect of six weeks of tai chi chuan training on the motor skills of children with autism Spectrum disorder. Journal of Bodywork and Movement Therapies, 23(2), 284–290. https://doi.org/10.1016/j.jbmt.2019.01.007

139.

Satiansukpong

Pongsaksri

Sasat

(2016). Thai elephant-assisted therapy programme in children with Down syndrome. Occupational Therapy International, 23(2), 121–131. https://doi.org/10.1002/oti.1417

140.

Schleien

S. J.

Heyne

L. A.

Berken

S. B.

(1988). Integrating physical education to teach appropriate play skills to learners with autism: A pilot study. Adapted Physical Activity Quarterly, 5(3), 182–192. https://doi.org/10.1123/apaq.5.3.182

141.

Schurink

Hartman

Scherder

E. J. A.

Houwen

Visscher

(2012). Relationship between motor and executive functioning in school-age children with pervasive developmental disorder not otherwise specified. Research in Autism Spectrum Disorders, 6(2), 726–732. https://doi.org/10.1016/j.rasd.2011.10.013

142.

Shaffer

R. J.

Jacokes

L. E.

Cassily

J. F.

Greenspan

S. I.

Tuchman

R. F.

Stemmer

P. J.

Jr (2001). Effect of interactive metronome® training on children with ADHD. The American Journal of Occupational Therapy, 55(2), 155–162. https://doi.org/10.5014/ajot.55.2.155

143.

Silva

L. M.

Schalock

Garberg

Smith

C. L.

(2012). Qigong massage for motor skills in young children with cerebral palsy and Down syndrome. The American Journal of Occupational Therapy, 66(3), 348–355. https://doi.org/10.5014/ajot.2012.003541

144.

Steiner

Kertesz

(2012, December). Effect of therapeutic riding on gait cycle parameters and behavioural skills of autistic children. In 2012 IEEE 3rd International Conference on Cognitive Infocommunications (CogInfoCom). (pp. 109–113). IEEE.

145.

Toomey

S. L.

Sox

C. M.

Rusinak

Finkelstein

J. A.

(2012). Why do children with ADHD discontinue their medication? Clinical Pediatrics, 51(8), 763–769. https://doi.org/10.1177/0009922812446744

146.

Ulrich

D. A.

Burghardt

A. R.

Lloyd

Tiernan

Hornyak

J. E.

(2011). Physical activity benefits of learning to ride a two-wheel bicycle for children with Down syndrome: A randomized trial. Physical Therapy, 91(10), 1463–1477. https://doi.org/10.2522/ptj.20110061

147.

Ulrich

D. A.

Lloyd

M. C.

Tiernan

C. W.

Looper

J. E.

Angulo-Barroso

R. M.

(2008). Effects of intensity of treadmill training on developmental outcomes and stepping in infants with Down syndrome: A randomized trial. Physical Therapy, 88(1), 114–122. https://doi.org/10.2522/ptj.20070139

148.

Ulrich

D. A.

Sanford

C. B.

(1985). Test of gross motor development. Pro-ed.

149.

Ulrich

D. A.

Ulrich

B. D.

Angulo-Kinzler

R. M.

Yun

(2001). Treadmill training of infants with down syndrome: Evidence-based developmental outcomes. Pediatrics, 108(5), e84–e84. https://doi.org/10.1542/peds.108.5.e84

150.

Uyanik

Bumin

Kayihan

HÜLYA

(2003). Comparison of different therapy approaches in children with Down syndrome. Pediatrics International, 45(1), 68–73. https://doi.org/10.1046/j.1442-200X.2003.01670.x

151.

Van Balkom

I. D.

Vuijk

P. J.

Franssens

Hoek

H. W.

Hennekam

R. C.

(2012). Development, cognition, and behaviour in Pitt–Hopkins syndrome. Developmental Medicine & Child Neurology, 54(10), 925–931. https://doi.org/10.1111/j.1469-8749.2012.04339.x

152.

Van der Oord

Prins

P. J.

Oosterlaan

Emmelkamp

P. M.

(2008). Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: A meta-analysis. Clinical Psychology Review, 28(5), 783–800. https://doi.org/10.1016/j.cpr.2007.10.007

153.

Vygotsky

L.S.

(1967). Play and its role in the mental development of the child. Soviet Psychology, 5(3), 6–18. https://doi.org/10.2753/RPO1061-040505036

154.

Wang

W. Y.

Y. H.

(2002). Promoting balance and jumping skills in children with Down syndrome. Perceptual and Motor Skills, 94(2), 443–448. https://doi.org/10.2466/pms.2002.94.2.443

155.

