Dunia Keperawatan: Jurnal Keperawatan dan Kesehatan DOI: 10.
20527/dk.
Received July 2025.
Accepted November 2025
@JDK 2025
eISSN: 2541Ae5980.
pISSN: 2337-8212 The Effectiveness of Safety Flour Clay Therapy on Fine Motor Skills of Children with Autism Sindi Rosy Puspita1.
Deisy Sri Hardini2* Nursing Science Study Program.
Faculty of Health Sciences.
Universitas Muhammadiyah Purwokerto.
KH.
Ahmad Dahlan Street.
Dusun i.
Dukuhwaluh.
Kembaran District.
Banyumas Regency.
Central Java.
Indonesia, 53182 *Corresponding email: deisysrihardini@ump.
ABSTRACT
Data from the World Health Organization indicate a high prevalence of autism-related disabilities, with many children experiencing developmental delays of over five years and limited fine motor skills typically seen at the level of children aged 3 to 4.
This study aims to support children with autism by enhancing their fine motor development through Safety Flour Clay therapy.
The research was conducted to examine the effect of this therapy on improving fine motor skills in children with autism at SLB C and C1 Yakut Purwokerto and SLB Negeri Banjarnegara.
A quantitative approach was employed using a preexperimental design with a one-group pretest-posttest format without a control group.
A total of 30 participants were selected through total sampling.
Data were collected through observation using standardized instruments and analyzed with the Wilcoxon Signed Ranks Test.
The results showed a significance value of 0.
< 0.
, indicating a significant effect of Safety Flour Clay therapy on the improvement of fine motor skills in children with autism.
This therapy presents a promising alternative to support physical development, particularly in the area of fine motor coordination.
Keywords: Autis.
Fine Motor Skills.
Safety Flour Clay Cite this as: Puspita SR and Hardini DS.
The Effectiveness of Safety Flour Clay Therapy on Fine Motor Skills of Children with Autism.
Dunia Keperawatan.
: 238-249.
DOI: 10.
20527/dk.
INTRODUCTION
diagnostic indicators highlights the importance of understanding autism within a broader public health context.
The term autism originates from the Greek word autos, meaning Auself,Ay which describes children with autism who appear to live in their own world.
Rather than general tendencies such as preferring solitude or showing minimal responses, autism is characterized by identifiable differences in reciprocal social communication as well as restricted or repetitive patterns of behaviors, interests, or activities.
diagnosis of autism can be established as early as 18Ae24 months of age, based on observable behavioral patterns aligned with DSM-5 diagnostic criteria, at which point characteristic symptoms can be distinguished from typical development and from other developmental delays or conditions .
Recognizing these clinical characteristics and early According to data from the World Health Organization (WHO), the global prevalence of autism continues to increase, with approximately one in every 100 children worldwide diagnosed with autism.
This prevalence varies across studies, and the figures represent the average across multiple research findings .
Recent studies indicate that the global prevalence of Autism Spectrum Disorder (ASD) has reached 6%, which reflects a more recent metaanalytic estimate and may differ from the broader global average reported by WHO, showing a rapid increase in recent The prevalence rate in Southeast Asia is also recorded at 0.
6%, mirroring Dunia Keperawatan.
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November 2025: 238-249 the global figure.
A recent meta-analysis of 23 studies revealed that the estimated incidence of ASD in various Asian countries and regions including China.
Japan.
Iran.
Indonesia.
Israel, and Taiwan ranges from 1.
1 to 21.
8 per 10,000 individuals .
Children with autism who experience fine motor delays may find it difficult to control their hands when writing, sketching, grasping, clapping, playing, pointing, or performing daily They may also struggle to carry objects, squeeze clothing, or use scissors .
Considering this situation, various strategies are needed to help children with autism improve their fine motor abilities.
A childAos fine motor skills can be developed through basic games and play materials such as clay, building blocks, newspapers, and balls .
Despite this growing prevalence, many children with ASD continue to experience significant delays in fine motor development, and effective therapeutic nursing interventions remain limited in educational and clinical settings in Indonesia.
Therefore, this study aims to examine the effectiveness of Safety Flour Clay therapy as a supportive intervention to improve fine motor skills in children with autism.
