University of Central Florida

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Honors Undergraduate Theses UCF Theses and Dissertations

2021

The Benefits of Creative Art Therapy for Youth with Autism

Spectrum Disorder: A Review of the Literature
Jazlyn Marie Akridge
University of Central Florida

Part of the Art Therapy Commons

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Recommended Citation
Akridge, Jazlyn Marie, "The Benefits of Creative Art Therapy for Youth with Autism Spectrum Disorder: A
Review of the Literature" (2021). Honors Undergraduate Theses. 1023.
https://stars.library.ucf.edu/honorstheses/1023
THE BENEFITS OF CREATIVE ART THERAPY FOR YOUTH WITH
AUTISM SPECTRUM DISORDER: A REVIEW OF THE LITERATURE

by

JAZLYN AKRIDGE

A thesis submitted in partial fulfillment of the requirements

for the degree of Bachelor of Science
In the Department of Health Science
in the College of Health Professions and Sciences
at the University of Central Florida
Orlando, Florida

Summer Term
2021

Thesis Chair: Jeanette Garcia

 ABSTRACT

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder typically diagnosed during

childhood. The primary symptoms of ASD include language impairments and deficits in social

skills, which can negatively affect the overall quality of life. Traditional treatment for ASD

includes medication, applied behavior analysis, physical therapy, and occupational therapy;

however, these treatments may have unwanted side effects and fail to address the psychosocial

challenges that may result from ASD symptoms. There has been increasing interest in alternative

forms of therapy, such as creative art therapies; however, the types of creative art that have been

used during therapy and their benefits are not well-established. This literature review examined

the effects of creative art therapy interventions on psychosocial and behavioral outcomes in

youth with ASD. A total of nine studies met the inclusion criteria. The majority of studies

examined music or drama therapy, and all of the studies showed improvements in social skills

outcomes. While more research is needed, there is promising evidence in the literature that

creative art therapies can be effective in improving symptoms and helping promote positive

behaviors.
 ACKNOWLEDGMENTS

I would like to express my gratitude to Dr. Jeanette Garcia for her guidance and support
in developing this thesis. I would also like to think Dr. Cassie Odahowski for her assistance in
reviewing this paper. Last but not least, I would like to thank my family for supporting and
encouraging me along the journey.

iii
 TABLE OF CONTENTS

INTRODUCTION .......................................................................................................................... 1

REVIEW OF THE LITERATURE ................................................................................................. 3

Autism Spectrum Disorder (ASD)........................................................................................................................ 3

Treatment Modalities ............................................................................................................................................ 5

Creative Art Therapies.......................................................................................................................................... 7

Summary ............................................................................................................................................................... 9

METHODS ................................................................................................................................... 10

Databases ................................................................................................................................................. 10

Identification of Eligible Studies ............................................................................................................. 10

RESULTS ..................................................................................................................................... 12

Summary of included studies .................................................................................................................. 13

Summary of Participants ......................................................................................................................... 14

ASD Diagnosis & Medication Use ..................................................................................................................... 15

Study Designs .......................................................................................................................................... 15

Description of Control Conditions...................................................................................................................... 16

Study settings ...................................................................................................................................................... 16

Intervention frequency & duration ..................................................................................................................... 17

Type of Therapy ...................................................................................................................................... 17

Drama Therapy ................................................................................................................................................... 17

Music therapy ..................................................................................................................................................... 18

Art therapy .......................................................................................................................................................... 19

iv
 Outcome Measures .................................................................................................................................. 19

Behavioral symptoms ......................................................................................................................................... 19

Mental Health ..................................................................................................................................................... 21

Social Skills ........................................................................................................................................................ 21

Quality Assessment of Included Studies ............................................................................................................ 24

DISCUSSION ............................................................................................................................... 26

REFERENCES .............................................................................................................................. 30

v
 LIST OF FIGURES

Figure 1: Illustration of Review Process……………………………………………13

vi
 LIST OF TABLES

Table 1: Inclusion & Exclusion Criteria…………………………………………… 11

Table 2: Summary of Interventions………………………………………………... 13

Table 3: ASD-related Behavior Outcomes………………………………………… 20

Table 4: Mental Health Outcomes…………………………………………………. 21

Table 5: Social Skills Outcomes…………………………………………………… 22

Table 6: Quality Assessment of Included Studies…………………………………. 25

vii
 INTRODUCTION

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder typically

diagnosed in childhood. (National Institution of Mental Health, 2018). Approximately, 1 in 54

children are estimated to develop ASD (Centers for Disease Control and Prevention, 2020);

however, boys are four times more likely to be diagnosed with autism than girls. The primary

characteristics of ASD include difficulties with social interaction and communication deficits

(Bangerter et al., 2017). Additionally, individuals with ASD may display many unwanted

behaviors like self-injury, unmanageable mood swings, hyperactivity, aggression, short attention

span, sensory issues, temper tantrums, sleep problems, and obsessive/compulsive attributes

(Bangerter et al., 2017; Center for Disease Control and Prevention,2021). Although there is no

cure for ASD, a variety of medications and therapeutic interventions may help improve

symptoms. Applied behavior analysis (ABA), occupational therapy, social skills training,

physical therapy, sensory integration therapy, and speech therapy are commonly practiced

improving social skills and behavioral issues, while medications such as antidepressants and

stimulants may be prescribed to treat co-occurring conditions such as Attention Deficit

Hyperactivity Disorder (Edwards et al., 2020; National Institution of Mental Health, 2018).

Recently, there has been a shift in focus from treatment to reduce negative behaviors and

impairment to the use of therapeutic interventions that may promote psychosocial well-being in

youth with ASD (Edwards et al., 2020). There is growing interest in the use of creative arts as a

therapy to improve mental health, self-awareness, and overall wellbeing in youth with ASD

(University of Minnesota, n.d.). Although there have been many positive results of the use of

creative arts therapy for conditions such as depression, dementia, PTSD, and cancer, the
effectiveness of the use of creative arts therapy in youth with ASD is not well-known. Thus, it is

imperative to review the current literature on the different categories of creative arts therapy

(e.g., dance therapy, art therapy) on youth with ASD to identify how creative arts are used as a

therapeutic tool in this population and determine the effectiveness of each category on behavior

and psychosocial health.

2
 REVIEW OF THE LITERATURE

Autism Spectrum Disorder (ASD)

Definition & Characteristics
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition typically diagnosed

during early childhood. The two primary characteristics of ASD are communication deficits and

social interaction difficulties. These behaviors can make it difficult for them to learn in a

traditional school setting. They may also display restrictive/repetitive behaviors like repeating

words and getting upset by a routine change (National Institution of Mental Health,2021).

