Volume 37, Issue 147 (May 2024)                   IJN 2024, 37(147): 2-21 | Back to browse issues page


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Tayyar-Iravanlou F, Sotoodeh H, Nouri M, Naseri N, Alsadat Rahnemaei F, Abdi F. Effects of Bibliotherapy on Individuals With Autism Spectrum Disorder: A Systematic Review. IJN 2024; 37 (147) :2-21
URL: http://ijn.iums.ac.ir/article-1-3819-en.html
1- Department of Psychiatric Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
2- Student Research Committee, Urmia University of Medical Science, Urmia, Iran.
3- Department of Medical-Surgical, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran.
4- Department of Pediatric Nursing, School of Nursing and Midwifery, Joundishapour University of Medical Sciences, Ahvaz, Iran.
5- Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.
6- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran. , abdi.fh@iums.ac.ir
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Introduction
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can affect individuals’ social interactions, communication abilities, learning, and behavior. There has been a rise in the incidence of ASD in the past few decades. This disorder significantly impairs an individual’s capacity to engage in social and educational activities. It creates difficulties in perceiving the perspectives of others, delays learning, and causes language impairment. Prompt and efficient intervention can be effective in improving their social interactions and overall quality of life. Bibliotherapy has a beneficial impact on reducing the challenges faced by individuals with ASD. It is a therapeutic approach that includes reading selected books or storytelling to help the person perceive and solve emotional and mental problems. Furthermore, this approach relies on modifying individuals’ behavior and mindset to induce alterations in the reader’s attitude or conduct through reading to manage adverse emotions and enhance overall life performance, thus increasing problem-solving abilities and, consequently, resourcefulness.
 Furthermore, it is an evidence-based technique and does not involve the use of medication. It employs cognitive and behavioral strategies to enhance initiative, social skills, and problem-solving abilities. It also guides the thinking process and helps individuals gain a deeper understanding of the actual challenges they face in their lives. Additionally, it enhances the cognitive skills of individuals with ASD, enabling them to effectively address challenges in their lives, alleviate stress, alter behaviors, regulate emotions, enhance engagement and productivity, improve social interactions, and expedite their communication. This systematic review study aims to investigate various forms of bibliotherapy (such as poetry therapy, book therapy, and story therapy) for addressing the disorders of individuals with ASD. 

Methods 
In this systematic review study, a search was first conducted in Web of Science, PubMed, Scopus, ProQuest, Google Scholar, SID, and MagIran databases on related studies published until May 31, 2024, according to the PRISMA guidelines and using the MeSH terms Autism, Autism Spectrum Disorder, Asperger Syndrome, Book Therapy, Bibliotherapy, Narrative Therapy, storytelling, Poetry Treatment, Poetry Book, Poetry, and Poem, by employing the Boolean operators (AND, OR). 
The research question was formulated based on the PICOS framework. The population (P) included individuals of different ages, sexes, and educational groups with ASD. The intervention (I) involved bibliotherapy methods such as book therapy, storytelling, and poetry therapy. The comparison (C) included individuals with ASD and typically developing peers. The outcomes (O) included improvements in behavioral problems, cognitive behaviors, thinking skills, attention, storytelling abilities, social abilities, speech and writing skills, and communication. The study design (S) included mixed-method, descriptive, qualitative, and interventional studies on bibliotherapy for individuals with ASD. 
The quality of studies was evaluated using the mixed methods appraisal tool (MMAT). The studies with scores >50% were deemed high quality. Ultimately, the relevant data were extracted from the eligible studies, including the first author’s name, year of publication, study area, study design, sample size, gender of samples, the age range of samples, type and method of intervention, instruments, and primary outcome.

Results
The initial search yielded 403 relevant articles. After removing 126 duplicates, the titles and abstracts of the remaining articles were examined. During the screening process, 185 studies did not meet the inclusion criteria and one study was excluded due to lack of access to the full text. Finally, 31 eligible studies were included in the systematic review.
 The participants included people with ASD aged 3-30 or their caregivers. The studies were conducted in 10 different countries, including the United States of America (n=14), Iran (n=5), England (n=2), Australia (n=3), Switzerland (n=1), South Korea (n=1), China (n=2), Malaysia (n=1), Thailand (n=1), and Italy (n=1). Among the studies, there were 8 studies related to book therapy, one study related to poetry reading, 11 studies related to storytelling, two studies related to reading books, 6 studies related to shared book reading, one study related to illustrated storytelling, one study related to narrative therapy, and one study related to dialogue reading. 
The therapeutic approaches in individuals with ASD had various outcomes, including enhancing speech and language abilities, improving social activities and development, facilitating better interaction with others, promoting increased social participation, identifying specific social skills, fostering positive social behaviors while reducing negative behaviors, enhancing comprehension and concentration through accurate storytelling, reducing inappropriate behaviors and psychological distress, increasing verbal long-term engagement of children. Overall, there were significant improvements in the social, motor, verbal, and behavioral skills of participants.

Conclusion
The bibliotherapy includes simple and accessible methods for individuals with ASD. Caregivers can easily administer these interventions to enhance the function of these individuals. Bibliotherapy interventions can improve their performance in different areas. Thus, it is recommended that these interventions be used in hospitals, care centers, or educational institutions for individuals with ASD, with the participation of their teachers, parents, or caregivers, to help reduce their social, cognitive, behavioral, and verbal problems. 

Ethical Considerations
Compliance with ethical guidelines

All ethical principles were considered in this study. Since no experiments were conducted on human or animal samples, no ethical code was obtained.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization and methodology: Fatemeh Abdi and Faraz Tayyar-Iravanlou; literature review and data extraction: Hedyeh Sotoodeh, Mahsa Nouri, Nahid Naseri; data analysis: Faraz Tayyar-Iravanlou, Fatemeh Alsadat Rahnemaei, Fatemeh Abdi; supervision, editing & review: Fatemeh Abdi.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Nursing and Midwifery Care Research Center of Iran University of Medical Sciences.


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Type of Study: Review | Subject: nursing
Received: 2024/06/11 | Accepted: 2024/04/20 | Published: 2024/05/1

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