Effects of a Combined Physical Activity and Educational Drama Intervention on Core Symptoms and Physical Fitness in Children with ASD

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Twenty children were randomly assigned to an experimental group (n = 10), receiving the combined intervention, or a control group (n = 10), receiving conventional physical activity. Outcomes were assessed using the Repetitive Behavior Scale-Revised (RBS-R), Social Responsiveness Scale-2 (SRS-2), and a physical fitness test battery. Results indicated that both groups showed significant improvements in repetitive behaviors and physical fitness. However, the experimental group demonstrated significantly greater reductions in stereotyped behaviors, restricted behaviors, and social impairments—specifically in social communication, motivation, and autistic mannerisms—compared to the control group. These findings suggest that integrating educational drama with physical activity is more effective than physical activity alone in ameliorating core ASD symptoms, offering a promising holistic intervention approach. Ethics : This study has been approved by the Guangzhou Sport University Research Ethics Committee (102772021RT067) . Trail registration number : This study has been registered prospectively in the Chinese Clinical Trail Registry(CTR2500103810). Health sciences/Health care Biological sciences/Neuroscience Biological sciences/Psychology Social science/Psychology Autism Spectrum Disorder Integrated Intervention Educational Drama Physical Activity Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that originates in early childhood, characterized primarily by persistent deficits in social communication and interaction, along with restricted and repetitive patterns of behavior, interests, or activities[1]. Globally, the prevalence of ASD has shown a marked upward trend, emerging as a major public health concern that imposes substantial caregiving and economic burdens on affected families and society at large[2]. At present, the etiology of ASD remains incompletely understood, and no specific pharmacological treatments are available. Consequently, evidence-based and effective non-pharmacological rehabilitation interventions have become the central focus of both research and clinical practice. Traditional behavioral interventions, such as Applied Behavior Analysis (ABA), have demonstrated certain efficacy in improving specific behaviors. However, their highly structured nature often limits the generalization of acquired skills to naturalistic settings and may fail to sufficiently stimulate children’s intrinsic social motivation[3]. In addition, children with ASD often present with a range of comorbid conditions, among which deficits in Fundamental Motor Skills (FMS) have attracted increasing research attention in recent years. A substantial body of evidence indicates that up to 80% of children with ASD exhibit pronounced motor coordination impairments, poor balance, and clumsy or awkward movements[4]. These motor deficits do not exist in isolation; rather, they are closely intertwined with and mutually influence the core symptoms of ASD. For instance, inadequate motor skills can restrict children’s participation in peer play and physical activities, thereby depriving them of valuable opportunities for social engagement and exacerbating social isolation[5]. Conversely, diminished social motivation further reduces their likelihood of engaging in movement-based activities, creating a self-reinforcing cycle of impairment[6]. Therefore, there is an urgent need for an integrative intervention approach for children with ASD—one that simultaneously addresses their deficits in social communication and motor skills. Against this background, Physical Activity Interventions have demonstrated distinct advantages. Systematic exercise programs—such as ball skill training, balance exercises, and functional play—have been shown to directly enhance strength, coordination, balance, and motor proficiency in children with ASD[7]. More importantly, the benefits of physical activity interventions may extend well beyond the motor domain. The inherent elements of such activities—rule following, turn-taking, and teamwork—naturally create a “training ground” for the development of social cognition and adaptive behaviors[8]. Evidence suggests that physical activity interventions can also effectively reduce stereotyped behaviors, improve attention, and alleviate anxiety, thereby exerting positive and indirect effects on the core symptoms of ASD[9].However, purely exercise-based interventions remain relatively indirect in their mechanisms for eliciting complex socio-emotional responses and enhancing theory of mind, resulting in limited overall effectiveness in these domains. Educational Drama, or Drama Therapy, as a form of expressive arts intervention, has shown considerable potential in the field of ASD intervention[10]. Educational drama does not aim to train performance skills, but rather utilizes theatrical elements—such as role-playing, improvisation, and story enactment—to provide children with opportunities to experience different roles, perspectives, and social scenarios within a safe and fictional context[11]. This approach is highly compatible with the intervention needs of children with ASD. By engaging them in embodied role-playing activities, it translates abstract social rules, emotional expressions, and communication skills into concrete, actionable behaviors, effectively alleviating the immediate stress and anxiety of social situations[12]. Empirical evidence has confirmed that drama-based interventions can significantly improve emotional recognition, language communication, social interaction skills, and imaginative capacity in children with ASD[13]. However, drama-based interventions typically require a certain level of physical expressiveness and motor ability. Given that children with ASD often exhibit motor impairments, these limitations may constrain their participation and performance in theatrical activities, thereby restricting the maximal effectiveness of the intervention[14]. In summary, physical activity and educational drama interventions are theoretically highly complementary and potentially synergistic. Physical activity provides a solid foundation for the bodily expression and motor execution required in drama-based interventions, while educational drama offers a socially and emotionally meaningful context in which motor skills can be applied.This integrated approach, combining physical activity with educational drama, is expected to operate through a bidirectional pathway. On one hand, improved motor skills can enhance children’s confidence and engagement in drama activities, enabling them to benefit more effectively from social drama training. On the other hand, the social motivation and enjoyment elicited by drama activities can, in turn, encourage children to participate more actively and attentively in physical activities, further reinforcing motor skill development. However, despite the evidence supporting each approach individually, systematic integration of the two into a unified intervention program—and scientific evaluation of its combined effects on both core ASD symptoms and fundamental motor skills—remains unexplored. Currently, there is a lack of randomized controlled trials investigating whether this combined intervention can produce synergistic benefits. Participants and Methods Participants and Grouping A total of 23 children with autism were initially recruited from the third grade of Foshan Qizhi School. Based on the inclusion and exclusion criteria, 20 participants met the eligibility requirements and were included in the study. They were assigned to either the experimental group (n = 10) or the control group (n = 10), matched according to demographic variables such as age, sex, and class. The experimental group received a combined Physical Activity and Educational Drama intervention, while the control group participated in a conventional Physical Activity intervention. Participants were informed that they could withdraw from the study at any time without penalty if they experienced discomfort or were unwilling to continue during the intervention period. Randomization Numbers (1–20) will be assigned to the participants according to their recruitment times in an Excel software database, and then a random sequence will be generated using the "= rand ()" formula. This sequence will be sorted to allocate the participants to the study groups. These tasks will be completed by professional computer workers blinded to recruitment and allocation after the completion of recruitment. Study Design This study adopted a 2 (time: pre-test, post-test) × 2 (group: experimental group, control group) mixed experimental design, with time as the within-subjects factor and group as the between-subjects factor. The study was conducted between June and September 2025 in Foshan City, Guangdong Province, China. The study protocol received approval from the Ethics Committee of Guangzhou Sport University (Approval No.: 2025LCLL-067) and was registered with the Chinese Clinical Trial Registry (Registration No.: CTR2500103810). This investigation was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all parents/legal guardians of the participants prior to their inclusion in the study. Experimental Group The Physical Activity combined with Educational Drama intervention consisted of three progressive stages: adaptation, fundamental, and advanced phases (Table 2 ). Each session followed a structured sequence comprising a warm-up, foundational training, core activity, and relaxation segment ( Table 3 ). The intervention dosage was as follows: (1) each session lasted 30 minutes; (2) exercise intensity was maintained at a moderate level, corresponding to 60–69% of the participant’s maximum heart rate (maximum heart rate = 220-age); (3) the intervention period lasted 12 weeks(2025.6.15-2025.9.10); and (4) sessions were conducted three times per week. Table 1 Inclusion and Exclusion Criteria of the Study Participants Inclusion Criteria: Exclusion Criteria: 1)Diagnosed with Autism Spectrum Disorder (ASD) in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM−5) criteria; 1)Presence of other neurological, psychiatric, or cardiovascular disorders; 2)Participant’s guardian provided informed consent for participation in the study; 2)Recent use of medications affecting the central nervous system; 3)No comorbid neurological or psychiatric disorders. 3)Visual or auditory impairments; Table 2 The Combined Physical Exercise and Educational Drama Intervention Program Phase Week Intervention Content Learning Objectives Adaptation Week 1 1. Cultivation of social etiquette; 2. Establishment of classroom routines; 3. Visual and tactile desensitization exercises 1. Foster basic social etiquette and classroom behavioral norms in children with autism; 2. Reduce resistance to the classroom environment and sports equipment; 3. Enhance interest in physical activities Foundation Week 2 1. Drama warm-up activities: Follow the Leader, Circle Games, Statue Photos; 2. Learning basic movements: Natural Walk, Marching, Imitating Animal Walks; 3. Educational drama picture books: The Farmer and the Fox, Monkey Training, The Three Little Pigs 1. Embed educational drama concepts into the classroom to enrich emotional experiences; 2. Improve fundamental motor skills; 3. Alleviate behavioral problems Week 3 1. Drama warm-up activities: Eye Contact Stickers, Yang Village Exercise Routine, Passing the Tambourine; 2. Learning basic movements: Quick Run, Natural Jog, Circle Run, Curve Run, Straight Run, Shuttle Run; 3. Educational drama picture books: The Tortoise and the Hare, The Animal Sports Day, The Lost Duckling Week 4 1. Drama warm-up activities: Thought Bubbles, Forest Concert, Crab Gymnastics; 2. Learning basic movements: Two-Foot Jump Down, Two-Foot Forward Jump, One-Foot Continuous Jump; 3. Educational drama picture books: Pulling the Radish, Hopscotch, Little Crab Finds Friends Week 5 1. Drama warm-up activities: Swatting Mosquitoes, Keep the Bag Aloft, What's in the Bag; 2. Learning basic movements: Two-Handed Chest Throw, Two-Handed Overhead Throw, One-Handed Overhead Throw; 3. Educational drama picture books: Lovely Panda Gymnastics, Little Duck Swimming, Space Throwing Challenge Week 6 1. Drama warm-up activities: The Ant and the Giant, I am a Snowman, Crawling Around; 2. Learning basic movements: Front Drill, Hand-Knee Crawl, Prone Crawl; 3. Educational drama picture books: The Snow Queen, A Monkey Mountain, Pinocchio Week 7 1. Drama warm-up activities: Walk and Stop, Shark is Coming, Face to Face; 2. Learning basic movements: Walking/Running on Balance Beams, Run-Walk Sudden Stop, One-Leg Stand; 3. Educational drama picture books: The Little Goat Crosses the Bridge, The Key Keeper, Let's Ride Together Week 8 1. Drama warm-up activities: The Old Lady's Oil Jar, The Little Monkey Takes an Unusual Path, Eyes Open Explosion; 2. Learning basic movements: Side Roll, Forward Roll, Backward Roll; 3. Educational drama picture books: Little Rabbit Rolling the Hoop, Carousel, Chameleon Week 9 1. Drama warm-up activities: Pair Push Hands, Who's the Winner, Emotion Statues; 2. Learning basic movements: Push, Pull, Push + Pull; 3. Educational drama picture books: The Lion Who Loved Tug-of-War, The Terracotta Warriors, The Lost Duckling Week 10 1. Drama warm-up activities: Tail Game, Group Sculpture, Eagle Catches Chicks; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull; 3. Educational drama picture books: Maisy Goes to the Sports Day, Carnival of the Animals, The Three Billy Goats Gruff Advanced Week 11 1. Drama warm-up activities: Jumping Frogs, Happy Little Driver, Athlete Competition; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull; 3. Educational drama picture books: The Little Bear Who Danced, The Gruffalo, Little Bear's Adventure 1. Facilitate flexible application of learned educational drama concepts and fundamental motor skills; 2. Alleviate behavioral problems Week 12 1. Drama warm-up activities: Random Selection; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull; 3. Educational drama picture books (Random Selection) Table 3 Introduction to Educational Drama Warm-up Activities Game Name Practice Method Main Objectives Change the Leader One student is given a hat to wear, while the other students line up behind. When music plays, the child with the hat leads the line around the room, performing repetitive actions for the others to mimic. Later, the teacher transfers the hat to another student and gives the "Change the Leader" command. Trains students' ability to listen to instructions and react quickly, attention, walking accuracy, and coordination with peers. Circle Games Students sit in a circle. The teacher gives instructions, e.g., form pairs, raise your right hand, raise both hands, stretch out your legs. Helps students fully explore their physical potential and enhances mental flexibility. Statue Photos The teacher shows pictures one by one. Students imitate the poses in pairs, having 10 seconds to think before immediately striking the pose. The teacher then scores their performance. Trains teamwork and the ability to observe details in pictures and reproduce accurate actions. Eye Contact Stickers Using the classroom as the activity area, everyone walks around naturally with heads down, trying to cover the entire space. At the teacher's signal, everyone looks up; the first person a student sees becomes their partner. Students without a partner take on the teacher's role for the next round. Exercises concentration, execution ability, and lets students experience the fun and wonder of the game within a limited space. Sheep Sports Meet Two students are randomly chosen to play wolves; the others are sheep. On the teacher's command, the sheep run and jump within a limited area while the wolves try to catch them. Exercises full coordination of upper and lower limbs, reinforces clear role identity, distinguishes between roles, and fosters subjective judgment Passing the Tambourine One student sits in the center of a circle with eyes closed. The others sit in the circle with hands behind their backs. They pass a tambourine behind their backs as quickly as possible. When the teacher says "stop," the center child opens their eyes and points to who they think has the tambourine. Younger students often reveal through facial expressions or body language if they have the tambourine. The teacher guides them to disguise this and use expressions/gestures appropriately Thought Bubbles After students create a static scene, everyone reflects on what each person in the scene might be thinking. The teacher walks around and taps a student's head; that student must immediately verbalize the inner thoughts of their character/object, using divergent thinking to offer different possibilities. Trains the use of body language to express ideas and actively explore answers to the teacher's questions. Forest Concert The teacher plays "Forest Rhapsody" to set the scene. Using verbal cues, the teacher announces a forest concert. Students imagine animals attending and portray them, then use actions to show which animal is performing. Trains musicality, using prior knowledge to immerse in the scenario, choosing and role-playing favorite animals, showcasing talents, and enhancing achievement motivation. Crab Gymnastics The teacher plays music and demonstrates corresponding crab poses (standing, prone crawling, hand-knee crawling, etc.). Students follow along. Exercises arm strength, leg strength, imitation skills, and teaches knowledge about crabs. Swatting Mosquitoes Students are divided into two groups: sleepers and mosquitoes. The sleepers crouch pretending to sleep. The mosquitoes buzz and fly near them. When the teacher says, "Listen, there's a sound," sleepers can squint and swat with their hands without moving their feet. If hit, a mosquito becomes a sleeper. Exercises arm muscle strength, control of upper/lower limbs, and adaptability. Keep the Bag Aloft Two groups, each with one plastic bag. On start, they toss the bag and keep it from touching the ground. The group whose bag touches the ground first loses. Exercises lung capacity, control over object positioning, and teamwork/inquiry skills. What's in the Trash Bag? The teacher provides a large trash bag. Students imagine what's inside. One student names an item; others, guided by the teacher's words/actions, mimic creating that trash (e.g., for an apple core, act out eating an apple and throwing the core; for paper, act out typing on a computer and crumpling paper). Develops awareness of waste sorting and classification, and improves hands-on ability between teacher and students. The Ant and the Giant Students lie freely on