Moula, Zoe

A systematic review of child-focused outcomes of arts therapies delivered in primary mainstream schools

Zoe Moula

Co-authors: Supritha Aithal, Vicky Karkou

Introduction: Arts therapies are being widely used at schools in an effort to alleviate and prevent children’s difficulties. In contrast to talking therapies, arts therapies facilitate personal change and growth through the use of arts media; particularly, visual arts, music, drama, dance and movement.

Aim: To identify, appraise, and synthesise all available evidence regarding child-focused outcomes of arts therapies delivered in primary schools.

Research Questions:

1.What are the verbal, non-verbal, and physical responses to school-based arts therapies as reported through:

  i. children’s experiences, perspectives, and arts-work?

  ii. self-reported standardised measurements of outcomes and biomarkers?

2. How have the child-focused outcomes been collected and evaluated in qualitative and quantitative studies?

Methods: Major electronic databases were systematically searched: AMED, PsycINFO, CINAHL, ERIC, MEDLINE, Campbell Collaboration Library, WHO ICTRP, Cochrane library databases, including CDSR, CENTRAL, HTA (01/01/1980 until 31/03/2018 published in English). We also hand-searched grey literature, art therapy–specific journals and contacted experts in the field.

Results: Initially, 13,941 potential results were identified; of which 13,704 were excluded following title and abstract screening. The full text of 237 papers was requested, seven of which met the inclusion criteria. These studies were pilot-RCTs, a cluster-RCT, quasi-RCT, controlled before-after, and grounded theory. Three of the interventions were in music therapy, two in art therapy, and two in dance movement therapy. None of the studies in dramatherapy met the inclusion criteria. The interventions were delivered over 8-20 sessions, lasted between 1-2 hours, 1-3 times weekly. The sample sizes ranged between 14-138 participants, with a total of 358 participants. The interventions took place in USA, UK, Canada, South Korea, and Saudi Arabia.

Conclusions: Arts therapies showed significant improvements in self-esteem, self-confidence, self-expression, mood, communication, understanding, resilience, learning, and aggressive behaviours. However, only small changes were reported in depression, anxiety, attention problems, and withdrawn behaviours. The diversity in the dosage, outcome measurements and quality of assessment tools might explain these results. The primary outcomes were mainly reported by adults, while children’s perspectives were complementary. We found no evidence for long-term outcomes.

Protocol available:




Zoe Moula is a PhD and Graduate Teaching Assistant at Edge Hill University. She earned her BSc in Early Years Education, as well as her MSc in Therapeutic Play, and MRes in Health Research. Her previous work has included teaching and researching at schools in China, Greece, and Wales, focusing on the impact of play for children’s emotional well-being. Currently, she is conducting research with Liverpool and Manchester area schools to explore the outcomes of arts therapies from children’s perspectives.


Recent Presentations

2018: The 3rd EADMT Conference Crossing Borders and The In-Between: DMT at the Leading Edge, ‘Dance Movement Therapy Across Modalities and Disciplines: Alleviation of Discomfort or Support of Wellness?’ Athens, Greece, 5-8 October.

2018: PhD Symposium Improving and Understanding Health, ‘More than words: exploring children’s responses to school arts therapies.’ Liverpool, UK, 3-4 July.

2018: International Conference in Health and Social Work, ‘Researching arts therapies: Simply a paper exercise?’, Nijmegen, Netherlands, 5-8 February.

2017: International Symposium of Health Humanities & Arts in Health, ‘A systematic review of the effectiveness of art therapy at primary schools.’ Derby, UK, 27-28 November.

2017: Creative Arts in Education and Therapy, ‘Sociometric status and play: a cross-cultural study in the United Kingdom, Greece and China.’ Beijing, China, 6-8 May.