Design and application of emotion-oriented play-learning tools for children with autism: a cross-cultural qualitative study of parents and teachers in China and Malaysia

BackgroundAutistic children experience enduring difficulties with emotion regulation and daily participation. Emotion-oriented play-learning tools (EPLTs, sensory play-learning tools for supporting emotion and self-regulation) are recognized as low-threshold supports across home–school–community settings; however, robust real-world evidence (RWE) on their use, design requirements, and cross-cultural variation remains limited.PurposeThe purpose of this study is to examine the meanings, applications, and design requirements of emotion-oriented play-learning tools in China and Malaysia, and to identify system-level enablers and barriers to their development and use from stakeholder perspectives.MethodsAdopting reflexive thematic analysis, we conducted semi-structured interviews with 30 stakeholders (15 in China; 15 in Malaysia)—parents/primary caregivers and frontline teachers. Data were analyzed inductively in NVivo using three-level coding, and the reporting followed the Standards for Reporting Qualitative Research (SRQR).ResultsFive overarching themes were identified: (1) driving factors (heightened emotional difficulties and trend-driven impetus); (2) attitudes to advanced technologies [virtual/augmented reality (VR/AR) and artificial intelligence (AI)]; (3) potentials and applications (multimodal sensory feedback, support for emotional expression, and transition support); (4) design and market requirements (safety, affordability, maintainability, collaboration, and data minimization); and (5) socio-environmental issues (stigma and policy accessibility). Coding frequencies indicated Theme 4 was the most salient, with stronger emphasis among parents than teachers. Attitudes to technology diverged by country—Malaysian participants were generally more open, whereas Chinese participants were more cautious—while socio-environmental constraints were common to both. Overall, Chinese participants offered denser, institution-focused accounts, whereas Malaysian participants emphasized family- and community-based practical coping.ConclusionsEmotion-oriented play-learning tools may operate as low-threshold, context-adaptable supplement tools in real-world settings. Scalable adoption depends on evidence-informed design; integrated affordability across price, maintenance, and training; and governance frameworks for privacy and explainability. We propose a design paradigm centered on safety, affordability, evidence, and collaboration. This paradigm is intended to guide small-scale RWE pilots, enable home-school data sharing and cross-cultural adaptation, and ultimately enhance quality of life for autistic children—aligning with the Sustainable Development Goals (SDGs) on Good Health and wellbeing, Quality Education, and Reduced Inequality.