Effects of Massage on Self-regulatory Difficulties, Tactile and Oral Abnormalities, and Parenting Stress in Children with Autism Spectrum Disorder (ASD): A Systematic Review and Meta-analysis

The Centers for Disease Control and Prevention stated that about 1 in every 44 children between the ages of 4 and 8 years old had been identified with autism spectrum disorder (ASD). Complementary interventions such as massage are crucial for the improvement of the health outcomes of ASD patients, such as abnormal sensory response; Autism Behavior Checklist; parenting stress, self-regulatory difficulties, social, language, and communication abilities; tactile or oral abnormalities; Vineland daily living skills; Vineland socialization; Childhood Autism Rating Scale; Preschool Language Scale 5th Edition (PLS-5) auditory communication; and PLS-5 expressive communication. We aim to systematically investigate the effects of different types of massage on self-regulatory difficulties, tactile and oral abnormalities, and parenting stress in children with ASD. PubMed, Cochrane Library, Scopus, and Web of Science were scoured from their inception through November 15, 2022. Research comparing massage efficacy in children with ASD to other methods or a control group was included. For randomized controlled trials (RCTs), we utilized the Cochrane risk of bias tool; and for cohort studies, we used the tool developed by the National Institutes of Health. Meta-analysis was carried out with Review Manager 5.4. For our continuous data, we calculated the mean difference (MD) and 95% confidence interval (95% CI). We included 10 studies with a total number of 485 children with autism. Our analysis showed a significant decrease in the massage group regarding self-regulatory difficulties (MD = -9.15; 95% CI (-13.69 to -4.60), p < 0.0001). Also, the massage group showed a significant decrease in tactile or oral abnormalities compared with the control group (MD = -4.83; 95% CI (-7.86 to -1.80), p = 0.002). Moreover, parenting stress significantly decreased in the massage group compared to the control group (MD = -4.31; 95% CI (-7.02 to -1.61), p = 0.002). Qigong and traditional Thai massage improved self-regulatory difficulties and decreased tactile or oral abnormalities in children with autism. Moreover, they decreased parenting stress. However, we need more RCTs with larger sample sizes with high quality to assess the different types of massage effects on autistic children and produce more valid results. So, Qigong and traditional Thai massage could be used as a complement to educational and training interventions in children with autism.