An Examination of Child-Centered Play Therapy on Problem Behaviors for Children with Intellectual Disabilities
Karrie L. Swan, PhD, LPC, RPT, Kansas State University
Dee Ray, PhD, LPC-S, NCC, RPT-S, University of North Texas
The basis for this study is a growth in mental health needs of children with intellectual disabilities and their lack of treatment. To address this existent gap, we proposed that child-centered play therapy (CCPT); a holistic treatment that fosters children’s emotional, developmental, and social growth would serve as a viable treatment. Two children qualified to participate in this study because they exhibited problem behaviors and met diagnostic requirements for an intellectual disability falling along the spectrum from mild to severe. Using a single case, A-B-A design (N = 2), changes in participants’ problem behaviors as measured on the Aberrant Behavior Checklist (ABC) were assessed across conditions. Trained raters used the ABC to rate participants’ problem behaviors 3 times per week during the course of this study. Participants completed 2 weeks of a no-intervention baseline phase, 5 weeks of play therapy three times per week, and 2 weeks of a no-intervention maintenance phase. Additionally, participants were administered the Gesell Developmental Observation to assess developmental changes.
Participants’ behavioral responses across conditions were analyzed using visual analysis. Specific visual analyses included changes in trend, level, and variability within and across the baseline, intervention, and maintenance phases. In addition to performing visual analyses, the magnitude of treatment effect was analyzed by calculating the percent of non-overlapping data (PND) between baseline and treatment phases (Morgan & Morgan, 2009). Because play therapy was expected to decrease participants’ behaviors, PND was calculated using the percentage of treatment data that overlapped with the lowest data point evidenced during the baseline phase. According to Scruggs and Mastroperi (1998), a PND equal to or greater than 90% indicates a “very effective” treatment, a PND of 70-90% is “effective,” 50-70% suggests “questionable” effectiveness, and less than 50% is “ineffective.”
Participant 1. Andrea, a 6-year old Caucasian female, was in first grade during this study. She qualified to participate because teacher and parent ratings of her behaviors fell in the clinical range on the hyperactivity and irritability subscales of the ABC. Results of visual analysis (see Figure 1 and Figure 2) revealed an immediate decrease in the level of hyperactivity and irritability behaviors following introduction to the play therapy condition and showed a moderate downward trend, indicating that Andrea’s exhibition of hyperactive and irritability behaviors decreased during the play therapy intervention and continued to decrease during the maintenance phase. Results from examining the magnitude of the treatment effect using the PND showed the PND was 100%, which indicates that play therapy was a very effective treatment for reducing Andrea’s hyperactivity and irritability behaviors. Results from the administration of the Gesell Developmental Observation indicated that Andrea’s developmental functioning had advanced, and the examiner noted Andrea’s expressive communication improved during the course of the study.
Participant 2. Randy, a 7-year-old Mexican-American male, was in the first grade during this study. Randy qualified to participate in the study because parent and teacher ratings indicated that his behaviors fell in the borderline range on the hyperactivity and irritability subscale of the ABC. A graphical analysis of Randy’s hyperactivity and irritability behaviors indicates that his behaviors changed over the duration of this study (see Figure 3 and Figure 4). By analyzing the data, we noted a decrease in the level, a moderate downward trend, and low variability, indicating that Randy’s exhibition of hyperactive and irratibility behaviors decreased during the play therapy intervention and continued to decrease during the maintenance phase. In using the PND statistic to examine the treatment effect, we found the PND was 100%, which indicates that play therapy was a very effective treatment for reducing Randy’s hyperactivity and irritability behaviors. Data from the Gesell Developmental Observation indicated that Randy’s developmental functioning remained stable throughout the duration of the study, and the examiner noted that Randy demonstrated a greater willingness to participate in the activities during the second testing interval.
Results of this study revealed that CCPT was helpful in decreasing hyperactivity and irritability behaviors for both children. The study also highlighted the effect of CCPT on maturational age, indicating that CCPT may improve the developmental functioning for children identified with intellectual disabilities. Overall, we conclude that CCPT can be helpful for children identified as having an intellectual disability and problematic behaviors.
The findings of this study are consistent with other experiential studies that demonstrated the effectiveness of play therapy as an intervention for reducing children’s externalized and internalized behaviors (Baggerly, 2004; Fall, Navelski, & Welch, 2002; Packman & Bratton, 2003; Post, 1999; Raman & Kapur, 1999). Moreover, the large treatment effect for both participants is a promising finding because humanistic tenets of CCPT may affect children’s self-direction, autonomy, self-responsibility, and self-control (Bratton, 2010; Landreth, 1993). More importantly, the results seem to highlight the possibility that children with intellectual disabilities manifest problem behaviors due to intrapsychic processes and provides support for mental health treatments to alleviate undesirable behaviors. The apparent implication is that children with intellectual disabilities might benefit from holistic interventions that promote cognitive, social, and emotional development.
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Figure 1. Andrea’s hyperactivity behaviors as rated on the ABC throughout all phases.
Figure 2. Andrea’s irritability behaviors as rated on the ABC throughout all phases.
Figure 3. Randy’s hyperactivity behaviors as rated on the ABC throughout all phases.
Figure 4. Randy’s irritability behaviors as rated on the ABC throughout all phases.