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Gao J, Song W, Huang D, Zhang A, Ke X. The effect of game-based interventions on children and adolescents with autism spectrum disorder: A systematic review and meta-analysis. Front Pediatr 2025; 13:1498563. [PMID: 40256395 PMCID: PMC12006128 DOI: 10.3389/fped.2025.1498563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 03/18/2025] [Indexed: 04/22/2025] Open
Abstract
Purpose The purpose of this meta-analysis was to conduct a comprehensive evaluation of randomized controlled trials (RCTs) of game-based interventions (GBI) for children and adolescents with autism spectrum disorder (ASD) to identify the clinical efficacy of GBI on core symptoms and other concomitant symptoms of ASD. Methods PubMed, Web of Science, Embase and the Cochrane Library were systematically searched for articles published until July 2023. Results Twenty-four studies with 1,801 patients met the inclusion criteria. The results showed that GBI had a significant positive effect on social skills (g = -0.59, p = 0.004), social behaviors (g = 0.45, p < 0.001), and cognition (g = 0.57, p < 0.001) in children and adolescents with ASD, while the effects of language expression (g = 0.15), anxiety (g = -0.13), and parenting stress (g = -0.51) were small and nonsignificant. Conclusions The results of the current meta-analysis showed that GBI was effective in improving social skills, social behaviors and cognition in children and adolescents with ASD in the existing studies and was not significant in improving language skills, anxiety and parental stress, but due to the limited number and low quality of the included studies, the above conclusions need to be validated by conducting more large-sample, high-quality RCTs. Systematic Review Registration www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023390793, identifier: CRD42023390793.
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Affiliation(s)
- Jiaxin Gao
- School of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University, Shanghai, China
| | - Wei Song
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University, Shanghai, China
| | - Dunbing Huang
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University, Shanghai, China
| | - Anren Zhang
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University, Shanghai, China
| | - Xiaohua Ke
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University, Shanghai, China
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Chan KLR, Ouyang G. Impact of child-centered play therapy intervention on children with autism reflected by brain EEG activity: A randomized controlled trial. RESEARCH IN AUTISM SPECTRUM DISORDERS 2024; 112:102336. [DOI: 10.1016/j.rasd.2024.102336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Elbeltagi R, Al-Beltagi M, Saeed NK, Alhawamdeh R. Play therapy in children with autism: Its role, implications, and limitations. World J Clin Pediatr 2023; 12:1-22. [PMID: 36685315 PMCID: PMC9850869 DOI: 10.5409/wjcp.v12.i1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 01/03/2023] Open
Abstract
Play is a pleasurable physical or mental activity that enhances the child’s skills involving negotiation abilities, problem-solving, manual dexterity, sharing, decision-making, and working in a group. Play affects all the brain's areas, structures, and functions. Children with autism have adaptive behavior, adaptive response, and social interaction limitations. This review explores the different applications of play therapy in helping children with autism disorder. Play is usually significantly impaired in children with autism. Play therapy is mainly intended to help children to honor their unique mental abilities and developmental levels. The main aim of play therapy is to prevent or solve psychosocial difficulties and achieve optimal child-healthy growth and development. Play therapy helps children with autism to engage in play activities of their interest and choice to express themselves in the most comfortable ways. It changes their way of self-expression from unwanted behaviors to more non-injurious expressive behavior using toys or activities of their choice as their words. Play therapy also helps those children to experience feeling out various interaction styles. Every child with autism is unique and responds differently. Therefore, different types of intervention, like play therapy, could fit the differences in children with autism. Proper evaluation of the child is mandatory to evaluate which type fits the child more than the others. This narrative review revised the different types of play therapy that could fit children with autism in an evidence-based way. Despite weak evidence, play therapy still has potential benefits for patients and their families.
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Affiliation(s)
- Reem Elbeltagi
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Bahrain
| | - Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Dr. Sulaiman Al-Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Pathology Department, Salmaniya Medical Complex, Manama 12, Bahrain
- Pathology Department, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Bahrain
| | - Rawan Alhawamdeh
- Pediatrics Research and Development Department, Genomics Creativity and Play Center, Manama 0000, Bahrain
- School of Continuing Education, Masters in Psychology, Harvard University, Cambridge, MA 02138, United States
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López-Nieto L, Compañ-Gabucio LM, Torres-Collado L, Garcia-de la Hera M. Scoping Review on Play-Based Interventions in Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1355. [PMID: 36138664 PMCID: PMC9497526 DOI: 10.3390/children9091355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
Play as a therapeutic strategy can help to improve daily functioning in children and adolescents with autism spectrum disorder (ASD). Play-based intervention can thus be an optimal option for treatment of this population. Our aim was to describe play-based interventions used in children and adolescents with ASD. We conducted a scoping review. A peer-reviewed literature search was conducted on PubMed, Scopus, EMBASE, Web of Science and PsycINFO databases. We included experimental studies which analyzed play-based interventions in children and adolescents with ASD, which were published in English/Spanish with full text available. We used three tables elaborated a priori to perform data extraction by two authors. Fifteen studies were included, mostly conducted in Australia and published during the past 10 years. Play-based intervention was categorized into three groups: new technologies, symbolic play or official techniques. Interventions lasted approximately 11 weeks, contained one weekly session of 30-60 min and were delivered by parents and teachers. Play-based interventions using new technologies were the most used. Intervention duration and number of sessions varied between articles. Further studies are needed to create play-based intervention protocols which can be implemented in clinical practice with children and adolescents with ASD, thus promoting evidence-based interventions in this field.
