Collaborative arts therapies as a supportive intervention for autism spectrum disorders: Bibliometric analysis, insights, and directions

Abstract

Purpose

Arts therapies (ATs) for the treatment of autism spectrum disorders (ASD) has attracted widespread attention from scholars. However, resources, technical, and ethical issues still pose significant obstacles to current research. A collaborative design approach is needed to guide the intervention treatment process involving multiple stakeholders. Therefore, this study focuses on exploring the current status, development and potential value of the collaborative arts therapies (CATs), providing a comprehensive perspective for subsequent research.

Methods

The Web of Science, PubMed, ScienceDirect, and Cochrane Library were searched for publications up to August 30, 2023, related to the use of CATs for the treatment of ASD. CiteSpace was used to build a knowledge graph to achieve visual analysis of current research countries, institutions, journals, authors, and hot topics.

Results

A total of 845 articles met the inclusion criteria. In terms of quantity, the USA is the leading country which has the greatest influence in advancing the field. The University of Haifa is the most productive institution. Arteterapia Papeles De Arteterapia Y Educacion Artistica and Frontiers in Psychology occupy key publishing positions. The most central keywords were related to the quality of life of people with ASD. “family”, “social robot” and “participation” are emerging topics in the research field. The positive impact of the combination of caregivers, technology and artistic media on enhancing connections between people with ASD and their everyday environment is the focus of current research.

Conclusions

Research on CATs as an adjunctive therapy for the treatment of ASD is evolving. Providing comprehensive rehabilitation and support intervention for patients with ASD is a key research direction. The research process requires more interdisciplinary resources and technical assistance. Collaboration will be the best way to improve the effectiveness of ATs.

1. Introduction

In recent years, the incidence of autism spectrum disorders (ASD) has been rising globally, positioning it as a significant public health concern [1,2]. Currently, there is no cure for ASD [3], prompting researchers to focus on enhancing patients' quality of life and treatment efficacy. The main symptoms of ASD include social interaction deficits, communication disorders, and stereotyped behaviors [4]. To cope with these symptoms, various therapeutic strategies, including educational programs, behavioral interventions, and psychological support, have been employed [[5], [6], [7]]. Nonetheless, pharmaceutical interventions [8], specific settings [9], and unfamiliar therapists [10] inevitably elicit resistance from patients. Standard behavioral interventions can become tedious over time, leading to a lack of engagement and motivation, which impedes therapeutic progress. Consequently, art therapies (ATs) have been introduced as a non-educational and safer alternative.

ATs leverage artistic expression to improve the physical and mental well-being of individuals, facilitating their rehabilitation [11]. Employing a range of artistic media such as painting [12], music [13], gaming [14], dance, and movement [15], ATs provide a nonverbal communication channel aimed at enhancing patients' quality of life [16,17]. Schweizer [18] reported in a meta-analysis comprising 18 descriptive cases that ATs enhanced social behavior, flexibility, and attention skills among children with ASD. Additionally, ATs have shown to be effective in complementing traditional interventions [19] and improving patients' moods [20]. Despite these benefits, there remain significant technical, resource-based, and ethical challenges that need addressing [21,22]. Relying solely on artistic media as a treatment modality does not fully meet the complex needs of individuals with ASD. Thus, there is a pressing necessity for a design approach that promotes collaboration among various stakeholders to guide the ATs process effectively.

Establishing connections between design and the real-world applications, while serving the future development of humanity, is crucial in contemporary design theory [23]. Within this context, collaborative design stands out as a methodology that allows users to actively participate in design processes, fostering direct interaction and creativity. This approach emphasizes the importance of interaction and collaboration among stakeholders [[24], [25], [26]]. ATs, as a creative therapeutic modality, facilitate individuals in addressing psychological challenges through artistic expression, highlighting the dynamic interplay between individuals and their environment. From this perspective, a collaborative design approach can adopt a guiding role in analyzing the connections and effects among participants involved in the ATs process. Cross-disciplinary and cross-media co-creation among individuals with autism, relevant stakeholders, techniques, and settings—such as co-designing therapy sessions or developing assistive rehabilitation products—opens up innovative possibilities for the medical treatment and rehabilitation of autism. However, it remains a fact that further insights are required concerning the process, fundamental techniques, benefits, and challenges associated with implementing a collaborative design approach to ATs. Exploring pertinent literature on Collaborative Arts Therapies (CATs) becomes essential to gain insights into this emerging field.

