Motor development delays affect a substantial majority of children with autism spectrum disorder, yet structured physical activity remains underutilized as a therapeutic tool. A systematic review now synthesizes the best available controlled-trial evidence on whether organized sports — not generalized physical education — can meaningfully shift gross motor trajectories in this population, offering a potential complement to behavioral and communication-focused interventions.
The review analyzed eleven studies — six randomized controlled trials and five non-randomized controlled trials — published through November 2025, encompassing martial arts, aquatic training, gymnastics, trampoline, and other sport modalities. Effect sizes for the most responsive outcomes were striking in magnitude: balance improvements ranged from d = 0.18 to 4.99, object control skills from d = 1.10 to 3.83, locomotor skill scores from d = 0.63 to 2.02, and total motor composite scores from d = 0.61 to 3.90. Martial arts and aquatic training produced the most consistent moderate-to-large effects across multiple motor domains, suggesting that structured, repetitive, sensory-rich movement environments may be particularly well-suited to children with ASD.
The findings are directionally encouraging but must be interpreted cautiously. Risk of bias was rated high in five of the six RCTs and serious or critical in four of the five non-randomized studies — a significant methodological concern that limits causal inference. The field is also hampered by small sample sizes, heterogeneous outcome measures, and the absence of standardized intervention protocols, making cross-study comparisons imprecise. From a broader landscape perspective, motor skill deficits in ASD are now understood to interact bidirectionally with social participation and adaptive behavior, meaning motor gains could carry downstream psychosocial benefits — a hypothesis that future research should explicitly test. This review is best classified as confirmatory and incremental: it reinforces clinical intuition around sports-based programming for ASD while underscoring that rigorous, adequately powered trials with standardized protocols remain urgently needed before strong evidence-based recommendations are possible.
