Evaluating the Effectiveness of Art Therapy on Autism Severity, Emotional Regulation, and Anger Control Among 6- to 17-Year-Old Individuals with Autism Spectrum Disorders in Western Iran

Evaluating the Effectiveness of Art Therapy on Autism Severity, Emotional Regulation, and Anger Control Among 6- to 17-Year-Old Individuals with Autism Spectrum Disorders in Western Iran | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating the Effectiveness of Art Therapy on Autism Severity, Emotional Regulation, and Anger Control Among 6- to 17-Year-Old Individuals with Autism Spectrum Disorders in Western Iran Farzaneh Baroonian, Helen Behmanesh, Saeid Yazdi-Ravandi, Mahdieh Seyedi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7924120/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: According to various studies, art therapy can be helpful for emotion regulation and anger control in children and adolescents with autism spectrum disorders (ASD). However, sufficient research, particularly involving Iranian individuals with autism, is lacking. Therefore, the present study aimed to investigate the effectiveness of art therapy on autism severity, emotion regulation, and anger control in individuals aged 6 to 17 years diagnosed with autism spectrum disorders. Methods: In this clinical trial, 30 children (12 boys and 3 girls in each group) diagnosed with autism spectrum disorders based on DSM-5 criteria were evaluated. The intervention group underwent art therapy in 10 sessions over 5 weeks, with each session lasting 90 minutes. The control group received only routine care similar to the intervention group. Before and after the intervention, participants were assessed using the Childhood Autism Rating Scale (CARS), Gilliam Autism Rating Scale (GARS), State-Trait Anger Expression Inventory (STAXI-2), and Emotion Regulation Checklist. Data were statistically analyzed using SPSS version 24 at a significance level of 0.05. Results: The mean age of children was 10.3 ± 2.4 years, ranging from 7 to 14 years. In both study groups, the mean severity of anger, emotion dysregulation, and autism before the intervention did not show statistically significant differences (p > 0.05). The mean autism severity, measured by both scales (CARS and GARS), emotion regulation checklist scores, and anger control scores in the intervention group demonstrated a statistically significant difference at the end of the intervention and were lower compared to the control group (p < 0.05). Conclusion: Art therapy, in addition to conventional treatments, may be effective in individuals under 18 years of age with autism spectrum disorders due to reductions in disease severity, emotional dysregulation, and anger. However, studies with larger sample sizes and longer follow-up periods are necessary to confirm the results of this study. Current study is registered with the Iranian Clinical Trials Center under the registration number IRCT20151123025202N40 on 2024-09-04. autistic art therapy Emotion Regulation Anger Introduction Autism spectrum disorder (ASD) is a heterogeneous condition with varying symptom severity, which complicates early diagnosis [ 1 ]. The essential diagnostic feature is persistent deficits in communication skills and social interaction, such as impairments in emotional expression, recognition and attention toward others, and the use of verbal and nonverbal communication [ 2 , 3 ]. Other characteristics include difficulties with emotion regulation, alexithymia, limited emotional language, poor flexibility, low inhibition, and weaknesses in problem-solving, and sensitivity to environmental changes [ 4 ]. Emotion regulation is a mechanism by which individuals modify their emotions in order to achieve their goals [ 5 ]. Individuals with ASD tend to use maladaptive strategies such as avoidance and crying more often for emotion regulation, while using adaptive strategies like cognitive reappraisal less frequently [ 6 ]. Consequently, they may exhibit irritability, uncontrolled tantrums, aggression, and self-injurious behaviors [ 7 ]. Anger is another characteristic of this disorder, and children with autism frequently have difficulty controlling it [ 8 ]. Methods This study was a quasi-experimental design conducted in 2023 at Sina Hospital and the Autism Association in the city of Hamedan. The research population consisted of children and adolescents aged 6 to 17 years diagnosed with autism spectrum disorder (ASD). The diagnosis of autism was made based on the evaluation of a child and adolescent psychiatry subspecialist using DSM-5 criteria and the Childhood Autism Rating Scale (CARS). The study sample included 15 individuals with ASD, selected by convenience sampling from the clients of the Autism Association center in Hamedan and the pediatric psychiatry specialty clinic of Sina Hospital. The required sample size for this study was determined based on prior studies [ 9 ] and with reference to Dr. Ali Delavar's guidelines on statistical methods in psychology, which state that for quasi-experimental behavioral and psychological studies, a minimum of 12 to 15 participants is sufficient. Considering the limited number of individuals with ASD, a sample size of 15 was deemed appropriate for this study. Data collection tools included the Childhood Autism Rating Scale (CARS), which comprises 15 items measuring autism severity with a total score range from 15 to 60. Scores of 30 or above indicate autism diagnosis, with scores between 30 and 36 representing mild to moderate autism, and scores from 36 to 60 indicating severe autism. This scale has been used and validated in Iran and several other countries. Additionally, the Gilliam Autism Rating Scale-Third Edition (GARS-3), developed by Gilliam (2014), consisting of 56 items scored on a 4-point Likert scale (0 to 3), was employed. This questionnaire includes six subscales: repetitive/restrictive behaviors, social interaction, social communication, emotional responses, cognitive style, and inconsistent speech [ 10 ]. To assess emotion regulation processes and emotional instability, the Emotion Regulation Checklist was used, consisting of 24 items divided into two subscales: emotion regulation (8 items) and lability/negativity (16 items). Melina et al. (2014) reported Cronbach’s alpha coefficients of 0.79 for emotion regulation and 0.90 for lability/negativity. Mahmoudi et al. (1970) validated the Persian version of this instrument, demonstrating