the floor, curling up as small as possible, imagining themselves smaller than an ant. Then they relax to a normal state. Next, they stretch their bodies to the maximum, imagining themselves as giants, before relaxing back to normal. Develops flexibility, reaching one's limits; also a stretching exercise to relieve physical and mental fatigue. I Am a Snowman Teacher guides students to act as snowmen, reciting: "I am a little snowman, round body, round head, white and chubby, so cute." The teacher acts as the sun: "The sun is out, melting the snowman's head (students relax, lower head), melting the snowman's body (relax, bend forward), melting the snowman's legs (relax, squat down)." The snowman disappears, melting into a puddle (students completely relax and lie down). Exercises concentration, appropriate use of limbs, and fully develops body potential. Crawling Around Teacher and students discuss animals that crawl. The teacher acts as a fairy, asking, "Which crawling animal do you want to become? Where do you want to crawl?" All students act out their chosen animal (e.g., turtle, crab, snake) and mimic its movements to crawl to a specified spot. Exercises cooperative inquiry between teacher and students, and students' ability to control flexibility, strength, and speed in their limbs. Walk and Stop The teacher leads all students walking from one end of the area to the other via different paths (straight, diagonal, large S-curve, wavy line). Students then take turns leading, freely choosing a path. Guide students to use a different route each time they reach the end. Exercises visual perception, muscle endurance, and adaptability to different paths. Shark is Coming Students stand in a circle facing inward. The teacher is the shark first, calls a student's name, and walks towards them with hands reaching out and eyes locked on. Before being caught, the named student must call another student's name. Trains students to stay calm under pressure, react quickly, and use space reasonably for self-protection. Face to Face Like mirroring. Students sit facing a partner; decide who is A and B. Give instructions for A to slowly trace a pattern in the air with one arm; B must mirror the movements. When the teacher says "switch," roles reverse without stopping the game. Exercises comprehensive physical quality, simultaneous use of hands and feet, attention, imagination, and spatial awareness. Grandma's Oil Jar One student plays a mouse sleeping next to Grandma's oil jar. The other students' main task is to return the jar to its owner without waking the mouse. The mouse occasionally wakes up, so timing is crucial. Exercises control of limbs. The uncertainty of the mouse waking adds challenge, boosting curiosity and sense of justice. The Little Monkey's Walk Students imitate a monkey's walk. The teacher encourages them to imagine different ways: forward, backward, sideways, or cooperating with partners to create unique walking styles. Develops observation skills, limb coordination, and through teacher guidance, students verbalize monkey traits, imitate, and add creativity. Eyes Open Explosion Students stand in a circle, practicing opening and closing their eyes. When eyes are open, they must find someone to make eye contact with. If two people lock eyes, they say "bang" and must not laugh. Exercises concentration in complex environments and impacts executive function. Pair Push Hands In pairs, students stand facing each other, extend hands, and push palm-to-palm. Both apply force, not to win, but to maintain the current position and balance of power. Exercises core control and balance, focusing on feeling physical force opposition rather than competition. Who's the Winner? In pairs, students stand facing each other, extend one hand forward, and grasp hands. On command, both pull simultaneously. The first to move their foot loses; the other wins. Experience push/pull forces, exercise balance, coordination, flexibility, and develop overall fitness. Emotion Statues All students stand in a line, teacher 10 meters away. On command (e.g., sad, crying, stomping feet), students quickly run to the teacher, perform the action, and shout its name. Exercises using body and facial expressions to convey emotions, vent feelings, and reduce psychological stress. Tail Game Three children are "it"; others tuck a cloth strip in their waistband as a "tail." The three try to grab tails. If a tail is grabbed, the grabber keeps it, and the tailless child must grab someone else's tail. Exercises thinking, problem-solving, quick reaction, and improves limb coordination and agility. Group Sculpture Students form groups of 4–5. Using raised hands, holding hands, adjusting body height, etc., they form upright letters, stars, Eiffel Tower, etc. Develops analogical thinking, divergent thinking, and body coordination. Eagle Catches Chicks Students line up in a column. One student plays the eagle; others are chicks, led by one with sharp insight to change direction/angle to avoid capture. If a chick is caught, it becomes the eagle. Exercises mental agility, sense of direction, teamwork, and rule awareness. Frog Jump Students form two columns. Within a set time, they jump over obstacles in a frog-like posture. Upon reaching the end, they pass a frog doll to the next student to continue. Exercises lower limb explosive power, jumping ability, concentration during competition, and accuracy in object choice. Happy Little Driver One student dresses as a driver who chooses passengers. The teacher gives commands (fast, slow, brake). Passengers focus on the driver and mimic their actions. Trains quick reaction to sudden situations and appropriate response, while improving execution ability. Athlete Showdown The teacher gives five representative animal dolls (e.g., turtle, rabbit, lion) to the first round of participants. Students summarize the animal's characteristics based on prior knowledge, imitate its actions, and complete the race. Exercises flexible thinking, ability to summarize familiar animals, think critically, act accordingly, and enhances competitive spirit and rule awareness. Table 4 Drama Picture Book Drama Picture Book Title Synopsis The Farmer and the Fox This classic fable is transformed into a "Farm Olympics"! The farmer is no longer just a guardian, but a "field coach" setting up soccer goalpost traps and basketball net barriers; the fox becomes an agile obstacle course expert, using hurdling and ring-passing skills to break through. When the fox "gets injured" in the snow and pauses the game, the farmer lends a hand, co-creating the sportsmanship spirit of "fair play". The Monkeys Transforms monkey troop training into structured physical activities. The orderly vine training, rhythmic coconut drumming, and predictable fruit collection games provide safe and stable movement paradigms for children with autism. The Three Little Pigs Transforms the house-building process into progressive physical training. Repetitive construction activities like straw bale throwing, stick building, and brick stacking are converted into predictable, structured exercises, providing a safe and stable behavioral paradigm. The Tortoise and the Hare Reconstructs the classic race into graded physical training. The tortoise's steady crawl provides vestibular input, the hare's jumping enhances proprioception, and sensory stations (tactile grass areas/foot-stimulating pebble paths) are integrated. Uses a structured track with clear paths marked by colored tape to reduce anxiety; sensory modulation stations with a 6-texture touch wall offer tactile desensitization; social interaction design includes a duo collaboration mode to operate the finish flag together. The Animal Sports Day Transforms sports events into structured therapeutic activities. Sheep's steady rolling provides deep pressure input, antelope's rhythmic jumping trains balance, and sensory obstacle levels (furry tunnel/soft cushion hill) are integrated. Uses a sports narrative to build a therapeutic framework, helping children with autism improve physical coordination, emotion regulation, and social participation through predictable activities and multi-sensory experiences. The Lost Duckling Transforms the story into structured navigation training. Colored feather paths and textured markers (leaves/pebbles/puddles) provide vestibular and proprioceptive integration training, helping build spatial security. Uses a multi-sensory wayfinding system with fluorescent footprints and varied path textures; pressure regulation activities include wing-flapping and waddling; social interaction framework involves duo collaboration to find the "way home", fostering non-verbal communication. Pulling the Radish Depicts the power of teamwork through the story of an old man, an old woman, and animals pulling a giant radish. The predictable, repetitive pulling motion provides deep pressure input, helping children build body awareness and team participation. Uses collective labor narrative to build a therapeutic framework, enhancing coordination, emotional resonance, and social collaboration. Hopscotch A girl named Lily uses magical chalk to create hopscotch grids leading to adventures in different worlds. Fluorescent grids provide visual cues, varied textures offer tactile input, and predictable jumping sequences build body awareness and spatial security. Uses structured play to improve coordination, emotion regulation, and social interaction. Little Crab Finds Friends 1. Tells the story of a crab named Cleo learning to make friends. His unique sideways walk promotes coordination; claw open-close rhythm games teach interactive response; multi-sensory experiences include a sandbox beach and water basin ocean. Helps children learn social interaction through imitating crab movements. Lovely Panda Gymnastics Transforms panda's cute actions into structured therapeutic exercises. "Bamboo stretching" provides deep pressure, "roly-poly rolling" trains vestibular balance, "black-and-white swaying" promotes bilateral coordination. Uses structured sequences, multi-sensory integration, and self-regulation design to build body awareness and emotional regulation. The Little Duck Learns to Swim Replicates water benefits in a dry environment. Duck's paddling becomes upper body resistance training, floating is replaced by balance board exercises, wave sensation is achieved via vibration mats. Uses land-based stroke training, balance exercises, and sensory paths to provide a safe, controlled environment for improving sensory integration and motor coordination. Space Throwing Competition Set in a space exploration story, children throw different cosmic objects to activate planet devices and save a galaxy. Each throw challenges force control, angle judgment, and spatial awareness. Varied projectile weights/textures provide diverse tactile/proprioceptive input, helping improve motor planning and spatial judgment. The Snow Queen A fantasy adventure where a boy's heart and eye are pierced by a mirror shard, making him cold. A girl's quest saves him. Uses cold-themed exercises, sensory training with varied cold textures, and snowflake imitation movements to help children improve body awareness and emotional regulation in a predictable, cool-themed environment. A Monkey Mountain • A modern fable about a zoo employee posing as a monkey, accepted despite being different. Activities imitate natural monkey movements and social structures. Provides bilateral coordination, vestibular stimulation, and hand-eye coordination training through clear visual cues and predictable routines, helping children learn social rules while maintaining self-identity. Pinocchio Uses Pinocchio's transformation from marionette to real boy to help children develop autonomous movement through structured exercises. Stages include joint isolation, transition from passive to active movement, and rhythm training. Integrates multi-sensory paths and auditory feedback to improve body awareness and problem-solving. The Little Goats Cross the Bridge Two goats meet on a narrow bridge and learn to compromise. Activities include balance training on different widths, spatial awareness exercises, and simulated bridge movement. Social decision-making uses visual cue cards, timers, and a win-win reward system to teach flexible thinking and social compromise. The Key Keeper Transforms a key-keeping parable into structured equipment management training. Activities involve key transfer, guarding, and finding, providing proprioceptive input, fine motor skill practice, and sequential memory. Social interaction design includes key transfer etiquette and collaborative carrying, teaching responsibility and rule-following. Let's Ride Together In "Wheel Village", all animals ride special bikes except a fearful wolf pup. Uses phased balance training and social interaction design to help the pup build confidence through a gradual process, experiencing the "fall-get up-try again" growth cycle. The Little Rabbit Rolls the Hoop 1. A rabbit practices rolling a hoop, exploring physics like friction and balance, eventually winning a race. The story emphasizes perseverance and discovery. The Carousel A modern fable about a carousel horse named Breeze breaking free from endless cycles. Uses graded rotational sensation training and social interaction games to improve vestibular processing and action control, helping children explore physical boundaries within safe limits. The Terracotta Warriors Through imitating the Terracotta Warriors' static poses at varying difficulty levels, engaging in coordinated position swaps, participating in formation changes and strategic movements, taking part in relic-passing relays (which foster social interaction during object exchange), and collaborating on joint guardian missions (achieving team objectives), children enhance their motor control, spatial awareness, and teamwork skills during physical activities. This process helps them understand that both steadfastness and adaptability are equally important—that while it is essential to follow necessary rules, one must also learn to respond flexibly. Each child can find their own place within the team and become a guardian of history. The Chameleon A chameleon named Chico can change color but loses himself until a storm washes away his disguises. Activities include color recognition games, emotional expression training, and environmental adaptation exercises. Helps children learn self-regulation, emotion identification, and social referencing, understanding the value of staying true amidst change. The Little Lion Who Loved Tug-of-War A strong lion learns that true power lies in cohesion, not brute force. He reorganizes a tug-of-war game with clear roles and rules. Team role training provides deep pressure, static support practice, and social referencing practice through unified commands and role rotation, teaching social interaction and team belonging. Maisy Goes to the Sports Day A small mouse finds his place in the forest sports day by leveraging his unique skills. Features personalized event design, social interaction support, and sensory adaptation to help children build confidence, improve coordination, and understand that participation matters more than winning. Carnival of the Animals In a deep forest, animals hold a grand carnival where everyone showcases unique talents. A young monkey finds his by observing others. Activities involve animal movement imitation, personalized movement paths, and low-pressure social interaction support, helping children discover their strengths and build confidence in a supportive setting. The Three Billy Goats Gruff Three goats outsmart a bridge troll. Uses graded bridge-crossing training, social interaction design, and sensory integration activities. The predictable story structure and controlled risk experience help children learn problem-solving, emotion management, and physical coordination. The Little Bear Who Danced A bear named Brownie loves dancing but is mocked until he finds unique friends. Activities include body rhythm training, sensory integration, and progressive social interaction through mirror dancing and group circles. Helps improve coordination, emotional expression, and sensory integration through non-verbal expression and predictable rhythms. The Gruffalo A quick-witted mouse invents a monster to scare predators, only to meet the real creature. Features forest adventure path training, strategic movement games, and social interaction design. The predictable adventure path and role-play help children learn problem-solving and social interaction. Little Bear's Adventure A bear named Beibe embarks on a quest for the "Eternal Spring". Training involves adventure path exercises, task-oriented activities, and sensory regulation design. Clear stage goals, controlled sensory stimuli, and progressive social interaction help children improve physical abilities, environmental adaptation, and problem-solving skills. Table 5 Curriculum Structure for the Experimental Group Course Structure Teaching Procedure for Experimental Group Duration Starting Phase 1. Classroom Routines 2. Announcement of learning objectives and requirements for the session 2 min Warm-up Phase Educational Drama Games, etc. 5 min Core Phase 1. Delivery of core teaching content to achieve session learning objectives 2. Educational Drama Picture Books + Physical Training Exercises 20 min Closing Phase 1. Stretching Exercises 2. Session Summary and Review 3 min The intervention was primarily delivered by graduate students majoring in Physical Education who held official teaching qualifications. Instruction was conducted in group sessions. Given that children with autism often have difficulty participating independently, their guardians were encouraged to accompany them during the sessions. To ensure consistent attendance and maximize the effectiveness of the intervention, strict attendance records were maintained for each class; participants were not permitted to miss more than three consecutive sessions or more than seven sessions in total. In addition, during each session, two children with autism were randomly selected to wear Polar heart rate monitors to assess exercise intensity. Across the 12-week intervention period, the mean heart rate of the experimental group was 136.21 ± 6.19 beats/min, corresponding to a moderate-intensity level. Control Group The control group intervention followed a structured program consisting of three progressive stages: adaptation, fundamental, and advanced phases (Table 6 ). Each session included a warm-up, foundational training, core activity, and relaxation segment (Table 7 ). The intervention dosage, intensity, and frequency were consistent with those of the Physical Activity combined with Educational Drama group. The sessions were primarily conducted by graduate students majoring in Physical