Bibliometrics is a quantitative approach used to measure the characteristics of scholarly publications. This approach facilitates the rapid identification of developmental trends across various disciplines and unlocks potential knowledge value through the analysis of extensive data sets [[27], [28], [29]]. In this study, we employ bibliometric visualization to map the research landscape of CATs for ASD, identifying key trends and knowledge gaps. Specifically, this research seeks to address the following questions (1) What are the latest published developments concerning the interplay between CATs and ASD? (2) What are the main trends and obstacles encountered in implementing CATs for ASD? (3) How can CATs be used for ASD?

This study reports an account of the significant trends, crucial methodologies, impediments, and advantages linked to CATs for ASD. The novelty of this research lies in its development of an innovative framework that provides both practitioners and scholars with a deeper understanding of how CATs can be used as a strategy for addressing ASD. By leveraging the resources of multiple caregivers and technical expertise, CATs positively influence the harmonious relationship between individuals with ASD and their everyday environments. This inclusive approach not only enhances the therapeutic experience but also builds a supportive community, thereby improving the social and emotional wellbeing of individuals with ASD.

2. Materials and methods

2.1. Search strategies and inclusion criteria

As of August 30, 2023, a comprehensive search was conducted in four electronic databases: Web of Science, PubMed, ScienceDirect, and Cochrane Library. The search utilized specific combinations of keywords, including: (a) Arts Therapies, Painting Therapy, Music Therapy, Dance Therapy, Play Therapy; (b) Group, Family, Companion, Friend; and (c) Autism Spectrum Disorder (Table 1). The selection was limited to original articles, excluding letters, editorial materials, and book reviews. The advanced search yielded 1648 articles. Two independent researchers reviewed titles and abstracts and removed articles that were not relevant to the study. Ultimately, 845 articles were included in the analysis, which constituted the core dataset of the study.

Table 1.

PubMed search strategy.

Number	Search terms
#1	Arts Therapies
#2	Painting Therapy
#3	Music Therapy
#4	Dance Therapy
#5	Play Therapy
#6	#1 OR #2 OR #3 OR #4 OR #5
#7	Group
#8	Family
#9	Companion
#10	Friend
#11	#7 OR #8 OR #9 OR #10
#12	Autism Spectrum Disorder
#13	Autism Spectrum Disorders
#14	ASD
#15	#12 OR #13 OR #14
#16	#6 AND #11 AND #15

2.2. Data extraction and analysis

CiteSpace is the primary analytical tool used to examine the search results and construct visualization maps based on co-citation analysis theory. The key functionalities of this tool include burst detection, betweenness centrality, and analysis of heterogeneous networks [30,31]. CiteSpace 6.1. R6 was used for visual transformation and analysis of the original data sets. Significant data metrics were utilized to capture the dynamics within this field. These metrics highlighted aspects such as publication volume, trends in publication across different countries, regions, or research institutions, as well as core journals, prominent authors, research themes, and emerging topics [32].

The results are visualized through a knowledge graph. This knowledge graph employs nodes and lines to illustrate collaborative relationships among publications [30]. Nodes represent elements like citing organizations, authors, and countries, with their size reflecting frequency or quantity. Connections denote links between elements signifying collaboration or shared citation relationships [33]. Purple circles denote centrality, with nodes having high centrality often considered pivotal or hub points [[30], [34]]. Wider lines indicate stronger connections [33].

