Static and dynamic balance in children and adolescents with autism spectrum disorder compared with typically developing peers: a systematic review and meta-analysis.

Children with autism often have balance problems that can affect their daily activities and independence. This large review of 34 studies found that children with autism consistently showed poorer balance compared to other children, whether measured through clinical tests or specialized equipment. The differences were significant but varied depending on how balance was tested. More high-quality research is needed to better understand these balance challenges.

This systematic review and meta-analysis examined balance performance in 1,278 children and adolescents (612 with ASD, 666 typically developing) across 34 studies. Both observational tools (MABC-2, BOT-2) and instrumental force platform assessments demonstrated significantly poorer static and dynamic balance in participants with ASD compared to typically developing peers. Effect sizes ranged from moderate to very large depending on the assessment method and conditions. Observational tools showed moderate effect sizes (SMD = -0.66), while force platform measures revealed larger differences in postural sway, center of mass displacement, and velocity.

However, substantial heterogeneity between studies and low to very low certainty of evidence limit confidence in findings.

Balance assessment should be routine in autism evaluations using validated tools like MABC-2 or BOT-2. Clinicians should consider both static and dynamic balance components when developing intervention plans. The significant balance differences support targeted interventions to improve postural control and reduce impact on daily functioning and participation.

High heterogeneity between studies (0-98%), low to very low certainty of evidence according to GRADE assessment, and sensitivity analyses showing some effect estimates were influenced by individual studies. Limited ecological validity in real-world settings.

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. 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. • 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. • 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.