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Affiliation(s)
- Lucía López-Nieto
- Nutritional Epidemiology Unit, University of Miguel Hernández, 03550 Alicante, Spain
| | - Laura María Compañ-Gabucio
- Nutritional Epidemiology Unit, University of Miguel Hernández, 03550 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Laura Torres-Collado
- Nutritional Epidemiology Unit, University of Miguel Hernández, 03550 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
| | - Manuela Garcia-de la Hera
- Nutritional Epidemiology Unit, University of Miguel Hernández, 03550 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28034 Madrid, Spain
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Francis G, Deniz E, Torgerson C, Toseeb U. Play-based interventions for mental health: A systematic review and meta-analysis focused on children and adolescents with autism spectrum disorder and developmental language disorder. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415211073118. [PMID: 36438159 PMCID: PMC9685160 DOI: 10.1177/23969415211073118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Play-based interventions are used ubiquitously with children with social, communication, and language needs but the impact of these interventions on the mental health of this group of children is unknown. Despite their pre-existing challenges, the mental health of children with developmental language disorder (DLD) and autism spectrum disorder (ASD) should be given equal consideration to the other more salient features of their condition. To this aim, a systematic literature review with meta-analysis was undertaken to assess the impact of play-based interventions on mental health outcomes from studies of children with DLD and ASD, as well as to identify the characteristics of research in this field. METHODS The study used full systematic review design reported to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (PRISMA prisma-statement.org) with pre-specified inclusion criteria and explicit, transparent and replicable methods at each stage of the review. The study selection process involved a rigorous systematic search of seven academic databases, double screening of abstracts, and full-text screening to identify studies using randomised controlled trial (RCT) and quasi-experimental (QE) designs to assess mental health outcomes from interventions supporting children with DLD and ASD. For reliability, data extraction of included studies, as well as risk of bias assessments were conducted by two study authors. Qualitative data were synthesised narratively and quantified data were used in the metaanalytic calculation. MAIN CONTRIBUTION A total of 2,882 papers were identified from the literature search which were double screened at the abstract (n = 1,785) and full-text (n = 366) levels resulting in 10 papers meeting the criteria for inclusion in the review. There were 8 RCTs and 2 QEs using 7 named play-based interventions with ASD participants only. Meta-analysis of 5 studies addressing positive mental health outcomes (e.g. positive affect and emotional functioning) found a significant overall intervention effect (Cohen's d = 1.60 (95% CI [0.37, 2.82], p = 0.01); meta-analysis of 6 studies addressing negative mental health outcomes (e.g., negative affect, internalising and externalising problems) found a non-significant overall intervention effect (Cohen's d = 0.04 -0.17 (95% CI [-0.04, 0.51], p = 0.88). CONCLUSIONS A key observation is the diversity of study characteristics relating to study sample size, duration of interventions, study settings, background of interventionists, and variability of specific mental health outcomes. Play-based interventions appear to have a beneficial effect on positive, but not negative, mental health in children with ASD. There are no high quality studies investigating the efficacy of such interventions in children with DLD. IMPLICATIONS This review provides good evidence of the need for further research into how commonly used play-based interventions designed to support the social, communication, and language needs of young people may impact the mental health of children with ASD or DLD.
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Affiliation(s)
| | | | | | - Umar Toseeb
- Umar Toseeb, Department of Education,
University of York, York YO10 5DD.
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Dijkstra-de Neijs L, Tisseur C, Kluwen LA, van Berckelaer-Onnes IA, Swaab H, Ester WA. Effectivity of Play-Based Interventions in Children with Autism Spectrum Disorder and Their Parents: A Systematic Review. J Autism Dev Disord 2021; 53:1588-1617. [PMID: 34853960 DOI: 10.1007/s10803-021-05357-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Evidence of the effectivity of play-based interventions in children with autism spectrum disorder (ASD) was evaluated by PRISMA-based literature study and a Risk of Bias (RoB) assessment. Many of the 32 eligible randomized controlled trials (RCT) reported improved social interaction, communication, daily functioning and play behaviour. They also reported decreased problem behaviour, better parental attunement and parent-child interaction. We assessed 25/32 of the RCTs with high RoB, mainly related to homogeneity of the study population, lack of power, and performance bias. We concluded with due care that the effectivity of play-based interventions differed across RCTs, most reported improvements are found in ASD symptoms, everyday functioning, and parental attunement. In future research, findings should be replicated, taking account of the RoB.