3. Results

3.1. Publication trends and geographic distribution

A total of 1648 potentially eligible articles were identified in 4 electronic databases, of which 128 were excluded due to duplication. By screening titles and abstracts, 638 studies were excluded, including 4 studies that were not in English, 376 studies that were not original articles, 97 studies that were not related to CATs, and 161 studies that were not related to ASD. The full texts of 869 articles were selected for further evaluation. Ultimately, 845 studies met the inclusion criteria (Fig. 1).

Fig. 1.

PRISMA flow diagram of the study process.

Fig. 2 illustrates the quantity of publications related to the application of CATs in ASD treatment over time. There is a clear upward trend in publication volume, particularly from 2020 to 2022, reaching a peak in 2021. Results from the Pearson correlation analysis reveal a significant positive correlation between the year of publication and the number of publications (r = 0.905 > 0.5, p = 0.000 < 0.01). This field is gradually gaining the attention of researchers.

Fig. 2.

Annual trend in the number of related publications.

Fig. 3 visualizes international collaborations in the field of CATs for ASD treatment, where each node represents a country, and each link indicates a collaborative relationship. Fig. 3A displays the collaboration among countries/regions, involving 77 nodes and 190 links. 845 articles and reviews published in 77 countries and regions. Table 2 ranks the top 10 countries/regions based on their publication count. The USA contributed the most publications (n = 169). Spain (n = 101), England (n = 101), People's Republic of China (n = 51), and Italy (n = 49) are also prominent countries in this field. The highest centrality among countries is the USA (0.54), followed by Spain (0.24), indicating the significant roles played by the USA and Spain in international collaborations.

Fig. 3.

The partnership of Country or Region (A), and research institutions (B).

Table 2.

The top 10 countries/regions in the field of CATs research.

Rank	Country/Regions	Publications	Percentage (%)	Centrality
1	USA	169	16.17	0.54
2	Spain	101	9.67	0.24
3	England	101	9.67	0.03
4	Peoples R China	51	4.88	0.03
5	Italy	49	4.69	0.09
6	Germany	45	4.31	0.05
7	Netherlands	43	4.11	0.04
8	Israel	40	3.83	0.07
9	Australia	34	3.25	0.15
10	South Korea	29	2.78	0.01

295 institutions contributed publications related to applying CATs in ASD. Fig. 3B shows the collaboration among research institutions. In terms of publication quantity, the University of Haifa is the most productive institution (n = 22), followed by Drexel University (n = 17), and the University of London (n = 15). Table 3 details the top 10 research institutions involved in this field. Notably, Harvard University exhibits the highest centrality score of 0.14, indicating its central role in the network of institutional collaborations.

Table 3.

The top 10 institutions contributing to publications in the field of CATs research.

Rank	Institution	Publications	Percentage (%)	Centrality
1	University of Haifa	22	3.46	0.03
2	Drexel University	17	2.68	0.04
3	University of London	15	2.36	0.13
4	Complutense University of Madrid	14	2.20	0.01
5	CIVIS	10	1.57	0.03
6	Radboud University Nijmegen	10	1.57	0.1
7	Charite Universitatsmedizin Berlin	9	1.42	0.05
8	Harvard University	9	1.42	0.14
9	Ministry of Education & Science of Ukraine	9	1.42	0.01
10	Open University Netherlands	9	1.42	0.01

3.2. Distribution of journals

Table 4 identifies the top 10 journals that have prominently featured articles on CATs across various fields such as rehabilitation, clinical nursing, psychology, psychiatry, and medicine. The impact factors (IF) of the journals range from 0.3 to 4.7. Six of these journals have an IF greater than 2, with Frontiers in Psychiatry having the highest IF (IF: 2022 = 4.7). Additionally, Arteterapia Papeles De Arteterapia Y Educacion Artistica (IF: 2022 = 0.3) has published 111 articles or reviews related to CATs, followed by Frontiers in Psychology (n = 73, IF: 2022 = 3.8), and Arts in Psychotherapy (n = 39, IF: 2022 = 1.8).

Table 4.

The top 10 countries/regions in the field of CATs research.

