Original Article

Effects of Image-Sandplay Therapy on the Mental Health and Subjective Well-Being of Children with Autism


Background: Autism significantly affects mental health and lowers subjective well-being (SWB). The rehabilitation therapy of autism is attracting widespread attention. We aimed to explore the effects of image-sandplay therapy on the mental health and SWB of children with autism.

Methods: A total of 90 children with autism treated in Changchun Women and Children Health Hospital from Jan 2019 to Jun 2020 were enrolled by convenient sampling method. They were randomly divided into control (n=45) and observation (n=45) groups. The observation group had a 12-week image-sandplay therapy based on conventional rehabilitation therapy. In the image-sandplay therapy, the one-to-one intervention was provided once a week, 60 min in each. Autism treatment evaluation checklist (ATEC), autism behavior checklist (ABC), Conners parent symptom questionnaire (PSQ), satisfaction with life scale (SWLS), and positive and negative affect scale for children (PANAS-C) of the two groups were assessed.

Results: After intervention, the observation group showed lower scores in ATEC scale and ABC scale than the control group, and the difference show statistical significance (P<0.05). Meanwhile, the observation group showed significantly lower scores in PSQ scale than the control group, showing a significant difference (P<0.05). The observation group shows higher scores in SWLS scale and positive affect scores than the control group, as well as significantly lower negative affected scores than the control groups, showing a significant difference (P<0.05).

Conclusion: Image-sandplay therapy can improve the symptoms of children with autism and is conducive to promoting mental health and increasing SWB. It is a feasible and effective rehabilitation method.

