Static and dynamic balance in children and adolescents with autism spectrum disorder compared with typically developing peers: a systematic review and meta-analysis
Balance is reliably weaker in ASD youth, so screen with MABC-2 or force plates and target it in treatment.
01Research in Context
What this study did
The team pooled 34 studies that compared balance in youth with autism and typically developing peers.
They looked at both static balance (standing still) and dynamic balance (moving).
Tools ranged from simple checklists to high-tech force plates that track tiny body sway.
What they found
Kids and teens with ASD scored lower on every type of balance test.
The gap was medium to large, but the evidence quality was low because studies used different methods.
Force-plate and MABC-2 tools gave the clearest pictures of the deficit.
How this fits with other research
Lim et al. (2017) already showed big static-balance problems; Martín-Díaz et al. (2026) widens the lens to include moving balance too.
Martín-Díaz et al. (2024) and LeBlanc et al. (2003) are single studies inside this new meta — their bad-balance results now become the norm, not one-off findings.
Ament et al. (2015) hints that poor MABC-2 balance can even help tell ASD from ADHD; the meta endorses the same test for screening.
Why it matters
Expect balance issues in most clients with ASD and plan for them.
Use the MABC-2 or a force plate during intake to get quick, valid numbers.
Add balance goals to the plan — they’re easy to measure and affect safety, sports, and social play.
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02At a glance
03Original abstract
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 (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 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. 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. The online version contains supplementary material available at 10.1007/s00431-026-06871-0.
European Journal of Pediatrics, 2026 · doi:10.1007/s00431-026-06871-0