1.    Introduction
Children with intellectual disabilities (ID) experience significant challenges in both cognitive and motor functions, which greatly affect their daily lives (2). These challenges often show up as difficulties in maintaining balance and postural control, both of which are essential for carrying out everyday tasks and ensuring physical safety (15,16). Postural control is a complex process that requires the integration of sensory information and motor responses. This process is especially impaired in children with ID due to issues with sensory processing and motor planning (17.18). Executive functions (EF)—which include cognitive skills like attention, working memory, inhibitory control, and cognitive flexibility—are critical for maintaining balance, especially in dynamic environments (3). Previous studies have highlighted the link between EF and motor performance (25). However, there is limited research examining the specific interaction between EF and postural control in this group. This study aims to explore the relationship between EF and postural control in children with ID and compare their performance with that of typically developing (TD) children. The results are expected to offer insights into the underlying causes of postural instability in children with ID and help guide the development of targeted interventions..
2.    Methods
This causal-comparative and correlational study involved 15 individuals with ID and 15 TD as the control group. Participants were recruited from special education and mainstream schools, respectively. The inclusion criteria for both groups included being within the age range of 7–12 years. Exclusion criteria included the presence of neurological disorders (other than ID in the ID group), chronic medical conditions, visual impairments, or physical disabilities affecting balance.
Static balance was assessed using a force plate (Kistler 9281 EA) under two conditions: stable (barefoot on the force plate) and unstable (standing on foam placed on the force plate). Center of pressure (CoP) parameters, including sway, speed, and displacement in the anterior-posterior (AP) and medial-lateral (ML) directions, were recorded. Executive functions (EF) were assessed using simple reaction time and response inhibition (Go/No Go) tests.
The Shapiro-Wilk test was used to assess data normality. Since the balance data followed a normal distribution, a three-way repeated measures ANOVA was conducted for between-group comparisons of balance variables. As the cognitive data were not normally distributed, the Mann-Whitney U test was used for group comparisons of cognitive performance. Spearman’s correlation coefficient was used to examine the relationship between balance performance (CoP sway) and cognitive performance (reaction time and response inhibition). Statistical significance was set at p < 0.05.
3.    Results
The results showed significant differences between the ID and TD groups in both cognitive and postural control measures. Children with ID had slower reaction times and higher rates of incorrect responses on the cognitive tests compared to TD children (p < 0.05). Regarding postural control, children with ID exhibited greater sway, faster speed, and increased variability in both the AP and ML directions, especially under unstable conditions (p < 0.05) (Table 1). The interaction between task type (stable vs. unstable) and direction (AP vs. ML) was significant for CoP speed, with the ID group showing a notable increase in ML speed during unstable conditions (p < 0.05).

Correlation analyses revealed strong to moderate relationships between cognitive performance and postural control variables. Specifically, the number of unresponsive stimuli in the reaction time test was positively correlated with CoP speed and variability in the AP direction under stable conditions, as well as with postural deviations, sway, and speed in the ML direction under unstable conditions (r = 0.51–0.66). On the other hand, the number of correct responses was negatively correlated with CoP speed and variability in the AP direction (r = -0.82 and -0.56, respectively). These findings suggest that deficits in attention and processing speed may contribute to postural instability in children with ID.
4.    Conclusion
The findings of this study highlight the significant impact of ID on both cognitive and motor functions. Children with ID demonstrated slower reaction times and higher error rates in cognitive tasks, which aligns with previous research pointing to deficits in EF within this population. These cognitive impairments are likely contributing factors to the observed postural instability, as EF are crucial for integrating sensory inputs and generating appropriate motor responses (33). The increased CoP sway and speed observed in children with ID, especially under unstable conditions, may suggest the use of compensatory strategies to maintain balance. However, these strategies appear to be less efficient and more energy-consuming, possibly leading to greater fatigue and an increased risk of falls (39). The strong correlations between cognitive performance and postural control measures underscore the importance of EF in maintaining balance. Specifically, deficits in attention and inhibitory control may hinder the ability of children with ID to effectively adapt to dynamic postural challenges, resulting in greater instability (36). These findings are consistent with previous studies that suggest EF and postural control share overlapping neural substrates, such as the prefrontal cortex and cerebellum.
The study also emphasizes the need to address both cognitive and motor deficits in interventions for children with ID (27,36). Comprehensive programs that combine cognitive-motor training, balance exercises, and strength training could be beneficial in improving postural control and reducing the risk of falls in this population. Finally, future research should delve deeper into the neural mechanisms underlying the relationship between EF and postural control in children with ID, and assess the long-term effectiveness of targeted interventions in enhancing both cognitive and motor outcomes.
This study provides compelling evidence of the significant impact of ID on both cognitive processing and postural control. Children with ID exhibit slower reaction times, higher error rates, and greater postural instability compared to TD children, particularly under more challenging conditions. The increased CoP speed and variability observed in children with ID may indicate the use of inefficient compensatory strategies to maintain balance, which could lead to increased fatigue and a higher risk of falls. The strong correlations between cognitive performance and postural control variables emphasize the critical role of EF in maintaining balance. These findings underscore the importance of integrated interventions that address both cognitive and motor deficits in children with ID. Future research should focus on developing and evaluating targeted interventions that not only aim to improve postural control but also enhance overall quality of life for children with intellectual disabilities.

Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be addressed in this research.
Funding
This research did not receive any financial support from government, private, or non-profit organizations.
Authors' contributions
All authors contributed equally to preparing the article.
Conflicts of interest
The authors declare that there are no conflicts of interest associated with this article.