The Effect of a Movement Program with a Lighted Stepping Board on Cortisol Levels and Sleep Disorders in Children with Autism Spectrum Disorder

Background and Purpose
Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects various physical, motor, cognitive, and psychological dimensions. Stress and sleep disturbances are common issues among individuals with ASD, significantly impacting their quality of life. Sensory-motor integration-based rehabilitation methods are widely used to address these challenges, as they help children process sensory input more efficiently, reducing stress and improving adaptive behaviors.
Technology-based interventions, such as electronic devices and visual-auditory feedback systems, have shown promise in engaging children with ASD.Building on these findings, this study introduces a novel exercise method using a lighted stepping board, which provides visual and auditory feedback to simplify and enhance motor patterns. The program aims to improve sensory-motor integration, reduce stress, and address sleep disturbances in children with ASD.
The primary objective of this study is to determine the effect of a 12-week movement program using a lighted stepping board on cortisol levels (a biomarker of stress) and sleep disturbances in children with ASD.
 
Materials and Methods
This semi-experimental study involved 20 children with moderate ASD, aged 6 to 12 years, and an IQ above 75. Participants were randomly assigned to two groups: 1) Experimental Group that performed the movement program using a lighted stepping board; 2) Control Group that performed the same program using a simple, non-lighted board. The movement program consisted of four 45-minute sessions per week for 12 weeks, conducted under the supervision of trained instructors. The lighted stepping board provided visual and auditory feedback, guiding children through progressively complex walking patterns. Cortisol levels were measured via saliva samples collected at pre-test and post-test. Sleep disturbances were assessed using the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using analysis of covariance (ANCOVA) to compare post-test results between groups, controlling for pre-test scores. Statistical significance was set at p≤0.05.
 
Findings
The results revealed significant differences between the experimental and control groups. The experimental group showed a significant reduction in cortisol levels compared to the control group (p=0.018). The effect size of the intervention on cortisol levels was 28.6%. The experimental group demonstrated a significant improvement in sleep quality compared to the control group (p=0.032). The effect size of the intervention on sleep disturbances was 24.4%. These findings indicate that the lighted stepping board program effectively reduced stress and improved sleep quality in children with ASD.
 
Conclusion
The study demonstrates that the lighted stepping board program is an effective intervention for reducing cortisol levels and sleep disturbances in children with ASD. The visual and auditory feedback provided by the board enhances sensory-motor integration, making the exercises more engaging and effective. The program's ability to lower cortisol levels suggests its potential as a stress management tool for children with ASD. By addressing sensory-motor integration and reducing stress, the program indirectly improves sleep quality. The lighted stepping board can be integrated into existing rehabilitation programs to enhance their effectiveness. It can be suggested that the lighted stepping board is a cost-effective and space-efficient tool that can be used at home to support children with ASD. Also, the program can be incorporated into sensory-motor integration therapies to enhance outcomes.
 Article Message
This study highlights the therapeutic potential of step-pattern motor exercises using a lighted stepping grid in children with autism spectrum disorder. The intervention, which integrates visual and auditory feedback, was found to significantly reduce salivary cortisol levels an indicator of physiological stress and alleviate sleep disturbances as measured by the Pittsburgh Sleep Quality Index. These findings suggest that combining motor coordination tasks with multisensory stimuli may promote neurophysiological regulation and improve overall well-being in children with autism. As a result, such structured, technology-enhanced movement programs can serve as an effective, non-pharmacological strategy in autism rehabilitation settings.
Ethical Considerations
Prior to the commencement of the study, ethical approval was obtained from the Ethics Committee of the University of Isfahan under the code IR.UI.REC.1398.032. The study adhered to the ethical principles outlined in the Helsinki Declaration.
Authors’ Contributions
All authors contributed to the design, implementation, and writing of all sections of the present study.
Conflict of Interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Acknowledgments
The authors sincerely thank all individuals who contributed to the implementation of this research.