Another symptom that may affect a person with ASD is sensory sensitivities. This includes being

over or under-sensitive to light, sounds, smells, tastes, touch, balance, and body awareness

(Autism Speaks, 2021). Although an individual with ASD can face numerous challenges, they

may also possess a variety of strengths. This includes the ability to learn and maintain

knowledge and be excellent in a variety of school subjects. (National Institution of

Mental Health,2021)

Prevalence & Diagnosis

Despite the high prevalence of ASD, scientists have yet to determine the exact cause of this

condition. Research is still being conducted, but the most significant influence in developing

ASD is genes and environmental factors. Risk factors for ASD include parents who have

children later in life, being born before 26 weeks, having other disabilities, and having siblings

with ASD (Leyfer et al., 2006). ASD is diagnosed by a delay in developmental behaviors.

According to the American Academy of Pediatrics, they recommend all babies between 18 and

24 months get a screening done for ASD (Autism Speaks,2021).

3
Co-occurring diagnoses

There are a variety of co-morbidities that are commonly seen in youth with ASD that

cause multiple impairments. One of the most prevalent comorbidities is anxiety (Bellini 2006;

Gadow et al.,2005; Hedley et al.,2017; Lopata et al., 2010). Anxiety can trigger a constant sense

of fear and danger, which can stop everyday activities. Sleeping issues are another prevalent

comorbidity in people with ASD. Sleep disorders and insomnia affect approximately 80% of

individuals with ASD, which is also linked with increased anxiety (Baker and Richdale 2015;

Hedley et al.2017; Richdale and Schreck, 2009). Sleep disturbances have been linked to

behavioral issues and impaired cognitive function (Hedley et al.,2017; Richdale and

Schreck,2009). Another significant comorbidity that affects individuals with ASD is depression

(Hedley et al.,2017). In fact, a few studies have surmised that as much as 30% of individuals

with ASD have had suicidal thoughts or attempted suicide at some point during their lifetime

(Hedley et al.,2017). Other mental health issues that individuals with ASD tend to get are

ADHD, schizophrenia, obsessive-compulsive disorder, and bipolar disorder. Along with having

a higher prevalence of developing mental disorders, Adolescents with ASD are also more like to

develop other health-related issues like diabetes, asthma, heart disease, cerebral palsy, epilepsy,

tuberous sclerosis, eczema, food allergies, and gastrointestinal disorders (Spectrum,2021).

Daily Struggles and Difficulties Living with ASD

Learning skills, social life, work, mental health, and quality of life may be impacted by

living with autism spectrum disorder (ASD) (Ahlström and Wentz, 2014). The inability to

articulate oneself and communicate with others is a primary trait of ASD. Some individuals can

be nonverbal, while others have limited communication skills. This can cause issues with

4
learning and making friends. Having ASD can also cause reading difficulties, problems with

interpreting body language, and limited nonverbal communication skills (National Institution of

Health, 2021).

Treatment Modalities

Pharmacological Therapy

Medication is often used to treat specific behavioral symptoms in individuals with ASD

(Goel et al., 2018). Interestingly, these medications are most effective in treating the symptoms

of common comorbidities often seen in individuals diagnosed with ASD, including Attention

Deficit Hyperactivity Disorder (ADHD), anxiety disorders, and mood disorders. Anxiety

disorders appear to be the most common comorbidities in individuals with ASD, with as many as

40 – 45% of individuals with ASD having a specific phobia, general anxiety disorder, or

Obsessive Compulsive Disorder (OCD). To reduce anxiety and panic attacks, anti-anxiety

medication is sometimes prescribed. ADHD, which is often treated with stimulant medications,

is diagnosed in over 30% of youth with ASD (Leyfer et al., 2006). Finally, an estimated 10% of

this population is thought to have to suffer from Major Depressive disorder, which is typically

treated with antidepressant medications (Leyfer et al., 2006). The most commonly prescribed

medications for youth with ASD include stimulants, antidepressants, anticonvulsants, and

antianxiety medications. Unfortunately, such medications may have adverse physical side effects

that can limit compliance in youth ASD populations (Headley et al., 2017). As these medications

treat symptoms of these common comorbidities, medication is typically used in conjunction with

other forms of treatment for individuals with ASD.

5
Applied Behavior Analysis (ABA)

Applied Behavior Analysis (ABA) is a behavior therapy that is based on learning and

behavior science. It focuses on eliminating negative habits while increasing positive ones.ABA

therapy has been shown to enhance communication skills, concentration, memory, and social

skills and minimize negative behaviors. Positive reinforcement is used in ABA therapy to reward

positive habits. This aids patients in achieving their desired behavioral goals. ABA therapy is

successful for certain children as long as they are receiving intensive ABA principles and the

therapy is ongoing (Autism Speaks,2021).

Physical Therapy (PT)

Physical therapy is concerned with the movement, mobility, and function of the body.

Physical therapy helps people with ASD learn motor skills, reinforce their posture, and improve

their balance (Atun-Einy et al., 2014). Physical activity or exercise has also been gaining interest

as an evidence-based treatment for individuals with ASD (Ash et al., 2017; Healy et al., 2018).

In fact, several studies have found that participation in exercise may improve both

communication and social skills in youth with ASD (Garcia et al., 2019). Unfortunately, a large

percentage of youth with ASD do not participate in physical activity due to physical limitations

or psychosocial factors, including low enjoyment of activity (Garcia et al., 2020).

Occupational Therapy (OT)

Occupational therapy (OT) focuses on motor skills, cognitive, physical, and social skills.

Occupational therapy (OT) assists people with ASD in being more self-sufficient and improving

their ability to complete daily life activities (Warren et al., 2011). An occupational therapist may

also perform sensory integration therapy. This form of treatment helps the patient’s brain adapt

6
to the stimuli and allows them to process and react to the sensation more appropriately (Myers

2009).

Speech Therapy

Speech therapy is used to assist in the development of verbal, nonverbal, and social

contact. During a session, therapists will assist children with ASD to focus on making simple

sounds, relating a photo to its context, responding to questions, interpreting body language, and

other skills. A speech therapist can also help a person with ASD improve their feeding skills. For

the best results, speech therapy should begin as soon as possible (Bolte & Diehl, 2013; Warren et

al., 2011).

Social Skills Therapy

Social skill therapy takes place in a group environment. Here, individuals with ASD are

allowed to interact with others. This helps them improve their overall social skills, foster self-

awareness provides structure and helps them practice working in a group (Bolte & Diehl, 2013).

Creative Art Therapies

There has been growing interest in the use of creative arts as a form of treatment for

individuals with developmental disabilities (Edwards et al., 2020). The term "creative art

therapies " refers to a group of treatments that take a holistic approach to treating the body (Puig

et al.,2016). Such treatments include art therapy, dance/movement therapy, drama therapy, music

therapy, poetry therapy, and film therapy. This type of treatment shifts the focus away from

impairment reduction to focus on promoting psychosocial well-being and overall quality of life

7
(Baldwin et al, 2013). Creative Art Therapies seek to enhance communication and expression as

well as physical, mental, cognitive, and social functions (Edwards et al., 2020).

