Data Sheet 1_Art-based interventions and social–emotional outcomes in children with autism spectrum disorder: a systematic review and meta-analysis with a proposed neurodevelopmental framework.docx

Risk of bias was assessed using RoB 2.0 and ROBINS-I, and Hedges’ g was pooled using random-effects models. Fourteen studies involving 521 participants aged 3–15 years across seven countries were included; 481 participants were children with autism spectrum disorder and 40 were typically developing comparison participants. Twelve studies used a control group and formed the basis of the primary analysis.

Art-based interventions were associated with a small-to-moderate improvement in EI-related social–emotional outcomes (all studies: k = 14, SMD = 0.47, 95% CI [0.30, 0.63], p < 0.001; controlled studies only: k = 12, SMD = 0.46, 95% CI [0.28, 0.64]), with no detectable statistical heterogeneity [I² = 0, 95% prediction interval (0.28, 0.65)]. Exploratory subgroup analyses showed no material difference between multimodal and drawing-focused programs (p = 0.79) and a larger point estimate for interventions lasting 9–16 weeks, but these moderator findings were descriptive and should be interpreted cautiously.

Under the GRADE approach the certainty of the evidence was rated low. Neuroimaging evidence suggests that visual art engagement may support EI through frontoparietal attentional control, graded affective exposure, and prefrontal regulation of limbic reactivity. Direct longitudinal neuroimaging trials are needed to test these proposed mechanisms.</p>