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. 2021 Feb 5;11(2):195. doi: 10.3390/brainsci11020195

Impacts of Participation in Community-Based Physical Activity Programs on Cognitive Functions of Children and Youth with Neurodevelopmental Disabilities: A Scoping Review

Mojgan Gitimoghaddam 1,2, Leigh M Vanderloo 3,4, Rebecca Hung 5, Andrea Ryce 6, William McKellin 7, Anton Miller 1,2,6, Jean-Paul Collet 1,2,*
Editor: James Brasic
PMCID: PMC7916019  PMID: 33562519

Abstract

This review paper aimed to undertake an extensive exploration of the extent, range, and nature of research activities regarding the effect and emerging evidence in the field of physical activity interventions on cognitive development among children and youth (0–17.99 years) with neurodevelopmental disorders (NDD), and to help identify key gaps in research and determine precise research questions for future investigations. To carry out this scoping review, five electronic databases were searched. A total of 12,097 articles were retrieved via search efforts with an additional 93 articles identified from the identified review papers. Sixty articles were eligible for inclusion. The results of this scoping review revealed many positive key cognitive outcomes related to physical activity including, but not limited to: focus, attention, self-control, cognitive process, and alertness. No studies reported a negative association between physical activity and cognitive outcomes. Based on the findings from this scoping review, physical activity appears to have a favorable impact on the cognitive outcomes of children and youth with NDD.

Keywords: physical activity, cognition, neurodevelopmental disorders, children and youth

1. Introduction

The prevalence of neurodevelopmental disabilities (NDD) among children continues to grow. In the United States and Canada, approximately 10–17% of the pediatric population (4–14 years) is diagnosed with NDD [1] including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), cerebral palsy (CP), development coordination disorder (DCD), or fetal alcohol spectrum disorder (FASD), to name a few. NDD are widely defined as a “group of congenital or acquired long-term conditions that are attributed to impairment of the brain and/or neuromuscular system and create functional limitations” [2]. The impairments and dysfunctions associated with NDD are usually associated with significant consequences for children, families, and society [3,4,5,6].

Physical activity provides numerous health benefits for children [7,8]. Due to physical and psychosocial limitations, children with NDD are often less active than their typically developing peers. Less frequent participation in physical activity may manifest as missed opportunities to positively impact various health outcomes including the development of motor skills, social learning, and mental wellness [9,10,11,12,13,14,15,16]. Families of children with NDD often report the desire to identify community-based physical activity programs aimed at stimulating cognitive development and improving self-control, autonomy, social integration, and quality of life. While this type of program has been found to be associated with a range of benefits for children, variations in research design, populations studied, intervention type, and outcomes measured have made determining the true effects of this type of program difficult.

To our knowledge, no in-depth review has been conducted to explore the existing literature regarding the multiple types of community-based physical activity programs for children with varieties of NDD, and the different types of outcomes studied. A scoping review of the literature was conducted to examine the impact of physical activity on the cognitive function of children with NDD, identify the most promising interventions, and clarify existing gaps and inconsistencies in the literature. More specifically, this manuscript aimed to: (a) investigate the extent, range, and nature of research activities regarding the effect and emerging evidence in the field of physical activity interventions on cognitive development among children and youth with NDD, and (b) help identify key gaps in research and determine precise research questions for future investigations. Collectively, this information will also help to determine the value of conducting further systematic reviews and meta-analyses.

2. Materials and Methods

According to Colquhoun et al., “a scoping review is a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in research related to a defined area or field by systematically searching, selecting, and synthesizing existing knowledge” (p. 1293, [17]). Guiding documents by Tricco et al. [18] were utilized for direction. A health research librarian with expertise in literature reviews (A.R.) provided guidance at all stages of this review.

2.1. Search Strategy

The following electronic databases were searched: PubMed, MEDLINE (EBSCOhost), CINAHL, PsycINFO, and ERIC (Education Resources Information Center). Search terms representing physical activity or specific activities such as exercise, recreation therapy, physical activity, and sport were combined with search terms representing NDD or specific conditions such as neurodevelopmental disorders, cerebral palsy, intellectual disability, autism spectrum disorder, and fetal alcohol spectrum disorder. Controlled vocabulary was incorporated into the search strategy to increase the breadth and relevance of the articles retrieved. The searches were limited by date from 1995 to 2017. No limits were set on type of publication. Only English language articles were included. See Appendix A for a search strategy for each database.

2.2. Selection Criteria

We used “population” and “intervention” criteria of PICO (Population, Intervention, Comparison, Outcome) to guide the selection of articles for this scoping review. We did not use “outcome” since it was one objective of our scoping review to identify the measured outcomes. We also did not use “comparison” as we did not want to limit the scope of our review by this restriction. Articles were eligible for inclusion if they focused on children and youth aged 0–17.99 years with NDD (e.g., ADHD, ASD, CP, FASD, DCD, intellectual disabilities, etc.). We adopted a non-categorical approach that focuses on children’s needs rather than disease category. When parents decide to send their child to a physical activity program in the community, they share the same need, whatever the disease. Therefore, we did not try to identify how the diagnosis of disease was made in the different studies we analyzed in the scoping review. All types of physical activity programs were of interest (e.g., sport, exercise, physical activity, equine-assisted therapy, dance, music, leisure, etc.) as long as they were offered in the context of community-based programs. Outcomes were not pre-specified in order to identify all outcomes used in different studies. Medically based rehabilitation programs (e.g., physiotherapy or occupational therapy) were excluded because they are attached to a specific domain of practice; although effective, these interventions are limited by their domain-specific boundaries. For instance, therapeutic sessions are provided individually, which limits the child’s interactions with other children. In addition, studies with an intervention duration of less than four weeks were excluded as they were unlikely to have long lasting effects; furthermore, these short programs are often offered in the context of holiday camps and the whole special context makes it difficult to identify the effects of physical activity from the broader effects of attending the camp. Primary research studies and dissertations were included: books, letters to the editor, commentary, and protocol papers were not included. For review papers, their selected articles have been screened and relevant papers have been selected for our scoping review.

2.3. Screening Process and Study Selection

Figure 1 outlines the screening process. Once the articles were identified and retrieved from the online databases and the selected articles from review papers were added, all documents were exported to RefWorks (a reference management software). Duplicates were manually removed using the referencing software. Using the pre-established selection criteria, the titles and abstracts of all retrieved articles were reviewed by two independent researchers. Retained papers were then reviewed in full by the same two independent researchers for inclusion in the review. In instances of disagreement between two reviewers (less than 1% of papers), a third reviewer was brought in as a mediator.

Figure 1.

Figure 1

PRISMA Flow Diagram: Identification, screening, eligibility, and inclusion of studies.

2.4. Data Extraction and Synthesis

Once the full set of included articles was ascertained, the key findings of each paper were mined and presented in a standardized extraction table. Extracted data included: general study information (author, year of publication, country, study design), study aim, population (including sample size), setting and duration, description of exposure, outcomes of interest, measurement tools, and key findings.

Data were synthesized for each study outcome as “improved”, “no change”, “regression”, or “mixed” depending on the findings of the paper. To the best of our abilities, findings were grouped based on age, gender, type of NDD, and type of physical activity exposure.

3. Results

3.1. Identified Studies

Figure 1 outlines the studies identified at each stage of the screening process. A total of 12,097 articles resulted from the initial search, with an additional 93 articles identified from the identified review papers. Upon removal of duplicates, 9243 potentially eligible articles remained. Citations were screened first by title and abstract. Of the 869 articles that made it to the full-text screening, 809 were subsequently removed as they did not meet the eligibility criteria (e.g., did not focus on the health outcome of interest, incorrect age, not published in English language, etc.). A total of 60 studies were deemed eligible for inclusion in this review.

3.2. Description of Included Papers

The publication dates ranged from 1987 to 2017, with most of the articles published in the United States followed by the United Kingdom and conducted mostly in the US followed by Taiwan. Table 1 summarizes the 60 studies included in this review. The mean sample size was 30 children (Standard Deviation (SD) + 25.8) and ranged from 1 to 116; about 75% had a sample size less than 43. The majority of studies (76.7%) focused on the age group of 6–12 years, followed by 13–18 years (18.3%), and 0–5 years (3.3%). Most papers (43.3%) either included male participants only, or more than 90% of their participants were male. This was followed by both male and females (51.7%), and not stated (5%). None of the studies included only females as their participants. The child’s neurodevelopmental diagnosis type varied across studies, with the vast majority focusing on ADHD (38.3%) and ASD (28.3%). Duration of physical activity interventions averaged 14 weeks (SD + 20.6) with about 75% being less than 12 weeks. Accordingly, the average study duration was 17.2 weeks (SD + 23.3) and about 75% of the studies had a duration of less than 20 weeks. There was much variability in study designs: 38.3% were randomized controlled trials (RCTs), 26.7% were quasi-experimental, followed by 13.3% prospective cohort studies, 6.7% single-subject studies, 6.7% qualitative designs, 5% case studies, 1.7% cross-sectional studies, and 1.7% retrospective cohort studies. Type of exposure also varied including physical activity and exercise (43.3%), equine-assisted therapy/hippotherapy (21.7%), yoga (11.7%), sport (11.7%) as the most frequent ones, followed by aqua therapy (5%), martial arts (3.3%), active video games (1.7%), and dance (1.7%). See Table 1 for additional details on each included study.

Table 1.

Summary of study characteristics.