its reliability and validity [ 11 ]. For the assessment of anger, the State-Trait Anger Expression Inventory-2 (STAXI-2) was employed, comprising 57 items across three sections: state anger, trait anger, and anger expression and control. It is scored on a 4-point Likert scale. Reliability of the questionnaire in the Iranian population was confirmed by Navidi (2006) with a Cronbach's alpha above 0.70 [ 12 ]. Inclusion criteria for this study were a diagnosis of ASD based on DSM-5 and CARS, age between 6 and 17 years, informed parental consent, and absence of chronic kidney, liver, or neurological diseases in the participant. Participants who had received similar interventions in the past six months, had serious limiting illnesses, or were unwilling to continue participation were excluded. The intervention consisted of 10 art therapy sessions (twice a week, each session lasting 90 minutes). Art therapy activities included individual and group painting using colored pencils, watercolors, crayons, and markers, clay sculpture creation, group discussions, and targeted activities focused on emotional expression, social interaction, and self-awareness. The art therapy approach in this study was based on a theoretical framework adapted from art therapy models [ 9 ]. Participants were randomly assigned to intervention and control groups using 30 cards: 15 marked (I) for the intervention group and 15 marked (C) for the control group. Upon the participant's entry into the research location, one card was randomly selected and opened; based on the letter inside, the participant was assigned to either the art therapy or control group. Pretest and posttest data (with a two-month follow-up) were collected and analyzed using SPSS version 24. The Wilcoxon signed-rank test was used to compare pre- and post-intervention results. A significance level of less than 0.05 was considered statistically significant. This study was conducted with coordination and approval from the University of Medical Sciences Ethical Committee under the code IR.UMSHA.REC.1403.096. Written informed consent was obtained from the guardians of the individuals with autism before the study. Data were reported in aggregate and anonymously, ensuring full confidentiality. This study is registered with the Iranian Clinical Trials Center under the registration number IRCT20151123025202N40. Results In this quasi-experimental study, the mean ages of the intervention and control groups did not differ significantly (10.3 and 10.2 years, respectively; P = 0.932), and in both groups, 80% of participants were male (each group included 3 females and 12 males). According to the results from GARS and CARS tests, no statistically significant difference was observed between the intervention and control groups regarding autism severity before the intervention (CARS: P = 0.234, GARS: P = 0.692). However, after the intervention, a significant difference in disease severity was found between the intervention and control groups (CARS: P = 0.049, GARS: P = 0.048) (Table 1 ). Table 1 – Comparison of autism severity between intervention and control groups before and after intervention Variable Control Group (Mean ± SD) Intervention Group (Mean ± SD) P (Mann–Whitney) Pre-Intervention CARS 47/0 ± 5.8 48.7 ± 5.4 0.234 GARS 90.5 ± 19. 9 88.6 ± 20.2 0.692 Post-Intervention CARS 46.1 ± 5.5 42.3 ± 6.1 0.049 GARS 87. 7 ± 20.4 73.4 ± 15.9 0.048 Regarding anger severity, no significant difference was observed between the groups before the intervention (P = 0.967), but post-intervention, the difference was statistically significant (P = 0.039), with a meaningful reduction in the intervention group (Table 2 ). Table 2 – Comparison of anger control between intervention and control groups before and after intervention Anger Control Control Group (Mean ± SD) Intervention Group (Mean ± SD) P (Mann–Whitney) Pre- Intervention 106. 0 ± 30.8 106.3 ± 31.3 0.967 Post- Intervention 104. 9 ± 29.1 85.8 ± 14.1 0.039 The severity of emotion regulation showed no significant differences between the two groups before the study, but at the end of the intervention, a significant decrease was observed in the intervention group compared to the control group (Table 3 ). Table 3 – Comparison of emotion regulation severity between intervention and control groups before and after intervention Emotion Regulation Control Group (Mean ± SD) Intervention Group (Mean ± SD) P (Mann–Whitney) Pre-Intervention 68.2 ± 10.5 70.3 ± 10.5 0.505 Post- Intervention 67.9 ± 11.8 60.0 ± 8.5 0.048 In this study, no significant differences were found in autism severity, anger control, or emotion regulation by gender either before or after the intervention (P > 0.05) (Table 4 ). Table 4 – Comparison of autism severity, emotion regulation, and anger control by gender before and after intervention Variable Female (Mean ± SD) Male (Mean ± SD) P (Wilcoxon signed-rank) CARS Pre- Intervention 50.6 ± 1.1 48.2 ± 5.6 0.942 Post- Intervention 44.3 ± 0.6 41.8 ± 6.8 0.612 GARS Pre- Intervention 86.0 ± 22.5 89.2 ± 20.6 0.827 Post- Intervention 73.3 ± 18.9 73.4 ± 16.1 0.885 Anger Control Pre- Intervention 111.3 ± 37.8 105.1 ± 30.9 0.469 Post- Intervention 86.7 ± 7.7 85.6 ± 15.4 0.514 Emotion Regulation Pre- Intervention 70.0 ± 10.5 69.8 ± 11.8 0.884 Post- Intervention 61.7 ± 2.9 59.6 ± 9.5 0.885 Discussion Considering the increasing incidence and prevalence of autism, efforts to identify therapeutic methods that can better empower affected children and reduce their disease severity are valuable. Among therapeutic approaches, non-pharmacological methods can be especially helpful when effective due to their lack of side effects. Art therapy is currently one of the most common interventions used alongside conventional treatments for individuals with autism spectrum disorder [ 13 , 14 ]. The findings of the present study showed that art therapy delivered over two months for individuals with autism can be an effective method, in addition to routine therapies, by reducing disease severity and improving emotion and anger regulation in children. Multiple studies with various designs have examined the effects of art therapy on individuals with autism, yielding results consistent with those of the present study. For example, Khodadadi et al. (2018) in Isfahan demonstrated that art therapy using a painting approach had a significant effect on participants’ facial emotion recognition scores after eight training sessions compared to the control group, which aligns with the present findings [ 15 ]. In the study by Zadeh Mohamadi et al. (2023) twenty mothers and children with ASD attending the Special Needs Children’s Education and Research Clinic at Shahid Beheshti University were randomly assigned to experimental and control groups of ten. Both groups completed the Gilliam Autism Rating Scale at three time points: pre-intervention, post-intervention, and two months after intervention. Their findings indicated that a mother-focused art therapy program significantly improved core problems in children with ASD in the intervention group [ 16 ]. According to a systematic review by Moradikelardeh et al. (2022) this approach has substantial potential to assist autistic children in addressing sensory, communication, and motor difficulties [ 17 ]. In a study conducted by Bakhshi et al.