Education who held official teaching qualifications, using a group-based instructional format. Table 6 Intervention Protocol for the Control Group Phase Week Intervention Content Learning Objectives Adaptation Week 1 1. Cultivation of social etiquette; 2. Establishment of classroom routines; 3. Visual and tactile desensitization exercises 1. Foster basic social etiquette and classroom behavioral norms in children with autism; 2. Reduce resistance to the classroom environment and sports equipment; 3. Enhance interest in physical activities Foundation Week 2 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Natural Walk, Marching, Imitating Animal Walks 1. Improve fundamental motor skills in children with autism; 2. Alleviate behavioral problems Week 3 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Quick Run, Natural Jog, Circle Run, Curve Run, Straight Run, Shuttle Run Week 4 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Two-Foot Jump Down, Two-Foot Forward Jump, One-Foot Continuous Jump Week 5 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Two-Handed Chest Throw, Two-Handed Overhead Throw, One-Handed Overhead Throw Week 6 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Front Drill, Hand-Knee Crawl, Prone Crawl Week 7 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Walking/Running on Balance Beams, Run-Walk Sudden Stop, One-Leg Stand Week 8 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Side Roll, Forward Roll, Backward Roll Week 9 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Push, Pull, Push + Pull Week 10 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull Advanced Week 11 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull 1. Improve fundamental motor skills in children with autism; 2. Alleviate behavioral problems 第12周 1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull Table 7 Curriculum Structure for the Control Group Course Structure Teaching Procedure for Control Group Duration Starting Phase 1. Classroom Routines 2. Announcement of learning objectives and requirements 2 min Warm-up Phase Jogging, Basic Stretching 5 min Core Phase 1. Delivery of core teaching content to achieve session learning objectives 2. Traditional Physical Training Exercises 20 min Cool-down Phase 1. Stretching Exercises 2. Session Summary and Review 3 min Measurement of Core Symptoms Repetitive Behaviors The Repetitive Behavior Scale–Revised (RBS-R) is a validated instrument for assessing stereotyped behaviors in children with autism[15]. The scale comprises 43 items across six subdomains: stereotyped behavior, self-injurious behavior, compulsive behavior, ritualistic behavior, sameness behavior, and restricted behavior. Items are rated on a 4-point scale, where 3 indicates severe behavioral problems, 2 indicates moderate problems, 1 indicates mild problems, and 0 indicates no problems. Higher scores reflect greater severity of repetitive and stereotyped behaviors. The scale is completed by the child’s primary caregiver based on the child’s behavior over the past three months, with the same caregiver completing both pre- and post-intervention assessments to ensure consistency. Social Impairment Social responsiveness was assessed using the Social Responsiveness Scale, Second Edition (SRS-2) [16]. The 65-item instrument comprises five subscales: Social Awareness, Social Cognition, Social Communication, Social Motivation, and Restricted Interests and Repetitive Behaviors. Items are rated on a 4-point Likert scale, where 3 indicates severe behavioral problems, 2 moderate problems, 1 mild problems, and 0 indicates no observable behavioral problems. Higher total scores reflect more severe social impairment. The scale was completed by guardians based on the child's typical behavior over the preceding three-month period, with the same informant completing the scale at all assessment time points. Childhood Autism Rating Scale (CARS) The Childhood Autism Rating Scale (CARS) (Schopler et al., 1980) was administered at baseline only. The total scores range from 0 to 60, with the following clinical cutoffs: a score below 30 indicates a non-autistic classification; a score of 30 or above leads to an autism classification. Within the autism spectrum, scores of 30–37 are classified as mild-to-moderate autism, while scores ranging from 37 to 60, accompanied by at least five items rated above 3, are classified as severe autism.[17]. Measurement of Basic Physical Fitness Based on the school's physical fitness testing schedule and the content of fundamental movement skill assessment scales, the basic physical fitness test battery was determined to comprise the following items: standing long jump, tennis ball throw, balance beam walk, shuttle run, and two-foot continuous jump. Standing Long Jump : The participant stood behind the take-off line with feet naturally apart, assumed a semi-squat position, and swung the arms backward with appropriate flexion. Subsequently, the arms were swung forward forcefully while the feet pushed off the ground to jump forward as far as possible. Two trials were performed, and the better result was recorded. Tennis Ball Throw : Facing the throwing direction, the participant stood approximately one step behind the throwing line with feet in a staggered stance. Holding a tennis ball with one hand overhead, the participant threw it forward as far as possible. A forward step with the rear foot was permitted during the release, but neither foot could touch or cross the throwing line. Balance Beam Walk : The balance beam was 15 cm in height, 3 m in length, and 20 cm in width. Starting from a platform behind the "start line" of the beam, the participant stood with arms abducted to the side and then walked forward by alternating steps. Test personnel walked alongside the beam to observe performance and prevent accidents. Timing stopped when either foot contacted the "end line." Shuttle Run : Beginning in a standing start position, timing commenced upon a verbal signal. The participant ran to a turn-around point, touched a designated object, turned, and ran back to the finish line, at which point timing was stopped. The total running distance was 10 meters. Two-Foot Continuous Jump : Ten soft blocks were placed in a straight line on level ground at 50 cm intervals. A "start line" was marked 20 cm from the first block, and a "finish line" was marked 20 cm beyond the last block. With feet together behind the start line, the participant performed a two-footed jump consecutively over all ten blocks without stopping. Statistical Analysis All statistical analyses were performed using SPSS (Version 27.0). The normality of continuous variables was assessed using the Shapiro‑Wilk test, and descriptive statistics are presented as mean ± standard deviation. For data conforming to a normal distribution, independent samples t‑tests were used to examine baseline differences between the two groups. A two‑way repeated‑measures analysis of variance (ANOVA) was then conducted, with group (intervention vs. control) as the between‑subjects factor and time (pre‑intervention vs. post‑intervention) as the within‑subjects factor. The Bonferroni correction was applied for post‑hoc comparisons, and the Greenhouse‑Geisser correction was used when the assumption of sphericity was violated. In cases of a significant interaction effect, simple effect analyses were performed. A p‑value < 0.05 was considered statistically significant. Result Demographic Variables The pre-test demographic and clinical characteristics of the participants are presented in the table. No significant differences were observed between the two groups in terms of age, gender, body mass index (BMI), scores on the Childhood Autism Rating Scale (CARS), Repetitive Behavior Scale-Revised (RBS-R), Social Responsiveness Scale-Second Edition (SRS-2), or physical fitness measures, confirming that the groups were well-matched and homogeneous at baseline.(Table 8 ) Table 8 Demographic and Baseline Characteristics Index Experimental Group Control Group P Gender(male/Female) 9/1 9/1 0.763 Year 10.80 ± 0.63 11.10 ± 0.99 0.241 BMI 20.95 ± 1.05 20.34 ± 0.78 0.160 CARS 35.50 ± 0.85 34.50 ± 1.78 0.200 RBS-R 73.50 ± 6.80 70.50 ± 8.05 0.380 SRS−2 79.50 ± 5.62 79.10 ± 6.30 0.883 Standing Long Jump(cm) 64.05 ± 7.15 62.30 ± 5.62 0.550 Tennis Ball Throw(m) 3.48 ± 1.30 3.10 ± 0.94 0.465 Balance Beam Walk(s) 13.64 ± 1.83 13.48 ± 1.28 0.822 Shuttle Run(s) 9.84 ± 0.83 10.74 ± 1.14 0.058 Two-Foot Continuous Jump(s) 11.02 ± 1.09 11.93 ± 1.28 0.105 Changes in Core Symptoms of Autism Spectrum Disorder Following Intervention Repetitive Behaviors For the total scale scores, a repeated-measures ANOVA revealed a significant main effect of time (F(1, 18) = 375.434, p < 0.001, η²p = 0.954) and a significant time × group interaction (F(1, 18) = 10.108, p = 0.005, η²p = 0.360). Simple effect analysis demonstrated that both the experimental and control groups exhibited a significant reduction in total scores compared to pre-intervention levels (p < 0.001). However, no significant difference was found between the two groups at post-intervention, indicating that both intervention approaches were effective in ameliorating repetitive behaviors in children with autism.(Figure 1 ) Regarding the subscale analyses, significant differences were observed between the experimental and control groups across specific dimensions of repetitive behavior. For stereotyped behavior, the repeated-measures ANOVA revealed a significant main effect of time (F(1, 18) = 3721.000, p < 0.001, η²p = 0.995) and a significant time × group interaction (F(1, 18) = 441.000, p < 0.001, η²p = 0.961). Simple effect analysis indicated that both groups exhibited a significant decrease in scores post-intervention (p < 0.001). Furthermore, post-intervention scores in the experimental group were significantly lower than those in the control group (p = 0.004). For self-injurious behavior, there was a significant main effect of time (F(1, 18) = 78.049, p < 0.001, η²p = 0.813) and a significant time × group interaction (F(1, 18) = 24.934, p < 0.001, η²p = 0.581). Simple effect analysis showed that both the experimental and control groups demonstrated significant reductions in scores following the intervention (p < 0.001 and p = 0.014, respectively). However, no significant difference was observed between the two groups at the post-intervention assessment. For restricted behavior, the analysis showed a significant main effect of time (F(1, 18) = 156.122, p < 0.001, η²p = 0.897) and a significant time × group interaction (F(1, 18) = 27.225, p < 0.001, η²p = 0.491). Simple effect analysis confirmed that both groups displayed a significant decrease in scores post-intervention (p < 0.001). Additionally, the experimental group exhibited significantly lower post-intervention scores compared to the control group (p = 0.008).(Figure 2 – 4 ) Social Impairment For the total scale scores, the repeated-measures ANOVA revealed a significant main effect of time (F(1, 18) = 259.146, p < 0.001, η²p = 0.935) and a significant time × group interaction (F(1, 18) = 32.629, p < 0.001, η²p = 0.644). Simple effect analysis demonstrated that both the experimental and control groups showed significant reductions in total scores compared to baseline (p < 0.001). Furthermore, post-intervention scores in the experimental group were significantly lower than those in the control group (p < 0.001). These results indicate that while both interventions were effective in ameliorating social impairments in children with autism, the experimental intervention demonstrated superior efficacy.(Figure 5 ) Regarding the subscale analyses, distinct patterns of intervention effects were observed across different social domains. In the domain of Social Cognition, the analysis revealed a significant main effect of time (F(1, 18) = 9.991, p = 0.005, η²p = 0.357) and a significant time × group interaction (F(1, 18) = 6.688, p = 0.019, η²p = 0.271). Post-hoc tests indicated a significant reduction in scores for the control group following the intervention (p < 0.001), with no significant difference emerging between the groups at post-test. For Social Communication, significant effects were found for the main effect of time (F(1, 18) = 33.280, p < 0.001, η²p = 0.649), the time × group interaction (F(1, 18) = 14.405, p = 0.001, η²p = 0.445), and the main effect of group (F(1, 18) = 6.045, p = 0.024, η²p = 0.251). Simple effect analysis confirmed that the experimental group showed a significant decrease post-intervention (p < 0.001), and their post-intervention scores were significantly lower than those of the control group (p < 0.001). In Social Motivation, the results showed a significant main effect of time (F(1, 18) = 235.200, p < 0.001, η²p = 0.929) and a significant time × group interaction (F(1, 18) = 58.800, p < 0.001, η²p = 0.766). Both groups exhibited significant improvements after the intervention (p < 0.001), with the experimental group demonstrating significantly lower scores than the control group at post-test (p = 0.009). For Autistic Mannerisms, significant effects were observed for the main effect of time (F(1, 18) = 101.220, p < 0.001, η²p = 0.849), the time × group interaction (F(1, 18) = 8.358, p = 0.01, η²p = 0.317), and the main effect of group (F(1, 18) = 13.160, p = 0.002, η²p = 0.422). Simple effect analysis indicated that both groups improved significantly from baseline (p < 0.001), and the experimental group's post-intervention scores were significantly lower than those of the control group (p < 0.001). In summary, these findings suggest that the control intervention was effective in improving social cognition, while the experimental intervention was particularly effective in enhancing social communication. Both interventions led to improvements in social motivation and autistic mannerisms, with the experimental intervention producing superior outcomes in social communication, social motivation, and autistic mannerisms compared to the control condition.(Figure 6 – 9 ) Physical Fitness Regarding physical fitness outcomes, the repeated-measures ANOVA revealed that none of the indicators showed a significant time × group interaction effect, while significant main effects of time were observed for all measures. Consequently, paired-samples t-tests were conducted to analyze within-group changes from pre- to post-intervention. The results indicated that both the experimental and control groups showed significant improvements in the standing long jump (p = 0.001; p < 0.001, respectively), tennis ball throw (p = 0.005; p = 0.002, respectively), balance beam walk (p < 0.001 for both groups), and shuttle run (p = 0.036; p = 0.043, respectively). For the two-foot continuous jump, a significant improvement was observed in the experimental group (p = 0.005), whereas the control group did not show a statistically significant change (p = 0.237).(Figure 10 – 14 ) Discussion The findings of this study revealed that the control group (receiving conventional exercise intervention) demonstrated a significant main effect of time on both the RBS-R and SRS-2 total scores, confirming the beneficial effects of regular physical activity for children with autism[18]. However, the significantly greater improvement observed in the experimental group across multiple subscales provides robust evidence for the unique value of the combined intervention. First, regarding repetitive and stereotyped behaviors (RBS-R), the experimental group demonstrated significantly lower post-intervention scores than the control group on both the "Stereotyped Behavior" and "Restricted Behavior" subscales. This outcome is supported by established neurophysiological and psychological mechanisms. A standalone exercise intervention may primarily function by modulating neurotransmitters—such as increasing dopamine and norepinephrine levels—and by promoting the balance of cortical excitation and inhibition, thereby reducing overall behavioral impulsivity and activity levels[19]. However, the introduction of educational drama offers a distinct "behavioral substitution" pathway for reducing stereotyped behaviors. Within the dramatic context, the demands of role-playing, imitation, and narrative development require children to suppress their inherent, self-stimulating stereotyped behaviors and instead execute context-appropriate, purposeful social actions.