Study Design Sample Size Age Group * Gender ** PD Activity Type and Setting SD Diagnosis Results (Positive [+], Negative/no change [−], Mixed [−/+])
Ahmed et al. (2011)
[19]
RCT 84 13–18 Male and Female 10 Exercise (Included upper limb, lower limb, trunk, and neck aerobic exercises in addition to free running)
Setting: School and home
10 ADHD (+) Attention
Alesi et al. (2014)
[20]
Single subject study design 3 13–18 Male and Female 8 Exercise (Integrated group exercise training with goal setting)
Setting:
Not mentioned
24 Down syndrome (−/+) Working memory
(+) Alertness and speed
Bass et al. (2009)
[16]
Quasi-experimental 34 6–12 Male and Female 12 Equine-assisted therapy Setting:
Good Hope
Equestrian
Training Centre
12 ASD (+) Attention
Borgi et al. (2016)
[21]
RCT 28 6–12 Male 24 Equine-assisted therapy Setting:
Equine-assisted therapy center
24 ASD (+) Planning
Bowling et al. (2017)
[22]
RCT 103 6–12 Male and Female 7 Exercise (Cybercycling during physical education classes)
Setting: School
24 Behavior disorders (+) Self-regulation
Bustamante et al. (2016)
[23]
RCT 35 6–12 Male and Female 10 Exercise (Physically active games and modified sports)
Setting: School
13 Disruptive Behavior disorders and ADHD (+) Cognitive control
(+) Working memory
(+) Cognitive flexibility
Chambers et al. (2016)
[24]
Single subject Study design 5 6–12 Male and Female 4 Exercise (short-burst high-intensity physical exercise such as lunges, side jumps, and Chinese push-ups) Setting: School 4 ADHD (+) Working memory
(+) Attention
Chang et al. (2014)
[25]
Quasi-experimental 27 6–12 Male and Female 8 Aqua therapy
Setting: Local swimming pool
Not Stated ADHD (+) Response inhibition
Choi et al. (2015)
[26]
RCT 50 13–18 Male 6 Exercise (Aerobic exercises consisted of running (shuttle run, zigzag run), jumping rope (individual and group jumps), and basketball (dribble, pass, shoot, and game)
Setting: Not mentioned
6 ADHD (+) Cognitive flexibility
(+) Attention
Chou et al. (2017)
[27]
Quasi-experimental 49 6–12 Male and Female 8 Yoga
Setting: Dance studio
8 ADHD (+) Attention
Cleary et al. (2017)
[28]
Qualitative 28 Students: 13–18 Students: Male and Female 9 Exercise (Included indoor activities (such as treadmill, stationary bicycle, stepping machine) and outdoor activities (such as running, sprinting drills, or cycling in the school grounds)
Setting: School
8 Students’ diagnosis: Cerebral palsy (+) Attention
Cuypers et al. (2011)
[29]
Quasi-experimental 5 6–12 Male 8 Equine-assisted therapy
Setting: Riding School
24 ADHD (+) Attention
Gabriels et al. (2015)
[30]
RCT 116 6–12 Male and Female 10 Equine-assisted therapy
Setting: Riding Centre
14 ASD (+) Self-regulation
Gabriels et al. (2012)
[15]
Quasi-experimental 42 6–12 Male and Female 10 Equine-assisted therapy
Setting: Colorado Therapeutic Riding Centre
18 ASD (+) Self-regulation
Garcia-Gomez et al. (2016)
[31]
Quasi-experimental 14 6–12 Male and Female 13 Equine-assisted therapy
Setting: Monfragüe Equestrian
Centre of Cáceres
Not Stated ADHD (−) Attention
Garcia-Gómez et al. (2014)
[12]
Quasi-experimental 16 6–12 Male and Female 12 Equine-assisted therapy
Setting: Monfragüe Equestrian Centre of Cácere
12 ASD (−) Attention
Garg et al. (2013)
[32]
Prospective cohort study 51 6–12 Male and Female 26 Yoga
Setting: Classroom
26 Multiple handicapping conditions, developmental disabilities, or ASD (+) Self-regulation
(+) Attention
Grönlund et al. (2005)
[33]
Quasi-experimental 2 6–12 Male 12 Dance
Setting: Clinic
12 ADHD (−/+) Attention
Hariprasad et al. (2013)
[34]
Prospective Cohort 9 6–12 Male 8 Yoga
Setting: Child Psychiatry Unit
12 ADHD (+) Attention
Hartshorn et al. (2001)
[35]
Quasi-experimental 38 0–5 Not Stated 8 Exercise (Involved using hoops and jumping in and out of them, putting different body parts
in and out of the hoops, following the therapist through an obstacle course of different shape and different height gym mats, and moving to a tambourine and stopping when the tambourine stopped)
Setting: Not mentioned
8 ASD (+) Attention
Hilton et al. (2014)
[36]
Quasi-experimental 7 6–12 Male and Female 10 Exergame
Setting: Clayton Child Centre
10 ASD (+) Working memory
(+) Alertness and speed
Hulls et al. (2006)
[37]
Cross-sectional 18
occupational therapists
Children: 6–12 Children: Not Stated Activity Type: Aqua therapy
Setting:
Not mentioned
Not Stated ASD (+) Attention
Jang et al. (2015)
[38]
Quasi-experimental 20 6–12 Male 12 Equine-assisted therapy Setting: Equine Facility 14 ADHD (+) Attention
Jenkin et al. (2013)
[39]
Quasi-experimental 7 6–12 Male 8 Equine-assisted therapy
Setting: Reserved are at a riding facility
9 ASD (−) Cognitive control(−) Attention(−) Language
Jensen et al. (2004)
[40]
RCT 19 6–12 Male 20 Yoga
Setting: Westmead hospital
20 ADHD (−) Attention
Johansson et al.(1998)
[41]
Retrospective Cohort 92 13–18 Male 156 Exercise (Physical education)
Setting: Pacific Northwest program
156 Social and emotional problems (+) Academic achievement
Kaiser et al. (2006)
[42]
Prospective Cohort 31 13–18 Male and Female 6 Equine-assisted therapy
Setting: CHUM Riding Therapeutic Centre
6 Cerebral palsy, emotional impairment, learning disability (+) Attention
Kang et al. (2011)
[43]
RCT 28 6–12 Male 6 Sport (Sport therapy program)
Setting: Department of Psychiatry of Chung Ang University Medical Centre
6 ASD (+) Attention
Lawson et al. (2012)
[44]
Single subject study design 3 0–5 Male 5 Yoga
Setting: The Preschool and Language Stimulation Program School
7 Speech and developmental delay, behavioral problem, ADHD (+) Attention
Lufi et al. (2011)
[45]
Quasi-experimental 32 6–12 Male 52 Sport (Sport-based group therapy such as basketball and running)
Setting: Not mentioned
104 Behavioral disorders (+) Attention
Macauley et al. (2004)
[46]
Prospective cohort 3 6–12 Male 6 Hippotherapy
Setting: Merlin Farms Equestrian Center
6 Learning disability (+) Language
Mackinnon et al. (1995)
[47]
RCT 19 6–12 Male and Female 26 Equine-assisted therapy
Setting: Therapeutic riding program
26 Cerebral palsy (−) Attention
MacMahon et al. (1987)
[48]
RCT 54 6–12 Male 20 The aerobic group’s exercise consisted of distance running, aerobic dance, and variants of soccer
Setting: Not mentioned
20 Learning disability (−) Academic achievement
Majorek et al. (2004)
[49]
Case series 5 6–12 Male 36 Exercise (Therapeutic Eurythmy-movement therapy)
Setting: Therapy rooms of a pediatrician’s surgery
36 ADHD (+) Attention
McKune et al. (2003)
[50]
Quasi-experimental 19 6–12 Male and Female 5 Exercise (Included activities such as relay runs, simple plyometric exercises, running through a mini obstacle course, a distance run of 1–2 km, and skipping)
Setting: Home
9 ADHD (+) Attention
Memarmoghaddam et al. (2016)
[51]
RCT 40 6–12 Male 8 Exercise (Aerobic and goal directed exercises)
Setting: University Sports Hall
8 ADHD (+) Cognitive inhibition
Milligan et al. (2015)
[52]
Qualitative 46 Youth: 13–18 Youth: Male and Female 20 Martial Arts
Setting: Child Development Institute
20 Learning disability (+) Self-regulation
Morand et al. (2004)
[53]
RCT 18 6–12 Male 12 Martial Arts
Setting: Martial arts school
12 ADHD (+) Academic performance
(+) Attention
Neely et al. (2015)
[54]
Case study 2 6–12 Male and Female 12 Exercise (Jumping on an indoor trampoline)
Setting: Classroom
12 ASD (+) Academic engagement
Nicholson et al.(2011)
[55]
Single subject study design 4 6–12 Male 6 Exercise (Jogging)
Setting: Classroom
6 ASD (+) Academic engagement
O’Callaghan et al. (2003)
[56]
RCT 4 6–12 Male and Female 6 Sport (Kickball)
Setting: Campus of a large public university
6 ADHD (+) Attention
Ozer et al. (2012)
[57]
RCT 76 13–18 Male 8 Sport (Soccer)
Setting: Soccer Field
8 Intellectual disability (+) Attention
Ozer et al. (2007)
[58]
RCT 23 6–12 Male and Female 14 Aqua therapy
Setting: Swimming pool
38 Cerebral palsy (+) Attention
Packard et al. (2007)
[59]
Prospective Cohort 10 6–12 Male and Female 4 Exercise (Vigorous aerobic physical activity)
Setting: School
6 ADHD (+) Attention
Pan et al. (2017)
[60]
RCT 22 6–12 Male 12 Exercise (Motor and movement skills related to table tennis)
Setting: Gymnasium
24 ASD (+) Cognitive flexibility
Pan et al. (2016)
[61]
RCT 32 6–12 Male 12 Sport (Racket sport)
Setting: Table tennis center
24 ADHD (+) Cognitive flexibility
(+) Attention
(+) Cognitive process
Porter et al. (2013)
[62]
Case study 1 6–12 Male 4 Yoga
Setting: Classroom
4 ASD (+) Attention
Ringenbach et al. (2016)
[63]
RCT 44 13–18 Male and Female 8 Exercise (Assisted cycling therapy)
Setting: Cycling Bike
8 Down syndrome (+) Response inhibition
(−) Cognitive flexibility
(+) Language
(+) Alertness and speed
Rosenblatt et al. (2011)
[64]
Prospective Cohort 24 6–12 Male 8 Yoga
Setting: Medical school teaching hospital
8 ASD (−) Attention
Rosenthal-Malek et al. (1997)
[65]
Quasi-experimental 5 13–18 Male 10 Exercise (Mildly strenuous jogging)
Setting: Urban public school and a community-based workshop
10 ASD (+) Academic performance
Smith et al. (2013)
[66]
Prospective Cohort 17 6–12 Male and Female 9 Exercise (Continuous
moderate-to-vigorous physical activity such as hopping, skipping, etc.) Setting: Not mentioned
11 ADHD (+) Response inhibition
(+) Working memory
Stickney et al. (2010)
[67]
Qualitative 34 Children: Not Stated Children: Not stated 8 Equine-assisted therapy
Setting: Central Kentucky Riding for Hope
8 ASD (+) Attention
(+) Language
(+) Academic achievement
Tsai et al. (2009)
[68]
RCT 43 6–12 Male and Female 10 Sport (Tennis)
Setting: A laboratory
10 Developmental coordination disorder (+) Inhibitory control
Tsai et al. (2012)
[69]
RCT 51 6–12 Male and Female 10 Sport (Soccer)
Setting: School
10 Developmental coordination disorder (+) Inhibitory control
(+) Attention
Tsai et al. (2014)
[70]
RCT 60 6–12 Male and Female 16 Exercise (The endurance training program consisted of interval training and one continuous long-distance running session, and one session with another aerobic activity (e.g., cycling, step aerobics, or rope jumping))
Setting: School
16 Developmental coordination disorder (+) Working memory
Verret et al. (2012)
[71]
Quasi-experimental 21 6–12 Male 10 Exercise (Sessions included warm-up; progressive aerobic, muscular, and motor skills exercises; and cool down)
Setting: School gymnasium
12 ADHD (+) Attention
Wehrle et al. (2017)
[72]
Qualitative 6 6–12 Male 8 Exercise (Includes warm-up, free play, and skill of a week)
Setting: Shady Lane Elementary School
8 ADHD (+) Attention
(+) Academic performance
Wendt et al. (2000)
[73]
Quasi-experimental 24 6–12 Male and Female 6 Exercise (Intense Aerobic-type physical activity program)
Setting: SUNY Buffalo
Amherst, Turf Football Stadium
6 ADHD (+) Cognitive control
(+) Working memory
(+) Cognitive flexibility
(+) Attention
(+) Cognitive performance
(+) Language
(+) Cognitive process
(+) Planning
(+) Academic achievement
(+) Fluid intelligence
Yildirim et al. (2010)
[74]
RCT 50 13–18 Male and Female 12 Exercise (Circuit training, resistance training, and interval speed training)
Setting: School
12 Intellectual disability (+) Alertness and speed
Ziereis et al. (2015)
[75]
RCT 43 6–12 Male and Female 12 Exercise (Various activities such as juggling, tennis, trampoline, juggling, etc.)
Setting: Facilities of the University of Regensburg’s Institute for Sport Science
14 ADHD (+) Working memory