(2018) in Zanjan, 26 children aged 6 to 22 with ASD underwent 44 art therapy sessions over four months. Their results showed that art therapy had a significant effect on emotion regulation and behavioral flexibility (p ≤ 0.001), supporting the use of art therapy as a complementary treatment method for emotion regulation and behavioral flexibility in children with ASD [ 18 ]. A meta-analysis by Bosgraaf et al. (2020), reviewing 37 studies, found that various forms of art therapy produced positive psychosocial outcomes in children with autism [ 19 ]. Similarly, a 2014 systematic review by Schweizer et al. (2014) indicated that art therapy can reduce autism severity, consistent with the present study [ 20 ]. Case et.al (2008) also reported that art therapy, employing diverse artistic tools, can improve cognitive, perceptual, emotional, behavioral, communicative, linguistic, and motor problems in children with special needs, thus enhancing their learning [ 21 ]. Despite the noted benefits of art therapy for individuals with autism, this intervention requires trained practitioners and is time-consuming, which may pose challenges for implementation in some autism centers. Art therapists must be familiar with the unique characteristics of each child and collaborate with pediatric occupational therapists to understand specific sensory issues [ 22 ]. Based on previous studies, autism prevalence is higher in males than females, which was also observed in the present study. No significant differences were found regarding severity and control of anger and emotion before and after the intervention between boys and girls, which may be due to the relatively small sample size, especially among females. Conclusion The findings of this study demonstrated that art therapy can be an effective non-pharmacological approach for individuals with autism by reducing disease severity and improving anger and emotion regulation. Therefore, based on these and other studies’ findings, art therapy is accepted as a complementary and alternative treatment with clinically acceptable effects for patients with autism. It is recommended to implement art therapy in rehabilitation centers and schools for autism. Due to limitations of this study related to short-term follow-up caused by impatience and aggression in participants with autism, further research with larger sample sizes and meta-analyses is advised. Declarations Acknowledgments The authors would like to thank the Research Vice-Chancellor of Hamadan University of Medical Sciences for supporting this research, Clinical Research Development Unit of Farshchian Heart Hospital, Hamadan University of Medical Sciences, Hamadan, Iran for their assistance throughout the period of study, which is a part of the doctorate’s thesis on medicine international branch, as well as the staff and administrators of Autism Association Center and the pediatric psychiatry specialty clinic of Sina Hospital in Hamadan and all the participating in this study. Authors’ Contribution: Conceptualization: Helen Behmanesh, Saeid Yazdi-Ravandi, Farzaneh Baroonian. Data curation: Farzaneh Baroonian, Helen Behmanesh. Formal analysis: Behnaz Alafchi. Funding acquisition: Helen Behmanesh, Saeid Yazdi-Ravandi. Investigation: Helen Behmanesh, Saeid Yazdi-Ravandi, Mahdieh Seyedi, Mona Doostizadeh, Farzaneh Baroonian. Methodology: Behnaz Alafchi, Helen Behmanesh, Saeid Yazdi-Ravandi, Mahdieh Seyedi, Mona Doostizadeh, Farzaneh Baroonian. Project administration: Helen Behmanesh, Saeid Yazdi-Ravandi. Resources: Helen Behmanesh, Saeid Yazdi-Ravandi, Farzaneh Baroonian. Software: Behnaz Alafchi. Supervision: Helen Behmanesh, Saeid Yazdi-Ravandi. Validation: Helen Behmanesh, Saeid Yazdi-Ravandi, Mahdieh Seyedi, Mona Doostizadeh, Behnaz Alafchi. Visualization: Helen Behmanesh, Tahere Etesamifard, Farzaneh Baroonian. Writing–original draft: Tahere Etesamifard, Helen Behmanesh. Writing–review & editing: Tahere Etesamifard, Helen Behmanesh, Saeid Yazdi-Ravandi, Mahdieh Seyedi, Mona Doostizadeh. Behnaz Alafchi. Farzaneh Baroonian. Competing Interests None. Ethical Approval and Clinical Trial Registry This study was approved by the Ethics Committee of Hamadan University of Medical Sciences (ethical code IR.UMSHA.REC.1403.096). All ethical standards, including obtaining permits, written consent, permission to withdraw at any time in case of unwillingness to continue cooperation in the study, statement of study objectives, and confidentiality of information, were observed in this study. This study is registered with the Iranian Clinical Trials Center under the registration number IRCT20151123025202N40 on 2024-09-04. Funding This study was financially supported by Research Vice-Chancellor of Hamadan University of Medical Sciences as grant ID: 140310048704. References Lai MC, Lombardo MV, Baron-Cohen S, Autism. Lancet. 2014;383(9920):896–910. Mehra C, Sil A, Hedderly T, Kyriakopoulos M, Lim M, Turnbull J, et al. Childhood disintegrative disorder and autism spectrum disorder: a systematic review. Dev Med Child Neurol. 2019;61(5):523–34. Fombonne E. Epidemiology of autistic disorder and other pervasive developmental disorders. J Clin Psychiatry. 2005;66(Suppl 10):3–8. Masi A, DeMayo MM, Glozier N, Guastella AJ. An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options. Neurosci Bull. 2017;33(2):183–93. Malchiodi CA. Handbook of art therapy. Guilford Press; 2011. Sampurno MBT, Prabandari YS, Marianto MD. Theoretical Exploration of Art Therapy and Education for Autistic Children. IJIET (International J Indonesian Educ Teaching). 