Ep 59- Research Review: Nature-Based Interventions for Autistic Children- A Systematic Review & Meta-Analysis
===
Laura Park Figueroa: Welcome to Therapy in the Great Outdoors, the podcast where we explore the business and practice of nature based pediatric therapy of all kinds. If you're an outdoor loving pediatric practitioner in the fields of occupational, physical, or speech therapy, social work, or mental health, this podcast will help you start and grow a successful nature based practice or program.
I am the ever honest, always 100 percent real. You'll hear it all on this podcast. Dr. Laura Park Figueroa. I'm a pediatric OT with over 20 years of experience and I run a thriving nature based practice with profitable locations in two different states and multi six figures in revenue. I also host the free online community at therapyinthegreatoutdoors.
com to help you pursue your nature based therapy dreams too. Are you ready to take action on those dreams? Let's jump in.
Hello. Hello. Welcome to therapy in the great outdoors this week, we are going to do an article review. And wow. Did I find a great one? So this article was just published in December. So only a few months ago. And the title of the article is nature based interventions for autistic children, a systematic review and meta analysis.
All of us as therapists know that systematic reviews are the pinnacle of all evidence-based research. So when we have systematic reviews that do the analysis of looking at the current evidence, We can make better decisions about whether certain interventions are evidence-based or not. Now. Do we all know that they are evidence-based approaches when we take children outdoors, we know the benefits of the outdoors for children.
So I think we can say that it is, but it is really cool to see a systematic review. And if the result. Found that it is evidence-based. This is an article that can really. Maybe lend itself to policies and procedures changing and healthcare systems in order to support nature-based interventions. The objective of the study was to systematically review and meta analyze available evidence on the health-related outcomes of nature-based interventions for children with. ASD autism spectrum disorder.
So they searched , 10 different databases. From the inception of the database until may of 2023, they also looked at Google scholar and references. They searched the references of the studies that they included. In order to find additional studies. That's a very common procedure when you're doing a systematic review. They included studies that were randomized controlled trials, controlled studies and single group before and after studies that reported on health related outcomes. So then they did their big analysis.
I won't bore you with all of the statistical language here. They used. The outcomes of interest were health-related outcomes. So things like social functioning, behavioral functioning, emotional, or sensory functioning, and the self-reported wellbeing of children with ASD. They included a total of 24 studies. With a total of 717 participants.
So the mean age range was 5.3 to 17.8 years. So basically. All of. All of childhood, essentially from not all of childhood, I guess the mean age range. So there might've been some younger kids studies in there, but basically ages five to 18. Only 22% or so were female. So 80% male, which. Is understandable because this was looking at children that have ASD and the diagnostic. Profile. Nowadays is mostly male for the time being okay. .
Very interesting to note as well. That these were studies from all over the world. 12 from the U S two from the UK. Two from Italy two from Iran, one study each from Brazil, Canada, China, India, Israel, and Spain. Very, this is worldwide research going on, which is really cool to see. So these were all face to face in our interventions as well.
So there weren't any digitally or kind of technology-based interventions and they all had to be outdoors with nature in natural outdoor settings. They did not include studies that just included physical activities, outdoors, that nature wasn't really a part of the intervention. So for instance, like a soccer program or something like that, Okay.
So I want to report the results. Now we D we do need to. Be aware these are associations. Okay. So you'd have to look at the actual studies that they included. To find out if any of these could be like causation, because correlation is not causation. So these are just showing kind of associations between. The intervention and different outcomes.
The pooled estimates of all of their results indicated a significant moderate association with social communication. So nature-based interventions were helpful for social communication at a moderate level. There were significant, small and moderate associations observed for autistic mannerisms, social cognition, social motivation and social awareness.
And then they move on to behavioral functioning outcomes. There was a significant moderate association with reduced hyperactivity. And a small to moderate association with reduced irritability. And then for sensory functioning, the outcomes showed a significant large association with improved inattention and distractibility the way they wrote that is very weird.
But it's, I guess it's saying that they were not as inattentive after the intervention. They also reported significant moderate associations for sensory seeking and sensory sensitivity. I'm not sure if they mean there, that it improved sensory seeking and sensory sensitivity.. There is a lot of supplemental content. If this is a topic that is very interesting to you. They have a lot of supplemental content online, like a bunch of charts, like 30 pages of charts to go with this.
And so you can look at the data yourself if there are certain outcomes or certain measures that you're interested in looking at in order to inform your own work or research that you may be doing. The one thing they did say was that no significant association was found with improvement in speech and language.
So that is interesting because I do know of other studies. Not done with children on the autism spectrum. That have demonstrated improvements in speech and language skills. I feel like that's an interesting finding and probably just indicates we need more research.
So they conclude the systematic review by saying our systematic review and meta analysis suggested a favorable association of nature-based interventions with improvements in all functional outcomes except emotional functioning. Which is weird because above they say that they did find a small to moderate association with reduced irritability, which to me would be an emotional thing.
