A pilot randomized controlled study of a digital art therapy paradigm for children with ASD: integrating pivotal response treatment into video animation and physical model design.

Background: The integration of digital technology into art therapy for children with autism spectrum disorder (ASD) represents an emerging trend, yet systematic design frameworks that translate evidence-based interventions into digital media remain underdeveloped. This study developed and evaluated a digital art therapy paradigm that structurally integrates pivotal response treatment (PRT) into video animation design while maintaining cross-media consistency with physical generalization tools. Methods: Based on the behavioral characteristics of children with ASD, 12 sets of video animations integrating PRT and corresponding physical scene models were custom developed. Thirty-eight children with mild to moderate ASD were randomly assigned to an intervention group (PRT-based video animation with physical models, n=19) and a control group (conventional video animation, n=19) for a 12-week intervention. Pre- and postintervention assessments were conducted using four dimensions of the Autism Treatment Evaluation Checklist (ATEC) and behavioral observation. Results: Compared with the control group, the intervention group demonstrated significantly greater improvements across all ATEC dimensions (language communication: F(1,36) = 67.74, p < 0.001, ηp² = 0.755; social skills, F(1,36) = 80.69, p < 0.001, ηp² = 0.786; sensory/cognitive awareness: F(1,36) = 55.69, p < 0.001, ηp² = 0.717; health/physical behavior, F(1,36) = 36.94, p < 0.001, ηp² = 0.627. The percentage of children who reported " no observable behavioral response" in the intervention group decreased from 35% to 10%. Conclusions: This pilot randomized controlled study provides preliminary evidence for the feasibility and efficacy of a multi-component, PRT-informed digital and physical intervention package for children with ASD. The intervention is characterized by three design principles: (1) theoretical translation--embedding the structured steps of PRT into digital interaction logic; (2) cross-media consistency--maintaining visual and functional coherence between video animations and physical generalization tools; and (3) progressive scaffolding--sequencing intervention content from foundational cognition to complex social skills. These findings offer a preliminary design framework for the development of digital art therapy interventions for children with ASD. Future large-checklist replication studies are needed to further validate this approach.