Rank	Journal	Publications	IF(2022)
1	Arteterapia Papeles De Arteterapia Y Educacion Artistica Para La Inclusion Social	111	0.3
2	Frontiers in Psychology	73	3.8
3	Arts in Psychotherapy	39	1.8
4	International Journal of Art Therapy	28	0.5
5	Art Therapy	25	1.4
6	Plos One	17	3.7
7	Children Basel	16	2.4
8	Frontiers in Psychiatry	14	4.7
9	International Journal of Environmental Research and Public Health	14	4.614
10	Evidence Based Complementary and Alternative Medicine	10	2.65

Furthermore, journals with a number of co-citations greater than 50 are shown in Fig. 4, consisting of 286 nodes and 762 links. A high co-citation count indicates journals with significant academic influence in this field. Arts in Psychotherapy has the highest co-citation count (291), followed by Art Therapy (273) and Plos One (166). These journals occupy central roles in this research domain.

Fig. 4.

Common citation knowledge graph of relevant journals.

3.3. Distribution of authors

A total of 3521 authors have contributed to research outcomes related to CATs. Most authors have only published one or two articles each. The top 5 most active authors are presented in Table 5. The H-index is used as a standard to measure the broad impact of an author's scientific achievements [35]. It is evident that most authors have a high impact. In terms of publication quantity, Gold, C has published the most studies implementing CATs for ASD (n = 111, H = 32). Following are Geretsegger, M (n = 12, H = 9), Bhat, AN (n = 9, H = 22), Srinivasan, Sudha M (n = 9, H = 13), and Schweizer, C (n = 6, H = 4). The number of publications by the above authors only includes research on the application of CATs in ASD treatment.

Table 5.

The top 10 countries/regions in the field of CATs research.

Rank	Author	Publications	H-index	Cited Author	Total Publications	Sum of Times Cited	H-index
1	Gold, C	21	32	Scassellati, B	127	6146	37
2	Geretsegger, M	12	9	Gold, C	111	3392	32
3	Bhat, AN	9	22	Spreen, M	47	594	11
4	Srinivasan, Sudha M.	9	13	Karkou, V	53	427	11
5	Schweizer, C	6	4	Thompson, G	31	400	10

Fig. 5 displays the co-citation network of authors. The most representative author is Scassellati, B from Yale University (GCS = 6146, H = 37), who specializes in the application of social robots in ASD research. Next is Gold, C from the Norwegian Research Centre (GCS = 3392, H = 32), who is dedicated to music therapy for ASD. The short distances between nodes indicate a close collaborative network among these researchers.

Fig. 5.

Joint citation knowledge graph of relevant authors.

3.4. Co-occurrence of keywords

The centrality of keywords reflects the focal points within this field. Nodes with a centrality value exceeding 0.1 are designated as central nodes, indicating their significant influence in the research (Table 6). It is evident that the psychological and mental well-being of both adults and children have garnered substantial attention as primary areas of interest. At present, CATs for ASD primarily employs therapeutic modalities encompassing music, group music, dance, physical activities, and gaming interventions. These interventions are focused on ameliorating symptoms encompassing “behavior problems”, “skills”, “anxiety disorders”, and “communication” experienced by patients. Furthermore, keywords related to caregivers, such as “parents”, “mothers”, “caregiver burden”, and “friendship” also emerge among the top 30. This underscores the urgency of investigating ATs within a multi-person collaborative model.

Table 6.

High frequency keywords.

