Effects of Parent-Child Sandplay Therapy for preschool children with autism spectrum disorder and their mothers: A randomized controlled trial

The effect of game-based interventions on children and adolescents with autism spectrum disorder: A systematic review and meta-analysis

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.

Sand Play and 0- to 8-Year-Old Children's Physical, Cognitive and Socioemotional Outcomes: A Mixed-Methods Systematic Review

BACKGROUND

Sand play (SP) is a global phenomenon that may be linked to children's health outcomes, but limited evidence exists. The purpose was to synthesize evidence on the association between SP and 0- to 8-year-old children's physical, cognitive and socioemotional outcomes.

METHODS

CINAHL, Academic Search Premier, PsycINFO, SPORTDiscus with Full Text, ERIC, Medline, Scopus and Google Scholar were searched. Studies were eligible if 0- to 8-year-old children's outcomes were reported while attending SP. Synthesis was performed using effect direction (quantitative), thematic (qualitative), narrative and results-based convergent synthesis incorporating the risk of bias and confidence in the evidence assessments. Studies were grouped by SP exposure context as education, leisure and rehabilitation.

RESULTS

The effect direction (Nstudies = 17; Nchildren = 677), thematic (Nstudies = 8; Nchildren = 131) and narrative (Nstudies = 8; Nchildren = 11 784) syntheses included 28 studies published in 1993-2023 (Ntotal = 12 646; Mchildage = 3-6 years; Mgirls 41%; Methnicity Asian 3%, African American/Black/Hispanic 8%, European American/White/Non-Hispanic 56%, Multi-ethnic 36%). Based on very low to moderate confidence in the evidence, findings indicated inconsistent associations between educational, rehabilitational and leisure SP and children's physical, cognitive and socioemotional outcomes. There was inconsistent evidence on the occurrence of SP by children's gender and age.

CONCLUSION

SP may enhance some childhood outcomes. However, high-quality controlled designs describing the exposure to SP are needed to inform the effectiveness of SP on children's health and development.

A systematic review of the effect of sandplay therapy on social communication deficits in children with autism spectrum disorder

Objective

To explore the efficacy of sandplay therapy in intervening social communication deficits in children with autism spectrum disorders (ASD), and whether this efficacy is influenced by the age of the children and the dosage of sandplay therapy intervention.

Methods

Following the PICOS principle, randomized controlled trials (RCTs) related to sandplay therapy for social communication deficits in ASD children were retrieved from seven databases: PubMed, WOS, The Cochrane Library, Embase, CNKI, Wanfang, and VIP, from the inception of each database to November 10, 2023. Two experimenters independently conducted study screening and excluded studies with concomitant diseases, incomplete data, unextractable data, and non-randomized controlled trials. The PEDro scale was used for methodological quality assessment, and the GRADEprofiler method was employed to evaluate the quality of evidence. Stata17 software was used for meta-analysis, subgroup analysis, sensitivity analysis, and publication bias testing. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as the effect statistics.

Results

A total of 12 RCTs (791 cases) were included. Sandplay therapy had a positive impact on the social communication deficits of ASD children [SMD = -1.42, 95%CI (-1.79, -1.04), P < 0.001]. Subgroup analysis revealed that sandplay therapy administered during the early school age (449 cases, SMD = -1.44, P < 0.05), for a duration of 22-28 weeks (208 cases, SMD = 1.69, P < 0.05), and with a frequency of once per week (218 cases, SMD = -1.67, P < 0.05) was most effective in improving on social communication deficits of ASD children.

Discussion

The quality of evidence in this study was rated as high, with good methodological quality, including 12 studies with better quality and no detection of bias risk. The study had high heterogeneity, which was attributed to the measurement tools and intervention duration through subgroup analysis, with no inconsistency found. Additionally, no downgrade factors related to imprecision, publication bias, or indirectness were identified. In conclusion, sandplay therapy is an effective measure to improve social communication deficits in children with ASD, and current evidence recommends early intervention using an individual sandplay therapy or integrated sandplay therapy intervention program once a week for 22-28 weeks, which can serve as evidence-based clinical guidance.

Systematic Review Registration

www.crd.york.ac.uk, identifier (CRD420234821750).

