A pilot randomized controlled study of a digital art therapy paradigm for children with ASD: integrating pivotal response treatment into video animation and physical model design.

BACKGROUND

The integration of digital technology into art therapy for children with autism spectrum disorder (ASD) represents an emerging trend, yet systematic design frameworks that translate evidence-based interventions into digital media remain underdeveloped. This study developed and evaluated a digital art therapy paradigm that structurally integrates pivotal response treatment (PRT) into video animation design while maintaining cross-media consistency with physical generalization tools.

METHODS

Based on the behavioral characteristics of children with ASD, 12 sets of video animations integrating PRT and corresponding physical scene models were custom developed. Thirty-eight children with mild to moderate ASD were randomly assigned to an intervention group (PRT-based video animation with physical models, n=19) and a control group (conventional video animation, n=19) for a 12-week intervention. Pre- and postintervention assessments were conducted using four dimensions of the Autism Treatment Evaluation Checklist (ATEC) and behavioral observation.

RESULTS

Compared with the control group, the intervention group demonstrated significantly greater improvements across all ATEC dimensions (language communication: F(1,36) = 67.74, p < 0.001, ηp² = 0.755; social skills, F(1,36) = 80.69, p < 0.001, ηp² = 0.786; sensory/cognitive awareness: F(1,36) = 55.69, p < 0.001, ηp² = 0.717; health/physical behavior, F(1,36) = 36.94, p < 0.001, ηp² = 0.627. The percentage of children who reported " no observable behavioral response" in the intervention group decreased from 35% to 10%.

CONCLUSIONS

This pilot randomized controlled study provides preliminary evidence for the feasibility and efficacy of a multi-component, PRT-informed digital and physical intervention package for children with ASD. The intervention is characterized by three design principles: (1) theoretical translation--embedding the structured steps of PRT into digital interaction logic; (2) cross-media consistency--maintaining visual and functional coherence between video animations and physical generalization tools; and (3) progressive scaffolding--sequencing intervention content from foundational cognition to complex social skills. These findings offer a preliminary design framework for the development of digital art therapy interventions for children with ASD. Future large-checklist replication studies are needed to further validate this approach.