Cluster	Count	Keywords (Centrality)
1–10	114	adults (0.26), young children (0.24), music (0.23), intervention (0.19), skills (0.12), mental health (0.07), behavior problems (0.07), anxiety disorders (0.05), parents (0.05), caregiver burden (0.05)
11–20	51	group music therapy (0.04), mothers (0.04), joint attention (0.03), spectrum disorder (0.03), communication (0.03), dance-movement (0.03), art therapy (0.03), cbt (0.03), experiences (0.03), diagnostic interview (0.03)
21–30	42	cognitive behavioral therapies (0.03), play (0.02), imitation (0.02), robot-assisted therapy (0.02), attention (0.02), autism therapy (0.02), friendship (0.02), developmental disability (0.02), basic emotions (0.02), randomized controlled trial (0.01)

3.5. Clustering of research themes and development of research hotspots

In order to comprehend the research dynamics more comprehensively, a cluster analysis was executed to identify themes sharing similar characteristics [36]. The 271 keywords were categorized into 10 thematic clusters (Fig. 6). With values of Q (Modularity Q) being 0.5922, exceeding the threshold of 0.3, and S (Mean Silhouette) being 0.8307, surpassing the 0.7 threshold, the statistical significance and reliability of the clustering structure are confirmed.

Fig. 6.

Co-occurrence analysis of keywords.

The current research on CATs for ASD spans various aspects including methodologies, symptoms, and technologies. Initially, the focus was concentrated on interventions related to “social”, “behavior” and “mental health” aspects of ASD patients. “Art therapy” and “group therapy” emerged as two distinct yet interconnected treatment approaches. The most active period of research occurred between 2010 and 2019, during which time CATs for ASD witnessed the development of diverse forms such as group music therapy, dance and physical movement therapy, robot-assisted therapy, integrated medical and educational approaches, and interdisciplinary collaborations. Technological integration in CATs was marked by the use of “play,” “virtual reality,” “affective computing,” and “computer science.” The expansion of terms like “group,” “care,” and “community” highlights the evolving and diversifying nature of collaborative art therapy methods that engage multiple stakeholders. Since 2020, emerging topics in the field have included “family,” “engagement,” and “social robots.” Concurrently, themes like “empathy”, “quality of life”, and “rehabilitation” have gained prominence, reflecting the current research trends.

3.6. Analysis of phased cutting-edge research

Utilizing CiteSpace for burst detection enables the retrospective exploration of the evolution of key thematic areas over time and the identification of emerging technologies with the potential for explosive growth in the future [29]. The study identified the 20 most significant burst keywords. These keywords can be divided into three distinct burst phases, as detailed in Table 7.

Table 7.

Top 20 keywords with the strongest citation bursts.

Keywords	Year	Strength	Begin	End	2005–2023
alternative medicine	2005	2.84	2005	2015
behavior problems	2008	0.91	2008	2013
pretend play	2012	1.02	2012	2015
friendship	2012	1.02	2012	2015
human-robot interaction	2013	1.7	2013	2014
joint attention	2014	1.17	2014	2015
mothers	2016	1.72	2016	2017
adjustment	2017	0.82	2017	2018
family therapy	2015	1.13	2017	2021
behavior	2009	1.65	2018	2019
group art therapy	2016	1.63	2018	2021
impact	2016	1.26	2019	2020
coping strategy	2019	0.95	2019	2020
design	2013	0.85	2019	2021
quality of life	2019	1.45	2019	2023
affective computing	2018	0.95	2019	2023
group music therapy	2018	1.21	2019	2023
play	2016	2.48	2021	2023
skills	2014	1.84	2021	2023
robot-assisted therapy	2017	1.5	2021	2023

Between 2008 and 2012, the emergent keyword was “behavioral problems”. This attests to the fact that the development of CATs is accompanied by an ongoing concern for the distinct symptoms and behaviors of individuals with ASD. At the same time, CATs has been used as an “alternative medicine” for ASD. Following the surge of keywords like “mothers”, “family therapy”; and “group art therapy” between 2013 and 2018, the research focus shifted from ASD patients themselves to encompass their broader environmental context. Concurrently, the eruption of “human-robot interaction” signifies the integration of technology into the realm of collaborative art therapy research.

From 2019 to 2023, the sustained emergence of “quality of life”, “affective computing”, and “skills” signifies that enabling ASD patients to lead normalized lives will become a focal point of future research in this field. Moreover, the involvement of additional stakeholders and technological approaches, such as “group art therapy”, “play”, and “robot-assisted therapy,” supports the ongoing expansion of collaborative art therapy methods.

