Background: Given the types of symptoms present in individuals with autism spectrum disorder (ASD), interventions should address deficits in motor control, social interactions, and emotional intelligence. Alternative interventions, such as exercise video gaming (exergaming) and dance movement therapy, may address these deficits in an engaging, age-appropriate manner, thus meeting the unique needs of adolescents with ASD.

Objectives: The purpose of this paper was first, to review the current literature on ASD for innovative movement strategies feasible to address emotional, social, cognitive, and physical outcomes for adolescents ages 11-18; and second, to determine the effectiveness of these interventions.

Methods: The databases used were: Pubmed, Cochrane Library, Web of Science, EMBASE, CINAHL, Psycinfo, REHABDATA, Human Kinetics Journal, and PEDro. Search terms included: autism or autism spectrum disorder; and dance, dancing or dance therapy, or exergaming, exergame, video gaming or video game. Selected articles were published in the last 10 years, written in English, and included subjects with ASD who participated in dance or exergaming interventions. After the initial screening of articles with relevant titles and abstracts, we included studies with evidence levels of 1-4.

Results: Five dance therapy intervention studies showed moderate effectiveness for social and emotional outcomes such as empathy skills, emotional regulation, and negative symptoms of ASD. Four exergaming studies had moderate effectiveness for motor and physical outcomes, such as energy expenditure and perceived object control.

Implications: Based on the review of dance and exergaming intervention studies, the authors recommend providing the interventions to selected clients depending on individual circumstances. Both dance and exergaming may be cost-effective and feasible in school settings. Future studies should include larger and more diverse samples with rigorous randomization procedures.

Cited References

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 74(Suppl. 2). https://doi.org/10.5014/ajot.2020.74S2001

American Psychiatric Association. (2013). Autism spectrum disorder. In Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596

Balshem, H., Helfan, M., Schunemann, H. J., Oxman, A.D., Kunz, R. Brozek, J., Vist, G. E., Falck-Ytter, Y., Meerpohl, J., Norris, S., & Guyatt, G. H. (2011). GRADE guidelines: 3. Rating the quality of evidence. Journal of clinical epidemiology, 64(4), 401-406.https://doi.org/10.1016/j.jclinepi.2010.07.015

Centers for Disease Control and Prevention. (2020, March 25). Data and Statistics on Autism Spectrum Disorder. https://www.cdc.gov/ncbddd/autism/data.html

DePoy, E., & Gitlin, L.N. (2011). Language and Thinking Processes. In Introduction to research: Understanding and applying multiple strategies (4th ed.). Mosby.

Edwards, J., Jeffery, S., May, T., 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

El Shemy, S. A., & El-Sayed, M. S. (2018). The impact of auditory rhythmic cueing on gross motor skills in children with autism. The Journal of Physical Therapy Science, 30(8), 1063-1068. https://doi.org/10.1589/jpts.30.1063

Fang, Q., Aiken, C. A., Fang, C., & Pan, Z. (2019). Effects of exergaming on physical and cognitive functions in individuals with autism spectrum disorder: A systematic review. Games for Health Journal, 8(2), 74-84. https://doi.org/10.1089/g4h.2018.0032

The GRADE Working Group. (2020). GRADE. https://www.gradeworkinggroup.org

Getchell, N., Miccinello, D., Blom, M., Morris, L., & Szaroleta, M. (2012). Comparing energy expenditure in adolescents with and without autism while playing Nintendo®️ Wii games. Games for Health Journal, 1(1), 58-61. https://doi.org/10.1089/g4h.2011.0019

Guba, E. G. (1981). Criteria for assessing the trustworthiness of naturalistic inquiries. Educational Technology Research and Development, 29(2), 75-91. https://doi-org/10.1007/BF02766777

Healy, S., Nacario, A., Braithwaite, R. E., & Hopper, C. (2018). The effect of physical activity interventions on youth with autism spectrum disorder: A meta-analysis. Autism Research, 11(6), 818–833. https://doi.org/10.1002/aur.1955

