Lessons learnt about implementing LEGO based therapy (Play Brick Therapy) based on fidelity data and experience from a large school-based randomised controlled trial

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Biggs, K., Cuesta, G. G. d. l., Kingsley, E., McPherson, J., Murray, F., Laurie, M., Bursnall, M., Coates, E., & Barr, A. (2026). Lessons learnt about implementing LEGO based therapy (Play Brick Therapy) based on fidelity data and experience from a large school-based randomised controlled trial. PLOS One, 21(2), e0336952. https://doi.org/10.1371/journal.pone.0336952

Publication date: 4 Feb 2026 Added to AutiHub: 6 Jul 2026 Type: Article Article language: English
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Authors

Publication authors
9
Publication authors identified as autistic
1 / 9 (11.1%)
  1. Katie Biggs
  2. Gina Gómez de la Cuesta
  3. Ellen Kingsley
  4. Jean McPherson
  5. Fergus Murray *
  1. Margaret Laurie
  2. Matt Bursnall
  3. Elizabeth Coates
  4. Amy Barr

Abstract

INTRODUCTION: LEGO® based therapy, a social skills program for autistic children and young people, involves collaborative LEGO® 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. METHODS: The I-SOCIALISE trial investigated LEGO® based therapy for autistic children in schools. Researchers recruited 98 schools and randomly assigned them to deliver LEGO® based therapy or usual care. LEGO® 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® 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. RESULTS: LEGO® 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 1-2 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. DISCUSSION: LEGO® 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® 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's 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® based therapy works.

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Bibliography inclusion overview

These indicators describe the cited bibliography imported for this publication. Cited-reference metrics use the cited-reference total as denominator. Cited-author metrics state whether they use all cited-author occurrences or only occurrences linked to authors already integrated in the AutiHub database. They use cached links between cited authors and authors integrated in the AutiHub database. Last computed: 16 Aug 2026 11:31.

Cited references
29
Total cited references integrated for this publication.
Cited references with an identified autistic author
1 / 29 (3.4%)
Cited author occurrences identified as autistic
1 / 109 (0.9%)
Among occurrences linked to AutiHub author records: 1 / 19 (5.3%). Distinct cited authors identified as autistic: 1 / 97 (1.0%).
Cited author occurrences linked to AutiHub author records
19 / 109 (17.4%)
Distinct linked cited authors: 13 / 97 (13.4%)
Linked cited-author occurrences not identified as autistic
18 / 19 (94.7%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 18 / 109 (16.5%). Distinct linked cited authors not identified as autistic: 12 / 13 (92.3%).
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