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This is a pilot randomised controlled trial to explore the acceptability and feasibility of laughter yoga about anxiety and depression reduction in children with ASD and parenting stress reduction for their parents. Hypotheses of this study include:
The intervention is a laughter yoga programme consisting of twelve sessions (biweekly). Sixty-six children with ASD and their father or mother from local autism support groups will join this study. Participants will be given an information sheet. Participants will be fully informed about laughter yoga's details, benefits and risks. All participants voluntarily take part in this study. If the family agrees to participate in this study, the parent will sign the consent form. Families will be randomized into an experimental group or a wait-list-control group. Before the laughter yoga programme, baseline data (T0) will be collected. The experimental group (n=33) will attend the twelve classes led by a certified laughter yoga trainer in an activity room that is suitable for indoor exercise. A research assistant will assist the laughter yoga teacher and provide first aid if needed. Parents will complete the questionnaire again immediately at the Programme End (T1) and at a 3-month follow-up (T2). The wait-list-control group (n=33) will receive the same laughter yoga programme after 3-month follow-up (T2).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Laughter Yoga Group | Experimental | The intervention is a laughter yoga program consisting of 12 sessions, two 1-hour sessions per month. |
|
| wait-list-control group | No Intervention | Participants will receive the same intervention after the 3-Months Follow-up (T2). |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| laughter yoga | Behavioral | each class, including warm-up exercises, laughter yoga exercises, breathing and a relaxation session and sharing |
|
| Measure | Description | Time Frame |
|---|---|---|
| Response rate | The proportion of eligible potential participants that agree to take part in. | Baseline (immediately before intervention) |
| Attrition rate | The proportion of recruited participants that withdraw from the study at any time. | 3 Months Follow-up (9 months from baseline) |
| Attendance rate | The number and percentage of families attend each laughter yoga session. | Each laughter yoga session, total 12 time points |
| Perception on laughter yoga | Families in the laughter yoga group will be interviewed to explore their perception of laughter yoga and its benefits. | Programme end (6 months from Baseline) |
| Difficulties in laughter yoga | Families in the laughter yoga group will be interviewed to explore difficulties when they practiced laughter yoga. | Programme end (6 months from Baseline) |
| Safety issues | Families in the laughter yoga group will be interviewed and explore any discomfort during or after the laughter yoga. | Programme end (6 months from Baseline) |
| Measure | Description | Time Frame |
|---|---|---|
| Depression | Parents will rate the 10 items related to their children's depression in the Revised Child Anxiety and Depression Scale - Parent Version. The scoring ranges from 0 to 30, with higher scores indicating greater severity of symptoms of depression. | at baseline (immediately before intervention) , Programme end (6 months from Baseline) and 3-month follow-up (9 months from Baseline) |
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Inclusion Criteria:
THE CHILD should:
THE PARENT should:
Exclusion Criteria:
THE CHILD:
THE PARENT has:
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| Name | Affiliation | Role |
|---|---|---|
| Chung Yan Lam | The Hong Kong Polytechnic University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Hong Kong Polytechnic University | Hong Kong | Hong Kong |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42303395 | Derived | Chung JOK, Lam CY, Leung SF, Bressington D, Chong ACY. Effects of laughter yoga on reducing depression and anxiety in children with autism spectrum disorder and parenting stress in their parents: study protocol for a randomised-controlled feasibility trial. BMJ Open. 2026 Jun 16;16(6):e112368. doi: 10.1136/bmjopen-2025-112368. |
| Label | URL |
|---|---|
| The Revised Child Anxiety and Depression Scale (RCADS) | View source |
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| ID | Term |
|---|---|
| D000067877 | Autism Spectrum Disorder |
| D003863 | Depression |
| D001008 | Anxiety Disorders |
| ID | Term |
|---|---|
| D002659 | Child Development Disorders, Pervasive |
| D065886 | Neurodevelopmental Disorders |
| D001523 | Mental Disorders |
| D001526 | Behavioral Symptoms |
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| ID | Term |
|---|---|
| D027641 | Laughter Therapy |
| ID | Term |
|---|---|
| D026441 | Mind-Body Therapies |
| D000529 | Complementary Therapies |
| D013812 | Therapeutics |
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| Anxiety | Parents will rate their children's social phobia (9 items, score from 0 to 27), panic disorder(9 items, score from 0 to 27), separation anxiety (7 items, score from 0 to 21), generalized anxiety (6 items, score from 0 to 18) and obsessive-compulsive behaviour (6 items, score from 0 to 18) in the Revised Child Anxiety and Depression Scale (RCADS) - Parent Version, with higher scores indicating greater severity of symptom of anxiety. | at baseline (immediately before intervention) , Programme end (6 months from Baseline) and 3-month follow-up (9 months from Baseline) |
| Parenting Stress | Parents will complete the Chinese version of the Parenting Stress Index - Fourth Edition Short Form (PSI-4-SF), from 36 to 180 (36 items), with higher scores indicating a greater level of parenting stress. | at baseline (immediately before intervention) , Programme end (6 months from Baseline) and 3-month follow-up (9 months from Baseline) |
| Child-parent Relationships | Families in the laughter yoga group will be interviewed to assess whether any child-parent relationships have changed since practicing laughter yoga. | Programme end (6 months from Baseline) |
| Official website of Chinese version of the Parenting Stress Index, Fourth Edition Short Form | View source |
| D001519 | Behavior |