Weas

Pawlowski

Miller

DePillis

Baumer

(2024). Psychotropic medication prescription patterns in Down syndrome in a large pediatric specialty clinic. Journal of Child and Adolescent Psychopharmacology. https://doi.org/10.1089/cap.2024.0028

156.

Weber

R. C.

Thorpe

(1989). Comparison of task variation and constant task methods for severely disabled in physical education. Adapted Physical Activity Quarterly, 6(4), 338–353. https://doi.org/10.1123/apaq.6.4.338

157.

Weerdmeester

Cima

Granic

Hashemian

Gotsis

(2016). A feasibility study on the effectiveness of a full-body videogame intervention for decreasing attention deficit hyperactivity disorder symptoms. Games For Health Journal, 5(4), 258–269. https://doi.org/10.1089/g4h.2015.0103

158.

Wentz

E. E.

(2017). Importance of initiating a “tummy time” intervention early in infants with Down syndrome. Pediatric Physical Therapy, 29(1), 68–75. https://doi.org/10.1097/PEP.0000000000000335

159.

Westendorp

Houwen

Hartman

Mombarg

Smith

Visscher

(2014). Effect of a ball skill intervention on children’s ball skills and cognitive functions. Medicine and Science in Sports and Exercise, 46(2), 414. https://doi.org/10.1249/MSS.0b013e3182a532b3

160.

Winchester

Kendall

Peters

Sears

Winkley

(2002). The effect of therapeutic horseback riding on gross motor function and gait speed in children who are developmentally delayed. Physical & Occupational Therapy In Pediatrics, 22(3–4), 37–50. https://doi.org/10.1300/J006v22n03_04

161.

Looper

Ulrich

D. A.

Angulo-Barroso

R. M.

(2010). Effects of various treadmill interventions on the development of joint kinematics in infants with Down syndrome. Physical Therapy, 90(9), 1265–1276. https://doi.org/10.2522/ptj.20090281

162.

Looper

Ulrich

B. D.

Ulrich

D. A.

Angulo-Barroso

R. M.

(2007). Exploring effects of different treadmill interventions on walking onset and gait patterns in infants with Down syndrome. Developmental Medicine & Child Neurology, 49(11), 839–945. https://doi.org/10.1111/j.1469-8749.2007.00839.x

163.

Ulrich

D. A.

Looper

Tiernan

C. W.

Angulo-Barroso

R. M.

(2008). Strategy adoption and locomotor adjustment in obstacle clearance of newly walking toddlers with Down syndrome after different treadmill interventions. Experimental Brain Research, 186(1), 261–272. https://doi.org/10.1007/s00221-007-1230-7

164.

Wuang

Y. P.

Chiang

C. S.

C. Y.

Wang

C. C.

(2011). Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome. Research in Developmental Disabilities, 32(1), 312–321. https://doi.org/10.1016/j.ridd.2010.10.002

165.

Xie

Gao

Song

Zhu

Chen

Yang

Ren

(2021). Effectiveness of physical activity intervention on ADHD symptoms: A systematic review and meta-analysis. Frontiers in Psychiatry, 12(706625), 1–12. https://doi.org/10.3389/fpsyt.2021.706625

166.

Yilmaz

Yanardağ

Birkan

Bumin

(2004). Effects of swimming training on physical fitness and water orientation in autism. Pediatrics International, 46(5), 624–626. https://doi.org/10.1111/j.1442-200x.2004.01938.x

167.

Young

A. J.

(2017). Effect of adapted physical education and homework on gross motor development for young children with down syndrome (Doctoral dissertation. Texas Woman's University).

168.

Zoccante

Marconi

Ciceri

M. L.

Gagliardoni

Gozzi

L. A.

Sabaini

Colizzi

(2021). Effectiveness of equine-assisted activities and therapies for improving adaptive behavior and motor function in autism spectrum disorder. Journal of Clinical Medicine, 10(8), 1726. https://doi.org/10.3390/jcm10081726

Non-pharmacological interventions targeting motor difficulties in neurodivergent children: A systematic review

Abstract

Lay Abstract

Keywords

Objectives

Methodology

Pre-registration

Inclusion criteria and study selection

Results

Objective 1: What are the common characteristics of effective interventions focused on motor skills? And what are the common characteristics of ineffective interventions?

Objective 2: What skills are targeted in these interventions?

Objective 3: How is motor delay assessed prior to intervention?

Objective 4: Which skills demonstrate improvement?

Objective 5: Are these interventions transferrable for non-clinical persons to use outside of a laboratory setting, if effective?

Discussion

Evidence synthesis

Limitations

Future directions

Footnotes

Acknowledgements

Declaration of conflicting interests

Funding

ORCID iD

References