4. Discussion

4.1. What are the published developments regarding the interplay between CATs and ASD?

This study reveals that research on CATs has a relatively short history, spans a variety of disciplines, and demonstrates strong interdisciplinary traits. Interest in CATs research has been growing among scholars, particularly since 2017, with annual publications surpassing 50. A notable peak occurred in 2021, with 129 publications. Moreover, this study is conducted globally, involving academic institutions and research organizations across approximately 77 countries and regions, offering valuable insights for researchers. The highest volumes of publications predominantly originate from North America and continental Europe. Notably, China, exemplifying a developing country, has made a substantial contribution with 51 publications, ranking it among the top publishing countries.

Furthermore, influential authors in the field include Scassellati, B from the USA, Gold, C from Norway, and Geretsegger, M. It is evident that North America and Europe are at the forefront of research. While the current publication trends clearly highlight the critical role of various art forms in ASD treatment, this poses a thought-provoking issue – high-impact factor journals have relatively fewer publications on this topic. Examining the research directions of these representative authors reveals that they encompass not only the theory and clinical assessment of art therapy but also the application of technologies such as robotics, human-computer interaction, and affective neuroscience. This implies that CATs methods involving multiple individuals and various technological forms, as well as the need for interdisciplinary resources and technical support, are the primary themes in current journals. Collaboration is an effective factor in enhancing publication quality [37]. Journals within the fields of psychiatry and psychology are expected to align with this trend by incorporating this subject matter into their editorial objectives. This could be facilitated through partnerships between arts colleges, medical schools, psychology departments, and research institutions. Such an alignment can integrate the resources and strengths of stakeholders from different disciplines and professions [38], establishing a cohesive art therapy and support system for ASD patients. Simultaneously, the collaboration can employ research methodologies from psychiatry and psychology, such as randomized controlled trials (RCTs) [39,40] and case studies [18,41], to better validate the effectiveness of CATs as the alternative treatments for ASD.

4.2. What are the main trends and obstacles encountered in implementing CATs for ASD?

This study's analysis of keyword dynamics indicates that group music therapy, dance and movement therapy are currently pivotal methods in addressing ASD [[42], [43], [44]]. Science and technology also validate their significance in AT, particularly within the realm of personalized medicine. Such as social robots [45], robots assisting in therapy [46], can encourage children with ASD to speak by engaging in activities that promote joint attention development through playing together. Engaging children with ASD in new activities has been shown to diminish problematic behaviors and enhance their willingness to participate in treatment [47].

Importantly, whether it involves diverse art therapy mediums such as music or dance or incorporates technology such as robots, the central emphasis remains on the intrinsic value of social interaction in ASD treatment. Caregivers and technology have gained traction within the realm of ATs, fostering a comprehensive environment that utilizes diverse resources to facilitate the recovery of ASD patients [48]. For instance, in a study focusing on adolescents aged 11 to 18 with social disorders, Epp [49] discovered that group art therapy significantly enhances language skills, and social aptitudes. Concurrently, the supportive atmosphere cultivated by parents and other caregivers positively influences ASD patients' sense of belonging, self-assurance, self-esteem, and social interactions [50,51].

Integrating CATs into ASD interventions within the context of “participation” and “collaboration” has emerged as a significant subject. While this underscores the importance of caregivers and technology for ASD patients, current literature also reflects the scarcity of research pertaining to CATs in various scenarios. The density of research on “family art therapy”, “group art therapy”, and “friendship” is relatively low. This is attributed to most researchers focusing on ASD patients themselves while neglecting exploration into their family, group, and societal contexts. The socioeconomic challenges exacerbated by low income and high rehabilitation costs pose a serious burden on the families of ASD patients, impacting both their material well-being and spiritual lives [52,53]. Considering the impact and significance of these limitations, the findings of this study to some extent reinforce and propel the development of CATs research.