2020;4(2):260–76. Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, et al. Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries. 2018;67(6):1. Ciernia AV, LaSalle J. The landscape of DNA methylation amid a perfect storm of autism aetiologies. Nat Rev Neurosci. 2016;17(7):411–23. Maenner MJ, Graves SJ, Peacock G, Honein MA, Boyle CA, Dietz PM. Comparison of 2 case definitions for ascertaining the prevalence of autism spectrum disorder among 8-year-old children. Am J Epidemiol. 2021;190(10):2198–207. Gilliam JE. Gilliam Autism Rating Scale– Third Edition (GARS-3). Austin, TX: Pro-Ed; 2014. Mahmoudi M, Borjali A, Alizadeh H, Ghobari-Bonab B, Ekhtiari H, Akbari-Zardkhaneh S. Emotion regulation in children with learning disorders and normal children. Res school virtual Learn. 1970;4(13):69–84. Navidi A. Testing the effect of anger management training on anger self-regulation skills adaptability and general health of boys in Tehran secondary school [PhD Thesis]. Allameh Tabatabaei University of Tehran. 2006. Vogel SW, Mullins KL, Kumar S. Art therapy for children and adolescents with autism: a systematic review. Int J Art Therapy. 2024:1–10. Jalambadani Z. Art therapy based on painting therapy on the improvement of autistic children's social interactions in Iran. Indian J Psychiatry. 2020;62(2):218–9. Khodadadi N. Effectiveness of art therapy with painting approach on facial emotional expression recognition of children with high-functioning autism spectrum disorder. Empower Except Child. 2018;9(1):89–98. Zadeh Mohamadi K, Heydari M. The Effectiveness of Mother-Based Art Therapy on Stereotypic Behaviors, Verbal Skills and Social Interactions of Children with Autism Spectrum Disorders. Appl Psychol. 2023;17(1):126–07. Moradikelardeh P, Narimani M. Application of Art Therapy in Autism Spectrum Disorders; The Features and Logic of Therapy (A Systematic Review Study). Rooyesh-e-Ravanshenasi J (RRJ). 2022;11(1):47–58. Bakhshi M, Morovati Z, Elahi T, Shahmohamadian S. Effectiveness of Art Therapy on Social-Communication Skills, Flexibility Behavioral and Emotion Regulation in Children with Autism Spectrum Disorder. Psychol Except Individuals. 2018;8(30):155–77. Bosgraaf L, Spreen M, Pattiselanno K, Hooren S. Art therapy for psychosocial problems in children and adolescents: A systematic narrative review on art therapeutic means and forms of expression, therapist behavior, and supposed mechanisms of change. Front Psychol. 2020;11:2389. Schweizer C, Knorth EJ, Spreen M. Art therapy with children with Autism Spectrum Disorders: A review of clinical case descriptions on ‘what works’. Arts Psychother. 2014;41(5):577–93. Case C, Dalley T. Art therapy with children: From infancy to adolescence. Routledge; 2008. Akridge JM. The Benefits of Creative Art Therapy for Youth with Autism Spectrum Disorder: A Review of the Literature. 2021. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7924120","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549374073,"identity":"0f1e9ad3-5d17-44e5-88b1-46e397e00662","order_by":0,"name":"Farzaneh Baroonian","email":"","orcid":"","institution":"Hamadan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Farzaneh","middleName":"","lastName":"Baroonian","suffix":""},{"id":549374074,"identity":"db2feb32-a985-4b04-9846-01c7c89304e8","order_by":1,"name":"Helen 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Iran","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAutism spectrum disorder (ASD) is a heterogeneous condition with varying symptom severity, which complicates early diagnosis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The essential diagnostic feature is persistent deficits in communication skills and social interaction, such as impairments in emotional expression, recognition and attention toward others, and the use of verbal and nonverbal communication [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Other characteristics include difficulties with emotion regulation, alexithymia, limited emotional language, poor flexibility, low inhibition, and weaknesses in problem-solving, and sensitivity to environmental changes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Emotion regulation is a mechanism by which individuals modify their emotions in order to achieve their goals [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Individuals with ASD tend to use maladaptive strategies such as avoidance and crying more often for emotion regulation, while using adaptive strategies like cognitive reappraisal less frequently [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Consequently, they may exhibit irritability, uncontrolled tantrums, aggression, and self-injurious behaviors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Anger is another characteristic of this disorder, and children with autism frequently have difficulty controlling it [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was a quasi-experimental design conducted in 2023 at Sina Hospital and the Autism Association in the city of Hamedan. The research population consisted of children and adolescents aged 6 to 17 years diagnosed with autism spectrum disorder (ASD). The diagnosis of autism was made based on the evaluation of a child and adolescent psychiatry subspecialist using DSM-5 criteria and the Childhood Autism Rating Scale (CARS). The study sample included 15 individuals with ASD, selected by convenience sampling from the clients of the Autism Association center in Hamedan and the pediatric psychiatry specialty clinic of Sina Hospital. The required sample size for this study was determined based on prior studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and with reference to Dr. Ali Delavar's guidelines on statistical methods in psychology, which state that for quasi-experimental behavioral and psychological studies, a minimum of 12 to 15 participants is sufficient. Considering the limited number of individuals with ASD, a sample size of 15 was deemed appropriate for this study.