{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T08:42:57Z","timestamp":1776069777800,"version":"3.50.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>LEGO\u00ae based therapy, a social skills program for autistic children and young people, involves collaborative LEGO\u00ae building with adult guidance. This paper examines how well the program was delivered in a recent school randomised controlled trial and explores areas for improvement in implementation. The main trial results are published elsewhere.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The I-SOCIALISE trial investigated LEGO\u00ae based therapy for autistic children in schools. Researchers recruited 98 schools and randomly assigned them to deliver LEGO\u00ae based therapy or usual care. LEGO\u00ae based therapy sessions lasted one hour per week for 12 weeks with groups of 3 children. Schools received a 3-hour training session and a manual. Researchers measured fidelity to the LEGO\u00ae based therapy programme using self-reported checklists and video analysis. Research team insight and experience of the delivery of the training and intervention are included in this paper.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LEGO\u00ae based therapy was delivered to autistic children in schools with high fidelity according to facilitators and independent reviewers. Most groups (69%) received all 12 sessions, and nearly all groups received the minimum dose of 6 sessions (93%). Sessions typically lasted about an hour and had 1\u20132 autistic children. Facilitators were mostly teaching assistants with moderate experience in autism. Over 90% of sessions included core elements like group building and social interaction. There were disagreements between facilitators and reviewers on adherence to some program elements like rewards and discussing roles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>LEGO\u00ae based therapy was delivered with high fidelity in a large school trial, but there were areas for improvement, such as facilitator training and focus on social interaction for and between children. The authors suggest that facilitators may have been more focused on completing LEGO\u00ae builds than on facilitating meaningful social interaction and play between children. Three hours of training may not have been enough to prepare facilitators for their role. The study also did not capture young people\u2019s experience of the program, which is important for understanding its effectiveness and impact. Future research should explore how to better measure these aspects and develop a stronger theory of how LEGO\u00ae based therapy works.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336952","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T18:22:25Z","timestamp":1770229345000},"page":"e0336952","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Lessons learnt about implementing LEGO based therapy (Play Brick Therapy) based on fidelity data and experience from a large school-based randomised controlled trial"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4468-7417","authenticated-orcid":true,"given":"Katie","family":"Biggs","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gina","family":"Gomez de la Cuesta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"Kingsley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"McPherson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fergus","family":"Murray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6774-6830","authenticated-orcid":true,"given":"Margaret","family":"Laurie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Bursnall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Coates","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Barr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"issue":"5","key":"pone.0336952.ref001","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s10803-004-2550-0","article-title":"Use of LEGO as a therapeutic medium for improving social competence","volume":"34","author":"DB LeGoff","year":"2004","journal-title":"J Autism Dev Disord"},{"issue":"10","key":"pone.0336952.ref002","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1007\/s10803-008-0590-6","article-title":"LEGO therapy and the social use of language programme: an evaluation of two social skills interventions for children with high functioning autism and Asperger Syndrome","volume":"38","author":"G Owens","year":"2008","journal-title":"J Autism Dev Disord"},{"issue":"2","key":"pone.0336952.ref003","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.dhjo.2016.10.010","article-title":"A scoping review of the role of LEGO\u00ae therapy for improving inclusion and social skills among children and youth with autism","volume":"10","author":"S Lindsay","year":"2017","journal-title":"Disabil Health J"},{"issue":"6","key":"pone.0336952.ref004","doi-asserted-by":"crossref","first-page":"702","DOI":"10.3390\/brainsci11060702","article-title":"Could you give me the blue brick? LEGO\u00ae-based therapy as a social development program for children with autism spectrum disorder: a systematic review","volume":"11","author":"A Narzisi","year":"2021","journal-title":"Brain Sci"},{"issue":"5","key":"pone.0336952.ref005","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-030471","article-title":"Investigating social competence and isolation in children with Autism taking part in LEGO-based therapy clubs in school environments (I-SOCIALISE): study protocol","volume":"9","author":"D Varley","year":"2019","journal-title":"BMJ Open"},{"issue":"8","key":"pone.0336952.ref006","first-page":"13623613231159699","article-title":"I-SOCIALISE: Results from a cluster randomised controlled trial investigating the social competence and isolation of children with autism taking part in LEGO\u00ae based therapy ('Play Brick Therapy\u2019) clubs in school environments","volume":"27","author":"B Wright","year":"2023","journal-title":"Autism"},{"issue":"12","key":"pone.0336952.ref007","first-page":"1","article-title":"Play brick therapy to aid the social skills of children and young people with autism spectrum disorder: the I-SOCIALISE cluster RCT","volume":"11","author":"B Wright","year":"2023","journal-title":"Public Health Res (Southampt)"},{"issue":"7","key":"pone.0336952.ref008","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1002\/aur.2725","article-title":"A mixed methods evaluation of the acceptability of therapy using LEGO\u00ae bricks (LEGO\u00ae based therapy) in mainstream primary and