[20]. This sustained practice within an emotionally engaging and motivational context can effectively disrupt the circuitry of stereotyped behaviors and foster more adaptive behavioral patterns[11]. In contrast, for self-injurious behavior, while both groups showed improvement post-intervention, no significant difference was observed between them. This suggests that self-injurious behavior, as a more severe form of challenging behavior, may require more specialized and prolonged behavioral intervention strategies. Alternatively, its underlying triggers may be more complex, resulting in a relatively slower response to the psychological components of the combined intervention [21]. Second, the superiority of the combined intervention was more comprehensively demonstrated in the domain of social competence (SRS-2). The experimental group showed significantly greater improvement than the control group across three core subscales: Social Communication, Social Motivation, and Autistic Mannerisms. These findings clearly illustrate the core function of educational drama as a "rehearsal stage for social cognition." The central challenge in social interaction for children with autism stems from deficits in Theory of Mind—the ability to infer and respond to others' emotions and intentions[22]. Conventional exercise programs are typically conducted in clearly-defined, structured environments where social interactions tend to be procedural in nature [23]. In contrast, educational drama creates simulated social scenarios that provide children with repeated opportunities for a cycle of experience, reflection, and re-practice[24]. In the domains of social communication and motivation, drama activities require children to observe their peers' behavior, interpret the mental states of characters, and respond using their own language, facial expressions, and body movements. This process directly trains their theory of mind and non-verbal communication skills[25]. When children receive positive interactive feedback during drama activities—such as successfully advancing the plot through appropriate communication—their intrinsic social motivation is significantly enhanced. This process facilitates a shift from passive participation to active initiation of social interactions [26]. This finding is closely aligned with the significant improvement in social motivation observed in our study. Research has found that drama-based techniques, such as improvisational games and dramatic play, can enhance emotion comprehension in children with autism. These methods have been shown to improve emotion recognition and Theory of Mind capabilities, while also demonstrating positive effects on empathy and social interaction skills - findings that are consistent with the results of the present study[27]. Regarding autistic mannerisms, this dimension reflects the overall severity of the "autistic impression" an individual conveys. The marked improvement in the experimental group suggests that the combined intervention not only modified specific social behaviors but also holistically enhanced the children's social adaptability and integration, making their behavioral patterns more closely resemble those of typically developing children. In contrast, the control group demonstrated improvement comparable to the experimental group only in the "social cognition" domain. This may be attributed to the fact that rule comprehension and teamwork in conventional exercise involve fundamental cognitive processes, yet did not extend to the advanced social dimensions requiring complex emotional resonance and intentional understanding[28]. In terms of physical fitness, children in both groups demonstrated significant improvements in the standing long jump, tennis ball throw, balance beam walk, and shuttle run. These results confirm that the 12-week systematic exercise intervention, irrespective of the specific format, effectively enhanced fundamental physical attributes including strength, coordination, and speed in children with autism[29]. However, a significant improvement in the two-foot continuous jump—a test assessing agility and coordination—was observed exclusively in the experimental group. This differential outcome may stem from subtle differences in neuromuscular control demands between the two intervention models. Conventional exercise training typically emphasizes the repetitive practice of fundamental motor skills, which may provide insufficient challenge in terms of rhythmic complexity, motor sequencing, and rapid transitions between movements[9]. In contrast, educational drama activities incorporate a wide range of non-structured, expressive bodily movements—such as imitating animal walks, or suddenly halting, turning, and jumping in response to narrative cues. These activities require children to process storyline information cognitively while simultaneously executing rapid, varied, and coordinated physical responses. This cognitive‑motor dual‑task paradigm may more effectively stimulate cerebellar and basal ganglia functions and promote sensory integration, thereby offering specific benefits for the development of skills such as the two‑foot continuous jump, which relies heavily on precise rhythm and movement fluidity[30]. Conclusion In summary, this study provides compelling empirical support for the efficacy of the integrated intervention model combining physical exercise and educational drama. The results demonstrate that this program not only effectively enhances the physical fitness of children with autism, comparable to conventional exercise programs, but more importantly, achieves more profound and extensive improvements in the core deficits of autism—social communication and stereotyped behaviors—through the creative integration of movement and drama. Therefore, we recommend the consideration of this combined physical exercise and educational drama approach as a validated curricular or intervention module for implementation in special education schools, rehabilitation centers, and inclusive educational settings. Declarations Author contributions Bingxue Ma: Conceptualization, Investigation, Methodology, Writing –original draft. Xiru Du: Conceptualization, Funding acquisition, Supervision, Writing –review & editing. Funding The research work presented in this paper was supported by the 2023 Guangdong Provincial Education Science Planning Fund (Natural Science), and I am the author of this study (Project Number: 2023GXJK006). The funding did not and will not have any implication on the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript. 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. Data availability statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References Posar, A., F. Resca, and P. Visconti, Autism according to diagnostic and statistical manual of mental disorders 5(th) edition: The need for further improvements. Journal of Pediatric Neurosciences, 2015. 10 (2): p. 146-148. 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1","display":"","copyAsset":false,"role":"figure","size":63104,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of RBS-R Total Scores Between the Two Groups Pre- and Post-Intervention\u003c/p\u003e\n\u003cp\u003e*represents p \u0026lt; 0.05, EG represents the experimental group, CG represents the control group.\u003c/p\u003e","description":"","filename":"Figure1ComparisonofRBSRTotalScoresBetweentheTwoGroupsPreandPostIntervention.png","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/8ea0ff9e4749cb2f663bcd65.png"},{"id":96605455,"identity":"fa0768ed-fc52-4d96-97cb-f51c464b0cfb","added_by":"auto","created_at":"2025-11-24 09:23:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":64994,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of stereotyped behavior scores between the two groups before and after intervention\u003c/p\u003e\n\u003cp\u003e*represents p \u0026lt; 0.05, EG represents the experimental group, CG represents the control group.\u003c/p\u003e","description":"","filename":"Figure2Comparisonofstereotypedbehaviorscoresbetweenthetwogroupsbeforeandafterintervention.png","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/0b0b47470cc7063ecd5ed8fc.png"},{"id":96605595,"identity":"d58ba6fb-4cf5-456e-b851-abf945459414","added_by":"auto","created_at":"2025-11-24 09:23:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":59741,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of self-injurious behavior scores between the two groups before and after intervention\u003c/p\u003e\n\u003cp\u003e*represents p \u0026lt; 0.05, EG represents the experimental group, CG represents the control group.\u003c/p\u003e","description":"","filename":"Figure3Comparisonofselfinjuriousbehaviorscoresbetweenthetwogroupsbeforeandafterintervention.png","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/ebb32990fb18779bdba9408d.png"},{"id":96605387,"identity":"0128fa7e-22af-4ecd-996e-fa9bdaf52d73","added_by":"auto","created_at":"2025-11-24 09:22:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":65314,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of restricted behavior scores between the two groups before and after intervention\u003c/p\u003e\n\u003cp\u003e*represents p \u0026lt; 0.05, EG represents the experimental group, CG represents the control group.\u003c/p\u003e","description":"","filename":"Figure4Comparisonofrestrictedbehaviorscoresbetweenthetwogroupsbeforeandafterintervention.png","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/d18afa75e6e295d10cda3507.png"},{"id":96605814,"identity":"474dc291-a8a0-4528-bc55-3a8d94bdf95a","added_by":"auto","created_at":"2025-11-24 09:24:07","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":60717,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of SRS-2 Total Score between the two groups before and after intervention\u003c/p\u003e\n\u003cp\u003e*represents p \u0026lt; 0.05, EG represents the experimental group, CG represents the control group.\u003c/p\u003e","description":"","filename":"Figure5ComparisonofSRS2TotalScorebetweenthetwogroupsbeforeandafterintervention.png","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/bce9d15e97a25985fd39ad69.png"},{"id":96605035,"identity":"90893c13-e34a-4779-bc48-a725c09e3921","added_by":"auto","created_at":"2025-11-24 09:17:44","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":58860,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Social Cognition scores between the two groups before and after intervention\u003c/p\u003e\n\u003cp\u003e*represents p \u0026lt; 0.05, EG represents the experimental group, CG represents the control 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group.\u003c/p\u003e","description":"","filename":"Figure9ComparisonofAutisticMannerismsscoresbetweenthetwogroupsbeforeandafterintervention.png","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/e53e813b8a2ac03ea60135dc.png"},{"id":96592279,"identity":"ba30facc-ca41-47bf-b5d9-b015944d5ac7","added_by":"auto","created_at":"2025-11-24 06:40:12","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":64860,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Standing Long Jump between the two groups before and after intervention\u003c/p\u003e\n\u003cp\u003e*represents p \u0026lt; 0.05, EG represents the experimental group, CG represents the control group, cm represents 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second.\u003c/p\u003e","description":"","filename":"Figure13ComparisonofShuttleRunbetweenthetwogroupsbeforeandafterintervention.png","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/78209203d1b61860569d2a4f.png"},{"id":96592278,"identity":"4b1e9b57-0d37-4ef3-91b4-6968aa2de239","added_by":"auto","created_at":"2025-11-24 06:40:12","extension":"png","order_by":14,"title":"Figure 14","display":"","copyAsset":false,"role":"figure","size":61998,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Two-Foot Continuous Jump between the two groups before and after intervention\u003c/p\u003e\n\u003cp\u003e*represents p \u0026lt; 0.05, EG represents the experimental group, CG represents the control group, s represents second.\u003c/p\u003e","description":"","filename":"Figure14ComparisonofTwoFootContinuousJumpbetweenthetwogroupsbeforeandafterintervention.png","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/ec93b16018435dac7bcfbd0e.png"},{"id":102785748,"identity":"9b537815-43c5-4466-ab67-c1b1c49df714","added_by":"auto","created_at":"2026-02-16 16:09:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2639733,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/25cd3d24-d39c-40b1-ab11-3b794dec5042.pdf"},{"id":96592253,"identity":"7f9f19ee-144a-407d-8bc3-b9248f760bed","added_by":"auto","created_at":"2025-11-24 06:40:12","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35616,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORTChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/8d92edabed8563f60860a5c0.docx"},{"id":96604958,"identity":"fbbbf400-9cb4-4f4e-9c35-b428906f186f","added_by":"auto","created_at":"2025-11-24 09:16:46","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":28812,"visible":true,"origin":"","legend":"","description":"","filename":"ResearchProtocol.docx","url":"https://assets-eu.researchsquare.com/files/rs-7999898/v1/27d33988e5ed00055e197723.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of a Combined Physical Activity and Educational Drama Intervention on Core Symptoms and Physical Fitness in Children with ASD","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAutism Spectrum Disorder (ASD) is a neurodevelopmental condition that originates in early childhood, characterized primarily by persistent deficits in social communication and interaction, along with restricted and repetitive patterns of behavior, interests, or activities[1]. Globally, the prevalence of ASD has shown a marked upward trend, emerging as a major public health concern that imposes substantial caregiving and economic burdens on affected families and society at large[2]. At present, the etiology of ASD remains incompletely understood, and no specific pharmacological treatments are available. Consequently, evidence-based and effective non-pharmacological rehabilitation interventions have become the central focus of both research and clinical practice.\u003c/p\u003e\u003cp\u003eTraditional behavioral interventions, such as Applied Behavior Analysis (ABA), have demonstrated certain efficacy in improving specific behaviors. However, their highly structured nature often limits the generalization of acquired skills to naturalistic settings and may fail to sufficiently stimulate children\u0026rsquo;s intrinsic social motivation[3]. In addition, children with ASD often present with a range of comorbid conditions, among which deficits in Fundamental Motor Skills (FMS) have attracted increasing research attention in recent years. A substantial body of evidence indicates that up to 80% of children with ASD exhibit pronounced motor coordination impairments, poor balance, and clumsy or awkward movements[4]. These motor deficits do not exist in isolation; rather, they are closely intertwined with and mutually influence the core symptoms of ASD. For instance, inadequate motor skills can restrict children\u0026rsquo;s participation in peer play and physical activities, thereby depriving them of valuable opportunities for social engagement and exacerbating social isolation[5]. Conversely, diminished social motivation further reduces their likelihood of engaging in movement-based activities, creating a self-reinforcing cycle of impairment[6]. Therefore, there is an urgent need for an integrative intervention approach for children with ASD\u0026mdash;one that simultaneously addresses their deficits in social communication and motor skills.\u003c/p\u003e\u003cp\u003eAgainst this background, Physical Activity Interventions have demonstrated distinct advantages. Systematic exercise programs\u0026mdash;such as ball skill training, balance exercises, and functional play\u0026mdash;have been shown to directly enhance strength, coordination, balance, and motor proficiency in children with ASD[7]. More importantly, the benefits of physical activity interventions may extend well beyond the motor domain. The inherent elements of such activities\u0026mdash;rule following, turn-taking, and teamwork\u0026mdash;naturally create a \u0026ldquo;training ground\u0026rdquo; for the development of social cognition and adaptive behaviors[8]. Evidence suggests that physical activity interventions can also effectively reduce stereotyped behaviors, improve attention, and alleviate anxiety, thereby exerting positive and indirect effects on the core symptoms of ASD[9].However, purely exercise-based interventions remain relatively indirect in their mechanisms for eliciting complex socio-emotional responses and enhancing theory of mind, resulting in limited overall effectiveness in these domains.\u003c/p\u003e\u003cp\u003eEducational Drama, or Drama Therapy, as a form of expressive arts intervention, has shown considerable potential in the field of ASD intervention[10]. Educational drama does not aim to train performance skills, but rather utilizes theatrical elements\u0026mdash;such as role-playing, improvisation, and story enactment\u0026mdash;to provide children with opportunities to experience different roles, perspectives, and social scenarios within a safe and fictional context[11]. This approach is highly compatible with the intervention needs of children with ASD. By engaging them in embodied role-playing activities, it translates abstract social rules, emotional expressions, and communication skills into concrete, actionable behaviors, effectively alleviating the immediate stress and anxiety of social situations[12]. Empirical evidence has confirmed that drama-based interventions can significantly improve emotional recognition, language communication, social interaction skills, and imaginative capacity in children with ASD[13]. However, drama-based interventions typically require a certain level of physical expressiveness and motor ability. Given that children with ASD often exhibit motor impairments, these limitations may constrain their participation and performance in theatrical activities, thereby restricting the maximal effectiveness of the intervention[14].\u003c/p\u003e\u003cp\u003eIn summary, physical activity and educational drama interventions are theoretically highly complementary and potentially synergistic. Physical activity provides a solid foundation for the bodily expression and motor execution required in drama-based interventions, while educational drama offers a socially and emotionally meaningful context in which motor skills can be applied.This integrated approach, combining physical activity with educational drama, is expected to operate through a bidirectional pathway. On one hand, improved motor skills can enhance children\u0026rsquo;s confidence and engagement in drama activities, enabling them to benefit more effectively from social drama training. On the other hand, the social motivation and enjoyment elicited by drama activities can, in turn, encourage children to participate more actively and attentively in physical activities, further reinforcing motor skill development. However, despite the evidence supporting each approach individually, systematic integration of the two into a unified intervention program\u0026mdash;and scientific evaluation of its combined effects on both core ASD symptoms and fundamental motor skills\u0026mdash;remains unexplored. Currently, there is a lack of randomized controlled trials investigating whether this combined intervention can produce synergistic benefits.\u003c/p\u003e"},{"header":"Participants and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants and Grouping\u003c/h2\u003e\u003cp\u003eA total of 23 children with autism were initially recruited from the third grade of Foshan Qizhi School. Based on the inclusion and exclusion criteria, 20 participants met the eligibility requirements and were included in the study. They were assigned to either the experimental group (n = 10) or the control group (n = 10), matched according to demographic variables such as age, sex, and class. The experimental group received a combined Physical Activity and Educational Drama intervention, while the control group participated in a conventional Physical Activity intervention. Participants were informed that they could withdraw from the study at any time without penalty if they experienced discomfort or were unwilling to continue during the intervention period.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRandomization\u003c/h3\u003e\n\u003cp\u003eNumbers (1–20) will be assigned to the participants according to their recruitment times in an Excel software database, and then a random sequence will be generated using the \"= rand ()\" formula. This sequence will be sorted to allocate the participants to the study groups. These tasks will be completed by professional computer workers blinded to recruitment and allocation after the completion of recruitment.