\u003c/p\u003e\u003cp\u003eData collection tools included the Childhood Autism Rating Scale (CARS), which comprises 15 items measuring autism severity with a total score range from 15 to 60. Scores of 30 or above indicate autism diagnosis, with scores between 30 and 36 representing mild to moderate autism, and scores from 36 to 60 indicating severe autism. This scale has been used and validated in Iran and several other countries. Additionally, the Gilliam Autism Rating Scale-Third Edition (GARS-3), developed by Gilliam (2014), consisting of 56 items scored on a 4-point Likert scale (0 to 3), was employed. This questionnaire includes six subscales: repetitive/restrictive behaviors, social interaction, social communication, emotional responses, cognitive style, and inconsistent speech [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo assess emotion regulation processes and emotional instability, the Emotion Regulation Checklist was used, consisting of 24 items divided into two subscales: emotion regulation (8 items) and lability/negativity (16 items). Melina et al. (2014) reported Cronbach\u0026rsquo;s alpha coefficients of 0.79 for emotion regulation and 0.90 for lability/negativity. Mahmoudi et al. (1970) validated the Persian version of this instrument, demonstrating its reliability and validity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor the assessment of anger, the State-Trait Anger Expression Inventory-2 (STAXI-2) was employed, comprising 57 items across three sections: state anger, trait anger, and anger expression and control. It is scored on a 4-point Likert scale. Reliability of the questionnaire in the Iranian population was confirmed by Navidi (2006) with a Cronbach's alpha above 0.70 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInclusion criteria for this study were a diagnosis of ASD based on DSM-5 and CARS, age between 6 and 17 years, informed parental consent, and absence of chronic kidney, liver, or neurological diseases in the participant. Participants who had received similar interventions in the past six months, had serious limiting illnesses, or were unwilling to continue participation were excluded.\u003c/p\u003e\u003cp\u003eThe intervention consisted of 10 art therapy sessions (twice a week, each session lasting 90 minutes). Art therapy activities included individual and group painting using colored pencils, watercolors, crayons, and markers, clay sculpture creation, group discussions, and targeted activities focused on emotional expression, social interaction, and self-awareness. The art therapy approach in this study was based on a theoretical framework adapted from art therapy models [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Participants were randomly assigned to intervention and control groups using 30 cards: 15 marked (I) for the intervention group and 15 marked (C) for the control group. Upon the participant's entry into the research location, one card was randomly selected and opened; based on the letter inside, the participant was assigned to either the art therapy or control group.\u003c/p\u003e\u003cp\u003ePretest and posttest data (with a two-month follow-up) were collected and analyzed using SPSS version 24. The Wilcoxon signed-rank test was used to compare pre- and post-intervention results. A significance level of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003e This study was conducted with coordination and approval from the University of Medical Sciences Ethical Committee under the code IR.UMSHA.REC.1403.096. Written informed consent was obtained from the guardians of the individuals with autism before the study. Data were reported in aggregate and anonymously, ensuring full confidentiality. This study is registered with the Iranian Clinical Trials Center under the registration number IRCT20151123025202N40.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn this quasi-experimental study, the mean ages of the intervention and control groups did not differ significantly (10.3 and 10.2 years, respectively; P\u0026thinsp;=\u0026thinsp;0.932), and in both groups, 80% of participants were male (each group included 3 females and 12 males). According to the results from GARS and CARS tests, no statistically significant difference was observed between the intervention and control groups regarding autism severity before the intervention (CARS: P\u0026thinsp;=\u0026thinsp;0.234, GARS: P\u0026thinsp;=\u0026thinsp;0.692). However, after the intervention, a significant difference in disease severity was found between the intervention and control groups (CARS: P\u0026thinsp;=\u0026thinsp;0.049, GARS: P\u0026thinsp;=\u0026thinsp;0.048) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Comparison of autism severity between intervention and control groups before and after intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIntervention Group (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003cp\u003e(Mann\u0026ndash;Whitney)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCARS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e47/0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e48.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.234\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGARS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e90.5\u0026thinsp;\u0026plusmn;\u0026thinsp;19. 9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e88.6\u0026thinsp;\u0026plusmn;\u0026thinsp;20.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.692\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost-Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCARS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e46.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGARS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e87. 7\u0026thinsp;\u0026plusmn;\u0026thinsp;20.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e73.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding anger severity, no significant difference was observed between the groups before the intervention (P\u0026thinsp;=\u0026thinsp;0.967), but post-intervention, the difference was statistically significant (P\u0026thinsp;=\u0026thinsp;0.039), with a meaningful reduction in the intervention group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Comparison of anger control between intervention and control groups before and after intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnger Control\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention Group\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003cp\u003e(Mann\u0026ndash;Whitney)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e106. 0\u0026thinsp;\u0026plusmn;\u0026thinsp;30.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e106.3\u0026thinsp;\u0026plusmn;\u0026thinsp;31.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.967\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e104. 