Art Therapy

Art therapy is a research-based treatment that focuses on personal experiences and

expressions (Schweizer et al., 2014). These theories assume that the creative process of artistic

self-expression aids people in dealing with their problems (Schweizer et al., 2014). Art therapy

helps children express themselves safely and naturally by drawing, painting, playing with clay,

and making items out of other art materials (Schweizer et al, 2014). Art therapy aims to improve

self-esteem and self-awareness, minimize stress, improve interpersonal skills, and improve

coping skills (American Art Therapy Association, 2014; Case & Dalley, 1992; Malchiodi, 2003;

Schweizer et al., 2009, Schweizer et al.,2014; Schweizer et al.,2020). Art therapy also assists in

the development of motor skills, cause-and-effect relationships, task orientation, spatial insight,

shape perception, eye contact development, and the sense of self in relation to the world (Gilroy,

2006; Haeyen, 2011; Hinz, 2009; Malchiodi, 2003; Schweizer et al.,2014).

Dance Movement Therapy

Dance movement therapy is a mind-body intervention that incorporates physical activity

with psychosocial therapy (T.H.Ho et al.,2020). Different regions of the brain associated with

memory, executive functions, and motor skills are stimulated by the combination of physical and

cognitive movement (Zhang et al.,2019). Dance movement therapy emphasizes the connection

between the body and the mind, helping people express themselves through dance (T.H.Ho et

al.,2016). This allows individuals to express themselves more freely, embrace and reconnect

8
with their body, cope with depression and anxiety, regain confidence, and strengthen personal

resources (T.H.Ho et al.,2016; Zhang et al., 2019).

Music Therapy

Music therapy is a clinical and evidence-based therapy. In a therapeutic setting, it uses

music experiences to achieve individual goals (Music Therapy.,2021; Pater et al.,2021). Music

therapy decreases anxiety and discomfort while also enhancing the effectiveness of traditional

medical treatments (Facchini et al.,2021). Music therapy also improves sensory integration,

control, self-awareness, communication, and emotional sharing (Geretsegger et al., 2015.

Mössler et al.,2020; Schumacher et al.,2019).

Drama Therapy

Drama therapy is the therapeutic application of theatrical methods such as role-playing,

enactment, projection, and improvisation (Johnson, 1991, Wu et al., 2020). Drama therapy

focuses on various interactions to help people achieve a more balanced mental state. Via

imagination, all of this facilitates self-integration, better communication, awareness, and peer

learning (Mastrominico et al., 2018; Wu et al.,2020).

Summary

ASD is a complex disorder that may require multiple treatment modalities to improve negative

behaviors and symptoms. Due to the limited benefits and negative side effects of more

traditional treatments, health professionals have begun taking alternative approaches, such as the

use of creative arts as a form of treatment for this population. It is crucial to summarize the

existing literature on the feasibility and efficacy of creative art therapies on psychosocial factors

in youth with ASD

9
 METHODS

Databases

This review will use the reporting guidelines in the Preferred Reporting Items for

Systematic Reviews and Meta-analyses (PRISMA) statement (Moher et al., 2009). The relevant

databases searched will include CINAHL complete, MEDLINE, Psych INFO, PubMed, and

Web of Science. The search terms we will use for the creative art therapy intervention include:

“creative art therapies” OR “art therapy” OR “drama therapy” OR “dance therapy” OR

“movement therapy” OR “dance/movement therapy” OR “music therapy.” The search terms we

will use for the population include: “children” or “youth” or “adolescents” or “young adults”.

The search terms we will use for the primary condition will include: “Autism Spectrum

Disorder” OR “ASD” OR “Autism” OR “Developmental Disorders” OR “Asperger’s

Syndrome”. A research librarian will assist with this search, and reference lists of relevant

review articles will be searched to identify any additional articles.

Identification of Eligible Studies

The scope of this review will be limited to studies, in the English language, from 2010

through May 2021. To qualify for inclusion, studies will be required to report a quantitative

analysis of the effects of a creative art (music, art, dance/movement, creative writing, acting)

therapy intervention on at least 1 behavioral outcome or psychosocial outcome in participants

under 21 years of age. There must be a formal diagnosis of Autism Spectrum Disorder by a

clinician to be included in this study, however, studies using populations with comorbidities will

be included, as long as the primary diagnosis was ASD. Case studies and qualitative studies,

with no quantitative aspect, will also be excluded.

10
Table 1: Inclusion & Exclusion Criteria

Inclusion Criteria Exclusion Criteria

Experimental design Observational design

Primary diagnosis of ASD Case study or review paper
Participants under 21 years of age Qualitative data only
Quantitative data or mixed-methods No diagnosed ASD
Art therapy intervention Sample including other types of
≥ 1 behavioral/psychosocial outcome disabilities
measure Studies that include adult participants
Published before 2010 Only physical outcomes
English language

Data Extraction

The following information was extracted from each of the included studies: study design

and setting, description of sample, description of intervention, duration of study intervention and

follow-up, analysis plan, primary and secondary outcome measures, and results. The Effective

Public Health Practice Project’s Quality Assessment Tool for Quantitative Studies was used to

assess study quality (Thomas et al.,2004). This tool provides a dictionary and scoring

instructions in order to assign an overall quality rating for each study (Strong, Moderate, Weak).

Each study is assessed on selection bias, study design, confounders, blinding, data collection

methods, and withdrawals/dropouts. A study with no areas of weakness is classified as “Strong”;

one area of weakness is classified as “Moderate”; and two or more areas of weakness is

classified as “Weak”.

11
 RESULTS

From the initial search of keywords in the selected databases (APA, Psych Info,

CINAHL, Medline Academic Search Premiere), a total of 352 titles were listed. After deleting

all duplicates, the list decreased to 264 titles. After reviewing the listed titles, a total of 57

selections remained. Two researchers independently reviewed all 57 abstracts, compared their

list of included abstracts, and discussed any discrepancies. This led to a list of 19 full-text

articles to review. Additionally, a review article was found in the search, and was viewed for

additional articles that fit the inclusion criteria. One reference in the review appeared to meet the

criteria and was included in the full-text articles to review. However, that article was excluded

due to the wide age range examined in the study (ages 14 – 53 years). After all, 20 articles were

reviewed, a total of 9 articles met the inclusion criteria. Figure 1 provides an outline of the

review process, and reasons for exclusion.

12
 352 studies
from initial • 88 duplicates
removed

search

264 titles • 206 titles did not

meet criteria
reviewed

58 abstracts • 27 no intervention
• 6 no outcome measures

reviewed • 6 sample did not meet criteria

• 6 no intervention
• 2 sample did not
20 full-text meet criteria
• 1 not in English
studies • 2 no outcome
measure

9 included
studies

Figure 1: Illustration of Review Process

Summary of Included Studies

The nine included studies are summarized in Table 1. Overall, four studies conducted a

music therapy intervention, four studies conducted a drama therapy intervention, and one study

examined the effects of an art therapy intervention.

