Effect of an 8-Week Pickleball Program for Adults With Autism: A Feasibility Trial With a Delayed-Control Design

Autism spectrum disorder (ASD) is associated with sensory-motor impairments that can impact everyday functioning. Prior research suggests that disrupted visual-motor integration and altered sensory weighting (e.g., greater reliance on proprioceptive input relative to visual input) may relate to the severity of core autism symptoms. The current study evaluates whether a structured, community-based pickleball program can serve as a practical and scalable behavioral intervention to modify these sensory-motor mechanisms and improve outcomes in autistic adults.

Study Design

This study is a two-arm, parallel-group, delayed controlled trial (DCT) evaluating the effects of an 8-week pickleball intervention delivered in a community setting. Participants complete baseline testing and are randomized 1:1 to either:

• Early Start Group: completes pickleball classes during Phase 1
• Delayed Start Group: continues usual activity during Phase 1 and completes pickleball during Phase 2

Phase 1 is structured as the randomized comparison period. All participants complete post-testing at the end of Phase 1. The delayed group then receives the intervention during Phase 2. This design allows both a controlled between-group comparison during Phase 1 and a within-subject evaluation of change across all participants once they receive the intervention.

The study is planned to occur between February and May 2026, with assessments occurring at defined pre- and post-intervention timepoints.

Intervention Overview (Pickleball Program) The intervention consists of twice-weekly pickleball sessions for 8 weeks (16 sessions total). Each session lasts approximately 90 minutes and is delivered at indoor community court facilities with trained instructors. At least one study team member is present, along with undergraduate research assistants, to support implementation and monitoring.

Each session follows a standardized structure:

• Welcome/introduction
• Dynamic warm-up
• Skill-focused drills
• Supervised gameplay
• Cooldown with stretching

The class is designed to be beginner-friendly and self-paced, with built-in opportunities for rest and hydration. Participants may stop or rest as needed.

Testing Visits and Assessments Participants complete a structured series of assessments at baseline and follow-up timepoints. Data collection includes physical measurements, survey measures, and behavioral/motor testing. Testing procedures occur in-person at community-based testing locations selected to reduce access barriers. Written informed consent is obtained at the testing visit before any study procedures occur.

Sensory-Motor Function Assessment (Primary Outcome Domain)

Sensory-motor outcomes are assessed using two primary approaches:

• HaptiKart Task Participants complete HaptiKart, a computerized steering task designed to quantify proprioceptive versus visual feedback bias. The task uses a force-feedback steering wheel and includes brief delays in visual or proprioceptive feedback to assess sensory integration during dynamic control. The task includes familiarization and test blocks and generates quantitative metrics of sensory-motor bias and task performance.
• Pickleball Skill Assessment Pickleball skill is assessed using a structured ball-return task. An instructor feeds a standardized total of 40 balls under multiple conditions corresponding to different court locations and shot types. Trials are scored based on contact quality and accuracy using a standardized scoring approach, producing location-specific totals and an overall performance estimate. Video and audio recordings are collected to support quantitative and qualitative evaluation of paddle stroke mechanics and performance outcomes.

Autism Symptom Severity (Primary Outcome Domain) Core ASD symptom severity is assessed using the Social Responsiveness Scale, 2nd edition (SRS-2), adult self-report form. The primary symptom endpoint is the SRS-2 total score.

Secondary Outcomes

Secondary outcomes include self-reported measures of mental health and quality of life:

• PROMIS Depression subscale
• PROMIS Sleep measures (sleep disturbance and sleep-related impairment)
• WHOQOL-BREF quality of life measure

Physical Activity Monitoring (In-Session) To characterize activity levels during the intervention, wearable actigraphy (ActiGraph) is used to monitor movement intensity during pickleball classes on a bimonthly basis. The device is worn around the waist during class sessions and passively records movement without collecting audio, video, or location information.

Safety and Acceptability Monitoring Participants currently receiving the pickleball intervention complete brief bimonthly online check-ins (via REDCap) to monitor pain/injury and provide structured qualitative feedback.

Study Groups and Assessment Schedule

The delayed-control structure results in different assessment schedules depending on group assignment:

• Both randomized groups complete baseline testing and an immediate post-Phase 1 assessment.
• The delayed group completes a final post-intervention assessment after completing Phase 2.
• The early group completes an additional follow-up assessment after Phase 2 to examine whether changes persist after intervention completion.

In addition, the protocol allows continued enrollment during Phase 1 so that "late enrolled" participants can complete Phase 2 intervention participation and contribute to within-subject pre/post analyses, though not to the randomized Phase 1 comparison.

Sample Size and Accrual The study plans to enroll up to 50 participants to account for screen failures and attrition, with an expected completed sample of approximately 30-35 participants.

Planned Analytic Approach The study is designed to estimate the potential effectiveness of the pickleball program by comparing pre-to-post changes in primary and secondary outcomes. The Phase 1 randomized component supports a between-group comparison of change scores during the controlled period, while the delayed-start design also supports within-subject change analyses across participants who complete the intervention.

Study Setting Testing is conducted in community-based locations near the intervention sites to reduce participation barriers. Pickleball sessions are conducted at indoor community recreation facilities.

Inclusion criteria

• Aged 18-45 years
• Clinical diagnosis of autism spectrum disorder (ASD)
• Able to participate in group-based activities without caregiver support
• Able to understand English and independently communicate without assistance
• Available for at least two sessions per week for the intervention dates
• Access to reliable transportation to the intervention site
• Able to provide informed consent (i.e., no legally authorized representative)
• Pre-exercise screening indicates medical clearance is not needed, based on ACSM guidelines

Exclusion criteria

• Clinical diagnosis of intellectual disability (ID)
• Does not have normal or corrected-to-normal vision
• Actively participating in a racquet sport ≥1 time per week
• Use of mobility aids
• Moderate-to-severe joint pain (WOMAC pain subscale)
• Neurologic conditions (cerebral palsy, severe head injury, progressive neurological disorders, epilepsy)
• Individuals who cannot provide their own informed consent (i.e., have a legally authorized representative)
• Individuals who require medical clearance for exercise based on the ACSM preparticipation screening questionnaire