effectiveness of play therapy on joint attention of children with autism spectrum disorder

Document Type : Original Article

Authors

1 Master's degree in psychology and education of exceptional children, Faculty of Behavioral Sciences, University of Rehabilitation Sciences and Social Health, Tehran, Iran

2 Master's degree in psychology and education of exceptional children, Faculty of Behavioral Sciences, University of Rehabilitation Sciences and Social Health, Tehran, Iran

3 Ph.D. in Psychology and Education of Exceptional Children, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran.

4 Professor, Department of Psychology and Education of Exceptional Children, Faculty of Behavioral Sciences, University of Rehabilitation and Social Health Sciences, Tehran, Iran

5 Associate Professor, Department of Psychology and Education of Exceptional Children, Faculty of Behavioral Sciences, University of Rehabilitation and Social Health Sciences, Tehran, Iran

Abstract

Background and Objective: Children with Autism Spectrum Disorder (ASD) face significant challenges in developing communication skills and social interactions. One of the fundamental difficulties in these children is joint attention, which is recognized as a key component in establishing effective communication. Play therapy, as an intervention method, is designed to enhance social skills and promote joint attention. This study aimed to investigate the effectiveness of play therapy on joint attention in children with ASD.
Method: This study is a qualitative experimental research using a single-subject A-B design with a pre-test and post-test structure. To implement the intervention, four children aged 3 to 4 years old (three boys and one girl) were randomly selected. Prior to the intervention, an initial assessment was conducted twice for each child using the Early Social Communication Scales (ESCS) developed by Mundy et al. (2013). The intervention included individual play therapy sessions held over 10 sessions for five weeks (twice a week,60 minutes per session). Follow-up assessments were collected after the second, fifth, eighth, and tenth sessions, and the data were analyzed using Cohen's D effect size.
Findings: The results indicated that play therapy had a significant impact on improving the components of joint attention in children with ASD. Specifically, the findings showed a meaningful increase in initiating joint attention and responding to joint attention in the participating children after the intervention period (P< 0.05).
Conclusion: It can be concluded that play therapy is an effective approach for enhancing joint attention. Therefore, play therapy can be used as a therapeutic intervention to increase joint attention in children with ASD.