secondary education","volume":"15","author":"A Barr","year":"2022","journal-title":"Autism Res"},{"issue":"1","key":"pone.0336952.ref009","article-title":"Cost-utility analysis of LEGO based therapy for school children and young people with autism spectrum disorder: results from a randomised controlled trial","volume":"12","author":"H-I Wang","year":"2022","journal-title":"BMJ Open"},{"issue":"4","key":"pone.0336952.ref010","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1177\/1362361306064403","article-title":"Long-term outcome of social skills intervention based on interactive LEGO play","volume":"10","author":"DB Legoff","year":"2006","journal-title":"Autism"},{"issue":"7","key":"pone.0336952.ref011","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1177\/1362361315621054","article-title":"Maternal experience of lego therapy in families with children with autism spectrum conditions: what is the impact on family relationships?","volume":"20","author":"H Peckett","year":"2016","journal-title":"Autism"},{"issue":"4","key":"pone.0336952.ref012","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1207\/SLDRP1504_4","article-title":"Treatment integrity in learning disabilities intervention research: do we really know how treatments are implemented?","volume":"15","author":"FM Gresham","year":"2000","journal-title":"Learn Disabilit Res Pract"},{"issue":"9","key":"pone.0336952.ref013","doi-asserted-by":"crossref","first-page":"590","DOI":"10.3102\/0013189X19891436","article-title":"Using implementation fidelity to aid in interpreting program impacts: a brief review","volume":"48","author":"HC Hill","year":"2019","journal-title":"Edu Res"},{"issue":"4","key":"pone.0336952.ref014","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s40688-018-0175-0","article-title":"Is implementation fidelity important? A systematic review on school-based mental health programs","volume":"23","author":"R Rojas-Andrade","year":"2018","journal-title":"Contemp School Psychol"},{"key":"pone.0336952.ref015","volume-title":"LEGO\u00ae-based therapy: how to build social competence through LEGO\u00ae-based Clubs for children with autism and related conditions","author":"S Baron-Cohen","year":"2014"},{"issue":"1","key":"pone.0336952.ref016","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s13063-019-3807-4","article-title":"Challenges in the design, planning and implementation of trials evaluating group interventions","volume":"21","author":"K Biggs","year":"2020","journal-title":"Trials"},{"key":"pone.0336952.ref017","unstructured":"National Autistic Society. Education report. 2023. https:\/\/dy55nndrxke1w.cloudfront.net\/file\/24\/asDKIN9asAvgMtEas6gIatOcB5H\/NAS_Education%20Report%202023.pdf"},{"issue":"4","key":"pone.0336952.ref018","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1111\/cdev.13730","article-title":"Can guidance during play enhance children\u2019s learning and development in educational contexts? A systematic review and meta-analysis","volume":"93","author":"K Skene","year":"2022","journal-title":"Child Dev"},{"issue":"1","key":"pone.0336952.ref019","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1037\/0003-066X.55.1.68","article-title":"Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being","volume":"55","author":"RM Ryan","year":"2000","journal-title":"Am Psychol"},{"key":"pone.0336952.ref020","unstructured":"Deployment of Teaching Assistants. Education endowment foundation. Accessed 2025 November 10. https:\/\/educationendowmentfoundation.org.uk\/education-evidence\/guidance-reports\/teaching-assistants"},{"issue":"8","key":"pone.0336952.ref021","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1177\/13623613221129123","article-title":"The \u201cdouble empathy problem\u201d: ten years on","volume":"26","author":"D Milton","year":"2022","journal-title":"Autism"},{"issue":"1","key":"pone.0336952.ref022","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1089\/aut.2021.0017","article-title":"Investigating markers of rapport in autistic and nonautistic interactions","volume":"4","author":"OM Rifai","year":"2022","journal-title":"Autism Adulthood"},{"issue":"3","key":"pone.0336952.ref023","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/bjdp.12443","article-title":"Building connections through play: influences on children\u2019s connected talk with peers","volume":"41","author":"EJ Goodacre","year":"2023","journal-title":"Br J Dev Psychol"},{"key":"pone.0336952.ref024","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.3389\/fpsyg.2018.01124","article-title":"Accessing the inaccessible: redefining play as a spectrum","volume":"9","author":"JM Zosh","year":"2018","journal-title":"Front Psychol"},{"issue":"2","key":"pone.0336952.ref025","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/1471-3802.12504","article-title":"The implementation of Lego \u00ae \u2010based therapy in two english mainstream primary schools","volume":"21","author":"V Evans","year":"2021","journal-title":"Res Spec Educ Needs"},{"key":"pone.0336952.ref026","doi-asserted-by":"crossref","DOI":"10.1111\/j.1752-7325.2011.00233.x","article-title":"The assessment, monitoring, and enhancement of treatment fidelity in public health clinical trials","volume":"71","author":"B Borrelli","year":"2011","journal-title":"J Public Health Dent"},{"issue":"5","key":"pone.0336952.ref027","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s10935-014-0351-6","article-title":"Differences in observers\u2019 and teachers\u2019 fidelity assessments","volume":"35","author":"WB Hansen","year":"2014","journal-title":"J Prim Prev"},{"issue":"1","key":"pone.0336952.ref028","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1080\/20473869.2023.2207298","article-title":"Cross-cultural differences in autistic characteristics: a comparison between Spain and Colombia","volume":"71","author":"AE Mart\u00ednez-Gonz\u00e1lez","year":"2023","journal-title":"Int J Dev Disabil"},{"key":"pone.0336952.ref029","volume-title":"An International evaluation of the brick-by-brick programme in Kenya and Mexico","author":"M Laurie","year":"2023"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336952","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T18:22:33Z","timestamp":1770229353000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336952"}},"subtitle":[],"editor":[{"given":"Yuliang","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,4]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0336952","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,4]]}}}