Notes: PD = Program Duration in weeks; SD = Study Duration in weeks; RCT = Randomized Controlled Trials; ADHD = Attention-Deficit/Hyperactivity Disorder; ASD = Autism Spectrum Disorder. * We categorized the age to three groups including “0–5”, “6–12”, and “13–18”-year-olds. Each study has been assigned the age group based on the mean age of study participants; ** Study population has been considered as “Male” when all or more than 90% of study participants were male. Similarly, when all or more than 90% of study participants were female, the study population has been considered as “Female”.

When the study population consisted of children with ASD, the most common intervention was equine-assisted therapy (n = 7) followed by exercise (n = 5). For children with ADHD, the most common intervention was exercise (n = 12) followed by yoga (n = 3) and equine-assisted therapy (n = 3).

3.3. Study Outcomes and Findings

Table 1 shows different cognitive function outcomes with different populations. Some papers reported on more than one outcome and the impact reported varied.

Table 2 shows the frequency of cognitive outcomes assessed and the direction of change.

Table 2.

Frequency of cognitive outcomes assessed and the direction of change.

Outcomes Frequency n (%)
Included Studies * Improvement ** No Change ** Mixed **
Cognitive flexibility 7 (11.7) 6 (85.7) 1 (14.3)
Cognitive control 15 (25) 13 (86.7) 2 (13.3)
Working Memory 8 (13.3) 7 (87.5) 0 1 (12.5)
Attention 37 (61.7) 30 (81.1) 6 (16.2) 1 (2.7)
Language 5 (8.3) 4 (80) 1 (20)
Cognitive performance 1 (1.7) 1 (100) 0
Cognitive process 2 (3.3) 2 (100) 0
Planning 3 (5) 3 (100) 0
Academic Achievement 4 (6.7) 3 (75) 1 (25)
Academic Engagement 2 (3.3) 2 (100) 0
Academic Performance 3 (5) 3 (100) 0
Fluid intelligence 1 (1.7) 1 (100) 0
Alertness and Speed 4 (6.7) 4 (100) 0

* The percentage indicates the proportion of included studies that assessed each of the listed cognitive outcomes; ** The percentage indicates the proportion of included studies that showed improvement, no change, or mixed results when the study assessed the relevant outcome.

Most of the reported results were measured by standardized scales. Depending on the direction of the change of scores before and after intervention, results were classified as “improvement”, “no change”, “regression”, or “mixed results”.

Attention was measured in 37 out of 60 studies (61.7%) and 30 of them (81%) reported improvement (17 were statistically significant) and 1 study had mixed results. The six studies that did not show any change in attention were mostly RCT and quasi-experimental studies of yoga or equine-assisted therapy with children diagnosed with ADHD or ASD with a sample size ranging from 7 to 24.

Cognitive control was measured in 15 studies (25%) and 13 of them (92.9%) showed positive changes (9 were statistically significant). Two studies did not show any change: one was a quasi-experimental study of equine-assisted therapy with seven boys with ASD and the other one was a quasi-experimental study of an exergame with both genders with ASD.

Working memory was the outcome reported in 8 out of 60 studies (13.3%). Seven of them reported a positive change (four were statistically significant) and one had mixed results. Cognitive flexibility has been measured in seven studies (11.7%). Six of them reported a positive change (three were statistically significant); the single study that did not report improvement was an RCT of exercise intervention with 44 boys and girls with Down syndrome. Eighty per cent and 75% studies that measured language and academic achievement, respectively, reported favorable effects of physical activity interventions.

Other cognitive function outcomes included cognitive performance, cognitive process, academic engagement and performance, planning, fluid intelligence, alertness, and speed; all studies that assessed these functions noted positive changes. We did not find any research study that investigated the effect of physical activity on memory (short- and long-term) and perceptual processing. Different outcomes were selected for different NDD conditions. Table 3 shows the frequency of cognitive outcomes assessed in children with ADHD, ASD, CP, and Down syndrome and the direction of change.

Table 3.

Frequency of cognitive outcomes assessed in children with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), cerebral palsy (CP), and Down syndrome, and the direction of change.

ADHD ASD CP Down Syndrome
Outcomes
(Total Number of Studies)
Frequency
n (%)
Number of Positive Results Frequency
n (%)
Number of Positive Results Frequency
n (%)
Number of Positive Results Frequency
n (%)
Number of Positive Results
Cognitive flexibility
(7 studies)
3 (42.8) 3 2 (28.6) 2 0 (0) 0 1(14.3) 0
Cognitive control
(15 studies)
4 (26.7) 4 4 (26.7) 2 0 (0) 0 1(6.7) 1
Working Memory
(8 studies)
4 (50) 4 1 (12.5) 1 0 (0) 0 1(12.5) 0
Attention
(37 studies)
19 (51.4) 16 9 (24.3) 6 3 (8.1) 2 0 (0) 0
Language
(5 studies)
1 (20) 1 2 (40) 1 0 (0) 0 1(20) 1
Cognitive performance
(1 study)
1 (100) 1 0 (0) 0 0 (0) 0 0 (0) 0
Cognitive process
(2 studies)
2 (100) 2 0 (0) 0 0 (0) 0 0 (0) 0
Planning
(3 studies)
1 (33.3) 1 2 (66.7) 2 0 (0) 0 0 (0) 0
Academic Achievement
(4 studies)
1 (25) 1 1(25) 1 0 (0) 0 0 (0) 0
Academic Engagement
(2 studies)
0 (0) 0 2 (100) 2 0 (0) 0 0 (0) 0
Academic Performance
(3 studies)
2 (66.6) 2 1 (33.3) 1 0 (0) 0 0 (0) 0
Fluid intelligence
(1 study)
1 (100) 1 0 (0) 0 0 (0) 0 0 (0) 0
Alertness and Speed
(4 studies)
0 (0) 0 1 (25) 1 0 (0) 0 2 (50) 2

Specific to ADHD, attention was measured in 19 studies and 16 (84.2%) reported positive changes. Working memory and cognitive control were studied in four studies that all showed improvement. In studies of children diagnosed with ASD, 9 studies out of 37 (24.3%) measured attention, with 6 of them showing positive changes. Cognitive control was assessed in four studies, with two studies reporting favorable effects.

Additionally, different interventions were associated with specific outcomes. For instance, the effects of exercise (n = 26 studies) were assessed on attention in 11 articles and all reported positive changes. In addition, working memory has been measured in seven articles, with six reporting improvement. For equine-assisted therapy interventions (n = 13 studies), attention was measured in 9, with 5 reporting improvement. For language (n = 3) and cognitive control (n = 3), two studies for each of these outcomes showed positive changes (see Table 4).

Table 4.

Frequency of cognitive outcomes assessed for the two most common physical activity interventions and the direction of change.

