Effects of Child-Centered Play Therapy on Irritability and Hyperactivity Behaviors of Children With Intellectual Disabilities

This study evaluates the effects of child-centered play therapy (CCPT) on hyperactivity and irritability behaviors of two elementary-aged children identified with an intellectual disability. A single-case, ABA research design was used to examine the effectiveness of CCPT. Results indicate that CCPT decreased hyperactivity and irritability behaviors following introduction to the treatment intervention. For both participants, improvements in behaviors were maintained. A discussion of limitations and implications for future research are presented. Keywords: play therapy, intellectual disabilities, mental health, behavioral problems ********** Mental health problems for children with an intellectual disability (ID) are a common concern for service providers. The general consensus is that children with an ID are 4 times more likely than their nondisabled peer group to develop an emotional or behavioral disorder (Dekker, Koot, Ende, & Verhulst, 2002; Einfeld & Tonge, 1996; U.S. Public Health Service, 2002). A bevy of research reveals that children with an ID face neglect and substandard care (Floyd & Gallagher, 1997; Murphey et al., 2005) and experience serious inhibitions in adaptive functioning in a myriad of aspects of their lives (Dekker et al., 2002; Dykens, 2000; Matson, Fodstad, & Rivet, 2009). The enduring consequences for children identified with an ID and mental health problems include strained familial relationships, decreased access to educational and leisure activities, and increased risk for neglect and abuse and institutionalization (Murphey et al., 2005). Parents of children with an ID and mental health disorder also experience significantly more stress than do the parents of children without disabilities (Floyd & Gallagher, 1997; Paczkowski & Baker, 2007). Without early intervention, childhood behavioral problems suffered by children with an ID tend to remain constant (Green, O'Reilly, Itchon, & Sigafoos, 2004). There is pandemic acceptance of the use of behavioral methods for treating behavioral problems among individuals with an ID. Many behaviorists contend that children with an ID engage in problem behavior to obtain and avoid attention; fashion internal stimulation; and avoid tasks, attention, or internal motivation (Benson & Havercamp, 1999; Reese, Sherman, & Sheldon, 1998). Consequently, interventions target functions of behavior and address contingencies that maintain behavioral responses in the environment (Didden, Pieter, & Korzilius, 1997). Although the use of behavioral methods may produce transient effects, the long-standing consequences are less promising. Specifically, directive behavioral approaches are often associated with decreases in children's self-direction, quality of life, and autonomy (Mahoney & Wheeden, 1999; Seltzer & Krauss, 2001). Given the unfavorable outcomes of behavioral interventions, researchers have raised questions regarding how behavioral interventions affect the emotional, psychological, or developmental aspects of one's existence. In one such study, Goodman and Linn (2003) documented that adult-directed interventions might impede children's intrinsic motivation and task mastery. Similar results indicate that authoritative interventions lead to decreased social interactions, prosocial behaviors, and cooperation (Birch & Ladd, 1997; Ladd & Burgess, 2001; Mahoney & Wheeden, 1999). Because typical forms of problem behavior displayed by individuals with disabilities may serve as adaptive and developmentally appropriate means for assimilating experiences, there is a need to explore the effects of interventions that foster children's self-regulation, choice, and direction. One such approach is child-centered play therapy (CCPT). CCPT is an emerging intervention for therapists that is forging significant headway in the treatment of children with ID. Because children's language skills develop more slowly in relation to their cognitive skills, play is considered to be the process in which children communicate (Axline, 1947; Landreth, 2002). …