Neural and cognitive effects of exergaming interventions in autistic youth
Date
2025
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of Delaware
Abstract
Children and adolescents with autism spectrum disorder (ASD) present with executive functioning (EF) and motor impairments. These co-occurring EF and motor challenges are correlated with and impact the core impairments of ASD, including socialization, communication, and restricted and repetitive behaviors. Exergaming is the use of video gaming platforms to promote physical activity, offering direct benefits to motor skills and, potentially, EF skills that are often unaddressed in mainstream autism services. Our systematic review of DMI studies in developmental disabilities confirmed robust motor improvements across populations; however, cognitive effects in autistic individuals were less conclusive due to a limited number of studies. Therefore, we investigated the neural underpinnings of EF and body coordination challenges in autistic youth, and the impact of digital motor interventions (DMIs) on cortical activation during EF and multilimb coordination tasks. ☐ Using functional near-infrared spectroscopy (fNIRS), autistic youth (N=15, age 11.5 ± 0.57, 5-16 years) demonstrated lower EF performance, as shown in standardized questionnaire Behavior Rating Inventory of Executive Function (BRIEF) and greater reaction time variability during fNIRS Flanker inhibitory control tasks, accompanied by altered cortical activation patterns compared to age- and sex-matched non-autistic youth. Specifically, they demonstrated hypoactivation in the left inferior parietal lobule (IPL), precentral gyrus (PCG), and middle frontal gyrus (MFG), as well as hyperactivation in the left superior temporal sulcus (STS), and less left lateralization during inhibitory control. Moreover, lower left MFG hypoactivation was associated with elevated EF impairments. Interestingly, in the ASD group, right IPL and left/right STS activation were associated with better EF performance, indicating a potential compensatory strategy in autistic youth. These findings suggest that autistic children have different activation patterns in the default mode network (DMN) and the central executive network (CEN) compared to non-autistic peers during inhibitory control performance. ☐ Autistic youth also exhibited lower body coordination performance, as indicated by standardized motor assessment Bruininks-Oseretsky Test of Motor Proficiency- 2nd (BOT-2), Developmental Coordination Disorder Questionnaire (DCD-Q), and greater movement errors during a fNIRS whole-body, multilimb coordination task compared to controls. FNIRS revealed STS hypoactivation and inferior frontal gyrus (IFG) hyperactivation, indicating altered sensorimotor integration. While non-autistic youth primarily activated STS and IPL, autistic youth showed predominant IFG engagement, which was associated with increased task errors and reduced coordination. ☐ Two pilot randomized controlled trials evaluated the effect of 2 DMIs on EF, fine motor, and cortical activation in autistic youth. The BrainyAct motor intervention (N = 24, Age :10.5 ± 0.5 years) showed some improvements in game-specific cognitive scores, but trainers encountered significant technological difficulties. The intervention failed to produce transfer effects during standardized EF or motor assessments. In contrast, the Nintendo Switch exergaming intervention (N = 30, Age: 12.6 ± 0.62 years) led to moderate improvements in cognitive flexibility in the Stroop task and moderately improved inhibitory control performance, with large between-group differences in the Flanker task; however, it did not enhance fine motor skills. ☐ fNIRS neuroimaging post-intervention revealed that Nintendo exergaming induced cortical changes linked to reduced cortical activation in the IFG and PCG for the young NE subgroup (<13 years), as well as decreased activation in the IPL, MFG, and IFG for the older NE subgroup. In addition, a general reduction in cortical activation was shown in the left hemispheres for the lower communication score NE subgroup, and in both hemispheres in the high communication score NE subgroup. The regions showing an intervention response corresponded with the DMN and CEN regions identified as important for EF performance in our previous studies. Nintendo exergaming interventions may improve inhibitory control in autistic youth by enhancing neural efficiency through the development of inhibitory control skills, suppressing DMN regions, and increasing processing speed by enhancing neurotransmitter levels and receptor sensitivity. However, although we found robust evidence of body coordination improvements in our larger pilot RCT, no training-related neural changes were observed during the fNIRS whole-body coordination tasks, highlighting the need to improve our fNIRS task to better capture intervention-related changes. ☐ In conclusion, this dissertation presents evidence for autism-specific fNIRS cortical activation patterns that inform the development of autism interventions and support the assessment of motor and executive function (EF) challenges in autistic youth. Furthermore, it demonstrates that carefully designed, accessible exergaming can support EF improvements in autistic youth.
Description
Keywords
Autism spectrum disorder, Biomarker, Executive function, Exergaming, Motor function