\u003c/p\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThis study adopted a 2 (time: pre-test, post-test) × 2 (group: experimental group, control group) mixed experimental design, with time as the within-subjects factor and group as the between-subjects factor. The study was conducted between June and September 2025 in Foshan City, Guangdong Province, China. The study protocol received approval from the Ethics Committee of Guangzhou Sport University (Approval No.: 2025LCLL-067) and was registered with the Chinese Clinical Trial Registry (Registration No.: CTR2500103810). This investigation was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all parents/legal guardians of the participants prior to their inclusion in the study.\u003c/p\u003e\n\u003ch3\u003eExperimental Group\u003c/h3\u003e\n\u003cp\u003eThe Physical Activity combined with Educational Drama intervention consisted of three progressive stages: adaptation, fundamental, and advanced phases (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Each session followed a structured sequence comprising a warm-up, foundational training, core activity, and relaxation segment ( Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The intervention dosage was as follows: (1) each session lasted 30 minutes; (2) exercise intensity was maintained at a moderate level, corresponding to 60–69% of the participant’s maximum heart rate (maximum heart rate = 220-age); (3) the intervention period lasted 12 weeks(2025.6.15-2025.9.10); and (4) sessions were conducted three times per week.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInclusion and Exclusion Criteria of the Study Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInclusion Criteria:\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExclusion Criteria:\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1)Diagnosed with Autism Spectrum Disorder (ASD) in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM−5) criteria;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1)Presence of other neurological, psychiatric, or cardiovascular disorders;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2)Participant’s guardian provided informed consent for participation in the study;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2)Recent use of medications affecting the central nervous system;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3)No comorbid neurological or psychiatric disorders.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3)Visual or auditory impairments;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe Combined Physical Exercise and Educational Drama Intervention Program\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention Content\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLearning Objectives\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdaptation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Cultivation of social etiquette; 2. Establishment of classroom routines; 3. Visual and tactile desensitization exercises\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1. Foster basic social etiquette and classroom behavioral norms in children with autism; 2. Reduce resistance to the classroom environment and sports equipment; 3. Enhance interest in physical activities\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFoundation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: Follow the Leader, Circle Games, Statue Photos; 2. Learning basic movements: Natural Walk, Marching, Imitating Animal Walks; 3. Educational drama picture books: The Farmer and the Fox, Monkey Training, The Three Little Pigs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1. Embed educational drama concepts into the classroom to enrich emotional experiences; 2. Improve fundamental motor skills; 3. Alleviate behavioral problems\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: Eye Contact Stickers, Yang Village Exercise Routine, Passing the Tambourine; 2. Learning basic movements: Quick Run, Natural Jog, Circle Run, Curve Run, Straight Run, Shuttle Run; 3. Educational drama picture books: The Tortoise and the Hare, The Animal Sports Day, The Lost Duckling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: Thought Bubbles, Forest Concert, Crab Gymnastics; 2. Learning basic movements: Two-Foot Jump Down, Two-Foot Forward Jump, One-Foot Continuous Jump; 3. Educational drama picture books: Pulling the Radish, Hopscotch, Little Crab Finds Friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: Swatting Mosquitoes, Keep the Bag Aloft, What's in the Bag; 2. Learning basic movements: Two-Handed Chest Throw, Two-Handed Overhead Throw, One-Handed Overhead Throw; 3. Educational drama picture books: Lovely Panda Gymnastics, Little Duck Swimming, Space Throwing Challenge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: The Ant and the Giant, I am a Snowman, Crawling Around; 2. Learning basic movements: Front Drill, Hand-Knee Crawl, Prone Crawl; 3. Educational drama picture books: The Snow Queen, A Monkey Mountain, Pinocchio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: Walk and Stop, Shark is Coming, Face to Face; 2. Learning basic movements: Walking/Running on Balance Beams, Run-Walk Sudden Stop, One-Leg Stand; 3. Educational drama picture books: The Little Goat Crosses the Bridge, The Key Keeper, Let's Ride Together\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: The Old Lady's Oil Jar, The Little Monkey Takes an Unusual Path, Eyes Open Explosion; 2. Learning basic movements: Side Roll, Forward Roll, Backward Roll; 3. Educational drama picture books: Little Rabbit Rolling the Hoop, Carousel, Chameleon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: Pair Push Hands, Who's the Winner, Emotion Statues; 2. Learning basic movements: Push, Pull, Push + Pull; 3. Educational drama picture books: The Lion Who Loved Tug-of-War, The Terracotta Warriors, The Lost Duckling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: Tail Game, Group Sculpture, Eagle Catches Chicks; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull; 3. Educational drama picture books: Maisy Goes to the Sports Day, Carnival of the Animals, The Three Billy Goats Gruff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdvanced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: Jumping Frogs, Happy Little Driver, Athlete Competition; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull; 3. Educational drama picture books: The Little Bear Who Danced, The Gruffalo, Little Bear's Adventure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1. Facilitate flexible application of learned educational drama concepts and fundamental motor skills; 2. Alleviate behavioral problems\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Drama warm-up activities: Random Selection; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull; 3. Educational drama picture books (Random Selection)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntroduction to Educational Drama Warm-up Activities\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGame Name\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractice Method\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMain Objectives\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChange the Leader\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne student is given a hat to wear, while the other students line up behind. When music plays, the child with the hat leads the line around the room, performing repetitive actions for the others to mimic. Later, the teacher transfers the hat to another student and gives the \"Change the Leader\" command.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrains students' ability to listen to instructions and react quickly, attention, walking accuracy, and coordination with peers.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCircle Games\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents sit in a circle. The teacher gives instructions, e.g., form pairs, raise your right hand, raise both hands, stretch out your legs.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHelps students fully explore their physical potential and enhances mental flexibility.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatue Photos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe teacher shows pictures one by one. Students imitate the poses in pairs, having 10 seconds to think before immediately striking the pose. The teacher then scores their performance.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrains teamwork and the ability to observe details in pictures and reproduce accurate actions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEye Contact Stickers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUsing the classroom as the activity area, everyone walks around naturally with heads down, trying to cover the entire space. At the teacher's signal, everyone looks up; the first person a student sees becomes their partner. Students without a partner take on the teacher's role for the next round.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises concentration, execution ability, and lets students experience the fun and wonder of the game within a limited space.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSheep Sports Meet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo students are randomly chosen to play wolves; the others are sheep. On the teacher's command, the sheep run and jump within a limited area while the wolves try to catch them.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises full coordination of upper and lower limbs, reinforces clear role identity, distinguishes between roles, and fosters subjective judgment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePassing the Tambourine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne student sits in the center of a circle with eyes closed. The others sit in the circle with hands behind their backs. They pass a tambourine behind their backs as quickly as possible. When the teacher says \"stop,\" the center child opens their eyes and points to who they think has the tambourine.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYounger students often reveal through facial expressions or body language if they have the tambourine. The teacher guides them to disguise this and use expressions/gestures appropriately\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThought Bubbles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter students create a static scene, everyone reflects on what each person in the scene might be thinking. The teacher walks around and taps a student's head; that student must immediately verbalize the inner thoughts of their character/object, using divergent thinking to offer different possibilities.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrains the use of body language to express ideas and actively explore answers to the teacher's questions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eForest Concert\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe teacher plays \"Forest Rhapsody\" to set the scene. Using verbal cues, the teacher announces a forest concert. Students imagine animals attending and portray them, then use actions to show which animal is performing.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrains musicality, using prior knowledge to immerse in the scenario, choosing and role-playing favorite animals, showcasing talents, and enhancing achievement motivation.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCrab Gymnastics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe teacher plays music and demonstrates corresponding crab poses (standing, prone crawling, hand-knee crawling, etc.). Students follow along.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises arm strength, leg strength, imitation skills, and teaches knowledge about crabs.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSwatting Mosquitoes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents are divided into two groups: sleepers and mosquitoes. The sleepers crouch pretending to sleep. The mosquitoes buzz and fly near them. When the teacher says, \"Listen, there's a sound,\" sleepers can squint and swat with their hands without moving their feet. If hit, a mosquito becomes a sleeper.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises arm muscle strength, control of upper/lower limbs, and adaptability.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKeep the Bag Aloft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo groups, each with one plastic bag. On start, they toss the bag and keep it from touching the ground. The group whose bag touches the ground first loses.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises lung capacity, control over object positioning, and teamwork/inquiry skills.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat's in the Trash Bag?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe teacher provides a large trash bag. Students imagine what's inside. One student names an item; others, guided by the teacher's words/actions, mimic creating that trash (e.g., for an apple core, act out eating an apple and throwing the core; for paper, act out typing on a computer and crumpling paper).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDevelops awareness of waste sorting and classification, and improves hands-on ability between teacher and students.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Ant and the Giant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents lie freely on the floor, curling up as small as possible, imagining themselves smaller than an ant. Then they relax to a normal state. Next, they stretch their bodies to the maximum, imagining themselves as giants, before relaxing back to normal.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDevelops flexibility, reaching one's limits; also a stretching exercise to relieve physical and mental fatigue.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI Am a Snowman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeacher guides students to act as snowmen, reciting: \"I am a little snowman, round body, round head, white and chubby, so cute.\" The teacher acts as the sun: \"The sun is out, melting the snowman's head (students relax, lower head), melting the snowman's body (relax, bend forward), melting the snowman's legs (relax, squat down).\" The snowman disappears, melting into a puddle (students completely relax and lie down).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises concentration, appropriate use of limbs, and fully develops body potential.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCrawling Around\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeacher and students discuss animals that crawl. The teacher acts as a fairy, asking, \"Which crawling animal do you want to become? Where do you want to crawl?\" All students act out their chosen animal (e.g., turtle, crab, snake) and mimic its movements to crawl to a specified spot.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises cooperative inquiry between teacher and students, and students' ability to control flexibility, strength, and speed in their limbs.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalk and Stop\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe teacher leads all students walking from one end of the area to the other via different paths (straight, diagonal, large S-curve, wavy line). Students then take turns leading, freely choosing a path. Guide students to use a different route each time they reach the end.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises visual perception, muscle endurance, and adaptability to different paths.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShark is Coming\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents stand in a circle facing inward. The teacher is the shark first, calls a student's name, and walks towards them with hands reaching out and eyes locked on. Before being caught, the named student must call another student's name.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrains students to stay calm under pressure, react quickly, and use space reasonably for self-protection.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFace to Face\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLike mirroring. Students sit facing a partner; decide who is A and B. Give instructions for A to slowly trace a pattern in the air with one arm; B must mirror the movements. When the teacher says \"switch,\" roles reverse without stopping the game.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises comprehensive physical quality, simultaneous use of hands and feet, attention, imagination, and spatial awareness.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrandma's Oil Jar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne student plays a mouse sleeping next to Grandma's oil jar. The other students' main task is to return the jar to its owner without waking the mouse. The mouse occasionally wakes up, so timing is crucial.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises control of limbs. The uncertainty of the mouse waking adds challenge, boosting curiosity and sense of justice.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Little Monkey's Walk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents imitate a monkey's walk. The teacher encourages them to imagine different ways: forward, backward, sideways, or cooperating with partners to create unique walking styles.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDevelops observation skills, limb coordination, and through teacher guidance, students verbalize monkey traits, imitate, and add creativity.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEyes Open Explosion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents stand in a circle, practicing opening and closing their eyes. When eyes are open, they must find someone to make eye contact with. If two people lock eyes, they say \"bang\" and must not laugh.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises concentration in complex environments and impacts executive function.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePair Push Hands\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn pairs, students stand facing each other, extend hands, and push palm-to-palm. Both apply force, not to win, but to maintain the current position and balance of power.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises core control and balance, focusing on feeling physical force opposition rather than competition.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWho's the Winner?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn pairs, students stand facing each other, extend one hand forward, and grasp hands. On command, both pull simultaneously. The first to move their foot loses; the other wins.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExperience push/pull forces, exercise balance, coordination, flexibility, and develop overall fitness.