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.

中文翻译：

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基于游戏的心理健康干预：一项针对自闭症谱系障碍和发育性语言障碍儿童和青少年的系统回顾和荟萃分析

背景和目标

基于游戏的干预措施普遍用于有社交、交流和语言需求的儿童，但这些干预措施对这组儿童心理健康的影响尚不清楚。尽管发育性语言障碍 (DLD) 和自闭症谱系障碍 (ASD) 儿童的心理健康已经存在，但他们的心理健康应该与他们病情的其他更显着特征同等考虑。为此，我们进行了系统的文献综述和荟萃分析，以评估基于游戏的干预措施对 DLD 和 ASD 儿童心理健康结果的影响，并确定该领域研究的特点。

方法

该研究使用完整的系统评价设计报告给系统评价和荟萃分析的首选报告项目 (PRISMA) 指南 (PRISMA prisma-statement.org)，在每个阶段都有预先指定的纳入标准和明确、透明和可复制的方法审查。研究选择过程涉及对七个学术数据库的严格系统搜索、摘要的双重筛选和全文筛选，以确定使用随机对照试验 (RCT) 和准实验 (QE) 设计的研究，以评估支持干预措施的心理健康结果患有 DLD 和 ASD 的儿童。为了可靠性，纳入研究的数据提取以及偏倚风险评估由两位研究作者进行。

主要贡献

文献检索共确定了 2,882 篇论文，这些论文在摘要（n = 1,785）和全文（n = 366）级别进行了双重筛选，结果有 10 篇论文符合纳入审查的标准。有 8 项 RCT 和 2 项 QE 使用 7 种命名的基于游戏的干预措施，仅针对 ASD 参与者。对 5 项涉及积极心理健康结果（例如积极影响和情绪功能）的研究进行荟萃分析发现总体干预效果显着（Cohen's d = 1.60（95% CI [0.37, 2.82]，p = 0.01）；对 6 项研究的荟萃分析针对负面心理健康结果（例如，负面影响、内化和外化问题）的研究发现整体干预效果不显着 (Cohen's d = 0.04 -0.17 (95% CI [-0.04, 0.51], p = 0.88)。

结论

一个关键的观察是与研究样本量、干预持续时间、研究环境、干预者背景以及特定心理健康结果的可变性相关的研究特征的多样性。基于游戏的干预措施似乎对自闭症儿童的积极而非消极心理健康产生有益影响。没有高质量的研究调查此类干预措施对 DLD 儿童的疗效。

启示

这篇综述提供了很好的证据，表明需要进一步研究旨在支持年轻人社交、交流和语言需求的常用游戏干预措施如何影响 ASD 或 DLD 儿童的心理健康。