Hildebrandt, M. K., Koch, S. C., & Fuchs, T. (2016). “We dance and find each other”: Effects of dance/movement therapy on negative symptoms in autism spectrum disorder. Behavioral Sciences, 6(24), 1-17. https://doi.org/10.3390/bs6040024

Hilton, C. L., Attal, A., Best, J. R., Reistetter, T. A., Trapani, P., & Collins, D. M. (2015). Exergaming to improve physical and mental fitness in children and adolescents with autism spectrum disorders: Pilot study. International Journal of Sports and Exercise Medicine, 1(3), 1-6. https://doi.org/10.5014/ajot.2015.69S1-PO3095

Koch, S. C., Mehl, L., Sobanski, E., Sieber, M., & Fuchs, T. (2015). Fixing the mirrors: A feasibility study of the effects of dance movement therapy on young adults with autism spectrum disorder. Autism, 19(3), 338-350. https://doi.org/10.1177/1362361314522353

Koehne, S., Behrends, A., Fairhurst, M. T., & Dziobek, I. (2016). Fostering social cognition through an imitation-and synchronization-based dance/movement intervention in adults with autism spectrum disorder: A controlled proof-of-concept study. Psychotherapy and Psychosomatics, 85(1), 27-35. https://doi.org/10.1159/000441111

Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., Christensen, D. L., Wiggins, L. D., Pettygrove, S., Andrews, J. G., Lopez, M., Hudson, A., Baroud T., Schwenk, Y., White, T., Rosenberg, C.R., Lee, L., Harrington, R.A., Huston, M., ...Dietz, P. M. (2020). Prevalence of autism spectrum disorder among children aged 8 years - Autism and developmental disabilities monitoring network, 11 sites, United States, 2016. Morbidity and Mortality Weekly Report (MMWR) Surveillance Summaries, 69(4), 1-12. https://doi.org/10.15585/mmwr.ss6904a1

Mallidou, A. A., Atherton, P., Chan, L., Frisch, N., Glegg, S., & Scarrow, G. (2018). Core knowledge translation competencies: A scoping review. BMC Health Services Research, 18(502), 1-15. https://doi.org/10.1186/s12913-018-3314-4

Mateos-Moreno, D., & Atencia-Dona, L. (2013). Effect of a combined dance/movement and music therapy on young adults diagnosed with severe autism. The Arts in Psychotherapy, 40(5), 465-472. https://doi.org/10.1016/j.aip.2013.09.004

Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement, 6(7), 1000097. https://doi:10.1371/journal.pmed1000097

Morse, J. M., Barrett, M., Mayan, M., Olson, K., & Spiers, J. (2002). Verification strategies for establishing reliability and validity in qualitative research. International Journal of Qualitative Methods, 1(2), 13-22. https://doi.org/10.1177/160940690200100202

Oerlemans, A. M., Rommelse, N. N. J., Buitelaar, J. K., & Hartman, C. A. (2018). Examining the intertwined development of prosocial skills and ASD symptoms in adolescence. European Child and Adolescent Psychiatry, 27, 1033-1046. https://doi.org/10.1007/s00787-018-1114-3

Oxford Centre for Evidence-Based Medicine. (2009, March). Oxford centre for evidence based medicine: Levels of evidence (March 2009). https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009

Travers, B. G., Mason, A. H., Mrotek, L. A., Ellertson, A., Dean, D. C., Engel, C., Gomez, A., Dadalko, O. I., & McLaughlin, K. (2018). Biofeedback-based, video game balance training in autism. Journal of Autism and Developmental Disorders, 48(1), 163-175. https://doi.org/10.1007%2Fs10803-017-3310-2

University of Illinois at Chicago. (2017). Critical appraisal template for research articles – Form A [Lesson Content]. BlackBoard Learn. Reprinted with permission.