Physical Activity/Exercise/Movement Therapy Equine-Assisted Therapy
Outcomes
(Total Number of Studies)
Frequency
n (%)
Number of Positive Results Frequency
n (%)
Number of Positive Results
Cognitive flexibility
(7 studies)
5 (71.4) 4 0 (0) 0
Cognitive control
(15 studies)
6 (40) 6 3 (20) 2
Working Memory
(8 studies)
7 (87.5) 6 0 (0) 0
Attention
(37 studies)
11 (29.7) 11 9 (24.3) 5
Language
(5 studies)
2 (40) 2 3 (60) 2
Cognitive performance
(1 study)
1 (100) 1 0 (0) 0
Cognitive process
(2 studies)
1 (50) 1 0 (0) 0
Planning
(3 studies)
1 (33.3) 1 1 (33.3) 1
Academic Achievement
(4 studies)
3 (75) 2 1 (25) 1
Academic Engagement
(2 studies)
2 (100) 2 0 (0) 0
Academic Performance
(3 studies)
2 (66.7) 2 0 (0) 0
Fluid intelligence
(1 study)
1 (100) 1 0 (0) 0
Alertness and Speed
(4 studies)
3 (75) 3 1(25) 1

4. Discussion

This comprehensive scoping review reports the impact of physical activity on the cognitive functions of children and youth with different types of NDD conditions: ASD, ADHD, CP, Down syndrome, intellectual disabilities, physical disabilities, behavioral and social disabilities, learning disabilities, and developmental coordination disorder (DCD). A number of cognitive function outcomes were explored: executive function including cognitive flexibility, cognitive control and working memory, attention, short- and long-term memory, learning, perceptual processing, and alertness.

Most studies reported improvement in their measured cognitive function outcomes. About half of the reported improvements were statistically significant. No studies reported negative impacts or symptom regression on cognition among child participants with NDD. The majority of studies used standardized measurement tools in order to assess the change in studied outcomes. This finding indicates the role of physical activity in the learning and development of a child with NDD. The major findings of this scoping review will be discussed in the following paragraphs.

Most of the included studies have been conducted with boys 6–12 years of age who were diagnosed with ADHD (n = 23, 38.3%). This finding certainly corresponds to the fact that the main challenges described are triggered in the context of school exposure, and ADHD incidence is much higher among boys than girls. This focus of interest indicates the importance of identifying effective interventions for school age children with NDD. Regarding gender, most studies focus on boys, which corresponds to the fact that boys are more often diagnosed with ADHD and ASD in comparison to girls; however, we cannot eliminate a possible gender bias with more boys willing to participate in these studies. While some studies reported small improvements in girls with NDD, additional work is needed to clarify the relationship between physical activity and this particular sub-population.

Among the 60 studies that were included in the present scoping review, the largest number of positive impacts of physical activity was found in studies of exercise interventions followed by equine-assisted therapy, then sports. Of these papers, the majority focused on children with ADHD and ASD, where attention and its sub-domains of focus and concentration were the most commonly measured cognitive function. This finding corresponds to the main concern in this population, especially in the school context [76,77,78]. In the case of ADHD, participation in high-intensity physical activity or exercise may increase the release of endorphins (which helps regulate mood, pleasure, and pain) and neurotransmitters like dopamine, norepinephrine, and serotonin levels (which positively affect focus and attention) [79]. Combined, these effects on the brain help increase alertness and reduce the craving for new stimuli, which are typical characteristics of children with ADHD. Similarly, with ASD, higher-intensity physical activity has been noted in the literature as an effective supplement to children’s treatment regimens [80,81,82]. Studies show that moderate-to-vigorous physical activity is associated with decreases in self-stimulatory behaviors, hyperactivity, aggression, self-injury, and destructiveness [83]. Furthermore, as many children with ASD are at increased risk for weight gain, including regular physical activity in their daily routine may have beneficial effects [84,85]. The incorporation of animal therapy into the treatment of protocols of children with ADHD and ASD is well-received and its positive effects have been noted in other reviews [86,87].

The type of NDD diagnosis and physical activity intervention were examined in this review. We found that children with ASD saw the most improvements in attention and that equine-therapy appeared to be the best type of activity to produce such changes. As for children with CP, most gains were reported in the attention domain, with aqua therapy and movement therapy serving as ideal activities to realize such improvements. Lastly, children with ADHD reported improvements in attention, with again, exercise and movement therapy serving as the preferred conduits to improved cognitive functions, memory, and development. The acquisition of such information is paramount to our understanding of which domains of cognitive function are most positively impacted by physical activity and by which types of activity exposures. Consequently, this information will assist with the creation of tailored physical activity programming for children with NDD based on their unique abilities.

Our findings confirm the ones from other literature reviews. Pontifex et al. [88] in their narrative review examined the role of physical activity in reducing barriers to learning in children with developmental disorders including ADHD and ASD. Findings indicated that both single bouts of activity and chronic physical activity were associated with improved classroom performance [88,89]. A meta-analysis of 22 articles by Tan et al. [89] found an overall small to medium effect of exercise on cognition. Their findings support the efficacy of exercise interventions in enhancing certain aspects of cognitive performance in individuals with ASD and/or ADHD. In another systematic review and meta-analysis of eight RCTs, Cerrilo-Urbina et al. [90] reported that short-term aerobic exercise, based on several aerobic intervention formats, seems to be effective for mitigating symptoms such as attention, hyperactivity, impulsivity, anxiety, executive function, and social disorders in children with ADHD. However, to our knowledge, this scoping review is the first comprehensive review that explored the impacts of several types of physical activity interventions on all aspects of cognitive function for children with a variety of neurodevelopmental challenges.

4.1. Strengths and Limitations

The majority of papers included in this review were RCTs and quasi-experimental studies, which highlights the credibility of the overall evidence. In addition, having a research question that was broad in scope allowed us to investigate many aspects of the existing relevant research studies. Despite these strengths, there are several limitations of this review worth noting. First, most of the studies had small sample sizes (75% of studies included less than 43 participants) and the physical activity programs were short in duration (75% of studies had interventions less than 12 weeks). Second, most studies did not organize data collection by a person who was unaware of the intervention status, which makes the studies prone to different types of observation/report biases and Hawthorne effects (i.e., the change in behavior of study participants due to the awareness of being observed) [91,92]. Third, information was generally lacking regarding the child/family’s satisfaction of the effect and the level that the positive impacts of physical activity could meet the specific needs of a child and family. Fourth, due to the vast variability in reporting interventions and results, informing best practice recommendations is not possible. Finally, although the current review considered solely English-language, peer-reviewed publications and academic gray literature, examining the international and non-academic gray literature may help to expand and deepen our understanding of physical activity on acquisition of new functions (cognitive and psychological) and learning among children with NDD.

4.2. Future Directions

Based on the findings of this scoping review, we have identified several areas for further investigations. High quality studies on the impact of physical activity on brain function among very young children (under 6 years) with NDD are appealing. Brain plasticity is maximal in young children [93,94]; therefore, interventions should target younger children instead of waiting for impairments to be revealed in light of the demands of the school classroom. More generally, specific research questions include determining the type of activities at different ages and which effect is expected on different types of outcomes. A more focused look at the relationship between physical activity and brain function across disability categories including the undertaking of further investigations into the development of physical literacy for long-term physical activity and its impact on brain health would also be of interest. Given that peer relationships become increasingly important from childhood to adolescence, additional research to explore the impact of physical activity on social inclusion and personal identity development for children with NDD is important. As well, investigating the level of child/family’s satisfaction of the positive impacts is of paramount importance. Lastly, a rigorous systematic review and meta-analysis of RCTs that investigate the effects of physical activity on children and youth with NDD is warranted.

5. Conclusions

The findings of this scoping review highlight that physical activity may have a favorable impact on the cognitive outcomes of children and youth with NDD. Given these noted benefits, additional investigations are needed to help optimize the use of physical activity in the daily lives of children with NDD to not only support improved cognitive functions, but overall social integration and quality of life as well.

Acknowledgments

We wish to acknowledge the strong support and help of Michelle Shalinsky, Sanja Radulovic, and Gurtej Sangha in conducting this review. BC Children’s Hospital Research Institute supported part of the salary of JPC. LMV was supported by a Fellowship Award from the Canadian Institutes for Health Research.

Appendix A. Search Strategy for Each Individual Database

  • Pub Med

“Recreation Therapy” [Mesh] OR “Music Therapy” [Mesh] OR “Play Therapy”[Mesh] OR “Leisure Activities”[Mesh] OR “Recreation”[Mesh] OR “Art Therapy”[Mesh] OR “Exercise Therapy”[Mesh] OR “Sports”[Mesh] OR “Animal Assisted Therapy”[Mesh] OR “Equine-Assisted Therapy”[Mesh] OR “Gymnastics”[Mesh] OR “Dance Therapy”[Mesh] OR “aquatic therapy” [tiab] OR “hydro therapy” [tiab] OR “creative arts therapy” [tiab] OR “Exercise”[Mesh] OR “therapeutic recreation” [tiab] OR “recreation” [tiab] OR “exercise” [tiab] OR “exercises” [tiab] OR “physical activities” [tiab] OR “physical activity” [tiab] OR “sport” [tiab] OR “sports” [tiab].

AND

“Intellectual Disability” [Mesh] OR “Disabled Persons” [Mesh] OR “Developmental Disabilities” [Mesh] OR “Rett Syndrome” [Mesh] OR “Down Syndrome” [Mesh] OR “Autistic Disorder” [Mesh] OR “Autism Spectrum Disorder” [Mesh] OR “Cerebral Palsy” [Mesh] OR “Attention Deficit Disorder with Hyperactivity” [Mesh] OR “Fetal Alcohol Spectrum Disorders”[Mesh] OR “neurodevelopment disorder” [tiab] OR “neurodevelopment delay” [tiab] OR “neurodisability” [tiab] OR “Neurodevelopmental Disorders”[Mesh] OR “disability” OR “neurodevelopmental disabilities” OR “neurodevelopmental delays” OR “neurodevelopmental disorders” OR “neurodevelopmental disability” OR “neurodevelopmental disorder” OR “disabilities” OR “neurodevelopmental delay” OR “neurodisabilities”.

Limitations: 1995–2017, All child (birth–18), English.

