Pediatrics
META ANALYSIS
● Meta-analysis
Meta-analysis: Children with ASD show poorer balance vs. TD peers, SMD -0.66 with observational tools
European journal of pediatrics
Published March 30, 2026
Martín-Díaz Paloma, Carratalá-Tejada María, Navarro-López Victor, Fernández-González Pilar, Cuesta-G…
PubMed ↗
DOI ↗
This systematic review and meta-analysis, conducted following PRISMA guidelines, compared static and dynamic balance in children and adolescents with autism spectrum disorder (ASD) versus typically developing (TD) peers and identified the tools most used for assessment. The analysis included 34 studies in the descriptive synthesis and 16 in the meta-analyses, encompassing 1278 total participants (612 with ASD, 666 TD). Inclusion criteria focused on studies assessing static or dynamic balance in children aged 6-18 with ASD using validated observational or instrumental tools and including a TD group. Observational tools (e.g., MABC-2, BOT-2) revealed significantly poorer balance in ASD participants, with a standardized mean difference (SMD) of -0.66 (95% CI: -1.07 to -0.25; p = 0.002). Force platform assessments demonstrated larger differences across various postural sway measures. Specific SMDs for force platform outcomes were: mediolateral displacement on a stable surface (eyes open SMD = 0.83, eyes closed SMD = 0.56), anteroposterior displacement on a stable surface (eyes open SMD = 0.97, eyes closed SMD = 0.27), center of mass (COM) displacement area (SMD = 1.15-7.72 depending on condition), and COM velocity (SMD = 1.00-3.23 depending on condition). Heterogeneity across studies ranged from moderate to very high (I² = 0-98%). Sensitivity analyses indicated that some effect estimates, particularly for COM displacement area, were influenced by individual studies. The overall certainty of evidence was rated as low to very low according to the GRADE assessment. The authors conclude that children with ASD may exhibit poorer static and dynamic balance compared to TD peers and that further high-quality studies are needed.
For a child, being unsteady on their feet isn't just about sports—it can make walking, playing, and navigating the world feel harder. This is a common concern for children and adolescents with autism spectrum disorder (ASD). A major review of 34 studies, involving over 1,200 kids, set out to compare their balance to that of their typically developing peers. The findings show a clear pattern: kids with ASD had poorer static and dynamic balance. This was true whether clinicians used simple observational tests or more precise force platforms that measure tiny body sways. The high-tech tools revealed even larger differences, particularly in how much a child's body moves from side-to-side and front-to-back while trying to stand still. The researchers note the overall certainty of this evidence is low to very low, meaning more high-quality studies are needed. But the consistent signal across many studies points to balance as a significant area of difficulty. Understanding this helps explain why some daily tasks might be challenging and underscores the importance of assessing balance as part of care.
What this means for you: Children with autism may have more difficulty with balance than their peers, a review of over 1,200 kids suggests.
View Original Abstract ↓
UNLABELLED: Children and adolescents with autism spectrum disorder (ASD) often present motor difficulties, particularly in postural control, which can affect their autonomy and participation in daily activities. Despite growing interest in balance assessment, there is no comprehensive synthesis comparing balance performance in ASD using both observational and instrumental methods. To compare the static and dynamic balance of children and adolescents with ASD versus typically developing (TD) peers, and to identify the tools most used to assess balance in this population. A systematic review and meta-analysis were conducted following PRISMA guidelines. Six electronic databases were searched to November 2025. Inclusion criteria focused on studies assessing static or dynamic balance in children aged 6-18 with ASD, using validated observational or instrumental tools, and including a TD group. Data extraction, methodological quality assessment, risk‑of‑bias evaluation, and GRADE assessment were performed independently by two reviewers, with discrepancies resolved by discussion or by a third reviewer. Standardized mean differences (SMDs) were calculated using random-effects models, established a priori to account for expected clinical heterogeneity. A total of 34 studies were included in the descriptive synthesis and 16 in the meta-analyses, encompassing 1278 participants (612 ASD, 666 TD). Observational tools (e.g., MABC-2, BOT-2) revealed significantly poorer balance in ASD participants ((SMD = -0.66; 95% CI: -1.07 to -0.25; p = 0.002). Force platform assessments demonstrated larger differences across postural sway measures: mediolateral displacement (stable surface: eyes open SMD = 0.83, eyes closed SMD = 0.56), anteroposterior displacement (stable surface: eyes open SMD = 0.97, eyes closed SMD = 0.27), COM displacement area (SMD = 1.15-7.72 depending on condition), and COM velocity (SMD = 1.00-3.23 depending on condition). Heterogeneity ranged from moderate to very high (I = 0-98%). Sensitivity analyses indicated that some effect estimates, particularly for COM displacement area, were influenced by individual studies. The overall certainty of evidence was low to very low according to GRADE.
CONCLUSION: Children with ASD may exhibit poorer static and dynamic balance compared to TD peers using both observational and instrumental assessments. Further high-quality studies are needed to strengthen the evidence base and enhance ecological validity in real-world settings.
WHAT IS KNOWN: • Children and adolescents with autism spectrum disorder (ASD) frequently experience balance problems that affect daily functioning and participation. • Earlier reviews have described postural control in ASD but have not examined in depth the instruments used for its assessment.
WHAT IS NEW: • This review provides a systematic overview of the clinical and biomechanical tools applied to evaluate balance in ASD. • It also compares the performance of children across different assessment methods, offering practical guidance for clinicians and educators when selecting appropriate measures.