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Affiliation(s)
- Leanne Dijkstra-de Neijs
- Sarr Expert Centre for Autism, Youz Child- and Adolescent Psychiatry, Parnassia Group, Rotterdam, The Netherlands.,Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
| | - Chanel Tisseur
- Sarr Expert Centre for Autism, Youz Child- and Adolescent Psychiatry, Parnassia Group, Rotterdam, The Netherlands
| | - Laura A Kluwen
- Sarr Expert Centre for Autism, Youz Child- and Adolescent Psychiatry, Parnassia Group, Rotterdam, The Netherlands
| | - Ina A van Berckelaer-Onnes
- Sarr Expert Centre for Autism, Youz Child- and Adolescent Psychiatry, Parnassia Group, Rotterdam, The Netherlands.,Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
| | - Hanna Swaab
- Sarr Expert Centre for Autism, Youz Child- and Adolescent Psychiatry, Parnassia Group, Rotterdam, The Netherlands.,Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Wietske A Ester
- Sarr Expert Centre for Autism, Youz Child- and Adolescent Psychiatry, Parnassia Group, Rotterdam, The Netherlands. .,Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands. .,Curium-LUMC, Child- and Adolescent Psychiatry, Oegstgeest, The Netherlands.
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Ray DC, Burgin E, Gutierrez D, Ceballos P, Lindo N. Child‐centered play therapy and adverse childhood experiences: A randomized controlled trial. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Dee C. Ray
- Department of Counseling and Higher Education University of North Texas Denton Texas USA
| | - Elizabeth Burgin
- School Psychology and Counselor Education William & Mary Williamsburg VA US
| | - Daniel Gutierrez
- School Psychology and Counselor Education William & Mary Williamsburg VA US
| | - Peggy Ceballos
- Department of Counseling and Higher Education University of North Texas Denton Texas USA
| | - Natalya Lindo
- Department of Counseling and Higher Education University of North Texas Denton Texas USA
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Ardiyani ID, Setiawati Y, Hsieh YT. Education for Parents of Children with Gadget Addiction. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i32021.221-230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Inappropriate and excessive use of gadgets can cause addiction and interfere with physical, psychological, and emotional health, increase social isolation, and negatively affect development, especially in children. The resulting impact will be greatly influenced by the role of parents, family and the environment. Purpose: This study aims to understand what education can be provided to parents of children with gadget addiction, along with how parents can choose toys and alternative games for children to reduce this gadget addiction. Methods: The design used in this article was a narrative review that involved collecting and analyzing journals using the keywords "addiction", "children", "education", "parent" and "gadget"; this obtained 10 journal articles from PubMed, two journal articles from ScienceDirect, 14 journal articles from Google Scholar published between 2015–2020, three books, and one collection of survey data from the web. Results: There were several strategies that could be applied in managing the use of gadgets by children. The authoritative type of parenting style, good parent-child relationships, parent-child attachment and family environment conditions could also affect the use of gadgets and its impact on children. Parents could additionally provide toys and alternative games suitable for the children’s age, developmental ability and safety needs. Conclusion: Parents are expected to understand how to manage children with gadget addiction and how they can choose toys and alternative games for children to reduce gadget addiction.
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:857-883. [PMID: 33884535 PMCID: PMC8411365 DOI: 10.1007/s10488-021-01133-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. Correction to: A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:884-908. [PMID: 34196884 DOI: 10.1007/s10488-021-01144-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to the errors occurred in the originally published version, this article is being reprinted in its entirety as Correction. All errors have been corrected. It is the correct version.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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A Systematic Review on Clinimetric Properties of Play Instruments for Occupational Therapy Practice. Occup Ther Int 2020; 2020:2490519. [PMID: 32821250 PMCID: PMC7416293 DOI: 10.1155/2020/2490519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/24/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022] Open
Abstract
Play is considered the main occupation for children. Pediatric occupational therapists utilize play either for evaluation or intervention purpose. However, play is not properly measured by occupational therapists, and the use of play instrument is limited. This systematic review was aimed at identifying play instruments relevant to occupational therapy practice and its clinimetric properties. A systematic search was conducted on six databases (Academic Search Complete, CINAHL, MEDLINE, Psychology and Behavioral Science Collection, Scopus, and ASEAN Citation Index) in January 2020. The quality of the included studies was evaluated using Law and MacDermid's Appraisal for Clinical Measurement Research Reports, and psychometric properties of play instruments were evaluated using Terwee's checklist while the clinical utility is extracted from each instrument. Initial search identifies 1,098 articles, and only 30 articles were included in the final analysis, extracting 8 play instruments. These instruments were predominantly practiced in the Western culture, which consists of several psychometric evidences. The Revised Knox Preschool Play Scale is considered the most extensive and comprehensive play instrument for extrinsic aspect, whereas the Test of Playfulness + Test of Environmental Supportiveness Unifying Measure is a promising play instrument for intrinsic aspect on play, where both instruments utilize observation. My Child's Play is a potential questionnaire-based play instrument. However, the current development of play instruments in the occupational therapy field is immature and constantly evolving, and occupational therapists should exercise good clinical reasoning when selecting a play instrument to use in practice.
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