But. There's a little bit of confusing stuff here that you'd really have to dive into, I think the supplemental content to understand. But overall, they did say that there were positive improvements. Significant improvement was observed in sensory functioning outcomes, particularly in sustaining attention, ability to sustain attention.
They also said that this is the first study to our knowledge, to suggest an alternative approach to improve sensory functioning among children with ASD using nature-based interventions outside of traditional settings, such as clinic or education settings.
So that is a really cool quote from this article. They also reviewed here that notable associations were found between nature based intervention and improved hyperactivity and irritability.
And finally they wrap up by saying. This systematic review observed a significant association between nature based interventions and social functioning, but the association between nature-based interventions and subjective wellbeing could not be determined due to limited evidence. Now. They obviously in their implications for research say that it is important to note that the overall quality of evidence supporting nature-based interventions is limited.
This means we need more research. But. I really do think that this systematic review is a great first step in the right direction to summarize the current research. That we have out there. And I would really encourage you to look at some of the studies because there is a lot of supplemental content with this article. That may influence what you do in your nature-based practice.
If you do work with children who are autistic, so they have all of the articles that they included, they have information about what assessment tools they used in order to assess the outcomes. So that may be something of interest to all of you as well. And again, I'll put a link to the article in the show notes so that you can access that. If you want to.
I want to add one last thing. Because. They say in their limitations that all included studies lacked a theoretical framework. And despite the early stage of developing nature-based interventions for children with ASD, it is urged to use theoretical or conceptual frameworks to guide study designs and ensure results are interpretable and generalizable.
That's a hard word to say. It's an interesting thing, right? Because you've heard me say, maybe have heard me say before in this podcast that we need to be using theory and frameworks to guide our work. In order to make sure that our work is evidence-based as well as help guide our thinking about what we're doing in our nature-based work with children.
I have finally submitted for the second time, my article, which was tentatively accepted for publication, and I had to make some more edits. I've finally submitted it again to the journal for publication. My dissertation research, which was creation of a theoretical framework based on the occupational therapists that I interviewed for my dissertation research.
We'll see maybe it will be published someday. I'm losing hope. At this point, it was like over two years ago that I did the research. Now I'm just. It is such a long process to publish you guys. I I have wanted to give up many times, and the only reason that I continue carrying on and crying through making all these edits and the frustration of it all is because 22 occupational therapists who are awesome nature-based therapists volunteered to participate in my research.
And I want you all to see. How incredible the work that they do is, and there's a lot of quotes and a lot of analysis. And a lot of learning that I had from doing that research in this article that I am hoping will be published.
Gosh. I was hoping by end of December last year and we're in April now. So I'm hoping, let's say by this December by December 20 24, I'm hoping it will be published.
I may never publish again, but.
It is just, it's not my cup of tea. Y'all I'm the fakest most imposter syndrome, PhD person ever. Yeah, there we go. I have. Digressed and gone on a tangent about research. But my point is to go back to why I started sharing that. That I would encourage you, no matter what kind of professional you are, whether you're an OT or a speech therapist or a physical therapist or a mental health or social work therapist, working with children. I would say that you need to make sure that you are using a framework or a theory to guide your intervention.
It really does help you. Think clearly about the work that you are doing. It also helps you to be able to scale your business because you can train employees and thinking the same way you do about what you're seeing. And that is. that is. so important when you grow a practice to make sure that you're all on the same page using the same language.
I am opening the Contigo approach, which is my nature-based therapy certification and mentoring program. In just a few weeks, it's a practice framework. It's not a theory, but it is a practice framework based on several existing theories. That shares, how we've developed an evidence-based model in my own practice over the past many years. And it will help you do the same.
It will give you a framework to use in your practice. So we'll open for registration in two weeks. From April 22nd to the 26th, 2024. For a may cohort. So, if you're interested, you can join the waitlist at contigoapproach.com and I'll let you know when we open enrollment. I think that's it for this week.
I hope this article was helpful to you and I will put a link in the show notes so you can access it and I will talk to you next week. Bye.
Wait a second, don't go yet. Do you want 120 ways that you can take your pediatric therapy work outdoors into nature? I wrote the free, big, huge list of nature based therapy activities just for you. The big huge list will give you quick ideas for nature based sessions. In the big huge list, there are activities for gross motor, fine motor, visual perceptual, executive function, balance, group collaboration, and team building.
social, emotional, and self regulation skills, as well as speech and language, and a whole section just for swing activities. So go on and get your free big, huge list. So you can get started taking kids outdoors or have some new ideas. If you've been doing this a while, you can download your free copy at therapyinthegreatoutdoors.
com slash list. So until next time, get outside, connect, reflect, and enjoy therapy in the great outdoors.