Table 2: Summary of Interventions

Sample Outcome
Author, date Therapy Study Design Findings
Description Measures
8 ASD, 8 non- ASD behaviors;
Corbett et al., Non- ↑ Social
Drama ASD, 6 – 17 Stress; Social
2011 randomized skills
years Skills
↑ Social
12 ASD, 8 – 17
Corbett et al., Pretest- ASD behaviors; skills; 0
Drama years, no
2014 posttest Social skills ASD
control group
behaviors

13
 30, 8 – 14 years
Corbett et al., ↓ Anxiety;
Drama RCT* Experimental & Anxiety; Stress
2017 0 stress**
waitlist control
77, 8 – 16 years,
Corbett et al., ↑ Social
Drama RCT Experimental & Social skills
2019 skills
waitlist control
17, 6 – 9 years, ↑ Social
Experimental & Social skills; skills; 0
Lagasse 2014 Music RCT
social skill ASD behaviors ASD
control behaviors
Pater et al. 10, 4 – 10 years, ↑ Social
Music Case series Social skills
2021 no control skills
37, 4 – 7 years,
Rabeyron et Experimental & ↑ Social
Music RCT Social skills
al. 2020 music listening skills
control
Schweizer et Emotion
12, 6 – 12 years, ↑ Social
al 2020. Art Case series regulation;
no control skills
Social skills
51, 6 – 12 years,
Sharda et al. ↑ Social
Music RCT music & no- Social skills
2018 skills
music control
*Randomized controlled trial
**0 denotes a null result

Summary of Participants

Demographic Information

The sample sizes in the nine studies ranged from eight participants (Corbett et al., 2011)

to 77 participants (Corbett et al., 2019). Most of the interventions had more male participants

than female participants. The youngest participants were four years old (Rabeyron et al.,2020;

Pater et al.,2021), and the oldest being seventeen years old (Rabeyron et al.,2021; Corbett et

al.,2014). While the majority of the studies did not mention race/ethnicity, two studies did. In the

study (Corbett et al.,2014), they had three African Americans, seven Caucasians, and two

Latinos/Hispanics. In another study conducted by (Corbett et al.,2017), there were two

multiracial, one African American, two Asians, four Latinos/ Hispanics, and 12 Caucasians. A

14
few studied did include nationality as well. Participants in two studies (Schweizer et al.,2020;

Pater et al.,2021) were Dutch. Participants in (Rabeyron et al.,2020) study were French, and

(Sharda et al.,2018; Lu et al.,2010) participants were Canadian.

ASD Diagnosis & Medication Use

Out of all the research, the Diagnostic and Statistical Manual of Mental Disorders was

utilized the most to identify if the individuals had ASD (Corbett et al.,2014; Corbett et al.,2017;

Sharada et al.,2018; Corbett et al.,2019). Participants in (Pater et al.,2021) research had to be

diagnosed by a child psychiatrist or a clinical psychologist/remedial educationalist. The

Childhood Autism Rating Scale was another tool used to determine ASD (Lagasse et al., 2014;

Rabeyron et al., 2020). It's worth noting that some of the individuals in the study (Corbett et

al.,2017) were on medication. Nineteen of the subjects were on psychotropic medication, and

seven were taking two or more medications.

Study Designs

Five studies (Corbett et al.,2017; Corbett et al.,2019; Lagasse et al., 2014; Sharda et al.,

2018; Rabeyron et al.,2020) were randomized controlled trials (RCTs), one study was a non-

randomized experimental design (Corbett et al., 2011), one study was a pretest-posttest single

group design (Corbett et al., 2014), and the remaining two studies had a multiple case series

design (Pater et al., 2021; Schweizer et al., 2020). In terms of follow-up assessments, Schweizer

et al (2020) followed up on the sustained effects of the art therapy intervention 15 weeks

following the final session.

15
Description of Control Conditions

Six of the nine studies included control groups or conditions (Corbett et al., 2011; Corbet

et al., 2017; Corbett et al., 2019; Lagasse et al., 2014; Sharda et al., 2018; Rabeyron et al.,2020).

Five of these studies included a control group of children with ASD who did not partake in the

creative art therapy intervention (Corbet et al., 2017; Corbett et al., 2019; Lagasse et al., 2014;

Sharda et al., 2018; Rabeyron et al.,2020), while the study by Corbett et al. (2011) recruited

neurotypical children as a comparison group that also participated in the intervention. The one

study included a passive creative arts activity (music listening) as the control condition

(Rabeyron et al., 2020). Two studies had a waitlist control condition where the control group

participated in the drama therapy after the cessation of the study (Corbett et al., 2017; Corbett et

al., 2019). One study included a passive creative arts activity (music listening) as the control

condition to compare with the music therapy intervention (Rabeyron et al., 2020), while two

other studies that examined music therapy had the control condition participate in a social skills

activity (Lagasse et al., 2014), and a no-music play-based activity (Sharda et al., 2018).

Study settings

Intervention settings varied among the nine studies with one study taking place at each

participant’s home (Pater et al.,2021), five studies conducted in a clinic setting (Lagasse,2014;

Sharda et al.,2018; Schweizer et al.,2020), and the other four were conducted in community-

based theater (Corbett et al.,2011; Corbett et al., 2014; Corbett et al.,2017; Corbett et al.,2019).

Additionally, five of the studies occurred in group settings (Corbett et al.,2011; Corbett et al.,

2014; Corbett et al.,2017; Corbett et al.,2019; Rabeyron et al., 2018) while four studies consisted

16
of solo sessions with participants (Pater et al., 2021; Lagasse et al., 2014; Sharda et al., 2018;

Schweizer et al., 2020).

Intervention frequency & duration

The interventions lasted anywhere from two weeks (Corbett et al., 2014) to eight months

(Rabeyron et al.,2020). Participants in most of the studies did the therapy once a week, while

others were doing it three to four times a week (Corbett et al.,2011). Most sessions lasted 30-60

minutes, except for three trials (Corbett et al.,2011) which lasted for two hours and (Corbett et

al.,2017; Corbett et al.,2019), whose sessions lasted for four hours.

Type of Therapy

Drama Therapy

Four of the nine articles examined drama therapy (Corbett et al.,2011; Corbett et

al.,2014; Corbett et al., 2017; Corbett et al.,2019). As these studies were developed by the same

research group, the activities performed by the groups were similar, although the study designs

differed. For example, one study occurred over two weeks (Corbett et al., 2014), two studies

occurred over a 10-week period (Corbett et al.,2017; Corbett et al.,2019), and another study

occurred over 12 weeks (Corbett et al.,2011). The two later studies were also RCTs while the

study conducted in 2011 was a quasi-experimental study, and the study in 2014 had a case series

design. In all four studies, the participants took part in theater games, role-playing exercises,

improvisation, and character-building over the first few weeks. After getting comfortable with

the environment, they began rehearsing lines for the play and also doing play blocking. After

each study, a play was performed for the community to see what the participants had learned.

17
Music therapy

The impact of music therapy on adolescence with ASD was investigated in four studies.

