The effects of play-based interventions on social and play skills in children with autism spectrum disorder: a meta-analysis

Abstract Background Autism Spectrum Disorder (ASD) is characterized by deficits in social communication and interaction, along with restricted and repetitive behaviors. Play-based interventions are widely used to enhance social and play skills in children with ASD; however, their overall effectiveness remains unclear. Aims This meta-analysis aimed to evaluate the effects of play-based interventions on social and play skills in children with ASD. Methods A systematic search was conducted in PubMed, Web of Science, EBSCOhost, YOK Thesis, and Google Scholar between June and October 2024. Study quality was assessed using Joanna Briggs Institute appraisal tools appropriate to each design. Seven studies met the inclusion criteria. Data were analyzed using Comprehensive Meta-Analysis (CMA) Version 2. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using meta-analytic techniques, supported by narrative synthesis. Results Play-based interventions were significantly associated with improvements in social skills (SMD = -1.774, 95% CI: -3.088 to -0.461; p = 0.008; I² = 93.730) and play skills (SMD = 1.518, 95% CI: 0.237 to 2.798; p = 0.020; I² = 94.768). Subgroup analyses showed that Child-Centered Play Therapy (CCPT), Image-Sand Play Therapy (ISPT), and Sensory Integration-Based Play Therapy (SIBPT) demonstrated comparatively larger effect sizes. Interventions delivered by trained therapy professionals yielded greater effectiveness. High heterogeneity was observed across studies. Conclusions Play-based interventions appear effective in improving social and play skills in children with ASD; however, findings should be interpreted cautiously due to substantial heterogeneity. Further high-quality studies are warranted.