Previous Boediono .
found that playing with clay has a positive impact on the fine developmental disorders, particularly in improving their ability to coordinate finger movements such as pinching, squeezing, and grasping .
Boediono .
also explained that playing with clay provides an enjoyable and engaging activity for children, allowing them to stay motivated and receive continuous guidance throughout the process .
This approach helps children with autism achieve better progress in developing their fine motor skills.
Furthermore.
Boediono .
emphasized that playing with clay positively influences the hand and finger coordination of children with autism, such as pinching, squeezing, and holding objects.
These findings can serve as a reference for related or future studies .
At present, there is no definitive survey regarding the exact number of children with autism in Indonesia.
Between 2012 and 2021, it was estimated that 147 children were diagnosed with autism, and within the next ten years, the number of individuals with autism is projected to reach approximately 529,200, or around 2.
4 million people .
According to data from the Center for Data and Information (Pusdatin, 2.
of the Ministry of Education and Culture, there are 530 children with autism in Central Java .
Disability data from Banyumas Regency between 2020 and 2024 show that there are 2,630 individuals diagnosed with intellectual disability, while Banjarnegara Regency recorded 1,250 individuals within the same period .
A preliminary study conducted through interviews with the principals of SLB N Banjarnegara and SLB C and C1 Yakut Purwokerto revealed that clay therapy has never been implemented to support fine motor development in children with Based on an initial survey, there were 30 autistic students aged 7Ae16 years, from elementary to high school levels, all of whom were male: 5 Based on the findings of the Denver Developmental Screening Test (DDST), one of the tools used to identify developmental disorders in children, developmental delays of more than five years, and their fine motor skills are typically limited to the equivalent of those of three- to four-year-old children Puspita SR and Hardini DS.
The Effectiveness of.
students from grade 1, 2 students from grade 2, 6 students from grade 3, 1 student from grade 5, 5 students from grade 6, 4 students from grade 7, 2 students from grade 8, and 5 students from grade 10.
Interviews with teachers indicated that the learning activities follow a modified Merdeka Curriculum through an Individual Education Program (IEP), incorporating nonacademic physical aspects such as fine motor These activities include .
riting arithmeti.
, extracurricular programs, and self-development tasks related to basic classroom and daily activities .
riting, cutting, coloring, etc.
), as well as self-care skills .
uttoning clothes, tying shoelaces, brushing teeth, etc.
those of children aged approximately three to four years.
Based on previous research and preliminary studies, experts have shown a strong interest in helping children with autism enhance their fine motor abilities through the use of claybased therapy and developmental assessment tools.
Traditionally, the base material for clay often includes lem fox .
dhesive glu.
to soften its texture.
however, the increasing incidence of pica has raised safety concerns regarding its use.
The prevalence of pica among individuals with autism is notably high.
According to the Autism Research Institute, approximately 23.
2% of autistic children and up to 60% of autistic adults exhibit pica behavior, emphasizing its widespread occurrence within the autistic population .
address this concern, the present study introduces a novel approach by substituting the adhesive component with salt as an activator, creating Safety Flour Clay that is safer for autistic children and reduces the risk of pica The results showed that 6.
67% .
could hold a pencil properly during learning activities, 66.
67% .
had weak pencil grip, and 33% .
held pencils too Additionally, 16.
67% .
were able to button clothes independently, while 83.
33% could not, 67% .
could tie their shoelaces with assistance, whereas 33% could not and 23.
33% .
were able to brush their teeth with assistance, while 76.
67% .
were unable to do so.
These findings indicate that most students have not yet developed adequate fine motor skills, which directly affect their academic performance and physical activity capacity.
This study aims to identify the effect of Safety Flour Clay therapy on fine-motor development in children with autism at SLB C and C1 Yakut Purwokerto and SLB Negeri Banjarnegara.
It further characteristics such as age, gender, and autism category.
to examine the finemotor development of autistic children before the implementation of Safety Flour Clay therapy.
and to analyze their fine-motor intervention while determining the significance of the differences observed between pre- and post-therapy stages.
In a study conducted by Wulandari et al .
, it was noted that the prevalence of disabilities related to intellectual .
significantly high .