9\u0026thinsp;\u0026plusmn;\u0026thinsp;29.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e85.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe severity of emotion regulation showed no significant differences between the two groups before the study, but at the end of the intervention, a significant decrease was observed in the intervention group compared to the control group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Comparison of emotion regulation severity between intervention and control groups before and after intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotion Regulation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention Group\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003cp\u003e(Mann\u0026ndash;Whitney)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.505\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e67.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e60.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn this study, no significant differences were found in autism severity, anger control, or emotion regulation by gender either before or after the intervention (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Comparison of autism severity, emotion regulation, and anger control by gender before and after intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003cp\u003e(Wilcoxon signed-rank)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCARS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e50.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e48.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.942\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.612\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGARS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e86.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e89.2\u0026thinsp;\u0026plusmn;\u0026thinsp;20.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e73.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e73.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.885\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnger Control\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e111.3\u0026thinsp;\u0026plusmn;\u0026thinsp;37.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e105.1\u0026thinsp;\u0026plusmn;\u0026thinsp;30.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.469\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e86.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e85.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.514\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotion Regulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e69.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.884\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost- Intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e59.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.885\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eConsidering the increasing incidence and prevalence of autism, efforts to identify therapeutic methods that can better empower affected children and reduce their disease severity are valuable. Among therapeutic approaches, non-pharmacological methods can be especially helpful when effective due to their lack of side effects. Art therapy is currently one of the most common interventions used alongside conventional treatments for individuals with autism spectrum disorder [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe findings of the present study showed that art therapy delivered over two months for individuals with autism can be an effective method, in addition to routine therapies, by reducing disease severity and improving emotion and anger regulation in children.\u003c/p\u003e\u003cp\u003eMultiple studies with various designs have examined the effects of art therapy on individuals with autism, yielding results consistent with those of the present study. For example, Khodadadi et al. (2018) in Isfahan demonstrated that art therapy using a painting approach had a significant effect on participants\u0026rsquo; facial emotion recognition scores after eight training sessions compared to the control group, which aligns with the present findings [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In the study by Zadeh Mohamadi et al. (2023) twenty mothers and children with ASD attending the Special Needs Children\u0026rsquo;s Education and Research Clinic at Shahid Beheshti University were randomly assigned to experimental and control groups of ten. Both groups completed the Gilliam Autism Rating Scale at three time points: pre-intervention, post-intervention, and two months after intervention. Their findings indicated that a mother-focused art therapy program significantly improved core problems in children with ASD in the intervention group [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. According to a systematic review by Moradikelardeh et al. (2022) this approach has substantial potential to assist autistic children in addressing sensory, communication, and motor difficulties [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn a study conducted by Bakhshi et al.(2018) in Zanjan, 26 children aged 6 to 22 with ASD underwent 44 art therapy sessions over four months. Their results showed that art therapy had a significant effect on emotion regulation and behavioral flexibility (p\u0026thinsp;\u0026le;\u0026thinsp;0.001), supporting the use of art therapy as a complementary treatment method for emotion regulation and behavioral flexibility in children with ASD [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A meta-analysis by Bosgraaf et al. (2020), reviewing 37 studies, found that various forms of art therapy produced positive psychosocial outcomes in children with autism [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Similarly, a 2014 systematic review by Schweizer et al. (2014) indicated that art therapy can reduce autism severity, consistent with the present study [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Case et.al (2008) also reported that art therapy, employing diverse artistic tools, can improve cognitive, perceptual, emotional, behavioral, communicative, linguistic, and motor problems in children with special needs, thus enhancing their learning [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the noted benefits of art therapy for individuals with autism, this intervention requires trained practitioners and is time-consuming, which may pose challenges for implementation in some autism centers. Art therapists must be familiar with the unique characteristics of each child and collaborate with pediatric occupational therapists to understand specific sensory issues [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBased on previous studies, autism prevalence is higher in males than females, which was also observed in the present study. No significant differences were found regarding severity and control of anger and emotion before and after the intervention between boys and girls, which may be due to the relatively small sample size, especially among females.