{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:32:16Z","timestamp":1790051536642,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":160,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004035","name":"Jordan University of Science and Technology","doi-asserted-by":"publisher","award":["20160004"],"award-info":[{"award-number":["20160004"]}],"id":[{"id":"10.13039\/501100004035","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Pediatrics"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Expressive arts provide nonverbal therapeutic tools that can help children with post\u2010traumatic stress disorder (PTSD) overcome language and cultural barriers. This study compared the effectiveness of sandplay therapy and art therapy in reducing PTSD symptom severity among Syrian refugee children living in noncamp, host community settings in Jordan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>\n                      We conducted a three\u2010arm, parallel\u2010group, randomized controlled trial involving 102 Syrian refugee children (aged 5\u201313 years) with clinically diagnosed PTSD. Participants were randomly assigned to sandplay therapy (\n                      <jats:italic>n<\/jats:italic>\n                      = 32), art therapy (\n                      <jats:italic>n<\/jats:italic>\n                      = 42), or standard counseling (control,\n                      <jats:italic>n<\/jats:italic>\n                      = 28). Each group received one session per week for 12 weeks. The primary outcome was the total score on Part IV of the Arabic version of the Harvard Trauma Questionnaire (HTQ), assessed at baseline and postintervention. Between\u2010 and within\u2010group analyses, analysis of variance, and linear regression were used to evaluate changes in PTSD severity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were comparable across groups, though severe PTSD was more prevalent in the sandplay group (40.6%), compared to the art therapy (11.9%) and control (25.0%) groups. After 12 weeks, sandplay therapy resulted in the greatest reduction in PTSD symptom severity (mean HTQ score difference: \u221222.4,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), followed by art therapy (\u221210.8,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) and standard counseling (\u22122.1,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002). Between\u2010group analyses confirmed sandplay\u2032s superior efficacy over both art therapy and standard counseling (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), whereas art therapy was significantly more effective than control.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both sandplay and art therapies significantly improved PTSD symptoms in conflict\u2010affected children, with sandplay demonstrating the greatest impact. These findings underscore the effectiveness of expressive, nonverbal interventions in addressing conflict\u2010related trauma among refugee populations and support their integration into comprehensive mental health programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov identifier: NCT06984198.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/ijpe\/7636252","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T09:18:29Z","timestamp":1781083109000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Healing Beyond Words: A Randomized Controlled Trial of Sandplay and Art Therapies for PTSD Among Syrian Refugee Children in Jordan"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4810-0987","authenticated-orcid":false,"given":"Abdulqudos","family":"Al-Fakih","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0467-8420","authenticated-orcid":false,"given":"Abdallah","family":"Alzoubi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2458-8200","authenticated-orcid":false,"given":"Ahmad","family":"Alrawashdeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5858-0699","authenticated-orcid":false,"given":"Jomana W.","family":"Alsulaiman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1927-8507","authenticated-orcid":false,"given":"Saleh A.","family":"Ba-shammakh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3245-8847","authenticated-orcid":false,"given":"Adi","family":"Khasawneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3031-5484","authenticated-orcid":false,"given":"Karin","family":"Dannecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4504-4472","authenticated-orcid":false,"given":"Khalid A.","family":"Kheirallah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"e_1_2_11_1_2","article-title":"Population Stands at Around 9.5 Million, Including 2.9 Million Guests","volume":"30","author":"Ghazal M.","year":"2016","journal-title":"Jordan Times"},{"key":"e_1_2_11_2_2","volume-title":"Situation Syria Regional Refugee Response","author":"UNHCR","year":"2021"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijop.12695"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/136346159503200304"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10567-010-0081-0"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-004-0724-x"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.26719\/emhj.21.072"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2020.54"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdz026"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2018.12.013"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/650804"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2023.104949"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aip.2019.04.001"},{"key":"e_1_2_11_14_2","doi-asserted-by":"publisher","DOI":"10.1037\/pla0000180"},{"key":"e_1_2_11_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2011.02407.x"},{"key":"e_1_2_11_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/07421656.2003.10129630"},{"key":"e_1_2_11_17_2","doi-asserted-by":"publisher","DOI":"10.1080\/17450128.2016.1181288"},{"key":"e_1_2_11_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.aip.2020.101665"},{"key":"e_1_2_11_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/15248380241306029"},{"key":"e_1_2_11_20_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.811515"},{"key":"e_1_2_11_21_2","first-page":"134","article-title":"The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II)","volume":"2","author":"First M. B.","year":"2004","journal-title":"Comprehensive Handbook of Psychological Assessment, Personality Assessment"},{"key":"e_1_2_11_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/0020764007078362"},{"key":"e_1_2_11_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-199202000-00008"},{"key":"e_1_2_11_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chipro.2024.100078"},{"key":"e_1_2_11_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40359-025-02361-4"},{"key":"e_1_2_11_26_2","unstructured":"MaharjanC. L. Sandplay Therapy for Children With Trauma Living in a Residential Facility in Nepal : A Multiple Case Study 2020 California Institute of Integral Studies."},{"key":"e_1_2_11_27_2","doi-asserted-by":"publisher","DOI":"10.12964\/jsst.19009"},{"key":"e_1_2_11_28_2","article-title":"Sandtray and Sandplay in the Treatment of Trauma With Children and Adolescents: A Systemic Review","volume":"2","author":"Herce N. B.","year":"2024","journal-title":"World Journal for Sand Therapy Practice"},{"key":"e_1_2_11_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.1022"},{"key":"e_1_2_11_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000033469"},{"key":"e_1_2_11_31_2","doi-asserted-by":"crossref","unstructured":"TroshikhinaE. Sandplay Therapy for the Healing of Trauma. Is This a Culture of Trauma?: An Interdisciplinary Perspective 2013 Brill.","DOI":"10.1163\/9781848881624_023"},{"key":"e_1_2_11_32_2","doi-asserted-by":"publisher","DOI":"10.1080\/07421656.2001.10129454"},{"key":"e_1_2_11_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/sjop.12395"},{"key":"e_1_2_11_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11845-021-02688-y"},{"key":"e_1_2_11_35_2","doi-asserted-by":"publisher","DOI":"10.32604\/ijmhp.2023.022491"}],"container-title":["International Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ijpe\/7636252","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/ijpe\/7636252","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ijpe\/7636252","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T09:18:37Z","timestamp":1781083117000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/ijpe\/7636252"}},"subtitle":[],"editor":[{"given":"Nikhat","family":"Kaura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/ijpe\/7636252"],"URL":"https:\/\/doi.org\/10.1155\/ijpe\/7636252","archive":["Portico"],"relation":{},"ISSN":["1687-9740","1687-9759"],"issn-type":[{"value":"1687-9740","type":"print"},{"value":"1687-9759","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-07-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"7636252"}}