The study found that children with autism generally experience developmental delays of more than five years, and their fine motor abilities are typically limited to METHODS This study employed a quantitative approach with a pre-experimental design using a one-group pretestAeposttest format without a control group.
The Dunia Keperawatan.
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November 2025: 238-249 research was conducted over a two-week period in December.
The study population consisted of all elementary to high school students with autism at SLB Negeri Banjarnegara .
and SLB C and C1 Yakut Purwokerto .
The sampling technique applied was non-probability total sampling, resulting in a total of 30 The inclusion criteria covered all students with special needs .
from elementary to high school levels in both schools.
Clay, shaping molds, containers, and a standardized observation sheet that provided detailed scoring criteria for each indicator.
An Interrater Reliability test was conducted to evaluate the level of agreement between experts and raters in scoring the instrument indicators.
Data collection was performed directly through observation sheets completed by the researchers for each respondent.
Data processing involved nominal and ordinal data in Aubefore and afterAy formats, which did not follow a normal therefore, a non-parametric analysis was employed.
The data were analyzed using the Wilcoxon SignedRank Test to determine the relationship between two related variables, with a 95% confidence level used for decisionmaking.
All research procedures adhered to the ethical standards approved by the Muhammadiyah Health Research Ethics Committee (KEPK/UMP/46/VII/2.
The research instrument utilized the standardized Autism Child Module Score Sheet developed from the Learning Module by Daniel & Sukamto .
, which was used during both the pre-test and post-test to assess fine motor skills through specific indicators such as grasping, squeezing, rolling, shaping large and small balls, and placing clay into molds .
The module was applied directly within each intervention session, childrenAos performance while completing structured Safety Flour Clay activities.
RESULTS AND DISCUSSION
Table 1 presents the characteristics of the 30 students who participated in this The age distribution shows that most respondents were between 7 and 10 years old, accounting for 13 students .
33%).
Based on gender, all respondents were male .
%).
This homogeneous sample reflects the The intervention consisted of four sessions, each involving sequential finemotor tasks designed to stimulate hand strength, bilateral coordination, and handAeeye precision.
Special materials used in this study included Safety Flour Table 1.
Distribution of Respondent Characteristics Characteristics Age .
Above 10-13 Above 13-16 Total Gender Male Autism Category Mild Moderate Total Frequency Percentage (%) Puspita SR and Hardini DS.
The Effectiveness of.
demographic profile of autistic students enrolled in the participating schools, where the majority of diagnosed children were boys.
This pattern is consistent with existing epidemiological evidence, including Shrestha et al.
, .
, which reports that ASD is significantly more prevalent in boys than in girls .
fine motor skills, and cognitive abilities can be considered reliable with good Of the total 12 items included in the instrument, nine were found to be valid, as their calculated rvalues exceeded the r-table value of The remaining three items, which did not meet the validity threshold, were revised and refined prior to their use in the intervention to ensure clarity and measurement accuracy.
Nonetheless, the absence of female participants represents a limitation, as the intervention outcomes cannot be fully generalized to girls with ASD.
Regarding classification, 20 students .
7%) were categorized as having mild autism, while 10 students .
3%) were classified as These classifications were determined based on the diagnostic categories documented in each studentAos Individual Education Program (IEP), which follows schoolbased clinical assessments referencing DSM-5 However, standardized classification instruments such as CARS or ADOS were used, which should be considered when interpreting the findings.
The material and media validity assessments conducted by two raters showed that the material validity score 81, categorized as Auhighly feasible,Ay and the media validity score 33, also categorized as Auhighly Ay These results suggest that both the material and media are appropriate and feasible to be used as therapeutic tools for children with autism.
These findings strengthen the methodological rigor of the study, indicating that both the instrument and the therapeutic materials were appropriate, feasible, and supported by strong statistical evidence.
Table 2 describes the improvement in fine motor skills observed among students after the intervention.
At SLB C and C1 Yakut Purwokerto, before the intervention all respondents .
students = 100%) had not yet achieved fine motor After the intervention, fine motor development was achieved by 7 students .
%), while 3 students .
%) The Inter-Rater Reliability (IRR) analysis provided an overview of the level of agreement among experts and raters in assigning scores.
The CohenAos Kappa coefficient obtained was 0.
indicating a good level of agreement.