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotion Statues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll students stand in a line, teacher 10 meters away. On command (e.g., sad, crying, stomping feet), students quickly run to the teacher, perform the action, and shout its name.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises using body and facial expressions to convey emotions, vent feelings, and reduce psychological stress.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTail Game\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThree children are \"it\"; others tuck a cloth strip in their waistband as a \"tail.\" The three try to grab tails. If a tail is grabbed, the grabber keeps it, and the tailless child must grab someone else's tail.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises thinking, problem-solving, quick reaction, and improves limb coordination and agility.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup Sculpture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents form groups of 4–5. Using raised hands, holding hands, adjusting body height, etc., they form upright letters, stars, Eiffel Tower, etc.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDevelops analogical thinking, divergent thinking, and body coordination.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEagle Catches Chicks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents line up in a column. One student plays the eagle; others are chicks, led by one with sharp insight to change direction/angle to avoid capture. If a chick is caught, it becomes the eagle.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises mental agility, sense of direction, teamwork, and rule awareness.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrog Jump\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudents form two columns. Within a set time, they jump over obstacles in a frog-like posture. Upon reaching the end, they pass a frog doll to the next student to continue.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises lower limb explosive power, jumping ability, concentration during competition, and accuracy in object choice.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHappy Little Driver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne student dresses as a driver who chooses passengers. The teacher gives commands (fast, slow, brake). Passengers focus on the driver and mimic their actions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrains quick reaction to sudden situations and appropriate response, while improving execution ability.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAthlete Showdown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe teacher gives five representative animal dolls (e.g., turtle, rabbit, lion) to the first round of participants. Students summarize the animal's characteristics based on prior knowledge, imitate its actions, and complete the race.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercises flexible thinking, ability to summarize familiar animals, think critically, act accordingly, and enhances competitive spirit and rule awareness.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDrama Picture Book\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDrama Picture Book Title\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSynopsis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Farmer and the Fox\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThis classic fable is transformed into a \"Farm Olympics\"! The farmer is no longer just a guardian, but a \"field coach\" setting up soccer goalpost traps and basketball net barriers; the fox becomes an agile obstacle course expert, using hurdling and ring-passing skills to break through. When the fox \"gets injured\" in the snow and pauses the game, the farmer lends a hand, co-creating the sportsmanship spirit of \"fair play\".\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Monkeys\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransforms monkey troop training into structured physical activities. The orderly vine training, rhythmic coconut drumming, and predictable fruit collection games provide safe and stable movement paradigms for children with autism.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Three Little Pigs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransforms the house-building process into progressive physical training. Repetitive construction activities like straw bale throwing, stick building, and brick stacking are converted into predictable, structured exercises, providing a safe and stable behavioral paradigm.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Tortoise and the Hare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReconstructs the classic race into graded physical training. The tortoise's steady crawl provides vestibular input, the hare's jumping enhances proprioception, and sensory stations (tactile grass areas/foot-stimulating pebble paths) are integrated. Uses a structured track with clear paths marked by colored tape to reduce anxiety; sensory modulation stations with a 6-texture touch wall offer tactile desensitization; social interaction design includes a duo collaboration mode to operate the finish flag together.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Animal Sports Day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransforms sports events into structured therapeutic activities. Sheep's steady rolling provides deep pressure input, antelope's rhythmic jumping trains balance, and sensory obstacle levels (furry tunnel/soft cushion hill) are integrated. Uses a sports narrative to build a therapeutic framework, helping children with autism improve physical coordination, emotion regulation, and social participation through predictable activities and multi-sensory experiences.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Lost Duckling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransforms the story into structured navigation training. Colored feather paths and textured markers (leaves/pebbles/puddles) provide vestibular and proprioceptive integration training, helping build spatial security. Uses a multi-sensory wayfinding system with fluorescent footprints and varied path textures; pressure regulation activities include wing-flapping and waddling; social interaction framework involves duo collaboration to find the \"way home\", fostering non-verbal communication.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePulling the Radish\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDepicts the power of teamwork through the story of an old man, an old woman, and animals pulling a giant radish. The predictable, repetitive pulling motion provides deep pressure input, helping children build body awareness and team participation. Uses collective labor narrative to build a therapeutic framework, enhancing coordination, emotional resonance, and social collaboration.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHopscotch\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA girl named Lily uses magical chalk to create hopscotch grids leading to adventures in different worlds. Fluorescent grids provide visual cues, varied textures offer tactile input, and predictable jumping sequences build body awareness and spatial security. Uses structured play to improve coordination, emotion regulation, and social interaction.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLittle Crab Finds Friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Tells the story of a crab named Cleo learning to make friends. His unique sideways walk promotes coordination; claw open-close rhythm games teach interactive response; multi-sensory experiences include a sandbox beach and water basin ocean. Helps children learn social interaction through imitating crab movements.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLovely Panda Gymnastics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransforms panda's cute actions into structured therapeutic exercises. \"Bamboo stretching\" provides deep pressure, \"roly-poly rolling\" trains vestibular balance, \"black-and-white swaying\" promotes bilateral coordination. Uses structured sequences, multi-sensory integration, and self-regulation design to build body awareness and emotional regulation.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Little Duck Learns to Swim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReplicates water benefits in a dry environment. Duck's paddling becomes upper body resistance training, floating is replaced by balance board exercises, wave sensation is achieved via vibration mats. Uses land-based stroke training, balance exercises, and sensory paths to provide a safe, controlled environment for improving sensory integration and motor coordination.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpace Throwing Competition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSet in a space exploration story, children throw different cosmic objects to activate planet devices and save a galaxy. Each throw challenges force control, angle judgment, and spatial awareness. Varied projectile weights/textures provide diverse tactile/proprioceptive input, helping improve motor planning and spatial judgment.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Snow Queen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA fantasy adventure where a boy's heart and eye are pierced by a mirror shard, making him cold. A girl's quest saves him. Uses cold-themed exercises, sensory training with varied cold textures, and snowflake imitation movements to help children improve body awareness and emotional regulation in a predictable, cool-themed environment.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA Monkey Mountain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e• A modern fable about a zoo employee posing as a monkey, accepted despite being different. Activities imitate natural monkey movements and social structures. Provides bilateral coordination, vestibular stimulation, and hand-eye coordination training through clear visual cues and predictable routines, helping children learn social rules while maintaining self-identity.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePinocchio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUses Pinocchio's transformation from marionette to real boy to help children develop autonomous movement through structured exercises. Stages include joint isolation, transition from passive to active movement, and rhythm training. Integrates multi-sensory paths and auditory feedback to improve body awareness and problem-solving.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Little Goats Cross the Bridge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo goats meet on a narrow bridge and learn to compromise. Activities include balance training on different widths, spatial awareness exercises, and simulated bridge movement. Social decision-making uses visual cue cards, timers, and a win-win reward system to teach flexible thinking and social compromise.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Key Keeper\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransforms a key-keeping parable into structured equipment management training. Activities involve key transfer, guarding, and finding, providing proprioceptive input, fine motor skill practice, and sequential memory. Social interaction design includes key transfer etiquette and collaborative carrying, teaching responsibility and rule-following.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLet's Ride Together\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn \"Wheel Village\", all animals ride special bikes except a fearful wolf pup. Uses phased balance training and social interaction design to help the pup build confidence through a gradual process, experiencing the \"fall-get up-try again\" growth cycle.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Little Rabbit Rolls the Hoop\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. A rabbit practices rolling a hoop, exploring physics like friction and balance, eventually winning a race. The story emphasizes perseverance and discovery.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Carousel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA modern fable about a carousel horse named Breeze breaking free from endless cycles. Uses graded rotational sensation training and social interaction games to improve vestibular processing and action control, helping children explore physical boundaries within safe limits.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Terracotta Warriors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThrough imitating the Terracotta Warriors' static poses at varying difficulty levels, engaging in coordinated position swaps, participating in formation changes and strategic movements, taking part in relic-passing relays (which foster social interaction during object exchange), and collaborating on joint guardian missions (achieving team objectives), children enhance their motor control, spatial awareness, and teamwork skills during physical activities. This process helps them understand that both steadfastness and adaptability are equally important—that while it is essential to follow necessary rules, one must also learn to respond flexibly. Each child can find their own place within the team and become a guardian of history.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Chameleon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA chameleon named Chico can change color but loses himself until a storm washes away his disguises. Activities include color recognition games, emotional expression training, and environmental adaptation exercises. Helps children learn self-regulation, emotion identification, and social referencing, understanding the value of staying true amidst change.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Little Lion Who Loved Tug-of-War\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA strong lion learns that true power lies in cohesion, not brute force. He reorganizes a tug-of-war game with clear roles and rules. Team role training provides deep pressure, static support practice, and social referencing practice through unified commands and role rotation, teaching social interaction and team belonging.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaisy Goes to the Sports Day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA small mouse finds his place in the forest sports day by leveraging his unique skills. Features personalized event design, social interaction support, and sensory adaptation to help children build confidence, improve coordination, and understand that participation matters more than winning.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCarnival of the Animals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn a deep forest, animals hold a grand carnival where everyone showcases unique talents. A young monkey finds his by observing others. Activities involve animal movement imitation, personalized movement paths, and low-pressure social interaction support, helping children discover their strengths and build confidence in a supportive setting.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Three Billy Goats Gruff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThree goats outsmart a bridge troll. Uses graded bridge-crossing training, social interaction design, and sensory integration activities. The predictable story structure and controlled risk experience help children learn problem-solving, emotion management, and physical coordination.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Little Bear Who Danced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA bear named Brownie loves dancing but is mocked until he finds unique friends. Activities include body rhythm training, sensory integration, and progressive social interaction through mirror dancing and group circles. Helps improve coordination, emotional expression, and sensory integration through non-verbal expression and predictable rhythms.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Gruffalo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA quick-witted mouse invents a monster to scare predators, only to meet the real creature. Features forest adventure path training, strategic movement games, and social interaction design. The predictable adventure path and role-play help children learn problem-solving and social interaction.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLittle Bear's Adventure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA bear named Beibe embarks on a quest for the \"Eternal Spring\". Training involves adventure path exercises, task-oriented activities, and sensory regulation design. Clear stage goals, controlled sensory stimuli, and progressive social interaction help children improve physical abilities, environmental adaptation, and problem-solving skills.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCurriculum Structure for the Experimental Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCourse Structure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeaching Procedure for Experimental Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDuration\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStarting Phase\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Classroom Routines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2. Announcement of learning objectives and requirements for the session\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eWarm-up Phase\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEducational Drama Games, etc.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCore Phase\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Delivery of core teaching content to achieve session learning objectives\u003c/p\u003e\u003cp\u003e2. Educational Drama Picture Books + Physical Training Exercises\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClosing Phase\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Stretching Exercises\u003c/p\u003e\u003cp\u003e2. Session Summary and Review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe intervention was primarily delivered by graduate students majoring in Physical Education who held official teaching qualifications. Instruction was conducted in group sessions. Given that children with autism often have difficulty participating independently, their guardians were encouraged to accompany them during the sessions. To ensure consistent attendance and maximize the effectiveness of the intervention, strict attendance records were maintained for each class; participants were not permitted to miss more than three consecutive sessions or more than seven sessions in total. In addition, during each session, two children with autism were randomly selected to wear Polar heart rate monitors to assess exercise intensity. Across the 12-week intervention period, the mean heart rate of the experimental group was 136.21 ± 6.19 beats/min, corresponding to a moderate-intensity level.