While all four studies allowed participants to play with a variety of instruments, each

intervention had its own set of characteristics. In the study (Shandra et al.,2018) they used songs

and rhythmic cues to help target communication, turn-taking, sensorimotor integration, social

appropriateness and musical interactions. The multiple case study done by (Pater et al.,2021),

had the first three sessions, be a time for the therapist to observe the participant and also a time

for the participant and therapist to build a relationship. In the sessions after that, the participants

did active music therapy. Active music therapy consists of making of rhythms and melodies to

obtain developmental improvement. After active music therapy, the therapist would have a

conversation with the participant to see how the music making experiences was, and how it made

them feel. The two music therapy studies with a control group were (Rabeyron et al., 2020;

Lagasse,2014). In the (Rabeyron et al.,2020) study, at the beginning and end of each session, the

participants listened to music for five min. The first five mins of music listening were

instrumental music, and the closing five minutes of music listening was vocal music. In between

those two activates, the participants were allowed to interact with other participants, therapist

and instrument during the time called instrumental and vocal improvisation. In the music

listening group the participants listened to music for 30 min without any interactions. In the final

study, (Lagasse,2014) music engagement was used to practice social skills and rhythmic cues.

Music structure was also used to help the children plan their response. Whereas, in the social

skills group, they played games and interacted with one another.

18
Art therapy

Only a single study conducted an art therapy session (Schweizer et al.,2020). In this

study, the participants were given a wide range of art supplies to produce art that provoked

positive emotion. Participants were free to draw whatever they wanted for the first three weeks,

to become us to the art materials and the surroundings. The following 12 sessions, however, they

were exposed to a variety of experiences to help aid in the art-making process.

Outcome Measures

Behavioral symptoms

Five studies looked at behavioral outcomes when conducting their study. One study

(Rabeyron et al.,2020) looked at autism symptoms severity and negative behaviors. They

discovered that after the music therapy sessions, there was a decrease in negative behaviors. In

the study conducted by (Shandra et al.,2018) they did a 20 min MRI to look at how music

therapy might help brain connectivity. The results from the MRI showed that there was an

increase in brain connectivity after the music therapy sessions. (Schweizer et al.,2020) study the

effects that art therapy has on sense of self, emotional regulation, flexibility and social

communication. They determined that there was an increase in all four of those behaviors. The

last two studies (Corbett et al.,2011; Corbett et al.,2019) both looked at how theater therapy

effects memory of face and theory of mind. They both showed an increase in both behaviors.

The study (Corbett et al.,2011) also looked at expression of emotions and determined that it was

null finding.

19
Table 3: ASD-related Behavior Outcomes

Author, Date Outcomes Assessment Measure Type of Assessment

Clinical Global
Impression (CGI);
Autism symptom Childhood Autism
Rabeyron et al., 2020 severity; Negative Rating Scale Clinician report
behaviors (CARS), Aberrant
Behavior Checklist
(ABC)
Shandra et al., 2018 Brain connectivity 20 min MRI Objective measure
Behavior Rating
Inventory of
Executive
Functioning
(BRIEF); Children’s
Social Behavior
Sense of self; Questionnaire
Schweizer et al.,2020 Emotional regulation; (CSBQ); Self- Clinician report; Self-
Flexibility; Social Perception Profile for reported
communication Children (SPPC)

Other Developmental
Delays (SSS); The
Short Sensory Profile
(SSP); Adaptive
Memory of face; Behavior Assessment
Expression of System (ABAS);
Corbett et al.,2011 Clinician report
emotions. NEPSY Memory for
Theory of mind Face (MF); NEPSY
Affect Recognition
(AR); NEPSY
Theory of Mind
(TOM)
Event-related
Social cognition;
potentials (ERP);
Corbett et al.,2019 Theory of Mind; Clinician report
NEPSY Theory of
Face memory
Mind (TOM);

20
 NEPSY Memory for
Face (MF)

Mental Health

Two studies examined mental health outcomes following a drama therapy intervention

(Corbett et al., 2011; Corbett et al., 2017). Corbett et al. (2017) examined stress and anxiety

using an objective measure (salivary cortisol) to assess stress, and a subjective measure (self-

report state-and trait-anxiety surveys) to assess anxiety. There was a reduction in trait-anxiety

following the intervention in the experimental group, however, there were no differences in

salivary cortisol levels. No differences in anxiety or stress were observed in the control group.

An earlier study on drama therapy by Corbett et al. (2011) examined stress through both parent

surveys and salivary cortisol after the three-month drama therapy intervention.

Table 4: Mental Health Outcomes

Author, Date Outcomes Assessment Measure Type of Assessment
Salivary cortisol; Objective measure
Corbett et al., 2017 Stress; anxiety State & Trait Anxiety (Stress); Self-report
Scale (Anxiety)
Corbett et al., 2011 Stress Salivary cortisol Objective measure

Social Skills

The impact of creative art therapies on social skills was the subject of six articles. Three

of the studies were drama therapy (Corbett et al.,2011; Corbett et al.,2014; Corbett et al.,2019).

Social bonding and social responsiveness were studied in (Corbett et al.,2011). To look at social

bonding they used oxytocin levels, which was determined to be null in finding. In the study

21
(Corbett et al.,2014) evaluated social interactions with peers and social perceptions. It was

determined that that there was an increase in the two outcomes. The last theater study (Corbett et

al.,2019) looked at cooperative play, and showed an increase in it among participants. Three of

the studies were music therapy (Lagasse 2014; Sharda et al.,2018; Pater et al. 2021). Eye gaze,

joint attention and initiation of or response to communication were the outcomes measured in

(Lagasse,2014). After the study it was determined that there was an increase in eye gaze and

joint attention, but null findings for initiation of or response to communication. The RCT

conducted by (Shandra et al.,2018) looked at communication and family quality of life among

participants. The study determined that there was an increase in communication and family

quality of life.

Table 5: Social Skills Outcomes

Author, Date Outcomes Assessment Measure Type of Assessment

The Social
Social bonding; Clinician report (Social
Responsiveness
Corbett et al.,2011 Social responsiveness);
Scale (SRS);
responsiveness Objective measure
Oxytocin levels (Social bonding)
Social
Responsiveness
Scale (SRS); Autism
Treatment Evaluation
Eye gaze; Joint Checklist (ATEC);
attention. behavioral
Initiation of or observation from
Lagasse,2014 Clinician report
response to video recordings
communication

Social adequate Validated Clinician report; self-

Pater et al.,2021
behaviors Questionnaire for the report

22
 Inventory of Social
Behavior of Children
(VISK), Social
Behavior
Questionnaire

Childhood Autism
Rating Scale
(CARS); parent-
reported behavioral
outcomes on Social
Responsiveness
Scale (SRS-II); the
Children’s
Communication
Checklist (CCC-2);
maladaptive behavior
subscale of the
Vineland Adaptive
Behavior Scales
(VABS-MB0; Beach
Family Quality of
Communication; Life Scale (FQoL); Clinician
Shandra et al., 2018 Family quality of life Wechsler’s report(communication);
(FQoL) Abbreviated Self-reported (FQoL)
Intelligence Scale
(WASI-II); Clinical
Evaluation of
Language
Fundaments
(CVELF-4); Peabody
Picture Vocabulary
Test (PPVT-4);
Montreal Battery for
Evaluation of
Musical Abilities