These results demonstrate that the module instrument used to assess autism.
Table 2.
Fine Motor Skill Development Through Safety Flour Clay Therapy Fine motor skill Before Slb C and C1 Yakut Purwokerto Achieved Not Achieved Total Slb Negeri Banjarnegara Achieved Not Achieved Total After Dunia Keperawatan.
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Similarly, at SLB Negeri Banjarnegara, before the intervention fine motor skills were not achieved in 17 respondents .
%), with only 3 respondents .
%) However, following the Safety Flour Clay therapy, fine motor skills were achieved by 13 students .
%), while 7 students .
%) still had not reached the targeted development level.
corresponding p-value of 0.
These results indicate a statistically significant difference in fine motor skills before and after the intervention, leading to the rejection of the null hypothesis (HCA) and acceptance of the alternative hypothesis (HC.
This finding demonstrates that Safety Flour Clay therapy has a significant effect on improving fine motor development in children with autism at SLB C and C1 Yakut Purwokerto as well as SLB Negeri Banjarnegara.
These findings demonstrate a clear improvement in the fine motor abilities of children with autism following the implementation of Safety Flour Clay The increase in postintervention achievement rates indicates that engaging, tactile-based play can coordination, grasping control, and sensory-motor integration among autistic This study was conducted among students with autism enrolled at SLB C and C1 Yakut Purwokerto and SLB Negeri Banjarnegara.
The prominence of children within the 7Ae10-year age range in this study is noteworthy, as this developmental period is recognized as a critical stage for the emergence and autism-related During these years, fine motor deficits tend to become more apparent, making early therapeutic intervention especially important.
Based on Table 3, it can be concluded that all research data were not normally significance value of less than 0.
Therefore, the appropriate statistical test used in this study was the Wilcoxon Signed-Rank Test, which analyzes paired data before and after the This finding is consistent with the study conducted by Heri .
, which stated that autism can cause serious health problems that require early intervention and prevention, particularly among children aged 6 to 12 years who are at higher risk.
In this age group, symptoms of autism tend to manifest more visibly .
Based on the prevalence data of Table 4 presents the results of the Wilcoxon Signed-Rank Test, which yielded a Z value of 4.
123 and a Table 3.
Normality Test Category Pretest Fine Motor Skills Posttest Fine Motor Skills Statistic Saphiro Wilk Sig Table 4.
The Effect of Safety Flour Clay Therapy on Fine Motor Development in Children with Autism at SLB C and C1 Yakut Purwokerto and SLB Negeri Banjarnegara Category Fine Motor Skills Before and After The Intervention p-value Puspita SR and Hardini DS.
The Effectiveness of.
autism among children under 19 years old, which reaches 1.
68 per 1,000 approximately 154,480 children in this age group are diagnosed with autism.
affect brain cell function.
Since females possess two X chromosomes, if one is damaged, the other can compensate for the defect.
Autism is often associated chromosome, which may explain the higher prevalence among males.
Children with autism aged 6 to 12 years generally experience more significant delays in fine motor development.
comparison, non-autistic children of the same age group typically demonstrate more optimal fine motor skill development and better performance .
Children with autism often face movements when writing or drawing, grasping objects, clapping, playing, pointing, and performing various behavioral or daily activities.
Such developmental delays can also affect their ability to use hand muscles effectively, leading to difficulties in holding objects, buttoning clothes, cutting with scissors, or writing .
Similarly.
Shrestha et al .
found that the prevalence of Autism Spectrum Disorder (ASD) was higher among males .
4%) compared to females .
6%) .
Female children are less likely to be diagnosed with ASD because they tend to exhibit fewer overtly atypical behaviors, which may contribute to this gender disparity.
Compared to boys, girls with ASD generally demonstrate stronger verbal abilities and fewer challenges in social interaction and communication.
These traits may mask some of the core symptoms of autism, leading to delayed or even inaccurate diagnoses in females.
This finding is further supported by research conducted by Agustina .
, which revealed that children aged 6 to 12 years generally achieve optimal fine motor development .
However, among children with autism, this development tends to lag behind, indicating the need for specific interventions or therapeutic programs to support their progress.
These persistent delays highlight the importance of strategies such as the Safety Flour Clay intervention used in this study to help enhance fine motor development in children with autism.