  • MedLine Search History

(MH “Recreation Therapy”) OR (MH “Leisure Activities”) OR (MH “Recreation”) OR (MH “Hydrotherapy”) OR (MH “Art Therapy”) OR “Creative Arts Therapy” OR “Therapeutic Exercise” OR (MH “Pet Therapy”) OR (MH “Equine Assisted Therapy”) OR (MH “Dance Therapy”) OR “Drama Therapy” OR (MH “Play Therapy”) OR (MH “Music Therapy”) OR (MH “Gymnastics”) OR (MH “Yoga”) OR (MH “Martial Arts”) OR (MH “Skating”) OR (MH “Skiing”) OR (MH “Baseball”) OR (MH “Basketball”) OR (MH “Soccer”) OR (MH “Recreation”) OR (MH “Dancing”) OR (MH “Racquet Sports”) OR (MH “Snow Sports”) OR (MH “Sports for Persons with Disabilities”) OR (MH “Sports”) OR (MH “Exercise+”) OR (MH “Movement”) OR (MH “Motor Activity”) OR TI “therapeutic recreation” OR AB “therapeutic recreation” OR TI recreation OR AB recreation OR TI exercise OR AB exercise OR TI “physical activities” OR AB “physical activities” OR TI sport OR AB sport OR TI “physical activity” OR AB “physical activity”.

AND

(MH “Developmental Disabilities”) OR (MH “Autistic Disorder”) OR (MH “Child Development Disorders, Pervasive”) OR “Neurodevelopmental Disability” OR “Neurodevelopmental Delay” OR (MH “Rett Syndrome”) OR (MH “Cerebral Palsy”) OR (MH “Down Syndrome”) OR (MH “Intellectual Disability”) OR (MH “Attention Deficit Disorder”) OR (MH “Attention Deficit Disorder with Hyperactivity”) OR (MH “Fetal Alcohol Spectrum Disorders”) OR (MH “Cerebral Palsy”) OR (MH “Neurodevelopmental Disorders”) OR (MH “Attention Deficit and Disruptive Behavior Disorders”) OR (MH “Motor Skills Disorders”) OR disability OR “Neurodevelopmental Disabilities” OR “Neurodevelopmental Delays” OR Neurodisability OR “Neurodevelopmental Disorders” OR “Neurodevelopmental Disorder” OR (MH “Disabled Children”).

Limitations: 1995–2017, All child (birth–18), English.

  • CINAHL Search History (CINAHL—Cumulative Index to Nursing and Allied Health Literature)

(MH “Recreation Therapy”) OR (MH “Leisure Activities”) OR (MH “Recreation”) OR (MH “Hydrotherapy”) OR (MH “Art Therapy”) OR “Creative Arts Therapy” OR (MH “Therapeutic Exercise”) OR (MH “Pet Therapy”) OR (MH “Horseback Riding”) OR “Equine Assisted Therapy” OR (MH “Dance Therapy”) OR (MH “Play Therapy”) OR (MH “Music Therapy”) OR (MH “Gymnastics”) OR (MH “Yoga”) OR (MH “Martial Arts”) OR (MH “Skating”) OR (MH “Skiing”) OR (MH “Baseball”) OR (MH “Basketball”) OR (MH “Soccer”) OR (MH “Walking”) OR (MH “Dancing”) OR (MH “Recreational Therapy”) OR (MH “Aquatic Sports”) OR (MH “Extreme Sports”) OR (MH “Animal Sports”) OR (MH “Winter Sports”) OR (MH “Wheelchair Sports”) OR (MH “Race Walking”) OR (MH “Racquet Sports”) OR (MH “Rock Climbing”) OR (MH “Motor Sports”) OR (MH “Running”) OR (MH “Sports, Disabled”) OR (MH “Team Sports”) OR (MH “Track and Field”) OR (MH “Weight Lifting”) OR (MH “Bowling”) OR (MH “Endurance Sports”) OR (MH “Cycling”) OR (MH “Sports”) OR (MH “Golf”) OR (MH “Handball”) OR (MH “Exercise”) OR (MH “Physical Activity”) OR TI “therapeutic recreation” OR AB “therapeutic recreation” OR TI recreation OR AB recreation OR TI exercise OR AB exercise OR TI “physical activities” OR AB “physical activities” OR TI sport OR AB sport OR TI “physical activity” OR AB “physical activity”.

AND

(MH “Intellectual Disability”) OR (MH “Developmental Disabilities”) OR (MH “Child, Disabled”) OR “Developmental Delay” OR (MH “Autistic Disorder”) OR (MH “Child Development Disorders, Pervasive”) OR “Neurodevelopmental Disorder” OR (MH “Rett Syndrome”) OR “Neurodisability” OR (MH “Cerebral Palsy”) OR (MH “Down Syndrome”) OR “Attention Deficit Disorder” OR (MH “Attention Deficit Hyperactivity Disorder”) OR (MH “Fetal Alcohol Disorder”) OR disability OR “Neurodevelopmental Disabilities” OR “Neurodevelopmental Delays” OR Neurodisability OR “Neurodevelopmental Disorders” OR “Neurodevelopmental Disability” OR (MH “Learning Disorders”) OR (MH “Motor Skills Disorders”) OR (MH “Child Development Disorders”).

Limitations: 1995–2017, Age Groups: Infant, Newborn: birth–1 month; Infant: 1–23 months; Child, Preschool: 2–5 years; Child: 6–12 years; Adolescent: 13–18 years; English.

  • PsychInfo Search History

DE “Recreation Therapy” OR DE “Leisure Time” DE “Recreation” OR DE “Art Therapy” OR DE “Creative Arts Therapy” OR DE “Exercise” OR DE “Sports” OR DE “Animal Assisted Therapy” OR DE “Dance Therapy” OR DE “Play Therapy” OR DE “Music Therapy” OR “equine assisted therapy”“gymnastics” OR “martial arts” OR “skating” OR “skiing” OR “hockey” OR “baseball” OR “soccer” OR “yoga” OR “basketball” OR DE “Physical Activity” OR DE “Aerobic Exercise” OR DE “Weightlifting” OR DE “Yoga” OR DE “Movement Therapy” OR DE “Baseball” OR DE “Basketball” OR DE “Extreme Sports” OR DE “Football” OR DE “Judo” OR DE “Martial Arts” OR DE “Soccer” OR DE “Swimming” OR DE “Tennis” OR DE “Weightlifting” OR DE “Childrens Recreational Games” OR TI “therapeutic recreation” OR AB “therapeutic recreation” OR TI recreation OR AB recreation OR TI exercise OR AB exercise OR TI “physical activities” OR AB “physical activities” OR TI sport OR AB sport OR TI “physical activity” OR AB “physical activity”.

AND

DE “Developmental Disabilities” OR DE “Autism Spectrum Disorders” OR “Neurodevelopmental Disability” OR “Neurodevelopmental Delay” OR DE “Rett Syndrome” OR DE “Cerebral Palsy” OR DE “Down’s Syndrome” OR DE “Intellectual Development Disorder” OR DE “Attention Deficit Disorder” OR DE “Attention Deficit Disorder with Hyperactivity” OR DE “Fetal Alcohol Syndrome” OR DE “Disabilities” OR DE “Learning Disabilities” OR DE “Multiple Disabilities” OR disability OR “Neurodevelopmental Disabilities” OR “Neurodevelopmental Delays” OR Neurodisability OR “Neurodevelopmental Disorder” OR “Neurodevelopmental Disorders”.

Limitations: 1995–2017, Age Groups: Childhood (birth–12 yrs), Adolescence (13–17 yrs), English.

  • ERIC Search History

DE “Therapeutic Recreation” OR DE “Play Therapy” OR DE “Leisure Time” OR DE “Recreation” OR “Aquatic Therapy” OR DE “Art Therapy” OR “Creative Arts Therapy” OR DE “Exercise” OR “gymnastics” OR “martial arts” OR “skating” OR “skiing” OR “hockey” OR “baseball” OR “soccer” OR “yoga” OR “basketball” OR “sport” OR “Animal Assisted Therapy” OR “Pet Therapy” OR “Equine Assisted Therapy” OR “Dance Therapy” OR DE “Music Therapy” OR DE “Physical Activities” OR DE “Athletics” OR DE “Physical Recreation Programs” OR DE “Playground Activities” OR DE “Recreational Activities” OR DE “Racquet Sports” OR DE “Aquatic Sports” OR DE “Team Sports” OR TI “physical activity” OR AB “physical activity” OR TI “therapeutic recreation” OR AB “therapeutic recreation” OR TI “recreation” OR AB “recreation” OR TI “exercise” OR AB “exercise” OR TI “physical activities” OR AB “physical activities”.

AND

“Intellectual Disability” OR DE “Mental Retardation” OR “Neurodevelopmental Delay” OR “Neurodevelopmental Disability” OR DE “Autism” OR DE “Pervasive Developmental Disorder” OR DE “Attention Deficit Disorder” OR “Attention Deficit Hyperactivity Disorder” OR DE “Fetal Alcohol Syndrome” OR “Rett Syndrome” OR DE “Down Syndrome” OR DE “Disabilities” OR DE “Adventitious Impairments” OR DE “Behavior Disorders” OR DE “Communication Disorders” OR DE “Congenital Impairments” OR DE “Developmental Disabilities” OR DE “Hearing Impairments” OR DE “Injuries” OR DE “Intellectual Disability” OR DE “Language Impairments” OR DE “Learning Disabilities” OR DE “Mental Disorders” OR DE “Multiple Disabilities” OR DE “Perceptual Impairments” OR DE “Physical Disabilities” OR DE “Special Health Problems” OR DE “Speech Impairments” OR DE “Visual Impairments” OR “cerebral palsy” OR “disability” OR “disabilities”.

AND

DE “Children” OR DE “Pediatrics” OR “Adolescents” OR “Youth”

Limitations: 1995–2017, English.

