Introduction
The American Psychiatric Association defines trauma as “an emotional response to a terrible event like an accident, rape, or natural disaster” [1]. A systematic review of international studies found that nearly two-thirds of children and adolescents under 18 years of age have experienced adverse childhood experiences. Childhood trauma is a key risk factor in psychopathology. Given the potential adverse effects of childhood trauma, developmental assessments are needed for these children to design therapeutic interventions. Research suggests that self-report assessment is a proper method for this purpose. However, in children under 10 who are still developing abstract thinking, such assessment is challenging, as they may not provide meaningful verbal expression. Attention to the play of children who have experienced trauma is particularly important. Playing can be seen as a language through which young children communicate their thoughts, feelings, and experiences, both directly and symbolically. In this regard, Play-based developmental assessments have been considered. A meta-synthesis study can help identify and review existing qualitative studies in this field. Therefore, this study aims to identify common themes in the play of children with traumatic experiences by meta-synthesis of qualitative studies.

Methods
This is a meta-synthesis study using the meta-ethnography approach. A systematic search in two databases, PubMed and Google Scholar, was conducted on qualitative studies published in English from 2001 to May 2024. Initially, 1,846 records were found, of which five articles and one thesis met the inclusion criteria. The findings were analyzed according to the seven steps of meta-ethnography. In the first step, the research topic was determined. In the second step, the studies closely related to the topic were selected. In the third step, the researchers read the studies. In the fourth step, the researchers determined how the studies were related to each other. In the fifth step, the studies were translated into one another. In the sixth step, the translations were synthesized. In the final step, the synthesis was expressed.

Results
The data analysis identified two main themes in the play of children with trauma: vulnerability to trauma and mastery over trauma (Figure. 1). Children who experienced trauma showed their vulnerability during playing by re-enactment of trauma, depicting death, and expressing feelings of fear and insecurity. Children symbolically gained control over their trauma by neutralizing threats, creating superheroes, and returning to the routine.

Conclusions 
Children who have experienced trauma often exhibit their vulnerability through re-enactments of their trauma during play, addressing themes of death, and displaying feelings of fear and insecurity. Play provides a safe space for children to overcome trauma symbolically. This meta-synthesis found that children achieve mastery over trauma by neutralizing threats, creating superheroes, and returning to the routine. Since children have a limited ability to think about and express their emotions and symptoms, various expressive tools are needed when assessing children exposed to traumatic events. Attention to the play of these children can be a suitable method for their psychological assessment.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Science and Culture - Academic Center for Education, Culture and Research (Code: IR.ACECR.USC.REC.1402.003)

Funding
This article was extracted from the PhD thesis of Parastoo Kafaeizad Tehrani at the University of Science and Culture, Tehran, Iran. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors contributions
The authors contributed equally to preparing this paper.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation in this research.