Based on the results of the study, the majority of respondents were classified as having mild autism, totaling 20 individuals .
7%), while the remaining .
categorized as having moderate autism.
This classification was based on diagnostic information recorded in each studentAos Individual Education Program (IEP), which follows DSM-5 diagnostic levels to distinguish mild and moderate This study specifically included respondents within the mild and moderate categories as part of the inclusion criteria, whereas those with severe autism were excluded.
This approach aligns with the findings of Rahma & Salsabila .
, who explained that children with mild to moderate autism tend to exhibit a more structured learning pattern, in contrast to those with severe autism who generally require a less systematic and more individualized learning approach .
The results of this study show that all respondents .
%) were male.
This finding aligns with the study conducted by Heri .
, which also reported that male participants constituted the majority of respondents .
According to that study, boys are more likely to experience genetic abnormalities that Dunia Keperawatan.
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November 2025: 238-249 The structured nature of the Safety Flour Clay intervention requiring sequential, guided fine-motor tasks aligns well with the learning characteristics of children in the mild to moderate severity range.
This alignment is important because the intervention results revealed a significant improvement between pre-test and posttest scores, indicating that children within these severity categories were able to benefit from the structured therapeutic activities provided.
receiving playdough therapy, the average fine motor ability of children with autism increased to 71.
8, categorized as good .
However, about 33.
3% of respondents showed no improvement comprising six children with moderate autism and four with mild autism.
This reinforces Werdini .
, who emphasized that the severity of autism affects the effectiveness of intervention outcomes .
One of the most common challenges identified was the ability to roll clay into large and small balls, which requires consistent and controlled hand pressureAian ability that remains difficult for some autistic children.
The severity level of the disorder directly influences the degree of success achieved in administering therapy to individuals with autism.
As the level of autism severity increases, it becomes more challenging to ensure that therapeutic interventions are effective .
Fine motor skills must be nurtured and stimulated because they play an essential role in a childAos overall development.
From a neurological perspective, the process of neural maturation which involves brain development and the regulation of neuromuscular systems leads to noticeable improvement in fine motor categories after children with autism receive Safety Flour Clay The development of ageappropriate motor skills involves the throughout the body, as well as the integration of the fine muscles, nerves, and brain.
This process is influenced by the fundamental principles of motor motivation, experience, and practice .
The results of this study showed that at SLB C and C1 Yakut Purwokerto, before the intervention, fine motor skills had not yet been achieved by all respondents .
students = 100%).
After the observed, with 7 respondents .
%) achieving fine motor proficiency, while 3 respondents .
%) had not yet reached the expected level.
Similarly, at SLB Negeri Banjarnegara, before the intervention, fine motor skills were not achieved in 17 respondents .
%), and only 3 respondents .
%) achieved the However, intervention, 13 respondents .
%) successfully achieved fine motor development, whereas 7 respondents .
%) remained below the target.
In this study.
Safety Flour Clay functioned as an educational play The clay was prepared in various colors such red, green, blue, and yellow to attract the respondents This aligns with Putri et al .
, who stated that educational play materials, such as origami paper, plasticine, and colored blocks, have distinctive and appealing visual features that can be used to engage children and These findings align with Agustina .
, who reported that prior to intervention, childrenAos fine motor abilities were in a very low category with an average score of 48.
5, indicating that their skills had not developed optimally .
Likewise, a study by Lestari .
showed that after Puspita SR and Hardini DS.
The Effectiveness of.
facilitate learning .
The use of Safety Flour Clay as a learning medium increased students interest because they are often easily bored with monotonous Through Safety Flour Clay play, children can train their fine motor skills in multiple ways, including touching and manipulating the material, squeezing, rolling, forming large and small balls, and using molds creatively.
Safety Flour Clay therapy in improving fine motor skills among autistic children .
This research is consistent with Anggraini .
, who found that fine motor abilities such as cutting, squeezing, shaping, and molding improved significantly after guided therapy sessions .
At the Autism Therapy Center AuAnak Manis,Ay Safety Flour Clay therapy was shown to have a positive impact on fine motor development among autistic children aged 6Ae12 years, reflected by an average score increase of 16.
53 points.