Author Contributions

Conceptualization, M.G. and J.-P.C., W.M., A.M.; Data curation, M.G. and R.H.; Formal analysis, M.G. and L.M.V.; Funding acquisition, J.-P.C.; Investigation, M.G., J.-P.C. and R.H.; Methodology, A.R., M.G. and J.-P.C.; Project administration, M.G. and J.-P.C.; Resources, A.R. and M.G.; Supervision, J.-P.C. and M.G.; Validation, M.G., L.M.V., A.R.; Visualization, M.G., L.M.V. and R.H.; Writing-original draft, M.G., L.M.V. and J.-P.C.; Writing-review and editing, M.G., L.M.V., J.-P.C., W.M., A.M. and A.R. All authors contributed to manuscript revisions and approved the submitted version. All authors have read and agreed to the published version of the manuscript.

Funding

The study was funded by a grant from the Kids Brain Health Network (KBHN)—Networks of Centres of Excellence (NCE) of Canada. The KBHN had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflicts of Interest

The authors declare no conflict of interest. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Footnotes

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  • 1.Boyle C.A., Boulet S.H., Schieve L.A., Cohen R.A., Blumberg S.J., Yeargin-Allsopp M., Visser S., Kogan M.D. Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics. 2011;127:1034–1042. doi: 10.1542/peds.2010-2989. [DOI] [PubMed] [Google Scholar]
  • 2.Morris C., Janssens A., Tomlinson R., Williams J., Logan S. Towards a definition of neurodisability: A Delphi survey. Dev. Med. Child. Neurol. 2013;55:1103–1108. doi: 10.1111/dmcn.12218. [DOI] [PubMed] [Google Scholar]
  • 3.Stabile M., Allin S. The economic costs of childhood disability. Future Child. 2012;22:65–96. doi: 10.1353/foc.2012.0008. [DOI] [PubMed] [Google Scholar]
  • 4.Brehaut J.C., Kohen D.E., Garner R.E., Miller A.R., Lach L.M., Klassen A.F., Rosenbaum P.L. Health among caregivers of children with health problems: Findings from a Canadian population-based study. Am. J. Public Heal. 2009;99:1254–1263. doi: 10.2105/AJPH.2007.129817. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Ginsburg K.R. The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics. 2007;119:182–191. doi: 10.1542/peds.2006-2697. [DOI] [PubMed] [Google Scholar]
  • 6.Statistics Canada Participation and Activity Limitation Survey 2006: Families of Children with Disabilities in Canada. [(accessed on 1 September 2018)]; Available online: https://www150.statcan.gc.ca/n1/pub/89-628-x/89-628-x2008009-eng.pdf.
  • 7.Timmons B.W., LeBlanc A.G., Carson V., Connor Gorber S., Dillman C., Janssen I., Kho M.E., Spence J.C., Stearns J.A., Tremblay M.S. Systematic review of physical activity and health in the early years (aged 0–4 years) Appl. Physiol. Nutr. Metab. 2012;37:773–792. doi: 10.1139/h2012-070. [DOI] [PubMed] [Google Scholar]
  • 8.Poitras V.J., Gray C.E., Borghese M.M., Carson V., Chaput J.P., Jansse I., Katzmarzyk P.T., Pate R.R., Connor Gorber S., Kho M.E., et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children. Appl. Phys. Nutr. Metab. 2016;41:197–239. doi: 10.1139/apnm-2015-0663. [DOI] [PubMed] [Google Scholar]
  • 9.Casady R.L., Nichols-Larsen D.S. The effect of hippotherapy on ten children with cerebral palsy. Pediatr. Phys. Ther. 2004;16:165–172. doi: 10.1097/01.PEP.0000136003.15233.0C. [DOI] [PubMed] [Google Scholar]
  • 10.Cook O., Frost G., Twose D., Wallman L., Falk B., Galea V., Adkin A., Klentrou P. CAN-flip: A pilot gymnastics program for children with cerebral palsy. Adapt. Phys. Avtivity Q. 2005;32:349–370. doi: 10.1123/APAQ.2015-0026. [DOI] [PubMed] [Google Scholar]
  • 11.Casey A.F., Quenneville-Himbeault G., Normore A., Davis H.M.S. A Therapeutic skating intervention for children with Autism Spectrum Disorder. Pediatr. Phys. Ther. 2015;27:170–177. doi: 10.1097/PEP.0000000000000139. [DOI] [PubMed] [Google Scholar]
  • 12.Garcia-Gomez A., Lopez Risco M., Rubio J.C., Guerrero E., Garcia-Pena I.M. Effects of a program of adapted therapeutic horse-riding in a group of autism spectrum disorder children. Electron. J. Res. Educ. Psychol. 2014;12:107–128. doi: 10.14204/ejrep.32.13115. [DOI] [Google Scholar]
  • 13.McGibbon N.H., Benda W., Duncan B.R., Silkwood-Sherer D. Immediate and long-term effects of hippotherapy on symmetry of adductor muscle activity and functional ability in children with spastic Cerebral Palsy. Arch. Phys. Med. Rehabil. 2009;90:966–974. doi: 10.1016/j.apmr.2009.01.011. [DOI] [PubMed] [Google Scholar]
  • 14.Davis E., Davies B., Wolfe R., Raadsveld R., Heine B., Thomason P., Dobson F., Graham H.K. A randomized controlled trial of the impact of therapeutic horse riding on the quality of life, health, and function of children with cerebral palsy. Dev. Med. Child. Neurol. 2009;51:111–119. doi: 10.1111/j.1469-8749.2008.03245.x. [DOI] [PubMed] [Google Scholar]
  • 15.Gabriels R.L., Agnew J.A., Holt K.D., Shoffner A., Zhaoxing P., Ruzzano S., Clayton G.H., Mesibov G. Pilot study measuring the effects of therapeutic horseback riding on school-age children and adolescents with autism spectrum disorders. Res. Autism Spectr. Disord. 2012;6:578–588. doi: 10.1016/j.rasd.2011.09.007. [DOI] [Google Scholar]
  • 16.Bass M., Duchowny C.A., Llabre M.M. The effect of therapeutic horseback riding on social functioning in children with autism. J. Autism Dev. Disord. 2009;39:1261–1290. doi: 10.1007/s10803-009-0734-3. [DOI] [PubMed] [Google Scholar]
  • 17.Colquhoun H.L., Levac D., O’Brien K.K., Strauss S., Tricco A.C., Perrier P., Kastner M., Moher D. Scoping reviews: Time for clarity in definition, methods, and reporting. J. Clin. Epidemiol. 2014;67:1291–1294. doi: 10.1016/j.jclinepi.2014.03.013. [DOI] [PubMed] [Google Scholar]
  • 18.Tricco A.C., Lillie E., Zarin W., O’Brien K.K., Colquhoun H., Kastner M., Levac D., Ng C., Pearson Shape J., Wilson K., et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med. Res. Methodol. 2016;16:15. doi: 10.1186/s12874-016-0116-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Ahmed G.M., Mohamed S. Effect of regular aerobic exercises on behavioral, cognitive and psychological response in patients with Attention Deficit-Hyperactivity Disorder. Life Sci. J. 2011;8 doi: 10.16194/j.cnki.31-1059/g4.2011.07.016. [DOI] [Google Scholar]
  • 20.Alesi M., Battaglia G., Roccella M., Testa D., Palma A., Pepi A. Improvement of gross motor and cognitive abilities by an exercise training program: Three case reports. Neuropsychiatr Dis. Treat. 2014;10:479–485. doi: 10.2147/NDT.S58455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Borgi M., Loliva D., Cerino S., Chiarotti F., Venerosi A., Bramini M., Nonnis E., Marcelli M., Vinti C., De Santis C., et al. Effectiveness of a standardized equine-assisted therapy program for children with Autism Spectrum Disorder. J. Autism Dev. Disord. 2016;46:1–9. doi: 10.1007/s10803-015-2530-6. [DOI] [PubMed] [Google Scholar]
  • 22.Bowling A., Slavet J., Miller D.P., Haneuse S., Beardslee W., Davison K. Dose-response effects of exercise on behavioral health in children and adolescents. Ment. Health Phys. Act. 2017;12:110–115. doi: 10.1016/j.mhpa.2017.03.005. [DOI] [Google Scholar]
  • 23.Bustamente E.E., Davis C.L., Frazier S.L., Rusch D., Fogg L.F., Atkins M.S., Marquez D.X. Randomized controlled trial of exercise for ADHD and distruptive disorders. Med. Sci. Sports Exerc. 2016;48:1297–1407. doi: 10.1249/MSS.0000000000000891. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Chambers S.A. Ph.D. Thesis. Piedmont College; Demorest, Georgia: Mar 15, 2016. Short-Burst High-Intensity Exercise to Improve Working Memory in Pre-Adolescent Children Diagnosed with Attention Deficit Hyperactivity Disorder. [Google Scholar]
  • 25.Chang Y.K., Hung C.L., Huang C.J., Hatfield B.D., Hung T.M. Effects of an aquatic exercise program on inhibitory control in children with ADHD: A preliminary study. Arch. Clin. Neuropsychol. 2014;29:217–223. doi: 10.1093/arclin/acu003. [DOI] [PubMed] [Google Scholar]
  • 26.Choi J.W., Han D.H., Kang K.D., Jung H.Y., Renshaw P.F. Aerobic exercise and Attention Deficit Hyperactivity Disorder: Brain research. Med. Sci. Sport Exerc. 2015;47:33–39. doi: 10.1249/MSS.0000000000000373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Chou C.C., Huang C.J. Effects of an 8-week yoga program on sustained attention and discrimination function in children with attention deficit hyperactivity disorder. PeerJ. 2017;5:2883. doi: 10.7717/peerj.2883. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Cleary S.L., Taylor N.F., Dodd K.J., Shields N. A qualitative evaluation of an aerobic exercise program for young people with cerebral palsy in specialist schools. Dev. Neurorehabil. 2017;20:339–346. doi: 10.1080/17518423.2016.1277798. [DOI] [PubMed] [Google Scholar]
