Background and aims

Play is used by practitioners from across disciplinary backgrounds as a natural and enjoyable context for providing intervention and support in early childhood. In the case of autism interventions, many therapies are based on the association between social play and the development of social skills, language development, and communication skills, as these are often particular areas of challenge for autistic children. However, play is a wide-ranging concept and the extant literature on play-based interventions is large and heterogeneous. This means it is challenging for practitioners and families to navigate the evidence base and make choices about differing intervention strategies. This review aims to provide a comprehensive map of the research on this topic and to develop a conceptual framework to inform clinical decision-making.

Methods

An initial stakeholder consultation confirmed the relevance of the topic to practitioners and autistic people. A scoping review methodology (preregistered) was used to identify relevant literature. We systematically searched seven databases to find peer-reviewed primary intervention studies of play-based approaches targeting language, social and communication outcomes for autistic children aged 2-8 years. We then summarised the literature using narrative synthesis and Evidence Gap Maps (EGMs). The literature was summarised according to a range of characteristics, including study design, population characteristics, agent of intervention and outcomes measured, among others. These summaries were then used to develop a framework for some key considerations for practitioners appraising play-based approaches.

Results

388 studies met inclusion criteria. Approximately 21% of studies were RCTs, and over 50% had ≤10 participants. Over 45% of studies reported multiple relevant outcomes, with social play skills being the most common single intervention target. Girls and minority background groups are under-represented. A range of intervention types were identified, and some high-level categorisations are proposed.

Main contribution: On the basis of the evidence synthesis we suggest important dimensions for appraisal of play-based interventions, including the role of play within an intervention (as a context, a key developmental mechanism, or a component of a larger approach), the underpinning philosophy (e.g. behaviourist or developmental), and the role of the practitioner (providing parent feedback, 1:1 intervention, group facilitation).

Conclusions

The wide range of approaches uncovered by this review is a testament to the wonderful diversity inherent to both play and autism. However, research could usefully focus on consolidating the evidence base for existing approaches, rather than aiming for further diversification.

Implications: The conceptual framework proposed in this review can help practitioners appraise the literature and aid their advice to families when making shared intervention decisions.

中文翻译：

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支持 2-8 岁自闭症儿童社交和沟通发展的基于游戏的干预措施：范围界定审查

背景和目标

游戏被来自不同学科背景的从业者用作在幼儿期提供干预和支持的自然而愉快的环境。就自闭症干预而言，许多疗法都基于社交游戏与社交技能、语言发展和沟通技巧发展之间的联系，因为这些通常是自闭症儿童面临挑战的特殊领域。然而，游戏是一个广泛的概念，现存关于基于游戏的干预措施的文献数量众多且种类繁多。这意味着从业者和家庭很难浏览证据库并就不同的干预策略做出选择。本综述旨在提供该主题研究的综合图谱，并制定一个概念框架来为临床决策提供信息。

方法

初步的利益相关者咨询确认了该主题与从业者和自闭症患者的相关性。使用范围界定审查方法（预注册）来识别相关文献。我们系统地搜索了七个数据库，以找到针对 2-8 岁自闭症儿童的语言、社交和沟通结果的基于游戏的方法的同行评审初级干预研究。然后，我们使用叙事综合和证据差距图 (EGM) 总结​​了文献。根据一系列特征对文献进行了总结，包括研究设计、人群特征、干预措施和测量的结果等。这些总结随后被用于为评估基于游戏的方法的从业者的一些关键考虑因素开发一个框架。

结果

388 项研究符合纳入标准。大约 21% 的研究是随机对照试验，超过 50% 的研究参与者少于 10 人。超过 45% 的研究报告了多种相关结果，其中社交游戏技能是最常见的单一干预目标。女孩和少数民族背景群体的代表性不足。确定了一系列干预类型，并提出了一些高级分类。

主要贡献：在综合证据的基础上，我们提出了评估基于游戏的干预措施的重要维度，包括游戏在干预措施中的作用（作为背景、关键发展机制或更大方法的组成部分）、支撑哲学（例如行为主义或发展主义），以及从业者的角色（提供家长反馈、1:1 干预、小组促进）。

结论

这篇评论揭示的广泛方法证明了游戏和自闭症固有的奇妙多样性。然而，研究可以有效地侧重于巩固现有方法的证据基础，而不是旨在进一步多样化。

含义：本综述中提出的概念框架可以帮助从业者评估文献并在做出共同干预决策时帮助他们向家庭提供建议。