This improvement indicates enhanced control over hand movements and emotional As stated by Tauriana & Siwi .
, motor skills not only support childrenAos independence but also contribute to their self-control and confidence, such as when playing musical instruments or performing other motor activities .
This finding is also consistent with Werdini .
, who explained that using Safety Flour Clay as a learning medium can be both enjoyable and In reality, most classroom activities rarely incorporate such media, causing children to lose interest quickly .
When lessons involve hands-on and creative materials, children become more enthusiastic and motivated to Consequently, fine motor skills improve when the media used are enjoyable and stimulating.
The analysis showed that Safety Flour Clay therapy had a significant effect on improving fine motor skills among children with autism at SLB C and C1 Yakut Purwokerto as well as SLB Negeri Banjarnegara.
These findings demonstrate that the intervention was effective in enhancing fine motor development within this population.
The present study revealed improvement in fine motor skills after four sessions of Safety Flour Clay therapy.
Respondents showed progress in at least two fundamental competencies: sensory ability .
ouching and squeezing the doug.
, bilateral coordination .
olling the clay using different technique.
, and hand stability .
lacing, pressing, and closing mold.
These improvements were supported by the respondentsAo active engagement through the Applied Behavior Analysis (ABA) approach and their attraction to the texture, color, and aroma of the clay.
However, several children displayed resistance due to reluctance to touch the medium for extended periods.
This challenge may be approaches, such as using fruits as complementary tactile media.
The results of this study support the findings of Rahayuningrum & Wahyuni .
who reported that Safety Flour Clay play therapy effectively improves fine motor development in children with autism .
The children were observed to be diligent in following the procedures and showed strong interest in the therapy medium, both of which contributed to the success of the Similar results were reported by Lestari .
in a study conducted at a special education school in Sidoarjo, which also yielded a p-value 000, confirming the effectiveness of This study also incorporated Jean WatsonAos theory, which emphasizes the Dunia Keperawatan.
Volume 13.
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November 2025: 238-249 importance of holistic and transpersonal caring approaches.
By applying these principles alongside ABA techniques, nurses and educators can create a therapeutic environment that supports the optimal development of children with autism.
Overall.
Safety Flour Clay therapy proved to have a positive and significant effect on improving fine motor skills in children with autism at SLB C and C1 Yakut Purwokerto and SLB Negeri Banjarnegara.
ACKNOWLEDGEMENTS
The authors would like to express their deepest gratitude to Allah SWT for His blessings and guidance throughout the completion of this article.
Appreciation is also extended to the authorsAo parents and family for their continuous support, and to the supervisor.
Ns.
Deisy Sri Hardini.
Kep.
Kep.
Sp.
Kep.
An.
for her valuable direction and guidance during the implementation of this Considering the therapyAos demonstrated effectiveness, a follow-up plan will be implemented at both SLB C and C1 Yakut Purwokerto and SLB Negeri Banjarnegara.
The follow-up activities will include presenting the research results, developing intellectual property rights (IPR) registration for the Safety Flour Clay medium and its Standard Operating Procedure (SOP), and creating a framed SOP as a guide for future CONCLUSION Based on the findings of this study.
Safety Flour Clay therapy proved to be effective in improving fine motor
development among children with autism at SLB C and C1 Yakut
Purwokerto
SLB
Negeri Banjarnegara.
This was evidenSced by the results of the Wilcoxon Signed-Rank Test, which showed a significance value 000 .
< 0.
, indicating a between pre- and post-intervention The improvement was observed through enhanced performance across several fine motor indicators, including rolling, squeezing, and pressing the clay into molds.
The effectiveness of the therapy was further supported by the application of the Applied Behavior Analysis (ABA) approach, which helped autistic children better understand and follow instructions during the sessions.
LIMITATIONS
This study has several limitations.
First, some respondents were reluctant to touch the therapy medium, which required additional patience and longer time for implementation.
Second, respondents with moderate autism were more easily distracted by their following instructions, resulting in slower progress toward achieving the targeted competencies.
Third, the use of natural materials made the clay medium more prone to changes in odor and When stored at room temperature for more than one week without refrigeration, the texture became softer and produced an unpleasant smell, necessitating repeated preparation of the clay for each session.
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