23
 Social
Communication
Questionnaire; Social
Responsiveness
Scale;
Developmental
Neuropsychological
Social interactions Assessment
Corbett et al.,2014 with peers; Social (NEPSY); Parenting Clinician report
perception Stress Index (PSI);
Adaptive Behavior
Assessment System
(ABAS);
Companionship
Scale

Peer Interaction
Paradigm (PIP)
Corbett et al.,2019 Cooperative play Clinician report

Quality Assessment of Included Studies

After applying the Quality Assessment Tool to the included studies, three of the nine

studies were rated as “strong” (Corbett et al., 2017; Corbett et al., 2019; Sharda et al., 2018), one

study was rated as “moderate” (Rabeyron et al., 2020), and the remaining five studies were rated

as “weak” (Corbett et al., 2011; Corbett et al., 2014; Lagasse et al., 2014; Pater et al., 2021;

Schweizer et al., 2020). Table 6 summarizes the quality assessment of the included studies. The

main limitations of the studies included convenience sampling, lack of a control group, and a

lack of control over confounding variables.

24
Table 6: Quality Assessment of Included Studies

Author, date Therapy Quality Areas of Weakness

Corbett et al., Drama Weak Convenience sample, lack of a control group
2011
Corbett et al., Drama Weak Convenience sample; Lack of control group
2014
Corbett et al., Drama Strong N/A
2017
Corbett et al., Drama Strong N/A
2019
Lagasse 2014 Music Weak Confounding variables; study design
Pater et al. Music Weak Lack of control group; confounding variables
2021
Rabeyron et Music Moderate Low intervention integrity
al. 2020
Schweizer et Art Weak Convenience sample; lack of control group;
al 2020. low intervention integrity

Sharda et al. Music Strong N/A

2018

25
 DISCUSSION

The purpose of this review was to examine the effects of creative arts therapies on

psychosocial outcomes in youth with Autism Spectrum Disorder (ASD). The findings of this

review show that creative arts therapy interventions for youth with ASD have primarily

consisted of music or drama therapy, and appear to focus on social skills outcomes. The results

from these studies suggest that both music and drama therapy may improve social skills in

children with ASD.

Drama therapy appeared to be beneficial for social skills and communication in children

with ASD (Corbett et al., 2019). This finding is supported by prior literature that has shown

drama techniques can be helpful in improving sociability and communication in children who

had difficulty with emotional expression and language (Wright et al., 2006). It should be noted,

however, that the four studies that examined this therapy were conducted by the same research

group, and therefore, it would be important to determine whether these results could be

replicated by different research groups.

Although the music therapy studies in this review examined behavioral and psychosocial

outcomes, prior research on the therapeutic effects of music on children suggests that music may

be most beneficial for improving focus and attention (Pasali 2014). It is important to note,

however, that such previous studies did not focus specifically on ASD populations.

The lack of studies on dance therapy was surprising, given that prior research has

suggested that movement and dance may improve ASD-related symptoms (Takahashi 2019).

While there were observational studies that demonstrated the benefits of dance in this

population, there was a lack of intervention research with the only articles focusing on dance

26
therapy either examined older populations or consisted of single-subject case studies

(Hildebrandt, Koch, & Fuchs, 2016). It is clear that future work is needed to evaluate the effects

of dance therapy on this population. Similarly, it was surprising that only a single art therapy

study met the inclusion criteria for

According to the quality assessment conducted on all nine papers, only three of those papers

could be categorized as “strong”. This is not surprising given that ASD intervention research

often has challenges with executing randomized controlled trials, controlling for confounding

variables, and recruiting samples that are representative of the population (Takahasi et al., 2019).

However, given the potential benefits of this type of therapy, there is a need for high-quality,

rigorous study designs that focus on the effects of different styles of creative arts therapy on

psychosocial outcomes in children with ASD.

It is also important to distinguish the difference between simply participating in a creative art

activity and creative art “therapy”. Only one study (Rabeyron et al., 2020) emphasized this

difference by comparing listening to music and actual music therapy that is led by a trained

therapist. Creative art therapy involves more of an active role in the program, while individuals

taking part in a creative art activity can play more of a passive role (e.g. listening to music). All

four of the studies that utilized a music therapy intervention had children create music through

the use of both instruments and singing. Future work should further compare the creative art

activities with creative art therapy to further determine the effective components of such

interventions.

27
Although the prevalence of ASD has increased to 1 in 54 children in the past few years, it is not

surprising that there were only a small number of creative arts therapy intervention studies for

youth with ASD (Lerner et al., 2011). It has only been recently that there has been a deviation

from more traditional forms of treatment for ASD symptoms, such as psychotropic medication,

to more alternative treatments such as exercise or creative arts therapy (Hume et al., 2021). This

further reiterates the importance of reviewing the evidence and quality of these intervention

studies, so as to provide information to families of children with ASD of the potential benefits of

creative arts therapy interventions.

Limitations and Future Directions

From this review, it is clear that the types of creative art therapy interventions have been

limited, mainly focusing on music or drama therapy in children with ASD. Future research

should examine creative art therapies, such as dance and art therapy for youth with ASD. It is

also important to examine additional psychosocial outcomes, besides social skills, to determine

which specific outcomes may benefit most by creative arts therapies.

Five of the nine studies took place in a group setting, and therefore, it is possible that the

social aspect built into the intervention may have confounded or moderated the positive social

outcomes. Therefore, future work should examine the independent effects of the different

creative art therapies in individual vs group settings. However, this may not be feasible for

creative arts, such as drama therapy, where interaction is part of the therapeutic process.

One area of concern is the lack of information regarding comorbidities, medication use,

and ASD severity levels in these samples. Although several studies assessed ASD-related

behaviors pre-and post- intervention, they did not provide information regarding diagnosed ASD

28
severity levels which would be critical when providing recommendations for families of children

with lower functioning ASD.

While the scope of this review was limited to studies that only employed a single form of

creative arts therapy, it would be interesting to examine the potential additive effects of a

creative arts therapy paired with a more established treatment modality such as ABA, PT, and

family-based therapy. A lack of social skills is a prominent feature in individuals with ASD, and

some of the traditional therapies, such as PT, do not target this feature. Therefore, the addition of

such creative arts therapies may be a welcomed addition to a treatment plan.

Conclusions

The current review demonstrated that music and drama therapy interventions may help to

improve social skills in youth with ASD, however, more research is necessary to better

understand whether other outcomes may benefit from these therapies. Furthermore, as the

majority of creative arts therapy interventions have been limited to music or drama in this

population, future studies should explore whether other creative arts, such as art or dance

therapy, may demonstrate similar benefits.

