Lessons learnt about implementing LEGO based therapy (Play Brick Therapy) based on fidelity data and experience from a large school-based randomised controlled trial
LEGO therapy stays faithful in schools, yet brief training nudges staff to finish sets, not friendships.
01Research in Context
What this study did
Biggs et al. (2026) checked how well 98 schools followed the LEGO therapy steps. They watched 1,200 sessions and scored each one for fidelity.
Every school got the same three-hour training. Staff learned the script: greet, build together, share bricks, praise talking, not just building.
What they found
Schools hit 92 % of the steps. The easy parts: set up the bricks and give clear roles. The weak spots: few adults prompted kids to chat or swap pieces.
In short, bricks got built; peer talk got missed.
How this fits with other research
LLee et al. (2024) ran a similar trial but let typical peers lead the groups. Their autistic kids still gained social skills, showing the method works even with less adult control.
Shabani et al. (2006) tracked kids for three years and saw lasting social gains. Biggs now shows those gains may shrink if staff skip the social prompts.
Peckett et al. (2016) moved LEGO therapy to living rooms and saw happier families. The new study moves it back to schools and finds the same risk: adults focus on the build, not the bond.
Why it matters
You can start LEGO therapy tomorrow, but add two tweaks. First, script one peer question every five minutes. Second, film one session and score only social exchanges. These small shifts keep the therapy true to its aim: kids talking, not just clicking bricks.
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02At a glance
03Original abstract
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. 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. 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. 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.
PLOS One, 2026 · doi:10.1371/journal.pone.0336952