Art therapy interventions and developmental outcomes in children with ASD: a systematic review

Although the prevalence of autism spectrum disorder (ASD) has increased globally, evidence-based interventions that address both emotional and social dimensions in low-cost, real-world settings remain limited. Art therapy, characterized by nonverbal and multisensory engagement, has been applied in clinical and educational contexts for children with ASD. However, recent studies have largely emphasized overall outcomes, with limited synthesis of intervention processes and research trends. This systematic review followed PRISMA 2020 guidelines. A search of Web of Science, Scopus, and PubMed identified 915 records, of which 22 empirical studies (2016-July 2025) were included, covering quantitative, qualitative, and mixed-method designs involving art therapy interventions for children with ASD. Study characteristics were extracted and synthesized using a narrative thematic synthesis approach. The findings identify four recurring themes: (1) Emotional Expression and Regulation, (2) Social Skills Development, (3) Creative and Nonverbal Processes, and (4) Sensory and Relational Integration. Across studies, interventions commonly involved multisensory art-making, nonverbal expression, and relational engagement within structured social contexts. Building on these four themes, the Creative-Relational Art Therapy Framework (CRATF) is proposed as a preliminary conceptual framework that integrates emotional, social, creative, and sensory-relational aspects, offering a basis for future intervention design and empirical evaluation in clinical and educational settings.