Exploring how play affects cognitive functioning in children with autism

Step into physical therapy professor Anjana Bhat's colorful Move 2 Learn Innovation Lab on the University of Delaware's Science, Technology and Advanced Research (STAR) Campus, and you may see children moving to the beat or leaping over structures as part of an obstacle course. For them, it's fun and games. But for researchers like Bhat, it's an exploration of how play affects cognitive functioning in children with autism. 

Bhat's intervention research, funded by the Delaware INBRE Pilot Project Award, separated autistic children ages 5 to 15 into two groups: a whole-body movement group and a sedentary play group. 

Children in the movement group participated in a gross motor intervention involving full-body exercise.

There was a lot of decision-making involved. Children can choose to jump over cups or leap over spots. The child had to make these choices ahead of time and cycle through the activity."

Anjana Bhat, University of Delaware

Sometimes music played, and children had to move in sync with an adult.

They'd make music with drums, bells and cymbals, or dance with an adult who switched between moving fast and slow, Bhat said. 

Meanwhile, children in the sedentary play group engaged in seated activities like building with blocks, arts and crafts, or reading. 

Research published in the journal Disability and Rehabilitation found that children who engaged in whole-body movement saw improved executive functioning.

"These are the skills required in daily life to make decisions and choices about how to do an activity with multiple parts," Bhat said. "It requires a lot of thinking ahead so the task becomes fluid."

Bhat also noted that exercise increases blood supply to the prefrontal cortex - the part of the brain involved in executive functioning. 

"That's another reason we may see generally improved cognitive performance following exercise," she said. 

No improvements in cognitive function were observed in the sedentary play group. 

The study, which spanned from 2020 to 2022, included children who participated either face-to-face or via telehealth. 

"Positive outcomes were seen across both subgroups, proving the intervention is effective whether delivered via Zoom or in person," Bhat said.

Next, Bhat hopes to use these findings to obtain federal funding for a larger study that uses neuroimaging to validate behavioral findings.

Why movement matters

Executive functioning and cognitive performance are linked to behavior.

"Past research shows that in children with autism, those with better executive functioning present with fewer negative and repetitive behaviors," Bhat said. "That association was also seen in our study."

In a separate exergaming study, Bhat observed similar positive impacts on improved executive function as children played sports games using Ring Fit, further reinforcing the connection between movement and cognitive gains.

Despite these promising findings, Bhat says children with autism often receive occupational therapy (OT) focused mainly on fine motor skills and emotional regulation, while gross motor challenges are largely overlooked.

"Physical therapists don't get referrals for autism, and gross motor issues in this population are largely unaddressed, and the issues extend into adulthood," Bhat said. 

Kamryn Lombardi, a 2023 graduate of UD's College of Health Sciences integrated health sciences program, obtained her master's in OT from Thomas Jefferson University. At UD, she worked on this research in Bhat's lab and now incorporates movement breaks into her practice as a pediatric occupational therapist. 

"Incorporating movement-based activities even when we're working on fine motor skills contributes to enhancing engagement," Lombardi said. "Improving their ability to focus enhances their ability to participate in therapy and work toward their goals."

It's still unclear whether the cognitive benefits of whole-body movement extend into children's daily lives outside structured sessions. However, Bhat's findings show the need for more movement breaks in school settings. 

"Post-exercise, you will see improved attention span and learning ability," Bhat said. "I don't think it's happening enough, especially at the middle-school level. As students get older, physical education time is reduced, resulting in students spending more sedentary time in the classroom."

For Fei Shan, the benefits of movement are clear. As a mother of two boys with autism who have participated in Bhat's movement studies, she has witnessed firsthand how movement positively impacts her children's daily lives.

"We hike, swim and do Taekwondo. Movement has been life-changing for my children," Shan said. "Even 20 minutes daily makes them more in sync and more focused on their daily tasks."