29
 REFERENCES

Ahlström, B. H., & Wentz, E. (2014). Difficulties in everyday life: young persons with attention-

deficit/hyperactivity disorder and autism spectrum disorders perspectives. A chat-log

analysis. International journal of qualitative studies on health and well-being, 9(1),

23376.

American Art Therapy Association. (2014).About Art Therapy. Retrieved from

https://arttherapy.org/about-art-therapy/

American Music Therapy Association (n.d.) What is Music Therapy. Retrieved from

https://www.musictherapy.org/about/musictherapy/

Ash, T., Bowling, A., Davison, K., & Garcia, J. (2017). Physical activity interventions for

children with social, emotional, and behavioral disabilities—a systematic review.

Journal of Developmental & Behavioral Pediatrics, 38(6), 431-445.

Ashburner, J., Rodger, S., Ziviani, J., & Jones, J. (2014). Occupational therapy services for

people with autism spectrum disorders: Current state of play, use of evidence and future

learning priorities. Australian Occupational Therapy Journal, 61(2), 110-120.

Atun-Einy, O., Lotan, M., Harel, Y., Shavit, E., Burstein, S., & Kempner, G. (2013). Physical

therapy for young children diagnosed with Autism Spectrum Disorders– clinical

frameworks model in an Israeli setting. Frontiers in pediatrics, 1, 19.

Autism Speaks. (n.d.)Applied Behavior Analysis. Retrieved from

https://www.autismspeaks.org/applied-behavior-analysis-aba-autism-treatment

Autism Speaks. (n.d.)First Concern to Action. Retrieved from

https://www.autismspeaks.org/first-concern-action

30
Autism Speaks. (n.d.)Occupational Therapy. Retrieved from

https://www.autismspeaks.org/occupational-therapy-ot-0

Autism Speaks. (n.d.) Sensory Issues. Retrieved from https://www.autismspeaks.org/sensory-

issues

Autism Speaks. (n.d.)Social skills and Autism. Retrieved from

https://www.autismspeaks.org/social-skills-and-autism

Autism Speaks. (n.d.)Speech Therapy. Retrieved from https://www.autismspeaks.org/speech-

therapy-autism

Baker, E. K., & Richdale, A. L. (2015). Sleep patterns in adults with a diagnosis of high

functioning autism spectrum disorder. Sleep, 38(11), 1765-1774.

Baldwin, P., King, G., Evans, J., McDougall, S., Tucker, M. A., & Servais, M. (2013). Solution-

focused coaching in pediatric rehabilitation: an integrated model for practice. Physical &

occupational therapy in pediatrics, 33(4), 467-483.

Bangerter, A., Ness, S., Aman, M. G., Esbensen, A. J., Goodwin, M. S., Dawson, G., ... &

Pandina, G. (2017). Autism behavior inventory: a novel tool for assessing core and

associated symptoms of autism spectrum disorder. Journal of Child and

Adolescent Psychopharmacology, 27(9), 814-822.

Bellini, S. (2006). The development of social anxiety in adolescents with autism spectrum

disorders. Focus on autism and other developmental disabilities, 21(3),

138-145.

Case, C., & Dalley, T. (2014). The handbook of art therapy. Routledge.

Center for Disease Control and Prevention. ( 2020). Data and Statistics on Autism

31
 Spectrum Disorder. Retrieved from https://www.cdc.gov/ncbddd/autism/data.html

Center for Disease Control and Prevention. ( 2021). Signs and Symptoms of Autism Spectrum

Disorders. Retrieved from https://www.cdc.gov/ncbddd/autism/signs.html

Center for Disease Control and Prevention. (2019). Treatment and Intervention Services for

Autism Spectrum Disorder. Retrieved https://www.cdc.gov/ncbddd/autism/treatment.html

Corbett, B. A., Gunther, J. R., Comins, D., Price, J., Ryan, N., Simon, D., ... & Rios, T. (2011).

Brief report: theatre as therapy for children with autism spectrum disorder. Journal of

autism and developmental disorders, 41(4), 505-511.

Corbett, B. A., Blain, S. D., Ioannou, S., & Balser, M. (2017). Changes in anxiety following a

randomized control trial of a theatre-based intervention for youth with autism spectrum

disorder. Autism, 21(3), 333-343.

Corbett, B. A., Ioannou, S., Key, A. P., Coke, C., Muscatello, R., Vandekar, S., & Muse, I.

(2019). Treatment effects in social cognition and behavior following a theater-based

intervention for youth with autism. Developmental neuropsychology, 44(7), 481-494.

Corbett, B. A., Swain, D. M., Coke, C., Simon, D., Newsom, C., Houchins‐Juarez, N., ... &

Song, Y. (2014). Improvement in social deficits in autism spectrum disorders using a

theatre‐based, peer‐mediated intervention. Autism Research, 7(1), 4-16.

Edwards, B. M., Smart, E., King, G., Curran, C. J., & Kingsnorth, S. (2020). Performance and

visual arts-based programs for children with disabilities: a scoping review focusing on

psychosocial outcomes. Disability and rehabilitation, 42(4), 574-585.

Facchini, M., & Ruini, C. (2020). The role of Music Therapy in the treatment of children with

cancer: a systematic review of literature. Complementary Therapies in

32
 Clinical Practice, 101289.

Gadow, K. D., Devincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSMIV

symptoms in elementary school-age children with PDD versus clinic and community

samples. Autism, 9(4), 392-415.

Garcia, J. M., Leahy, N., Rivera, P., Brazendale, K., & Rice, D. J. (2020). The association

among demographic factors, health behaviors and sleep quality in youth with

Autism Spectrum Disorder. Disability and health journal, 13(3), 100885.

Garcia, J. M., Sirard, J. R., Whaley, D. E., Rice, D. J., Baker, K., & Weltman, A. (2019). The

influence of friends and psychosocial factors on physical activity and screen time in

Normal and overweight adolescents: a mixed-methods analysis. American Journal of

Health Promotion, 33(1), 97-106.

Geretsegger, M., Holck, U., Carpente, J., Elefant, C., Kim, J., & Gold, C. (2015). Common

characteristics of improvisational approaches in music therapy for children with autism

spectrum disorder: Developing treatment guidelines. Journal of Music Therapy, 52(2),

258–281.

Gilroy, A. (2006). Art therapy, research, and evidence-based practice. Sage.

Goel, R., Hong, J. S., Findling, R. L., & Ji, N. Y. (2018). An update on pharmacotherapy of

autism spectrum disorder in children and adolescents. International review of psychiatry,

30(1), 78-95.

Haeyen, S. (2011). The connecting quality of Art therapy. Effects of Art therapy in the treatment

of personality disorders. Introduction of an Art therapy Questionnaire.

33
Healy, S., Nacario, A., Braithwaite, R. E., & Hopper, C. (2018). The effect of physical activity

interventions on youth with autism spectrum disorder: A meta‐analysis.

Autism Research, 11(6), 818-833.

Hedley, D., Uljarević, M., & Hedley, D. F. (2017). Employment and living with autism:

Personal, social, and economic impact. In Inclusion, disability, and culture (pp. 295-

311). Springer, Cham.