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study demonstrated that art therapy can be an effective non-pharmacological approach for individuals with autism by reducing disease severity and improving anger and emotion regulation. Therefore, based on these and other studies\u0026rsquo; findings, art therapy is accepted as a complementary and alternative treatment with clinically acceptable effects for patients with autism. It is recommended to implement art therapy in rehabilitation centers and schools for autism. Due to limitations of this study related to short-term follow-up caused by impatience and aggression in participants with autism, further research with larger sample sizes and meta-analyses is advised.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the Research Vice-Chancellor of Hamadan University of Medical Sciences for supporting this research, Clinical Research Development Unit of Farshchian Heart Hospital, Hamadan University of Medical Sciences, Hamadan, Iran for their assistance throughout the period of study, which is a part of the doctorate\u0026rsquo;s thesis on medicine international branch, as well as the staff and administrators of Autism Association Center and the pediatric psychiatry specialty clinic of Sina Hospital in Hamadan and all the participating in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e Helen Behmanesh, Saeid Yazdi-Ravandi, Farzaneh Baroonian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData curation:\u003c/strong\u003e Farzaneh Baroonian, Helen Behmanesh.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFormal analysis:\u003c/strong\u003e Behnaz Alafchi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding acquisition:\u003c/strong\u003e Helen Behmanesh, Saeid Yazdi-Ravandi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigation:\u003c/strong\u003e Helen Behmanesh, Saeid Yazdi-Ravandi, Mahdieh Seyedi, Mona Doostizadeh, Farzaneh Baroonian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e Behnaz Alafchi, Helen Behmanesh, Saeid Yazdi-Ravandi, Mahdieh Seyedi, Mona Doostizadeh, Farzaneh Baroonian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProject administration:\u003c/strong\u003e Helen Behmanesh, Saeid Yazdi-Ravandi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResources:\u003c/strong\u003e Helen Behmanesh, Saeid Yazdi-Ravandi, Farzaneh Baroonian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSoftware:\u003c/strong\u003e Behnaz Alafchi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision:\u003c/strong\u003e Helen Behmanesh, Saeid Yazdi-Ravandi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidation:\u003c/strong\u003e Helen Behmanesh, Saeid Yazdi-Ravandi, Mahdieh Seyedi, Mona Doostizadeh, Behnaz Alafchi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVisualization:\u003c/strong\u003e Helen Behmanesh, Tahere Etesamifard, Farzaneh Baroonian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting\u0026ndash;original draft:\u003c/strong\u003e Tahere Etesamifard, Helen Behmanesh.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting\u0026ndash;review \u0026amp; editing:\u003c/strong\u003e Tahere Etesamifard, Helen Behmanesh, Saeid Yazdi-Ravandi, Mahdieh Seyedi, Mona Doostizadeh. Behnaz Alafchi. Farzaneh Baroonian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Clinical Trial Registry\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Hamadan University of Medical Sciences (ethical code IR.UMSHA.REC.1403.096). All ethical standards, including obtaining permits, written consent, permission to withdraw at any time in case of unwillingness to continue cooperation in the study, statement of study objectives, and confidentiality of information, were observed in this study. This study is registered with the Iranian Clinical Trials Center under the registration number IRCT20151123025202N40 on 2024-09-04.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was financially supported by Research Vice-Chancellor of Hamadan University of Medical Sciences as grant ID: 140310048704.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLai MC, Lombardo MV, Baron-Cohen S, Autism. Lancet. 2014;383(9920):896\u0026ndash;910.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMehra C, Sil A, Hedderly T, Kyriakopoulos M, Lim M, Turnbull J, et al. Childhood disintegrative disorder and autism spectrum disorder: a systematic review. Dev Med Child Neurol. 2019;61(5):523\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFombonne E. Epidemiology of autistic disorder and other pervasive developmental disorders. J Clin Psychiatry. 2005;66(Suppl 10):3\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasi A, DeMayo MM, Glozier N, Guastella AJ. An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options. Neurosci Bull. 2017;33(2):183\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalchiodi CA. Handbook of art therapy. Guilford Press; 2011.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSampurno MBT, Prabandari YS, Marianto MD. Theoretical Exploration of Art Therapy and Education for Autistic Children. IJIET (International J Indonesian Educ Teaching). 2020;4(2):260\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, et al. Prevalence of autism spectrum disorder among children aged 8 years\u0026mdash;autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries. 2018;67(6):1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCiernia AV, LaSalle J. The landscape of DNA methylation amid a perfect storm of autism aetiologies. Nat Rev Neurosci. 2016;17(7):411\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaenner MJ, Graves SJ, Peacock G, Honein MA, Boyle CA, Dietz PM. Comparison of 2 case definitions for ascertaining the prevalence of autism spectrum disorder among 8-year-old children. Am J Epidemiol. 