  • 29.Cuypers K., De Ridder K., Strandheim A. The effect of therapeutic horseback riding on 5 children with attention deficit hyperactivity disorder: A pilot study. J. Altern. Complement. Med. 2011;17:901–908. doi: 10.1089/acm.2010.0547. [DOI] [PubMed] [Google Scholar]
  • 30.Gabriels R.L., Pan Z., Dechant B., Agnew J.A., Brim N., Msibov G. Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents with Autism Spectrum Disorder. J. Am. Acad. Child. Adolesc Psychiatry. 2015;54:541–549. doi: 10.1016/j.jaac.2015.04.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.García-Gómez A., Rodríguez-Jiménez M., Guerrero-Barona E., Rubio-Jimenez J.C., Garcia-Pena I., Moreno-Manos J.M. Benefits of an experimental program of equestrian therapy for children with ADHD. Res. Dev. Disabil. 2016;59:176–185. doi: 10.1016/j.ridd.2016.09.003. [DOI] [PubMed] [Google Scholar]
  • 32.Garg S., Buckley-Reen A., Alexander L., Chintakrindi R., Ocampo Tan L.V., Patten Koenig K. The effectiveness of a manualized yoga intervention on classroom behaviors in elementary school children with disabilities: A pilot study. J. Occup. Ther. Sch. Early Interv. 2013;6:158–164. doi: 10.1080/19411243.2013.810942. [DOI] [Google Scholar]
  • 33.Grönlund E., Renck B., Weibull J. Dance/movement therapy as an alternative treatment for young boys diagnosed as ADHD: A pilot study. Am. J. Danc. Ther. 2005;27:63–85. doi: 10.1007/s10465-005-9000-1. [DOI] [Google Scholar]
  • 34.Hariprasad V.R., Arasappa R., Varambally S., Srinath S., Ganghadhar B.N. Feasibility and efficacy of yoga as an add-on intervention in attention deficit hyperactivity disorder: An exploratory study. Indian J. Psychiatry. 2013;55:54–63. doi: 10.4103/0019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Hartshorn K., Olds L., Field T., Delage J., Culen C., Escalona A. Creative movement therapy benefits children with autism. Early Child. Dev. Care. 2001;166:1–5. doi: 10.1080/0300443011660101. [DOI] [Google Scholar]
  • 36.Hilton C.L., Cumpata K., Klohr C., Gaetke S., Artner A., Johnson H., Dobbs S. Effects of exergaming on executive function and motor skills in children with autism spectrum disorder: A pilot study. Am. J. Occup. Ther. 2014;68:57–65. doi: 10.5014/ajot.2014.008664. [DOI] [PubMed] [Google Scholar]
  • 37.Hulls D.S.V., Walker L.K., Powell J.M. Clinicians’ perceptions of the benefits of aquatic therapy for young children with Autism Darcy. Phys. Occup. Ther. Pediatr. 2006;26:13–22. doi: 10.1080/J006v26n01. [DOI] [PubMed] [Google Scholar]
  • 38.Jang B., Song J., Kim J., Kim S., Lee J., Shin H.-Y., Kwon J.-Y., Kim Y.-H., Joung Y.-K. Equine-assisted activities and therapy for treating children with Attention-Deficit/Hyperactivity Disorder. J. Altern. Complement. Med. 2015;21:546–553. doi: 10.1089/acm.2015.0067. [DOI] [PubMed] [Google Scholar]
  • 39.Jenkins S.R., Digennaro Reed F.D. An experimental analysis of the effects of therapeutic horseback riding on the behavior of children with autism. Res. Autism Spectr. Disord. 2013;7:721–740. doi: 10.1016/j.rasd.2013.02.008. [DOI] [Google Scholar]
  • 40.Jensen P.S., Kenny D.T. The effects of yoga on the attention and behavior of boys with Attention-Deficit/hyperactivity Disorder (ADHD) J. Atten. Disord. 2004;7:205–216. doi: 10.1177/108705470400700403. [DOI] [PubMed] [Google Scholar]
  • 41.Johansson J.O. PhD Thesis. Washington State University; Pullman, WA, USA: 1996. The impact of physical activity on identity formation of adolescents with social and emotional problems. [Google Scholar]
  • 42.Kaiser L., Smith K.A., Heleski C.R., Spence L.J. Effects of a therapeutic riding program on at-risk and special education children. J. Am. Vet. Med. Assoc. 2006;228:46–52. doi: 10.2460/javma.228.1.46. [DOI] [PubMed] [Google Scholar]
  • 43.Kang K.D., Choi J.W., Kang S.G., Han D.H. Sports therapy for attention, cognitions and sociality. Int. J. Sports Med. 2011;32:953–959. doi: 10.1055/s-0031-1283175. [DOI] [PubMed] [Google Scholar]
  • 44.Lawson L.M. The effects of yoga on attention of preschool-aged children with attention. Therap. Recr. J. 2012;39:131–139. [Google Scholar]
  • 45.Lufi D., Parish-Plass J. Sport-based group therapy program for boys with ADHD or with other behavioral disorders. Child Fam. Behav. Ther. 2011;33:217–230. doi: 10.1080/07317107.2011.596000. [DOI] [Google Scholar]
  • 46.Macauley B.L., Gutierrez K.M. The effectiveness of hippotherapy for children with language-learning disabilities. Commun. Disord. Q. 2004;25:205–228. doi: 10.1177/15257401040250040501. [DOI] [Google Scholar]
  • 47.Mackinnon J.R., Noh S., Lariviere J., Macphail A., Allan S.E., Laliberte D. A study of therapeutic effects of horseback riding for children with cerebral palsy. Phys. Occup. Ther. Pediatr. 1995;15:17–34. doi: 10.1080/J006v15n01_02. [DOI] [PubMed] [Google Scholar]
  • 48.MacMahon J.R., Gross R.T. Physical and psychological effects of aerobic exercise in boys with learning disabilities. J. Dev. Behav. Pediatr. 1987;8:274–277. doi: 10.1097/00004703-198710000-00006. [DOI] [PubMed] [Google Scholar]
  • 49.Majorek M., Tüchelmann T., Heusser P. Therapeutic Eurythmy—Movement therapy for children with attention deficit hyperactivity disorder (ADHD): A pilot study. Complement. Ther. Nurs. Midwifery. 2004;10:46–53. doi: 10.1016/S1353-6117(03)00087-8. [DOI] [PubMed] [Google Scholar]
  • 50.McKune A., Pautz J., Lomjbard J. Behavioural response to exercise in children with attention-deficit/hyperactivity disorder. South Afr. J. Sport Med. 2004;15:17. doi: 10.17159/2413-3108/2003/v15i3a223. [DOI] [Google Scholar]
  • 51.Memarmoghaddam M., Torbati H.T., Sohrabi M., Mashhadi A., Kashi A. Effects of a selected exercise programon executive function of children with attention deficit hyperactivity disorder. J. Med. Life. 2016;9:373–379. doi: 10.22336/jml.2016.0410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Milligan K., Badali P., Spiroiu F. Using integra mindfulness martial arts to address self-regulation challenges in youth with learning disabilities: A qualitative exploration. J. Child. Fam. Stud. 2015;24:562–575. doi: 10.1007/s10826-013-9868-1. [DOI] [Google Scholar]
  • 53.Morand M.K. Ph.D. Thesis. Hofstra University; Hempstead, NY, USA: May 18, 2004. The Effects of Mixed Martial Arts on Behavior of Male Children with Attention Deficit Hyperactivity Disorder. [Google Scholar]
  • 54.Neely L., Rispoli M., Gerow S., Ninci J. Effects of antecedent exercise on academic engagement and stereotypy during instruction. Behav. Modif. 2015;39:98–116. doi: 10.1177/0145445514552891. [DOI] [PubMed] [Google Scholar]
  • 55.Nicholson H., Kehle T.J., Bray M.A., Van Heest J.C. The effects of antecedent physical activity on the academic engagement of children with autism spectrum disorder. Pschology Sch. 2011;48:198–213. doi: 10.1002/pits.20537. [DOI] [Google Scholar]
  • 56.O’Callaghan P.M., Reitman D., Northup J., Hupp S.D.A., Murphy M.A. Promoting social skills generalization with ADHD-diagnosed children in a sports setting. Behav. Ther. 2003;34:313–330. doi: 10.1016/S0005-7894(03)80003-5. [DOI] [Google Scholar]
  • 57.Ozer D., Baran F., Aktop A. Effects of a Special Olympics unified sports soccer program on psycho-social attributes of youth with and without intellectual disability. Res. Dev. Disabil. 2012;33:229–239. doi: 10.1016/j.ridd.2011.09.011. [DOI] [PubMed] [Google Scholar]
  • 58.Ozer D., Nalbant S., Aktop A. Swimming training program for children with Cerebral Palsu: Body perceptions, problem behavior, and competence. Percept. Mot. Skills. 2007;105:777–787. doi: 10.2466/PMS.105.7.777-787. [DOI] [PubMed] [Google Scholar]
  • 59.Packard S.S. Ph.D. Thesis. Miami University; Oxford, OH, USA: 2007. Effects of Vigorous Bouts of Physical Activity in Elementary Students with and without a Diagnosis of Attention Deficit Disorder: An Examination of How Physical Activity Influences the Attention and Concentration of Students in the School Environment. [Google Scholar]
  • 60.Pan C.Y., Chu C.H., Tsai C.L., Sung M.-C., Huang C.-Y., Ma W.-Y. The impacts of physical activity intervention on physical and cognitive outcomes in children with autism spectrum disorder. Autism. 2017;21:190–202. doi: 10.1177/1362361316633562. [DOI] [PubMed] [Google Scholar]
  • 61.Pan C.Y., Chu C.H., Tsai C.L., Lo S.-Y., Cheng Y.-W., Liu Y.-J. A racket-sport intervention improves behavioral and cognitive performance in children with attention-deficit/hyperactivity disorder. Res. Dev. Disabil. 2016;57:1–10. doi: 10.1016/j.ridd.2016.06.009. [DOI] [PubMed] [Google Scholar]
  • 62.Porter J. Yoga as an effective behavioral intervention for children diagnosed with an Autism Spectrum Disorder. Grad. Annu. 2013;1:9. [Google Scholar]
