Journal of Rehabilitation (Jul 2018)
The Effectiveness of Play Therapy Based on Cognitive-Behavioral Model: Behavioral Problems and Social Skills of Pre-School Children With Attention Deficit Hyperactivity Disorder
Abstract
Objective Attention Deficit Hyperactivity Disorder (ADHD) is widely recognized as one of the most common neurodevelopmental disorders affecting children due to which they are frequently referred to clinics for their behavioral problems. Adding to their behavioral problems, many children with ADHD also have socialization with their parents, siblings and teachers. The long-lasting nature of ADHD easily results in social isolation. Thus, many children and adults with ADHD make few friends, even though they may desperately want to be liked. This can establish a vicious cycle in which they attempt to make new friends by latching onto people, with the least chance for interaction with others. It seems that play therapy could reduce behavioral problems and improve social skills of children with ADHD. The purpose of the present study was to investigate the efficacy of play therapy, based on the cognitive-behavioral model, on the behavioral problems and social skills of pre-school children with attention deficit hyperactivity disorder. Materials & Methods A semi-experimental study with pre-test and post-test design was conducted with 30 male participants, aged 5–6 years. These participants with ADHD were selected using an available method from the pre-school centers of Aran and Bidgol cities. The participants were divided into experimental and control groups, each group consisting of 15 children. The experimental group received 12 sessions of play therapy based on the cognitive-behavioral model while the control group did not have any sessions. The experiments were conducted using the Rutter child behavior questionnaire for parents (1975) and social skills rating scale of Gresham and Elliott (1990). Problem behavior questionnaires were completed by parents, and social skills rating scale was completed by teachers for all subjects during pre-test and post-test. Data collected before and after the training sessions were analyzed by multivariate analysis of covariance (MANCOVA) using the SPSS software V. 23. Results Normality of variables and contingency of variance and covariance assumptions were tested. The Kolmogorov-Smirnov test showed that all variables were normal (P>0.05). The Box test confirmed the contingency of variance-covariance assumption. The results of MANCOVA showed that play therapy based on the cognitive-behavioral model had a significant effect on the behavioral problems and social skills of children with attention deficit hyperactivity disorder (P<0.0001). It also had a significant effect on all the subscales of behavioral problems (aggression and hyperactivity, anxiety and depression, social maladjustment, antisocial behaviors, and attention shortage) and social skills (cooperation, self-assertiveness, and self-control) (P<0.0001) in these children. It can be stated that according to Eta square, 70%, 51%, 62%, 66%, 68%, and 67% of variations in components such as aggression and hyperactivity, anxiety and depression, social maladjustment, antisocial behaviors, antisocial behaviors, attention shortage, and behavioral problems, respectively, can be explained by the subjects’ participation in the play therapy program. Also, according to Eta square, 69%, 58%, 52%, and 61% of variations in components such as cooperation, self-assertiveness, self-control, and social skills respectively, can be explained by the subjects’ participation in the play therapy. Conclusion Play therapy based on the cognitive-behavioral model can reduce behavioral problems and improve the social skills of children with attention deficit hyperactivity disorder. It is recommended that serious attention be paid while planning play therapy for children.