2021;190(10):2198\u0026ndash;207.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGilliam JE. Gilliam Autism Rating Scale\u0026ndash; Third Edition (GARS-3). Austin, TX: Pro-Ed; 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahmoudi M, Borjali A, Alizadeh H, Ghobari-Bonab B, Ekhtiari H, Akbari-Zardkhaneh S. Emotion regulation in children with learning disorders and normal children. Res school virtual Learn. 1970;4(13):69\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavidi A. Testing the effect of anger management training on anger self-regulation skills adaptability and general health of boys in Tehran secondary school [PhD Thesis]. Allameh Tabatabaei University of Tehran. 2006.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVogel SW, Mullins KL, Kumar S. Art therapy for children and adolescents with autism: a systematic review. Int J Art Therapy. 2024:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJalambadani Z. Art therapy based on painting therapy on the improvement of autistic children's social interactions in Iran. Indian J Psychiatry. 2020;62(2):218\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhodadadi N. Effectiveness of art therapy with painting approach on facial emotional expression recognition of children with high-functioning autism spectrum disorder. Empower Except Child. 2018;9(1):89\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZadeh Mohamadi K, Heydari M. The Effectiveness of Mother-Based Art Therapy on Stereotypic Behaviors, Verbal Skills and Social Interactions of Children with Autism Spectrum Disorders. Appl Psychol. 2023;17(1):126\u0026ndash;07.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoradikelardeh P, Narimani M. Application of Art Therapy in Autism Spectrum Disorders; The Features and Logic of Therapy (A Systematic Review Study). Rooyesh-e-Ravanshenasi J (RRJ). 2022;11(1):47\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBakhshi M, Morovati Z, Elahi T, Shahmohamadian S. Effectiveness of Art Therapy on Social-Communication Skills, Flexibility Behavioral and Emotion Regulation in Children with Autism Spectrum Disorder. Psychol Except Individuals. 2018;8(30):155\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBosgraaf L, Spreen M, Pattiselanno K, Hooren S. Art therapy for psychosocial problems in children and adolescents: A systematic narrative review on art therapeutic means and forms of expression, therapist behavior, and supposed mechanisms of change. Front Psychol. 2020;11:2389.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchweizer C, Knorth EJ, Spreen M. Art therapy with children with Autism Spectrum Disorders: A review of clinical case descriptions on \u0026lsquo;what works\u0026rsquo;. Arts Psychother. 2014;41(5):577\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCase C, Dalley T. Art therapy with children: From infancy to adolescence. Routledge; 2008.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkridge JM. The Benefits of Creative Art Therapy for Youth with Autism Spectrum Disorder: A Review of the Literature. 2021.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"autistic, art therapy, Emotion Regulation, Anger","lastPublishedDoi":"10.21203/rs.3.rs-7924120/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7924120/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAccording to various studies, art therapy can be helpful for emotion regulation and anger control in children and adolescents with autism spectrum disorders (ASD). However, sufficient research, particularly involving Iranian individuals with autism, is lacking. Therefore, the present study aimed to investigate the effectiveness of art therapy on autism severity, emotion regulation, and anger control in individuals aged 6 to 17 years diagnosed with autism spectrum disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn this clinical trial, 30 children (12 boys and 3 girls in each group) diagnosed with autism spectrum disorders based on DSM-5 criteria were evaluated. The intervention group underwent art therapy in 10 sessions over 5 weeks, with each session lasting 90 minutes. The control group received only routine care similar to the intervention group. Before and after the intervention, participants were assessed using the Childhood Autism Rating Scale (CARS), Gilliam Autism Rating Scale (GARS), State-Trait Anger Expression Inventory (STAXI-2), and Emotion Regulation Checklist. Data were statistically analyzed using SPSS version 24 at a significance level of 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe mean age of children was 10.3 ± 2.4 years, ranging from 7 to 14 years. In both study groups, the mean severity of anger, emotion dysregulation, and autism before the intervention did not show statistically significant differences (p \u0026gt; 0.05). The mean autism severity, measured by both scales (CARS and GARS), emotion regulation checklist scores, and anger control scores in the intervention group demonstrated a statistically significant difference at the end of the intervention and were lower compared to the control group (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003e\u0026nbsp;Art therapy, in addition to conventional treatments, may be effective in individuals under 18 years of age with autism spectrum disorders due to reductions in disease severity, emotional dysregulation, and anger. However, studies with larger sample sizes and longer follow-up periods are necessary to confirm the results of this study. Current study is registered with the Iranian Clinical Trials Center under the registration number IRCT20151123025202N40 on 2024-09-04.\u003c/p\u003e","manuscriptTitle":"Evaluating the Effectiveness of Art Therapy on Autism Severity, Emotional Regulation, and Anger Control Among 6- to 17-Year-Old Individuals with Autism Spectrum Disorders in Western Iran","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-24 18:07:09","doi":"10.21203/rs.3.rs-7924120/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06ae36b7-6b75-4e58-aa28-aea1c23727ed","owner":[],"postedDate":"November 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-06T07:24:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-24 18:07:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7924120","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7924120","identity":"rs-7924120","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}