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Main Subjects

References

Abdelaziz, A., Wagner, M., & Naigles, L. R. (2025). Associations Between Joint Attention, Supported Joint Engagement and Language in TD Children and Children with ASD: Potential Sources of Individual and Group Differences in Language Outcomes. Language Learning and Development, 21(1), 27-57.
Ambarchi, Z., Boulton, K. A., Thapa, R., Arciuli, J., DeMayo, M. M., Hickie, I. B., ... & Guastella, A. J. (2024). Social and joint attention during shared book reading in young autistic children: a potential marker for social development. Journal of Child Psychology and Psychiatry, 65(11), 1441-1452.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: fifth edition (DSM-V). Washington, DC, London: American Psychiatric publishing.
Broomell, A. P., Reid, N. A., Patton, L. A., & Bell, M. A. (2025). Neural foundations of joint attention in infancy. Cognitive Development, 74, 101546.
Chiang, C.-H., Soong, W.-T., Lin, T.-L., & Rogers, S. J. (2008). Nonverbal communication skills in young children with autism. Journal of Autism and Developmental Disorders, 38 (10), 1898-1906. https://doi.org/10.1007/s10803-008-0586-2
Dalkılınç, G., Okumuş, S., & Güloğlu, B. (2025). Play Therapy for Children Exposed to Natural Disasters. Psikiyatride Güncel Yaklaşımlar, 17(1), 47-60.
Galanter, C. A., & Jensen, P. S. (Eds.). (2025). DSM-5-TR® Casebook and Treatment Guide for Child Mental Health. American Psychiatric Pub.
Issac, A., Halemani, K., Shetty, A., Thimmappa, L., Vijay, V. R., Koni, K., ... & Kapoor, V. (2025). The global prevalence of autism spectrum disorder in children: a systematic review and meta-analysis. Osong Public Health and Research Perspectives.
Jones, E. A., & Carr, E. G. (2004). Joint attention in children with autism: Theory and intervention. Focus on autism and other developmental disabilities, 19(1), 13-26.
Kaale, A., Smith, L., & Sponheim, E. (2012). A randomized control trial of preschool-based Joint attention intervention for children with autism. Journal of child Psychology and Psychiatry. 53: 1, 97-105.
Kerig, P.K., Ludlow, A., & Wenar, C. (2012). Developmental psychopathology: from infancy through adolescence (6th ed.). Maidenhead. UK: McGraw-Hill.
Kim, G. Y., Tuck, K. N., J. Malone, E., & Bigelow, K. M. (2025). Coaching Caregivers to Teach Responding to Joint Attention for Toddlers with Autism. Topics in Early Childhood Special Education, 44(4), 263-276.
López-Nieto, L., Compañ-Gabucio, L. M., Torres-Collado, L., & Garcia-de la Hera, M. (2022). Scoping review on play-based interventions in autism spectrum disorder. Children, 9(9), 1355.
Marcella, B., Riccardo, A., Franca, C., Antea, D. A., Mauro, P., Giovanni, M., & Rosalia, D. M. (2025). Joint attention effect on irrelevant stimuli resistance in high functional autism and neurotypical adults. Journal of Behavior Therapy and Experimental Psychiatry, 86, 102005.
Miller, K. (2024). Initiating Joint Attention With Gaze Shift (Doctoral dissertation, The Chicago School of Professional Psychology).
Mundy, P., Kim, K., McIntyre, N., Lerro, L., & Jarrold, W. (2016). Brief report: Joint attention and information processing in children with higher functioning autism spectrum disorders. Journal of autism and developmental disorders, 46, 2555-2560.
Mundy, P., Sullivan, L. & Mastergeorge, A.M. (2009) A parallel and dis- tributed-processing model of joint attention, social cognition and autism. Autism Res., 2, 2–21.
Novita, M., Atmodiwirjo, E. T., & Basaria, D. (2017). The Effectiveness of Child-Centered Play Therapy to Improve Joint Attention Skills in Children with Autism Spectrum Disorder. In The Asian Conference on Education.
Ozdemir, S., Akin-Bulbul, I., & Yildiz, E. (2024). Visual attention in joint attention bids: A comparison between toddlers with autism spectrum disorder and typically developing toddlers. Journal of Autism and Developmental Disorders, 1-20.
Pinto, C. F., Mohan, H., Shenoy, R., Guddattu, V., & Tiwari, S. (2024). The Effect of Parent-Mediated Joint Attention Intervention on Joint Attention and Language Skills in Children with Autism Spectrum Disorder-A Systematic Review. Child & Family Behavior Therapy, 46(3), 272-297.
Paparella, T., & Freeman, S. F. (2015). Methods to improve joint attention in young children with autism: A review. Pediatric Health, Medicine and Therapeutics, 65-78.
Qin, L., Wang, H., Ning, W., Cui, M., & Wang, Q. (2024). New advances in the diagnosis and treatment of autism spectrum disorders. European Journal of Medical Research, 29(1), 322.
Rudy, N.A., Betz, A.M., Malone, E. Henry, J. E., & Chong, I.M. (2014). Effect of jointattention mediated learning for toddlers with autism spectrum disorders. An initial randomized controlled study. Early Childhood Research Quarterly, 28(2).249-258.
Salter, G., & Carpenter, M. (2025). The Developmental Origins of Joint Attention: Infants' Early Joint Attention Bids. Infancy, 30(2), e70012.
Salter, K., Beamish, W., & Davies, M. (2016). The Effects of Child-Centered Play Therapy (CCPT) on the Social and Emotional Growth of Young Australian Children with Autism. International Journal of Play Therapy. 25 (2). 78-90.
Samadi SA, McConkey R. (2015) Screening for Autism in Iranian Preschoolers: Contrasting M-CHAT and a Scale Developed in Iran. Journal of autism and developmental disorders; 45(9):2908-16
Santomauro, D. F., Erskine, H. E., Herrera, A. M. M., Miller, P. A., Shadid, J., Hagins, H., ... & Sankararaman, S. (2025). The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021. The Lancet Psychiatry, 12(2), 111-121.
Schietecatte, I., Roeyers, H. & Warreyn, P. (2012) Can infants’ orientation to social stimuli predict later joint attention skills? Brit. J Dev. Psychol., 30, 267–282.
Shi, W., Le, H. V., & Choo, K. T. W. (2025, April). Towards multimodal large-language models for parent-child interaction: A focus on joint attention. In Proceedings of the Extended Abstracts of the CHI Conference on Human Factors in Computing Systems (pp. 1-6).
Vakilizadeh, Nahid, Abedi, Ahmad, Mohseni Ejei, Alireza, & Pishghadam, Elnaz. (2016). The effectiveness of parent-based early intervention on joint attention (responsiveness) in preschool children with autism spectrum disorder: A single-subject study. Archives of Rehabilitation, 17(1), 42–53. SID. https://sid.ir/paper/43313/fa

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History

  • Receive Date: 13 November 2024
  • Revise Date: 14 May 2025
  • Accept Date: 14 June 2025
  • Publish Date: 22 May 2025

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