Gamified Tai Chi for Cognitive Control and Behavioral Symptoms in Children With Autism Spectrum Disorder: An Assessor-Blinded Randomized Controlled Trial

This randomized controlled trial evaluates the effectiveness of a "Gamified Tai Chi" intervention on improving executive functions (such as inhibitory control, working memory, and cognitive flexibility) in children with Autism Spectrum Disorder (ASD). The study aims to determine whether integrating game mechanics (based on the Mechanics, Dynamics, and Aesthetics framework) into Tai Chi training offers superior benefits compared to traditional Tai Chi training or routine care. Approximately 200 children aged 8-15 years will be randomly assigned to one of three groups for a 12 months period: Gamified Tai Chi Group: Participants will attend sessions combining simplified Tai Chi forms with interactive tasks, such as digital chasing games and cooperative challenges, using a point-based reward system to enhance engagement. Traditional Tai Chi Group: Participants will learn the same Tai Chi movements but via standard instruction methods without gamification elements. Control Group: Participants will continue their routine rehabilitation or physical education classes (Waitlist design). Assessors who are blinded to group allocation will evaluate outcomes at baseline and post-intervention using standardized cognitive tasks (e.g., Flanker task, 1-back task) and behavioral questionnaires regarding social functioning and daily living skills.

Inclusion Criteria: * Children aged 9 to 12 years at enrollment. * Clinical diagnosis of autism spectrum disorder based on DSM-5 criteria, confirmed by a qualified clinician. * Full-scale or equivalent IQ of at least 80. * Able to understand basic instructions, imitate movements, and take part in group activities. * Able to tolerate low- to moderate-intensity exercise. * Educational, rehabilitation, and medication plans expected to remain stable during the study. * Written informed consent provided by a legal guardian, with child assent obtained when developmentally appropriate. Exclusion Criteria: * IQ below 80. * Unable to complete basic cognitive or motor assessments. * Severe psychiatric or neurological conditions. * Exercise contraindications or severe sensory impairments. * Safety risks during group activities. * Systematic executive-function training, cognitive training, Tai Chi, martial arts, or other structured exercise within the previous 3 months. * Medication or rehabilitation plan expected to change during the study.