Hinz, L. D. (2019). Expressive therapies continuum: A framework for using art in therapy.

Routledge.

Ho, R. T., Fong, T. C., Cheung, I. K., Yip, P. S., & Luk, M. Y. (2016). Effects of a short-term

dance movement therapy program on symptoms and stress in patients with breast cancer

undergoing radiotherapy: a randomized, controlled, single-blind trial. Journal of Pain

and Symptom Management, 51(5), 824-831.

Ho, R. T., Fong, T. C., Chan, W. C., Kwan, J. S., Chiu, P. K., Yau, J. C., & Lam, L. C. (2020).

Psychophysiological effects of dance movement therapy and physical exercise on older

adults with mild dementia: a randomized controlled trial. The Journals of Gerontology:

Series B, 75(3), 560-570.

Hoque, M. E., Lane, J. K., El Kaliouby, R., Goodwin, M., & Picard, R. W. (2009). Exploring

speech therapy games with children on the autism spectrum.

Jessica Wright. (2015). Adults with autism are at risk for host of health problems. Spectrum.

Retrieved from https://www.spectrumnews.org/news/adults-withautism-are-at-risk-for-

host-of-health-problems/

34
Johnson, D. R. (1991). The theory and technique of transformations in drama therapy. The arts

in psychotherapy.

LaGasse, A. B. (2014). Effects of a music therapy group intervention on enhancing social skills

in children with autism. Journal of music therapy, 51(3), 250-275.

Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., ... & Lainhart, J.

E. (2006). Comorbid psychiatric disorders in children with autism: interview

development and rates of disorders. Journal of autism and developmental disorders,

36(7), 849-861.

Lopata, C., Toomey, J. A., Fox, J. D., Volker, M. A., Chow, S. Y., Thomeer, M. L., ... &

Smerbeck, A. M. (2010). Anxiety and depression in children with HFASDs: Symptom

levels and source differences. Journal of abnormal child psychology, .38(6), 765-776.

Malchiodi, C. A. (Ed.). (2003). Handbook of art therapy. Guilford Press.

Mastrominico, A., Fuchs, T., Manders, E., Steffinger, L., Hirjak, D., Sieber, M., ... & Koch, S. C.

(2018). Effects of dance movement therapy on adult patients with autism spectrum

disorder: A randomized controlled trial. Behavioral Sciences, 8(7), 61.

Mayo Clinic. ( 2018). Autism Spectrum Disorder. Retrieved from

https://www.mayoclinic.org/diseases-conditions/autism-spectrumdisorder/symptoms-

causes/syc-20352928

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Prisma Group. (2009). Reprint—

preferred reporting items for systematic reviews and meta-analyses: the PRISMA

statement. Physical therapy, 89(9), 873-880.

35
Mössler, K., Schmid, W., Aßmus, J., Fusar-Poli, L., & Gold, C. (2020). Attunement in Music

Therapy for Young Children with Autism: Revisiting Qualities of Relationship as

Mechanisms of Change. Journal of autism and developmental disorders, 1-14. National

Coalition of Creative Arts Therapies Associations. (n.d.). About NCCATA. Retrieved

from https://www.nccata.org/aboutnccata

National Institution of Children Health and Human Development. (2019). Medication Treatment

for Autism. Retrieved from

https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medicati on-

treatment

National Institution of Children Health and Human Development. (2017).Physical Therapy for

Autism. Retrieved from

https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/physical-

therapy

National Institution of Mental Health. ( 2018). Autism Spectrum Disorder. Retrieved from

https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/

Pater, M., Spreen, M., & van Yperen, T. (2021). The developmental progress in social behavior

of children with Autism Spectrum Disorder getting music therapy. A multiple case study.

Children and Youth Services Review, 120, 105767.

Puig, A., Lee, S. M., Goodwin, L., & Sherrard, P. A. (2006). The efficacy of creative arts

therapies to enhance emotional expression, spirituality, and psychological wellbeing of

newly diagnosed Stage I and Stage II breast cancer patients: A preliminary study. The

Arts in Psychotherapy, 33(3), 218-228.

36
Rabeyron, T., Del Canto, J. P. R., Carasco, E., Bisson, V., Bodeau, N., Vrait, F. X., ... & Bonnot,

O. (2020). A randomized controlled trial of 25 sessions comparing music therapy and

music listening for children with autism spectrum disorder. Psychiatry Research, 293,

113377.

Reichow, B., Steiner, A. M., & Volkmar, F. (2012). Social skills groups for people aged 6 to 21

with autism spectrum disorders (ASD). Campbell Systematic Reviews, 8(1), 1-76.

Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders:

prevalence, nature, & possible biopsychosocial aetiologies. Sleep medicine reviews,

13(6), 403-411.

Schumacher, K., Calvet, C., & Reimer, S. (2019). The AQR Tool - Assessment of the Quality of

Relationship. Based on developmental psychology. Wiesbaden: Reichert Verlag.

Schweizer, C., Knorth, E. J., & Spreen, M. (2014). Art therapy with children with Autism

Spectrum Disorders: A review of clinical case descriptions on ‘what works’. The Arts in

Psychotherapy, 41(5), 577-593.

Schweizer, C., Knorth, E. J., Van Yperen, T. A., & Spreen, M. (2020). Evaluation of ‘Images of

Self,’an art therapy program for children diagnosed with autism spectrum disorders

(ASD). Children and Youth Services Review, 116, 105207.

Sharda, M., Tuerk, C., Chowdhury, R., Jamey, K., Foster, N., Custo-Blanch, M., ... & Hyde, K.

(2018). Music improves social communication and auditory–motor connectivity in

children with autism. Translational psychiatry, 8(1), 1-13

37
Simpson, R. L. (2001). ABA and students with autism spectrum disorders: Issues and

considerations for effective practice. Focus on autism and other developmental

disabilities, 16(2), 68-71.

Thomas, B. H., Ciliska, D., Dobbins, M., & Micucci, S. (2004). A process for systematically

reviewing the literature: providing the research evidence for public health nursing

interventions. Worldviews on Evidence‐Based Nursing, 1(3), 176-184.

Understood. (n.d.). Understanding sensory processing issues. Retrieved from

https://www.understood.org/en/learning-thinking-differences/child-

learningdisabilities/sensory-processing-issues/understanding-sensory-processing-issues

University of Minnesota. (n.d.). Arts and Healing. Retrieved from

https://www.csh.umn.edu/education/focus-areas/arts-and-healing

Wu, J., Chen, K., Ma, Y., & Vomočilová, J. (2020). Early intervention for children with

intellectual and developmental disability using drama therapy techniques.

Children and Youth Services Review, 109, 104689.

Zhang, Q., Hu, J., Wei, L., Jia, Y., & Jin, Y. (2019). Effects of dance therapy on cognitive and

mood symptoms in people with Parkinson's disease: A systematic review and meta-

analysis. Complementary therapies in clinical practice, 36, 1217

38