\u003c/p\u003e\n\u003ch3\u003eControl Group\u003c/h3\u003e\n\u003cp\u003eThe control group intervention followed a structured program consisting of three progressive stages: adaptation, fundamental, and advanced phases (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Each session included a warm-up, foundational training, core activity, and relaxation segment (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). The intervention dosage, intensity, and frequency were consistent with those of the Physical Activity combined with Educational Drama group. The sessions were primarily conducted by graduate students majoring in Physical Education who held official teaching qualifications, using a group-based instructional format.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntervention Protocol for the Control Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention Content\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLearning Objectives\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdaptation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Cultivation of social etiquette; 2. Establishment of classroom routines; 3. Visual and tactile desensitization exercises\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1. Foster basic social etiquette and classroom behavioral norms in children with autism; 2. Reduce resistance to the classroom environment and sports equipment; 3. Enhance interest in physical activities\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFoundation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Natural Walk, Marching, Imitating Animal Walks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1. Improve fundamental motor skills in children with autism; 2. Alleviate behavioral problems\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Quick Run, Natural Jog, Circle Run, Curve Run, Straight Run, Shuttle Run\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Two-Foot Jump Down, Two-Foot Forward Jump, One-Foot Continuous Jump\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Two-Handed Chest Throw, Two-Handed Overhead Throw, One-Handed Overhead Throw\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Front Drill, Hand-Knee Crawl, Prone Crawl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Walking/Running on Balance Beams, Run-Walk Sudden Stop, One-Leg Stand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Side Roll, Forward Roll, Backward Roll\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Push, Pull, Push + Pull\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdvanced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1. Improve fundamental motor skills in children with autism; 2. Alleviate behavioral problems\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e第12周\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Conventional warm-up activities: jogging, basic stretching; 2. Learning basic movements: Walk, Run, Jump, Throw, Drill, Crawl, Balance, Roll, Push/Pull\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCurriculum Structure for the Control Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCourse Structure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeaching Procedure for Control Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDuration\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStarting Phase\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Classroom Routines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2. Announcement of learning objectives and requirements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eWarm-up Phase\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eJogging, Basic Stretching\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCore Phase\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Delivery of core teaching content to achieve session learning objectives\u003c/p\u003e\u003cp\u003e2. Traditional Physical Training Exercises\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCool-down Phase\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Stretching Exercises\u003c/p\u003e\u003cp\u003e2. Session Summary and Review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMeasurement of Core Symptoms\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003eRepetitive Behaviors\u003c/h2\u003e\u003cp\u003eThe Repetitive Behavior Scale–Revised (RBS-R) is a validated instrument for assessing stereotyped behaviors in children with autism[15]. The scale comprises 43 items across six subdomains: stereotyped behavior, self-injurious behavior, compulsive behavior, ritualistic behavior, sameness behavior, and restricted behavior. Items are rated on a 4-point scale, where 3 indicates severe behavioral problems, 2 indicates moderate problems, 1 indicates mild problems, and 0 indicates no problems. Higher scores reflect greater severity of repetitive and stereotyped behaviors. The scale is completed by the child’s primary caregiver based on the child’s behavior over the past three months, with the same caregiver completing both pre- and post-intervention assessments to ensure consistency.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eSocial Impairment\u003c/h3\u003e\n\u003cp\u003eSocial responsiveness was assessed using the Social Responsiveness Scale, Second Edition (SRS-2) [16]. The 65-item instrument comprises five subscales: Social Awareness, Social Cognition, Social Communication, Social Motivation, and Restricted Interests and Repetitive Behaviors. Items are rated on a 4-point Likert scale, where 3 indicates severe behavioral problems, 2 moderate problems, 1 mild problems, and 0 indicates no observable behavioral problems. Higher total scores reflect more severe social impairment. The scale was completed by guardians based on the child's typical behavior over the preceding three-month period, with the same informant completing the scale at all assessment time points.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eChildhood Autism Rating Scale (CARS)\u003c/h2\u003e\u003cp\u003eThe Childhood Autism Rating Scale (CARS) (Schopler et al., 1980) was administered at baseline only. The total scores range from 0 to 60, with the following clinical cutoffs: a score below 30 indicates a non-autistic classification; a score of 30 or above leads to an autism classification. Within the autism spectrum, scores of 30–37 are classified as mild-to-moderate autism, while scores ranging from 37 to 60, accompanied by at least five items rated above 3, are classified as severe autism.[17].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMeasurement of Basic Physical Fitness\u003c/h2\u003e\u003cp\u003eBased on the school's physical fitness testing schedule and the content of fundamental movement skill assessment scales, the basic physical fitness test battery was determined to comprise the following items: standing long jump, tennis ball throw, balance beam walk, shuttle run, and two-foot continuous jump.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStanding Long Jump\u003c/b\u003e: The participant stood behind the take-off line with feet naturally apart, assumed a semi-squat position, and swung the arms backward with appropriate flexion. Subsequently, the arms were swung forward forcefully while the feet pushed off the ground to jump forward as far as possible. Two trials were performed, and the better result was recorded.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTennis Ball Throw\u003c/b\u003e: Facing the throwing direction, the participant stood approximately one step behind the throwing line with feet in a staggered stance. Holding a tennis ball with one hand overhead, the participant threw it forward as far as possible. A forward step with the rear foot was permitted during the release, but neither foot could touch or cross the throwing line.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBalance Beam Walk\u003c/b\u003e: The balance beam was 15 cm in height, 3 m in length, and 20 cm in width. Starting from a platform behind the \"start line\" of the beam, the participant stood with arms abducted to the side and then walked forward by alternating steps. Test personnel walked alongside the beam to observe performance and prevent accidents. Timing stopped when either foot contacted the \"end line.\"\u003c/p\u003e\u003cp\u003e\u003cb\u003eShuttle Run\u003c/b\u003e: Beginning in a standing start position, timing commenced upon a verbal signal. The participant ran to a turn-around point, touched a designated object, turned, and ran back to the finish line, at which point timing was stopped. The total running distance was 10 meters.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTwo-Foot Continuous Jump\u003c/b\u003e: Ten soft blocks were placed in a straight line on level ground at 50 cm intervals. A \"start line\" was marked 20 cm from the first block, and a \"finish line\" was marked 20 cm beyond the last block. With feet together behind the start line, the participant performed a two-footed jump consecutively over all ten blocks without stopping.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed using SPSS (Version 27.0). The normality of continuous variables was assessed using the Shapiro‑Wilk test, and descriptive statistics are presented as mean ± standard deviation. For data conforming to a normal distribution, independent samples t‑tests were used to examine baseline differences between the two groups. A two‑way repeated‑measures analysis of variance (ANOVA) was then conducted, with group (intervention vs. control) as the between‑subjects factor and time (pre‑intervention vs. post‑intervention) as the within‑subjects factor. The Bonferroni correction was applied for post‑hoc comparisons, and the Greenhouse‑Geisser correction was used when the assumption of sphericity was violated. In cases of a significant interaction effect, simple effect analyses were performed. A p‑value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Result","content":"\u003ch2\u003eDemographic Variables\u003c/h2\u003e\u003cp\u003eThe pre-test demographic and clinical characteristics of the participants are presented in the table. No significant differences were observed between the two groups in terms of age, gender, body mass index (BMI), scores on the Childhood Autism Rating Scale (CARS), Repetitive Behavior Scale-Revised (RBS-R), Social Responsiveness Scale-Second Edition (SRS-2), or physical fitness measures, confirming that the groups were well-matched and homogeneous at baseline.(Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and Baseline Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender(male/Female)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9/1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9/1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.763\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYear\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.80 ± 0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.10 ± 0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.241\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.95 ± 1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.34 ± 0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.160\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCARS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.50 ± 0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.50 ± 1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.200\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRBS-R\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.50 ± 6.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.50 ± 8.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.380\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSRS−2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79.50 ± 5.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79.10 ± 6.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.883\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStanding Long Jump(cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64.05 ± 7.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.30 ± 5.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.550\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTennis Ball Throw(m)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.48 ± 1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.10 ± 0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.465\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBalance Beam Walk(s)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.64 ± 1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.48 ± 1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.822\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eShuttle Run(s)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.84 ± 0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.74 ± 1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTwo-Foot Continuous Jump(s)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.02 ± 1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.93 ± 1.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.105\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eChanges in Core Symptoms of Autism Spectrum Disorder Following Intervention\u003c/h2\u003e\u003ch2\u003eRepetitive Behaviors\u003c/h2\u003e\u003cp\u003eFor the total scale scores, a repeated-measures ANOVA revealed a significant main effect of time (F(1, 18) = 375.434, p \u0026lt; 0.001, η²p = 0.954) and a significant time × group interaction (F(1, 18) = 10.108, p = 0.005, η²p = 0.360). Simple effect analysis demonstrated that both the experimental and control groups exhibited a significant reduction in total scores compared to pre-intervention levels (p \u0026lt; 0.001). However, no significant difference was found between the two groups at post-intervention, indicating that both intervention approaches were effective in ameliorating repetitive behaviors in children with autism.(Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eRegarding the subscale analyses, significant differences were observed between the experimental and control groups across specific dimensions of repetitive behavior. For stereotyped behavior, the repeated-measures ANOVA revealed a significant main effect of time (F(1, 18) = 3721.000, p \u0026lt; 0.001, η²p = 0.995) and a significant time × group interaction (F(1, 18) = 441.000, p \u0026lt; 0.001, η²p = 0.961). Simple effect analysis indicated that both groups exhibited a significant decrease in scores post-intervention (p \u0026lt; 0.001). Furthermore, post-intervention scores in the experimental group were significantly lower than those in the control group (p = 0.004). For self-injurious behavior, there was a significant main effect of time (F(1, 18) = 78.049, p \u0026lt; 0.001, η²p = 0.813) and a significant time × group interaction (F(1, 18) = 24.934, p \u0026lt; 0.001, η²p = 0.581). Simple effect analysis showed that both the experimental and control groups demonstrated significant reductions in scores following the intervention (p \u0026lt; 0.001 and p = 0.014, respectively). However, no significant difference was observed between the two groups at the post-intervention assessment. For restricted behavior, the analysis showed a significant main effect of time (F(1, 18) = 156.122, p \u0026lt; 0.001, η²p = 0.897) and a significant time × group interaction (F(1, 18) = 27.225, p \u0026lt; 0.001, η²p = 0.491). Simple effect analysis confirmed that both groups displayed a significant decrease in scores post-intervention (p \u0026lt; 0.001). Additionally, the experimental group exhibited significantly lower post-intervention scores compared to the control group (p = 0.008).(Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e–\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003ch2\u003eSocial Impairment\u003c/h2\u003e\u003cp\u003eFor the total scale scores, the repeated-measures ANOVA revealed a significant main effect of time (F(1, 18) = 259.146, p \u0026lt; 0.001, η²p = 0.935) and a significant time × group interaction (F(1, 18) = 32.629, p \u0026lt; 0.001, η²p = 0.644). Simple effect analysis demonstrated that both the experimental and control groups showed significant reductions in total scores compared to baseline (p \u0026lt; 0.001). Furthermore, post-intervention scores in the experimental group were significantly lower than those in the control group (p \u0026lt; 0.001). These results indicate that while both interventions were effective in ameliorating social impairments in children with autism, the experimental intervention demonstrated superior efficacy.(Figure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eRegarding the subscale analyses, distinct patterns of intervention effects were observed across different social domains. In the domain of Social Cognition, the analysis revealed a significant main effect of time (F(1, 18) = 9.991, p = 0.005, η²p = 0.357) and a significant time × group interaction (F(1, 18) = 6.688, p = 0.019, η²p = 0.271). Post-hoc tests indicated a significant reduction in scores for the control group following the intervention (p \u0026lt; 0.001), with no significant difference emerging between the groups at post-test. For Social Communication, significant effects were found for the main effect of time (F(1, 18) = 33.280, p \u0026lt; 0.001, η²p = 0.649), the time × group interaction (F(1, 18) = 14.405, p = 0.001, η²p = 0.445), and the main effect of group (F(1, 18) = 6.045, p = 0.024, η²p = 0.251). Simple effect analysis confirmed that the experimental group showed a significant decrease post-intervention (p \u0026lt; 0.001), and their post-intervention scores were significantly lower than those of the control group (p \u0026lt; 0.001). In Social Motivation, the results showed a significant main effect of time (F(1, 18) = 235.200, p \u0026lt; 0.001, η²p = 0.929) and a significant time × group interaction (F(1, 18) = 58.800, p \u0026lt; 0.001, η²p = 0.766). Both groups exhibited significant improvements after the intervention (p \u0026lt; 0.001), with the experimental group demonstrating significantly lower scores than the control group at post-test (p = 0.009). For Autistic Mannerisms, significant effects were observed for the main effect of time (F(1, 18) = 101.220, p \u0026lt; 0.001, η²p = 0.849), the time × group interaction (F(1, 18) = 8.358, p = 0.01, η²p = 0.317), and the main effect of group (F(1, 18) = 13.160, p = 0.002, η²p = 0.422). Simple effect analysis indicated that both groups improved significantly from baseline (p \u0026lt; 0.001), and the experimental group's post-intervention scores were significantly lower than those of the control group (p \u0026lt; 0.001). In summary, these findings suggest that the control intervention was effective in improving social cognition, while the experimental intervention was particularly effective in enhancing social communication. Both interventions led to improvements in social motivation and autistic mannerisms, with the experimental intervention producing superior outcomes in social communication, social motivation, and autistic mannerisms compared to the control condition.