The effectiveness of play as an intervention using International Classification of Functioning outcome measures for children with disabilities - a systematic review and meta-synthesis

PURPOSE

Over 240 million children worldwide experience inequities due to disablement/disability. Play is important for children's global development, to enable participation in life, and has been used in therapeutic settings. The purpose of this systematic review is to determine the effectiveness of play used in therapy for children with disabilities, to explore ways that play is used in therapy, and to classify and map outcome measures used in play-based interventions to the International Classification of Functioning.

METHODS

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

The search yielded 22 articles eligible for inclusion. A meta-analysis found significant heterogeneity for play-based intervention outcomes, precluding estimates of effectiveness. Body function and structure outcomes accounted for 61% of reported outcome measures.

CONCLUSION

There is a trend towards a small positive effect of play used in therapy for children with disabilities, but certainty of the effect is poor, and replication difficult due to heterogeneous reports of how play is used. Research aims and outcome measures focusing on meaningful aspects of activity and participation in addition to body function and structure domains of the International Classification of Functioning should be considered for play-based interventions for children with disabilities.

Analysis of initial sandplay characteristics among university students with different levels of loneliness

BACKGROUND AND OBJECTIVE

Loneliness is detrimental to mental health, with university students at higher risk of feeling lonely than other population groups. The mental health of college students is a hot topic at present. Despite numerous studies exploring interventions for loneliness among university students. However, little research has explored early psychological manifestations of university students with different levels of loneliness. Despite numerous studies exploring interventions for loneliness among university students, little research has explored early psychological manifestations of university students with different levels of loneliness. Initial sandplay is a good tool to reveal psychological activity. Therefore, our study aims to explore the characteristics of initial sandplay application among university students with different levels of loneliness.

METHODS

We recruited 60 volunteers from a university to perform a sandplay experiment from January to April 2021. The UCLA Loneliness Scale measured the levels of loneliness. These 60 participants were divided into the experimental group (n = 30) and control group (n = 30) according to their levels of loneliness. The experimental group included participants with a scale score of more than 44. Other participants with a scale score of less than 44 belong to the control group. We recorded their sandplay artwork and statistically analyzed it by the Sandplay Process Record Form. Group comparisons were performed using the t-test or Wilcoxon rank-sum test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables. The logistic regression analysis by forward stepwise method was conducted to analyze the sandplay theme features for loneliness.

RESULTS

Regarding the sandplay tools, the experimental group used fewer transportation tools (t=-3.608, p < 0.01) and more natural elements (t = 2.176, p < 0.05) than the control group. Moreover, the experimental group created more natural scenes (χ2 = 4.310, p < 0.05) and used less of the lower left (χ2 = 4.593, p < 0.05) and lower right (χ2 = 5.934, p < 0.05) spaces. With regards to sand changes, the experimental group was less likely than the control group to make substantial changes (χ2 = 5.711, p < 0.05) and more likely to make almost no changes (χ2 = 4.022, p < 0.05). In terms of the themes, the experimental group was more likely to exhibit sandplay artwork themes of emptiness (χ2 = 8.864, p < 0.05) and neglect (χ2 = 6.667, p < 0.05), and less likely to show themes of energy (χ2 = 5.079, p < 0.05). In the logistic regression analysis of the sandplay themes, emptiness (OR = 5.714, 95%CI: 1.724-18.944, p = 0.003) and neglect (OR = 7.000, 95%CI: 1.381-35.479, p = 0.010) were demonstrated a nominal association with high levels of loneliness among both groups (F = 16.091, p < 0.01, ΔR2 = 0.193), but failed to pass the Bonferroni testing correction (p threshold < 0.0025).

CONCLUSION

University students with higher degree of loneliness do not like to drastic changes and prefer to use natural elements in element selection, while the control group likes to drastic changes and prefers to use transportation tools in element selection. Regression analysis of sandplay theme features revealed emptines and neglect may as significant associated factors for loneliness. We propose sandplay characteristics can help identify university students with different levels of loneliness during psychological evaluations. Therefore, it is important that the school and healthcare systems assist college students in identifying the loneliness through initial sandplay and carrying on the necessary psychological counseling to the lonely student population.