Impact of Sandplay Therapy in Reducing Self-Handicapping Behaviors and Improving the Quality of Life in Children with Autism Spectrum Disorder (ASD)

Abstract

This study aimed to examine the effectiveness of Sandplay Therapy in reducing self-handicapping behaviors and improving the quality of life in children with autism spectrum disorder (ASD). A randomized controlled trial was conducted with 30 children diagnosed with ASD, who were randomly assigned to either the experimental group (n = 15) receiving Sandplay Therapy or the control group (n = 15) receiving no intervention. The intervention consisted of eight 90-minute sessions conducted over eight weeks. Self-handicapping behaviors were measured using the Self-Handicapping Scale (SHS), and quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL), both of which demonstrated established validity and reliability. Assessments were conducted at pre-test, post-test, and five-month follow-up. Data were analyzed using repeated-measures ANOVA, with post-hoc comparisons conducted using the Bonferroni test. The results indicated a significant reduction in self-handicapping behaviors in the experimental group from pre-test (M = 42.85, SD = 4.31) to post-test (M = 31.76, SD = 3.76) and further at follow-up (M = 29.45, SD = 3.45), while no significant changes were observed in the control group. Similarly, quality of life improved significantly in the experimental group, with scores increasing from pre-test (M = 52.12, SD = 5.12) to post-test (M = 63.45, SD = 4.78) and follow-up (M = 67.32, SD = 4.50), whereas the control group remained stable. ANOVA results confirmed significant main effects of time and group, as well as a significant interaction effect (p < 0.05). Bonferroni post-hoc comparisons indicated that improvements were sustained at follow-up. Sandplay Therapy is an effective intervention for reducing self-handicapping behaviors and enhancing the quality of life in children with ASD, with sustained benefits observed at follow-up. These findings highlight the potential of nonverbal, expressive therapies in supporting emotional regulation and adaptive functioning in children with ASD.