1. Kim IH, Kuk TS, Sang YP, Choi YS, Seo KS (2017). Prognosis following dental implant treatment under general anesthe-sia in patients with special needs. J Dent Anesth Pain Med, 17(3):205-13.
2. Ross LA, Del B, Molholm S, Frey HP, Foxe JJ (2015). Sex differences in multisensory speech processing in both typically de-veloping children and those on the au-tism spectrum. Front Neurosci, 9:185.
3. Liu TL, Chen G, Wen X, Zheng XY (2017). Trend of treatment and rehabilitation rates among people with psychiatric disa-bility from 2007 to 2013 in China. Chin Ment Health J, 31(3):195-202.
4. Gallego-Blasco VS, Martorell-Alsina SS, Sanchez-Galdon AI (2020). Analysis of trends and breakpoints in the evolution of occupational health indicators in Spain, in the period 1995 to 2017. Dyna-Bilbao, 95(1): 39-42.
5. Ruiz-Robledillo N, Moya-Albiol L (2015). Effects of a cognitive-behavioral inter-vention program on the health of care-givers of people with autism spectrum disorder. Psychosoc Interv, 24(1):33-9.
6. Friedman L, Sterling A (2019). A review of language, executive function, and inter-vention in autism spectrum disorder. Semin Speech Lang, 40(4): 291-304.
7. Wang YX, Lu GB, Ge P, et al (2019). Clini-cal efficacy of interactive group sandplay versus individual sandplay in the treat-ment of preschool children with autism spectrum disorder. Zhongguo Dang Dai Er Ke Za Zhi , 21(4):342-7.
8. Bejn H, Johansson S, Ramner J, Cepeda R (2018). Emergent language responses fol-lowing match-to-sample training among children with autism spectrum disorder. Int J Psychol Ther, 18(1):1-14.
9. Ho MH, Lin LY (2020). Efficacy of parent-training programs for preschool children with autism spectrum disorder: A ran-domized controlled trial. Res Autism Spect Dis, 71:101495.
10. Smith E, Toms P, Constantin A, Johnson H, Brosnan M. (2020). Piloting a digitally-mediated social story intervention for au-tistic children led by teachers within natu-ralistic school settings. Res Autism Spect Dis, 75:101533.
11. Zu YF, Xu G, Du YS, Xi J, Chen YT, Li YH (2019). Psychoeducational interven-tion improves chinese mothers’ parenting and symptoms of their autistic children. Soc Behav Pers Int J, 47: 112.
12. Jun J (2019). Cognitive behavior intervention on communication ability of autistic chil-dren. Adv Soc Sci, 8(3):430-6.
13. Alenezi A, Hassan A, Amr ES, Alsolais A (2021). Impact of cognitive-behavioral therapy on daily living skills of high func-tioning autistic children with anxiety dis-orders. Nusant Biosci, 13(1):115.
14. Palmer M, Joanne T, Perez JP, et al (2019). A novel group parenting intervention to re-duce emotional and behavioural difficul-ties in young autistic children: protocol for the Autism Spectrum Treatment and Resilience pilot randomised controlled trial. BMJ Open, 9(6): e029959.
15. Sim HO (2020). A case study of sandplay therapy for a middle-aged woman who goes the way of individuation through conflicts with an adolescent son. Fam En-viron Res, 58(2):239-53.
16. Liu GH, Huang LS, Qian QF, Wang YX, Ge P (2019). Curative effect of progres-sively integrated sandplay therapy on core symptoms and sleep management in pre-school children with mild-to-moderate autism spectrum disorder. Zhongguo Dang Dai Er Ke Za Zhi, 21(8):743-8.
17. Dobretsova A, Wiese E (2019). Sandplay: psychotrauma signs in asylum seeking adolescents. J Infant Child Adoles Psychoth, 1-14.
18. Han YJ, Chang JS, Yang SY (2019). The ef-fects of group sand-play program on self-perceived competence and ego-resilience in siblings of children with dis-abilities. J Korean Home Manag Assoc, 37(1):163-177.
19. Zhang PY, Huang F, Wang L, Chen X (2019). Effect of sandplay combined with rehabilitation training on language retar-dation in children. Anhui Med Pharm J, 23(12):2432-5.
20. Freire MH, André AM, Kummer AME (2018). Test-retest reliability and concur-rent validity of autism treatment evalua-tion checklist (atec). J Bras Psiquiatr, 67(1): 63.
21. Valicenti-Mcdermott M, Lawson K, Hot-tinger K,et al (2015). Parental stress in families of children with autism and other developmental disabilities. J Child Neurol, 30(13):1728-35.
22. Fan J, Du YS, Wang LW (2005). The norm and reliability of the Conners Parent Symptom Questionnaire in Chinese ur-ban children, Shahghai Arch Psychiat, 17(6):321-3.
23. Liu RD, Shen CX, Le X, Qin G (2013). Children’s Internet information seeking, life satisfaction, and loneliness: The me-diating and moderating role of self-esteem. Comput Educ, 68:21-8.
24. Pan TT, Ding XC, Sang B, et al (2015). Reli-ability and validity of the chinese version of the positive and negative affect scale for children, Chin J Clin Psychol, 23(3):397-400.
25. Mcclain RL, Porter SB, Arnold SM, Robards, CB (2017). Peripheral nerve blocks and postoperative physical thera-py: a single-institution survey of physical therapists’ preferences and opinions. Rom J Anaesth Intensive Care, 24(2):115-24.
26. Wang MJ, Liu JX, Luo QH, Qiu T, Zheng AH (2017). Study on rehabilitation inter-vention of Sandplay combined with mu-sic therapy for children with autism. Chin J Control Endemic Dis, 32(2):232-3.
27. Boyd BA , Watson LR , Reszka SS ,et al (2018). Efficacy of the ASAP intervention for preschoolers with ASD: A cluster randomized controlled trial. J Autism Dev Disord, 48(9):3144-62.
28. Lagutina L, Sperlinger D, Esterhuyzen A (2013). Addressing psychological aspects of physical problems through sandplay: A grounded theory study of therapists’ views. Psychol Psychother, 86(1):105-24.
29. Peng LJ, Yu WY, Hou XQ, Xiao N (2017). Effect of Sandplay Therapy on mental disorders of children with cerebral palsy. Chin J Phys Med Rehabil, 39(11):845-7.
30. Mathew NE, Burton K, Schierbeek A, Črnčec R, Eapen V (2019). Parenting pre-schoolers with autism: Socioeconomic in-fluences on wellbeing and sense of com-petence. World J Psychiatry, 9(2): 30-46.
31. Liu W, Mei J, Tian L, Huebner ES (2016). Age and gender differences in the rela-tion between school-related social sup-port and subjective well-being in school among students. Soc Ind Res, 125(3):1065-83.
32. Teiko KUME (2017). Practice of sandplay in a nursery school the essence of sandplay discovered at the common ground of psychotherapy and childcare. Arch Sandplay Ther, 29(3):65-76.
33. Angeles TMDL, Claudia C (2017). Change during psychotherapy through sand play tray in children that have been sexually abused. Front Psychol, 8:617.
IssueVol 50 No 10 (2021) QRcode
SectionOriginal Article(s)
Image-sandplay therapy Autism Children Mental health Subjective well-being

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Guo J, Li D. Effects of Image-Sandplay Therapy on the Mental Health and Subjective Well-Being of Children with Autism. Iran J Public Health. 2021;50(10):2046-2054.