4.3. How can CATs be used for ASD?

CATs extend beyond mere mechanisms for disease rehabilitation and prevention, showcasing substantial benefits in perceptual interaction, holistic well-being, and quality of life for individuals with ASD. Within this perspective, three insightful strategies are proposed to enhance collaboration in CATs implementation.

Strategy 1

Establishment of an art therapy system.

The implementation of CATs emphasizes the systematic integration of diverse resources such as healthcare professionals, parents, schools, communities, and governmental entities [54,55]. This creates a comprehensive framework that supports the entire art therapy process. On one hand, by combining caregivers and technology, CATs enable ASD patients to engage with a broader range of individuals during the artistic creation process [56]. This contributes to the development of their social interaction capabilities. On the other hand, it also provides support and assistance to the families of patients.

Strategy 2

Integration of emerging technologies and therapeutic products.

The field of CATs is being transformed by the introduction of advanced physiological sensing devices such as physiological sensors [57], eye-tracking devices [58], electroencephalograms (EEG) [59], perceptual image [60,61], and perceptual video technologies [62]. Particularly, the integration with artificial intelligence (AI) is ushering in new methodologies for dynamic data collection [63,64], analysis of treatment efficacy [65], and early detection [66,67] in individuals with ASD. By combining perceptual interaction and communication [68], technology-enhanced CATs offer clear objectives, immediate feedback, and appropriately challenging activities. This approach significantly boosts engagement and emotional expression among individuals with autism, thereby increasing their participation [69].

Strategy 3

Enhancing CATs through Collaboration with Caregivers.

Caregivers of ASD patients often face challenges due to economic constraints, social backgrounds, and a lack of professional training, all of which can adversely affect their caregiving capabilities [70]. Recognizing and supporting these caregivers is crucial for breaking this detrimental cycle [71]. CATs can establish a diverse and inclusive scene, enhancing the connection between individuals with autism and their daily surroundings, ultimately improving their quality of life [72]. This approach has been beneficially explored. For example, art exhibitions can be used as measures of CAT's effectiveness [73]. Additionally, combining the efforts of society and government can help mitigate public bias against individuals with mental disorders and the stigma faced by their family members.

5. Limitations and conclusions

This study employs a bibliometric approach to explore the role of CATs in ASD. Through investigating three interrelated research questions, we interpreted the publication dynamics of the interplay between CATs and ASD, the primary trends and limitations of CATs' application to ASD, and the ways CATs is utilized in the context of ASD. The categorization of key findings can provide a valuable framework for scholars, practitioners, and decision-makers in related fields to advance the development of CATs involving multiple individuals and technology.

The insights generated by this research framework trace a path for empirical exploration and validation in future studies. A key takeaway from this study is that CATs integrate multiple caregiver resources and technical capabilities, displaying a positive influence on enhancing the rapport between ASD patients and their daily environment. Looking ahead, the synergy between caregivers and technology is poised to propel more efficient and diverse ATs forward, thereby establishing an integrated rehabilitation and support system for individuals with ASD.

This study naturally has certain limitations. The use of CiteSpace restricts our ability to provide more detailed information on the literature under both full counting and fractional counting systems. The employment of distinct analytical tools and varying interpretations of the results may introduce biases in the analysis. To address these issues, future research could incorporate multiple databases and employ a range of knowledge graph visualization and analysis tools to perform alternative analyses.

CRediT authorship contribution statement

Aijia Zhang: Writing – original draft, Visualization, Software, Methodology, Formal analysis, Data curation, Conceptualization. Xuexing Luo: Methodology, Investigation, Formal analysis, Data curation. Fangtian Ying: Validation, Supervision, Resources, Project administration. Jue Wang: Writing – review & editing, Validation, Supervision, Project administration, Methodology. Guanghui Huang: Writing – review & editing, Validation, Supervision, Project administration, Funding acquisition.

Data availability statement

Data included in article/supplementary material is referenced in the article.

Funding

This study is supported by the Faculty Research Grant from Macau University of Science and Technology (Grant No.: FRG-24-049-FA).

Declaration of competing interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.