  • 63.Ringenbach S.D.R., Holzapfel S.D., Mulvey G.M., Jimenez A., Benson A., Richter M. The effects of assisted cycling therapy (ACT) and voluntary cycling on reaction time and measures of executive function in adolescents with Down syndrome. J. Intellect Disabil. Res. 2016;60:1073–1085. doi: 10.1111/jir.12275. [DOI] [PubMed] [Google Scholar]
  • 64.Rosenblatt L.E., Gorantla S., Torres J.A., Yarmush R.S., Rao S., Park E.R., Denninger J.W., Benson H., Fricchione G.L., Bernstein B., et al. Relaxation response-based yoga improves functioning in young children with autism: A pilot study. J. Altern. Complement. Med. 2011;17:1029–1035. doi: 10.1089/acm.2010.0834. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65.Rosenthal-Malek A., Mitchell S. The effects of exercise on the self-stimulatory behaviors and positive responding of adolescents with autism. J. Autism Dev. Disord. 1997;27:193–202. doi: 10.1023/A:1025848009248. [DOI] [PubMed] [Google Scholar]
  • 66.Smith A.L., Hoza B., Linnea K., McQuade J.D., Tomb M., Vaughn A.J., Shoulberg E.K., Hook H. Pilot physical activity intervention reduces severity of ADHD symptoms in young children. J. Atten. Disord. 2013;17:70–82. doi: 10.1177/1087054711417395. [DOI] [PubMed] [Google Scholar]
  • 67.Stickney M.A. PhD Thesis. University of Kentucky; Lexington, KY, USA: May 24, 2010. A qualitative study of the perceived health benefits of a therapeutic riding program for children with autism spectrum disorders. [Google Scholar]
  • 68.Tsai C.L. The effectiveness of exercise intervention on inhibitory control in children with developmental coordination disorder: Using a visuospatial attention paradigm as a model. Res. Dev. Disabil. 2009;30:1268–1280. doi: 10.1016/j.ridd.2009.05.001. [DOI] [PubMed] [Google Scholar]
  • 69.Tsai C.L., Wang C.H., Tseng Y.T. Effects of exercise intervention on event-related potential and task performance indices of attention networks in children with developmental coordination disorder. Brain Cogn. 2012;79:12–22. doi: 10.1016/j.bandc.2012.02.004. [DOI] [PubMed] [Google Scholar]
  • 70.Tsai C.L., Chang Y.K., Chen F.C., Hung T.-M., Pan C.-Y., Wang C.-H. Effects of cardiorespiratory fitness enhancement on deficits in visuospatial working memory in children with developmental coordination disorder: A cognitive electrophysiological study. Arch. Clin. Neuropsychol. 2014;29:173–185. doi: 10.1093/arclin/act081. [DOI] [PubMed] [Google Scholar]
  • 71.Verret C., Guay M.C., Berthiaume C., Gardiner P., Beliveau L. A physical activity program improves behavior and cognitive functions in children with ADHD: An exploratory study. J. Atten. Disord. 2012;16:71–80. doi: 10.1177/1087054710379735. [DOI] [PubMed] [Google Scholar]
  • 72.Wehrle S. Ph.D. Thesis. Rowan University; Glassborrow, NJ, USA: Jan 20, 2017. A Qualitative Case Study Describing the Relationship of Physical Activity and Classroom Behaviors Expectations for Elementary Students with Attention Deficit Hyperactivity Disorder. [Google Scholar]
  • 73.Wendt M.S. Ph.D. Thesis. State University of New York at Buffalo; Buffalo, NY, USA: May 13, 2000. The Effect of an Activity Program Designed with Intense Physical Exercise on the Behavior of Attention Deficit Hyperactivity Disorder (ADHD) Children. [Google Scholar]
  • 74.Yildirim N.Ü., Erbahçeci F., Ergun N., Pitetti K.H., Beets M.W. The effect of physical fitness training on reaction time in youth with intellectual disabilities. Percept. Mot. Skills. 2010;111:178–186. doi: 10.2466/06.10.11.13.15.25.PMS.111.4.178-186. [DOI] [PubMed] [Google Scholar]
  • 75.Ziereis S., Jansen P. Effects of physical activity on executive function and motor performance in children with ADHD. Res. Dev. Disabil. 2015;38:181–191. doi: 10.1016/j.ridd.2014.12.005. [DOI] [PubMed] [Google Scholar]
  • 76.Zajic M.C., McIntyre N., Swain-Lerro L., Novotny S., Oswald T., Mundy P. Attention and written expression in school-age, high-functioning children with autism spectrum disorders. Autism. 2018;22:245–258. doi: 10.1177/1362361316675121. [DOI] [PubMed] [Google Scholar]
  • 77.Spaniol M.M., Shalev L., Kossyvaki L., Mevorach C. Attention Training in Autism as a Potential Approach to Improving Academic Performance: A School-Based Pilot Study. J. Autism Dev. Disord. 2018;48:592–610. doi: 10.1007/s10803-017-3371-2. [DOI] [PubMed] [Google Scholar]
  • 78.Daley D., Birchwood J. ADHD and academic performance: Why does ADHD impact on academic performance and what can be done to support ADHD children in the classroom? Child. Care Health Dev. 2010;36:455–464. doi: 10.1111/j.1365-2214.2009.01046.x. [DOI] [PubMed] [Google Scholar]
  • 79.Woodman A.C., Breviglia E., Mori Y., Golden R., Maina J., Wisniewski H. The effect of music on exercise intensity among children with Autism Spectrum Disorder: A pilot study. J. Clin. Med. 2018;7:38. doi: 10.3390/jcm7030038. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 80.Oriel K.N., George C.L., Peckus R.S.A. The effects of aerobic exercise on academic engagement in young children with autism spectrum disorder. Pediatr Phys. Ther. 2011;23:187–193. doi: 10.1097/PEP.0b013e318218f149. [DOI] [PubMed] [Google Scholar]
  • 81.García-Villamisar D.A., Dattilo J. Effects of a leisure programme on quality of life and stress of individuals with ASD. J. Intellect Disabil Res. 2010;54:611–619. doi: 10.1111/j.1365-2788.2010.01289.x. [DOI] [PubMed] [Google Scholar]
  • 82.Elliott ROJr Dobbin A.R., Rose G.D., Soper H.V. Vigorous, aerobic exercise versus general motor training activities: Effects on maladaptive and stereotypic behaviors of adults with both autism and mental retardation. J. Autism Dev. Disord. 1994;24:565–576. doi: 10.1007/BF02172138. [DOI] [PubMed] [Google Scholar]
  • 83.Awamleh A.A., Woll A. The influence of physical exercise on individuals with autism: Is physical exercise able to help autistic. J. Soc. Sci. 2014;10:46–50. doi: 10.3844/jssp.2014.46.50. [DOI] [Google Scholar]
  • 84.Hill A.P., Zukerman K.E., Fombonne E. Obesity and autism. Pediatrics. Pediatrics. 2015;136:1051–1061. doi: 10.1542/peds.2015-1437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 85.Srinivasan M., Pestcatello L.S., Bhat A.N. Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders. Phys. Ther. 2014;94:875–889. doi: 10.2522/ptj.20130157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 86.Busch C., Tucha L., Talarovicova A., Fuermaier A.B.M., Lewis-Evans B., Tucha O. Animal-assisted interventions for children with attention deficit/hyperactivity: A theoretical review and consideration of future directions. Psychol. Rep. 2016;118:292–331. doi: 10.1177/0033294115626633. [DOI] [PubMed] [Google Scholar]
  • 87.McDaniel Peters B.C., Wood W. Autism and equine-assisted interventions: A systematic mapping review. J. Autism Dev. Disord. 2017;47:3220–3242. doi: 10.1007/s10803-017-3219-9. [DOI] [PubMed] [Google Scholar]
  • 88.Pontifex M.B., Fine J.G., da Cruz K., Parks A.C., Smith A.L. The role of physical activity in reducing barriers to learning in children with developmental disorders. Monogr. Soc. Res. Child. Dev. 2014;79:93–118. doi: 10.1111/mono.12132. [DOI] [PubMed] [Google Scholar]
  • 89.Tan B.W.Z., Pooley J.A., Speelman C.P. A meta-analytic review of the efficacy of physical exercise interventions on cognition in individuals with Autism Spectrum Disorder and ADHD. J. Autism Dev. Disord. 2016;46:3126–3143. doi: 10.1007/s10803-016-2854-x. [DOI] [PubMed] [Google Scholar]
  • 90.Cerrillo-Urbina A.J., García-Hermoso A.M., Sánchez-López M., Pardo-Guijaro M.J., Santos G.J.L., Martinez-Vizcaino M. The effects of physical exercise in children with attention deficit hyperactivity disorder: A systematic review and meta-analysis of randomized control trials. Child. Care Health Dev. 2015;41:779–788. doi: 10.1111/cch.12255. [DOI] [PubMed] [Google Scholar]
  • 91.Parsons H. What happened at Hawthorne? New evidence suggests the Hawthorne effect resulted from operant reinforcement contingencies. Science. 1974;183:922–932. doi: 10.1126/science.183.4128.922. [DOI] [PubMed] [Google Scholar]
  • 92.McCambridge J., Witton J., Elbourne D. Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects. J. Clin. Epidemiol. 2014;67:267–277. doi: 10.1016/j.jclinepi.2013.08.015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 93.Mundkur N. Neuroplasticity in children. Indian Journal of Pediatrics. J. Pediatr. 2005;72:855–857. doi: 10.1007/BF02731115. [DOI] [PubMed] [Google Scholar]
  • 94.Losardo A., McCullough K.C., Lakey E.R. Neuroplasticity and young children with Autism: A tutorial. Anat. Physiol. Curr. Res. 2016;6:234–235. doi: 10.4172/2161-0940.1000209. [DOI] [Google Scholar]

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