A Systematic Review of Play Based Intervention Effectivity for Children with Autism.

Background: Autismspectrumdisorders (ASD) are an urgent global mental health problem with a worldwide estimated prevalence of one in 132 individuals. Studies show that up to 64% of the people with ASD have comorbid problems. Parents of children with autism display more mental distress. Children with ASD with co-morbid problems in combination with parental distress influences the parent-child relationship and may significantly interfere with the overall life outcome of people with ASD. Play therapy has been proven effective for children who experience mental health problems. The development of play within children with ASD differs from other children. There are few evidence based play treatments for children with ASD.

Objectives: To determine which forms of play therapy and/or play based interventions are effective on behavioural problems in children with an ASD and their parents.

Methods: A systematic literature search following the PRISMA guidelines. Studies were included if they reported quantitative data on any type of ‘play therapy’ or ‘play based intervention’ used within a population of ‘children’ with ‘ASD’.

Results: We identified 69 studies fulfilling our search criteria constituting of 13 RCTs, 54 quasi experimental studies and 2 case studies. Positive outcomes regarding diminished behavioural problems and increased social skills in children with ASD were substantiated by randomized controlled trials (RCT) in seven play based interventions: 1) PLAY project, 2) Developmental, Individual-differences & Relationship-based model(DIR)/Floortime, 3) Lego® therapy, 4) Joint Attention Symbolic Play Engagement Regulation (JASPER), 5) Early Start Denver Model (ESDM), 6) 1-2-3 project and 7) Pivotal Response Treatment (PRT). Another three play based interventions showed positive results through quasi experimental research: 1) Theraplay, 2) Child Centered Play Therapy (CCPT) and 3) Parent-Child Interaction Therapy (PCIT). A large variation in treatment goals as well as in outcome measurements was found within all ten play based interventions. The main outcome measurements constituted of reduced withdrawn social behaviour or tantrums, increased social skills such as joint attention and eye contact and improved language skills.

Conclusions: Although a vast amount of studies regarding play based interventions for children with ASD are available, only a minority comprise RCT’s. Future research should focus on evaluating the effectiveness of play based interventions for children with ASD through RCT’s, in which parental distress and the parent-child relationship are included to improve the over all life outcome for people with ASD and their parents.