(Figure \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e–\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003ch2\u003ePhysical Fitness\u003c/h2\u003e\u003cp\u003eRegarding physical fitness outcomes, the repeated-measures ANOVA revealed that none of the indicators showed a significant time × group interaction effect, while significant main effects of time were observed for all measures. Consequently, paired-samples t-tests were conducted to analyze within-group changes from pre- to post-intervention. The results indicated that both the experimental and control groups showed significant improvements in the standing long jump (p = 0.001; p \u0026lt; 0.001, respectively), tennis ball throw (p = 0.005; p = 0.002, respectively), balance beam walk (p \u0026lt; 0.001 for both groups), and shuttle run (p = 0.036; p = 0.043, respectively). For the two-foot continuous jump, a significant improvement was observed in the experimental group (p = 0.005), whereas the control group did not show a statistically significant change (p = 0.237).(Figure \u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e–\u003cspan refid=\"Fig14\" class=\"InternalRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study revealed that the control group (receiving conventional exercise intervention) demonstrated a significant main effect of time on both the RBS-R and SRS-2 total scores, confirming the beneficial effects of regular physical activity for children with autism[18]. However, the significantly greater improvement observed in the experimental group across multiple subscales provides robust evidence for the unique value of the combined intervention.\u003c/p\u003e\u003cp\u003eFirst, regarding repetitive and stereotyped behaviors (RBS-R), the experimental group demonstrated significantly lower post-intervention scores than the control group on both the \"Stereotyped Behavior\" and \"Restricted Behavior\" subscales. This outcome is supported by established neurophysiological and psychological mechanisms. A standalone exercise intervention may primarily function by modulating neurotransmitters—such as increasing dopamine and norepinephrine levels—and by promoting the balance of cortical excitation and inhibition, thereby reducing overall behavioral impulsivity and activity levels[19]. However, the introduction of educational drama offers a distinct \"behavioral substitution\" pathway for reducing stereotyped behaviors. Within the dramatic context, the demands of role-playing, imitation, and narrative development require children to suppress their inherent, self-stimulating stereotyped behaviors and instead execute context-appropriate, purposeful social actions.[20]. This sustained practice within an emotionally engaging and motivational context can effectively disrupt the circuitry of stereotyped behaviors and foster more adaptive behavioral patterns[11]. In contrast, for self-injurious behavior, while both groups showed improvement post-intervention, no significant difference was observed between them. This suggests that self-injurious behavior, as a more severe form of challenging behavior, may require more specialized and prolonged behavioral intervention strategies. Alternatively, its underlying triggers may be more complex, resulting in a relatively slower response to the psychological components of the combined intervention [21].\u003c/p\u003e\u003cp\u003eSecond, the superiority of the combined intervention was more comprehensively demonstrated in the domain of social competence (SRS-2). The experimental group showed significantly greater improvement than the control group across three core subscales: Social Communication, Social Motivation, and Autistic Mannerisms. These findings clearly illustrate the core function of educational drama as a \"rehearsal stage for social cognition.\" The central challenge in social interaction for children with autism stems from deficits in Theory of Mind—the ability to infer and respond to others' emotions and intentions[22]. Conventional exercise programs are typically conducted in clearly-defined, structured environments where social interactions tend to be procedural in nature [23]. In contrast, educational drama creates simulated social scenarios that provide children with repeated opportunities for a cycle of experience, reflection, and re-practice[24]. In the domains of social communication and motivation, drama activities require children to observe their peers' behavior, interpret the mental states of characters, and respond using their own language, facial expressions, and body movements. This process directly trains their theory of mind and non-verbal communication skills[25]. When children receive positive interactive feedback during drama activities—such as successfully advancing the plot through appropriate communication—their intrinsic social motivation is significantly enhanced. This process facilitates a shift from passive participation to active initiation of social interactions [26]. This finding is closely aligned with the significant improvement in social motivation observed in our study. Research has found that drama-based techniques, such as improvisational games and dramatic play, can enhance emotion comprehension in children with autism. These methods have been shown to improve emotion recognition and Theory of Mind capabilities, while also demonstrating positive effects on empathy and social interaction skills - findings that are consistent with the results of the present study[27]. Regarding autistic mannerisms, this dimension reflects the overall severity of the \"autistic impression\" an individual conveys. The marked improvement in the experimental group suggests that the combined intervention not only modified specific social behaviors but also holistically enhanced the children's social adaptability and integration, making their behavioral patterns more closely resemble those of typically developing children. In contrast, the control group demonstrated improvement comparable to the experimental group only in the \"social cognition\" domain. This may be attributed to the fact that rule comprehension and teamwork in conventional exercise involve fundamental cognitive processes, yet did not extend to the advanced social dimensions requiring complex emotional resonance and intentional understanding[28].\u003c/p\u003e\u003cp\u003eIn terms of physical fitness, children in both groups demonstrated significant improvements in the standing long jump, tennis ball throw, balance beam walk, and shuttle run. These results confirm that the 12-week systematic exercise intervention, irrespective of the specific format, effectively enhanced fundamental physical attributes including strength, coordination, and speed in children with autism[29]. However, a significant improvement in the two-foot continuous jump—a test assessing agility and coordination—was observed exclusively in the experimental group. This differential outcome may stem from subtle differences in neuromuscular control demands between the two intervention models. Conventional exercise training typically emphasizes the repetitive practice of fundamental motor skills, which may provide insufficient challenge in terms of rhythmic complexity, motor sequencing, and rapid transitions between movements[9]. In contrast, educational drama activities incorporate a wide range of non-structured, expressive bodily movements—such as imitating animal walks, or suddenly halting, turning, and jumping in response to narrative cues. These activities require children to process storyline information cognitively while simultaneously executing rapid, varied, and coordinated physical responses. This cognitive‑motor dual‑task paradigm may more effectively stimulate cerebellar and basal ganglia functions and promote sensory integration, thereby offering specific benefits for the development of skills such as the two‑foot continuous jump, which relies heavily on precise rhythm and movement fluidity[30].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this study provides compelling empirical support for the efficacy of the integrated intervention model combining physical exercise and educational drama. The results demonstrate that this program not only effectively enhances the physical fitness of children with autism, comparable to conventional exercise programs, but more importantly, achieves more profound and extensive improvements in the core deficits of autism\u0026mdash;social communication and stereotyped behaviors\u0026mdash;through the creative integration of movement and drama. Therefore, we recommend the consideration of this combined physical exercise and educational drama approach as a validated curricular or intervention module for implementation in special education schools, rehabilitation centers, and inclusive educational settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBingxue Ma: Conceptualization, Investigation, Methodology, Writing \u0026ndash;original draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXiru Du: Conceptualization, Funding acquisition, Supervision, Writing\u0026nbsp;\u0026ndash;review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research work presented in this paper was supported by the 2023 Guangdong Provincial Education Science Planning Fund (Natural Science), and I am the author of this study (Project Number: 2023GXJK006). The funding did not and will not have any implication on the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be\u0026nbsp;construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePosar, A., F. Resca, and P. 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Menear, \u003cem\u003ePhysical activity and physical fitness of school‐aged children and youth with autism spectrum disorders.\u003c/em\u003e Autism research and treatment, 2014. \u003cstrong\u003e2014\u003c/strong\u003e(1): p. 312163.\u003c/li\u003e\n\u003cli\u003eWu, Y., et al., \u003cem\u003eThe effect of physical exercise therapy on autism spectrum disorder: a systematic review and meta-analysis.\u003c/em\u003e Psychiatry Research, 2024. \u003cstrong\u003e339\u003c/strong\u003e: p. 116074.\u003c/li\u003e\n\u003cli\u003eStratou, E., et al., \u003cem\u003eThe effect of drama in education on social skills development of children with autism spectrum disorders (ASD).\u003c/em\u003e International Journal of Caring Sciences, 2023. \u003cstrong\u003e16\u003c/strong\u003e(1): p. 464-473.\u003c/li\u003e\n\u003cli\u003eBololia, L., et al., \u003cem\u003eDramatherapy for children and adolescents with autism spectrum disorder: A systematic integrative review.\u003c/em\u003e The Arts in Psychotherapy, 2022. \u003cstrong\u003e80\u003c/strong\u003e: p. 101918.\u003c/li\u003e\n\u003cli\u003eKechen, L., S.C. Cheang, and S. Zainal, \u003cem\u003eA Study on Drama Therapy to Promote Imagination Development of Autistic Children--A Case Study in Guangxi, China.\u003c/em\u003e Pakistan Journal of Life \u0026amp; Social Sciences, 2024. \u003cstrong\u003e22\u003c/strong\u003e(2).\u003c/li\u003e\n\u003cli\u003eRahimi Pordanjani, S., \u003cem\u003eEffectiveness of drama therapy on social skills of autistic children.\u003c/em\u003e Practice in Clinical Psychology, 2021. \u003cstrong\u003e9\u003c/strong\u003e(1): p. 9-18.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Leary, K., \u003cem\u003eThe effects of drama therapy for children with autism spectrum disorders.\u003c/em\u003e 2013.\u003c/li\u003e\n\u003cli\u003eBodfish, J.W., et al., \u003cem\u003eVarieties of repetitive behavior in autism: Comparisons to mental retardation.\u003c/em\u003e Journal of autism and developmental disorders, 2000. \u003cstrong\u003e30\u003c/strong\u003e(3): p. 237-243.\u003c/li\u003e\n\u003cli\u003eBruni, T.P., \u003cem\u003eTest review: Social responsiveness scale\u0026ndash;Second edition (SRS-2).\u003c/em\u003e Journal of Psychoeducational Assessment, 2014. \u003cstrong\u003e32\u003c/strong\u003e(4): p. 365-369.\u003c/li\u003e\n\u003cli\u003eSchopler, E., et al., \u003cem\u003eToward objective classification of childhood autism: Childhood Autism Rating Scale (CARS).\u003c/em\u003e Journal of Autism and Developmental Disorders, 1980. \u003cstrong\u003e10\u003c/strong\u003e(1): p. 91-103.\u003c/li\u003e\n\u003cli\u003eBremer, E., M. 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Lloyd, \u003cem\u003eA systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder.\u003c/em\u003e Autism, 2016. \u003cstrong\u003e20\u003c/strong\u003e(8): p. 899-915.\u003c/li\u003e\n\u003cli\u003eLiang, X., et al., \u003cem\u003eThe effects of exercise interventions on executive functions in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis.\u003c/em\u003e Sports Medicine, 2022. \u003cstrong\u003e52\u003c/strong\u003e(1): p. 75-88.\u003c/li\u003e\n\u003cli\u003eCorbett, B.A., et al., \u003cem\u003eTreatment effects in social cognition and behavior following a theater-based intervention for youth with autism.\u003c/em\u003e Developmental neuropsychology, 2019. \u003cstrong\u003e44\u003c/strong\u003e(7): p. 481-494.\u003c/li\u003e\n\u003cli\u003eDogru, S.S.Y., \u003cem\u003eThe effect of creative drama on pre-teaching skills and social communication behaviors of children with autism.\u003c/em\u003e Studies on Ethno-Medicine, 2015. \u003cstrong\u003e9\u003c/strong\u003e(2): p. 181-189.\u003c/li\u003e\n\u003cli\u003eBaron-Cohen, S., A.M. Leslie, and U. Frith, \u003cem\u003eDoes the autistic child have a \u0026ldquo;theory of mind\u0026rdquo;?\u003c/em\u003e Cognition, 1985. \u003cstrong\u003e21\u003c/strong\u003e(1): p. 37-46.\u003c/li\u003e\n\u003cli\u003eSowa, M. and R. Meulenbroek, \u003cem\u003eEffects of physical exercise on autism spectrum disorders: A meta-analysis.\u003c/em\u003e Research in autism spectrum disorders, 2012. \u003cstrong\u003e6\u003c/strong\u003e(1): p. 46-57.\u003c/li\u003e\n\u003cli\u003eMpella, M., et al., \u003cem\u003eThe Effects of a Theatrical Play Programme on Social Skills Development for Young Children with Autism Spectrum Disorders.\u003c/em\u003e International Journal of Special Education, 2019. \u003cstrong\u003e33\u003c/strong\u003e(4): p. 828-845.\u003c/li\u003e\n\u003cli\u003eManna, N., \u003cem\u003eVelvi\u0026apos;s Theatre Intervention for Children with Autism Spectrum Disorder (ASD): An Assessment of Effect of Drama Therapy.\u003c/em\u003e Indian Journal of Health \u0026amp; Wellbeing, 2021. \u003cstrong\u003e12\u003c/strong\u003e(3).\u003c/li\u003e\n\u003cli\u003eLerner, M.D. and A.Y. Mikami, \u003cem\u003eA preliminary randomized controlled trial of two social skills interventions for youth with high-functioning autism spectrum disorders.\u003c/em\u003e Focus on Autism and Other Developmental Disabilities, 2012. \u003cstrong\u003e27\u003c/strong\u003e(3): p. 147-157.\u003c/li\u003e\n\u003cli\u003eD\u0026rsquo;Amico, M., C. Lalonde, and S. Snow, \u003cem\u003eEvaluating the efficacy of drama therapy in teaching social skills to children with Autism Spectrum Disorders.\u003c/em\u003e Drama Therapy Review, 2015. \u003cstrong\u003e1\u003c/strong\u003e(1): p. 21-39.\u003c/li\u003e\n\u003cli\u003eToscano, C.V., et al., \u003cem\u003eExercise improves the social and behavioral skills of children and adolescent with autism spectrum disorders.\u003c/em\u003e Frontiers in psychiatry, 2022. \u003cstrong\u003e13\u003c/strong\u003e: p. 1027799.\u003c/li\u003e\n\u003cli\u003eToscano, C.V., H.M. Carvalho, and J.P. Ferreira, \u003cem\u003eExercise effects for children with autism spectrum disorder: metabolic health, autistic traits, and quality of life.\u003c/em\u003e Perceptual and motor skills, 2018. \u003cstrong\u003e125\u003c/strong\u003e(1): p. 126-146.\u003c/li\u003e\n\u003cli\u003eBhat, A.N., R.J. Landa, and J.C. Galloway, \u003cem\u003eCurrent perspectives on motor functioning in infants, children, and adults with autism spectrum disorders.\u003c/em\u003e Physical therapy, 2011. \u003cstrong\u003e91\u003c/strong\u003e(7): p. 1116-1129.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Autism Spectrum Disorder, Integrated Intervention, Educational Drama, Physical Activity","lastPublishedDoi":"10.21203/rs.3.rs-7999898/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7999898/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study evaluated the effects of a 12-week combined physical activity and educational drama intervention on core symptoms and physical fitness in children with Autism Spectrum Disorder (ASD). Twenty children were randomly assigned to an experimental group (n\u0026thinsp;=\u0026thinsp;10), receiving the combined intervention, or a control group (n\u0026thinsp;=\u0026thinsp;10), receiving conventional physical activity. Outcomes were assessed using the Repetitive Behavior Scale-Revised (RBS-R), Social Responsiveness Scale-2 (SRS-2), and a physical fitness test battery. Results indicated that both groups showed significant improvements in repetitive behaviors and physical fitness. However, the experimental group demonstrated significantly greater reductions in stereotyped behaviors, restricted behaviors, and social impairments\u0026mdash;specifically in social communication, motivation, and autistic mannerisms\u0026mdash;compared to the control group. These findings suggest that integrating educational drama with physical activity is more effective than physical activity alone in ameliorating core ASD symptoms, offering a promising holistic intervention approach.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthics\u003c/b\u003e: This study has been approved by the Guangzhou Sport University Research Ethics Committee (102772021RT067) .\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrail registration number\u003c/b\u003e: This study has been registered prospectively in the Chinese Clinical Trail Registry(CTR2500103810).\u003c/p\u003e","manuscriptTitle":"Effects of a Combined Physical Activity and Educational Drama Intervention on Core Symptoms and Physical Fitness in Children with ASD","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-24 06:40:06","doi":"10.21203/rs.3.rs-7999898/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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