Preschoolers With Developmental Disabilities May Face Movement Gaps, Review Finds

The earliest years of life are a whirlwind of movement: toddlers sprint across playgrounds, collapse into naps, and settle into quiet play with picture books and tablets. For children with developmental disabilities, however, that daily rhythm of physical activity, sedentary behavior, and sleep may unfold very differently than it does for their typically developing peers. A new scoping review published in the Journal of Activity, Sedentary and Sleep Behaviors suggests that the scientific community still knows surprisingly little about how these so-called 24-hour movement behaviors take shape in preschool-aged children with developmental disabilities, even though the health consequences of these behaviors can last a lifetime.

The review, led by Serena Cacciola of the University of Massachusetts Amherst together with colleagues at the University of South Carolina and the University of Minnesota, set out to map the existing research landscape rather than to pool results statistically. The team systematically searched nine databases for empirical studies published between 2004 and 2024, applying strict inclusion criteria: children had to be between 33 and 72 months old, the sample had to include children with developmental disabilities, and each study had to measure at least two of the three movement behaviors that together fill a child’s 24-hour day. Screening of titles, abstracts, and full texts was completed by two independent reviewers, a safeguard designed to reduce selection bias in which studies made it into the final synthesis.

Twenty articles, the vast majority of them cross-sectional snapshots rather than longitudinal studies, met the criteria. The studies spanned a wide range of developmental domains, including autism spectrum disorder, cerebral palsy, and developmental coordination disorder, among other delays, disorders, and disabilities. That breadth is itself informative, the authors note, because it reflects growing recognition that movement behaviors are not a one-size-fits-all phenomenon: a child with motor impairments from cerebral palsy faces very different barriers to active play than a child with autism who may experience sensory sensitivities or strong preferences for screen-based activities.

The central finding of the review is, in a word, inconsistency. Across the twenty studies, findings on sleep, sedentary behavior, and physical activity were mixed. Some investigations reported statistically significant differences between children with and without developmental disabilities, while others found no differences at all, or produced results that shifted depending on which behavior was measured, how it was quantified, and which diagnostic group was under study. Sleep emerged as one of the more commonly examined behaviors, with several studies suggesting that children with certain developmental conditions may experience more sleep problems or shorter sleep durations, but even here the evidence did not point uniformly in one direction.

This heterogeneity matters because the 24-hour movement behavior framework treats physical activity, sedentary time, and sleep as interconnected rather than independent. Time is a fixed resource: every additional hour of screen-based sedentary behavior is an hour not spent in active play or sleep, and the health effects of these behaviors are thought to interact. International guidelines for preschoolers typically recommend specific daily targets for each behavior, yet the review makes clear that researchers still lack a reliable picture of whether children with developmental disabilities are meeting, exceeding, or falling short of those targets, and whether the patterns seen in older children with disabilities are already visible before school entry.

The methodological details of the included studies help explain the muddled picture. Measurement approaches varied widely, from parent-report questionnaires to accelerometers and other wearable devices, and each approach carries distinct strengths and weaknesses. Parent reports of a child’s activity or sleep can be shaped by recall bias and by the practical realities of caring for a child with high support needs, while objective devices can struggle to capture the sometimes atypical movement patterns of children with motor disabilities. Few studies measured all three behaviors simultaneously, which limits the ability to characterize the full 24-hour cycle that the framework is designed to capture.

The review also highlights a deeper conceptual gap: developmental considerations have largely been absent from previous syntheses. Evidence from older children indicates that differences in movement behaviors between those with and without disabilities may begin to emerge in early childhood, but reviews to date have rarely focused specifically on the preschool window. The authors argue that this period, roughly ages three to five, is critical because habits formed in early childhood tend to track into later life, and because early intervention is generally more effective than remediation after problems become entrenched. Without preschool-specific evidence, clinicians and families are left extrapolating from research on older children that may not apply.

Another limitation the authors identify is the fragmentation of research across diagnostic categories. Studies of children with autism spectrum disorder rarely included children with cerebral palsy, and vice versa, making it difficult to determine whether observed differences in movement behaviors are driven by the specific domain of developmental difference or by broader factors such as family routines, access to inclusive recreational programs, or therapist recommendations. The review’s third research question, whether movement behaviors varied by developmental domain, could only be partially addressed because so few studies made direct comparisons across conditions.

What the review does offer is a roadmap. The authors call for more comprehensive and consistent measurement that considers all three 24-hour movement behaviors together, ideally using validated instruments and, where possible, objective monitoring. They also call for studies that follow children over time, so that researchers can distinguish transient early-childhood patterns from trajectories that persist into school age. Better evidence, they argue, is the prerequisite for designing targeted interventions, whether that means adapted physical activity programs for children with motor impairments, sleep hygiene support for families of children with autism, or strategies to reduce sedentary screen time in ways that accommodate sensory and communication needs.

For parents, educators, and therapists, the immediate takeaway is one of cautious awareness rather than alarm. The review does not establish that preschoolers with developmental disabilities are uniformly less active, more sedentary, or worse sleepers than their peers; rather, it shows that the evidence base is too thin and too variable to say with confidence. What is clear is that movement behaviors in early childhood are measurable, modifiable, and consequential, and that children with developmental disabilities deserve the same rigorous attention to their daily activity, sedentary time, and sleep that has increasingly been extended to typically developing children. Closing that research gap, the authors conclude, is an essential step toward ensuring that every child, regardless of developmental profile, gets the strongest possible start.

Subject of Research: 24-hour movement behaviors in preschool-aged children with developmental disabilities

Article Title: Exploring 24-h movement behaviors in preschool children with developmental disabilities: a scoping review

Article References: Cacciola, S., Burkart, S., Toole, E., Horger, M. N., Woodman, A. C., Kiely, K., Fisher, M., Johnson, E., Salvati, G., Rosas, L., Freedman, S., Fandy, M., & St. Laurent, C. W. (2026). Exploring 24-h movement behaviors in preschool children with developmental disabilities: a scoping review. Journal of Activity, Sedentary and Sleep Behaviors. https://doi.org/10.1186/s44167-026-00106-1

Image Credits: AI Generated

DOI: 10.1186/s44167-026-00106-1

Keywords: physical activity, sedentary behavior, sleep, developmental disabilities, preschool children, early childhood, autism spectrum disorder, cerebral palsy, developmental coordination disorder, scoping review, 24-hour movement behaviors, child health