The Effectiveness of Group Play Therapy on Hyperactivity and Attention Deficit Symptoms in School Children

Transcription

1 The Effectiveness of Group Play Therapy on Hyperactivity and Attention Deficit Symptoms in School Children Maryam Mohseni Moghaddam* 1, Majid Zargham Hajebi 2, Abbas Habibzadeh 3 Abstract Objective: This study was conducted to explore the effectiveness of group play therapy on decreasing excessive activity and attention deficit in school children. Method: This study was semi-experimental with pre-test, post-test and control group. The Statistical population of this study consisted of all of the elementary school students of Tehran-district 5 who were studying during school year. This study included 40 individuals who were selected based on availability and randomly assigned to two experiment (n= 20) and control (n= 20) groups. In order to assess the hyperactivity and attention-deficit variable, the fourth revision of the Swanson, Nolan and Pelham Profile (SNAP-IV) of attention deficit and hyperactivity disorder was used. The experiment group participated in 10 sessions of group play therapy during 5 weeks, while the control group received no interventions. The results were analyzed using analysis of covariance (ANCOVA). Results: The results of ANCOVA showed that there was a significant difference between the post-tests of the two groups. Discussion and conclusion: The results showed that group play therapy intervention is effective in decreasing the symptoms of hyperactivity and attention-deficit of school children. Play therapy, along with other therapeutic interventions, can be applied as an intervention rich in constructive and effective relationships which has positive side effects on reducing hyperactivity and attention deficit symptoms of children. Keywords: hyperactivity and attention deficit; play therapy; children. 1.* Ph.D. Student of Educational Psychology, Islamic Azad University, Ghom Branch, Ghom, Iran. Mary.mohseni61@gmail.com 2. Ph.D. Department of Psychology, Faculty Member and Assistant Professor, Islamic Azad University, Ghom Branch, Ghom, Iran. 3. Department of Education, Faculty of Humanities, Qom, Iran. Page 1206

2 Introduction Attention deficit/hyperactivity disorder (ADHD) is a neurological or, more precisely, a biopsychological and social disorder. This disorder is one of the most common childhood and adolescence disorders which its symptoms include restlessness, excessive activity and lack of concentration. Different patients have different symptoms (Andrea, 2012). Bollaret (2006) stated that ADHD is a neuropsychological disorder with 70-80% genetic risk which is also influenced by environmental factors. Genetic tendencies of ADHD are complexly related to the environment. Faraone et al (2000), as well as Brookes et al (2006), showed that this disorder begins in childhood and is characterized by expandable, inappropriate levels of abnormal hyperactivity, motion incontinence, and inattention behaviors, along with psychological disorders. The major cause of ADHD is a chemical inconsistency in brain which leads to inadequate attention, hyperactivity and precipitancy; these symptoms begin before age 7 (Bollaret, 2006). This disorder has been known as the most common neurological disease syndrome in school age children in U.S. which involves 3 to 5 percent (approximately 2 million) of American children (Rebecca, 2002). Inattention may result in inability of children to pay close attention to the related details, or making mistakes in school tasks, work, or other activities due to inattention. About the hyperactivity feature of the disorder, it can be said that these children are constantly moving and in motion, and talk excessively. Impulsivity of these children is shown in their impatience, difficulty in delaying responses, answering before the question is complete, and disturbing others' activities to the extent that results in social and educational problems for them. This also can be problematic for family and society so finding a solution for its treatment is very important (Schepman, Fulton, Weyandt, 2009). Playing is a natural means of children to express "self". Landers states that playing for a child is equal to speaking for an adult, so playing and toys are children's words (Davidson, 2006). Play therapy is a method in which troubled children can solve their own problems. It also suggests the fact that for children playing is like a natural means of communication. The aim of play therapy is that the child can know himself/herself and his/her inner traits and act upon them. In this kind of therapy, the opportunity to express and demonstrate disturbing emotions and inner problems is provided for the child so that he/she may have the chance of being understood by others (Kar Ahmady et al., 2011). Group play therapy is the natural combination of two effective therapies. The combination of play therapy and group therapy is a psychological and social process, in which children learn things about themselves through communication with each other and the therapist may have the opportunity to help children solve their conflicts (Jones, 2002). Playing is one of the most important components of a child's life. Children can learn the most important basic social skills and develop through playing. In particular, play equipment has a decisive role in playing so that the child can explore his/her surrounding environment. Playing improves the quality of life through developing creative thinking (Michaelene, 2010). Playing is the means of expression and communication, and some researchers believe that it constitutes an important part of the therapy process (Watson, 2007). School children with behavioral and mental problems often show some behaviors in classroom and educational settings. These problems are common in those children who are referred to clinical centers. They have been evicted from the class due to uncontrollable behaviors once or more. Their behaviors include restlessness, aggressive behaviors, tantrums, Page 1207

3 cursing, biting, etc. These behaviors would result in being labeled as "bad", which increases their problems and leads to uncontrollable behaviors (Mostafavi et al., 2009). From a social development point of view, playing with other children enables the child to develop his/her general self- and other-images. The playing child changes his/her role frequently and as a result is forced to change his view as well. About child's verbal IQ development it can be said that the process of being friend with a doll would affect the child's power of speech significantly and would lead to its development. The child speaks instead of himself/herself, the doll and all of his/her imaginary characters. This iteration, creation and imitation of adults' words would be used as a new way of speaking (Derewes, 2009). A lot of research has explored the effectiveness of play therapy. In a research called "Play therapy with children exhibiting symptoms of attention deficit hyperactivity disorder ", Ray, Schottelkorb and Tsai (2007) studied 60 school age children during 16 sessions of individual play therapy; the results showed the significant effect of play therapy on reducing these children's anxiety. Norton et al (2011) studied the influence of experimental play therapy (EPT) on the consequences of a traumatic event. They concluded that play therapy results in the reduction of traumatic memories in children. In a qualitative research, Brumfield and Christensen (2011), studied the beliefs and perception of "counselling", "play" and "play therapy" of African-American parents of school age children. The analysis of these interviews showed that, in their view, playing and its acceptance as a direct consultation had a particular value (cited from Mostafavi et al., 2009). Therefore, according to the importance of decreasing and controlling hyperactivity and attention deficit in mental health of students, and the necessity of applying an effective intervention in order to diminish this disorder, in this research, the author tends to explore the impact of play therapy on diminishing hyperactivity and attention deficit of students. Methodology The present study conducted as a semi-experimental one with pre-test, post-test and control group. The Statistical population of this study consisted of all of the elementary school students of Tehran-district 5 who were studying during school year. This study included 40 individuals who were selected based on availability and randomly assigned to two experiment (n= 20) and control (n= 20) groups. Research Questionnaires The Swanson, Nolan and Pelham Profile (SNAP-IV) of attention deficit and hyperactivity disorder This rating scale was developed by Swanson, Nolan and Pelham based on the behavioral descriptions of the attention-deficit disorder. This questionnaire is a 30-question self-report inventory that its statements and questions are based on the revision of diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders and are scored using rated answers. According to the authors of this rating scale, it covers three factors: attention-deficit, hyperactivity/impulsivity, and the general factor. Sadrossadat, Hooshyari and Zamani (2007) have normalized this scale on two groups of parents and teachers of 7-12 year-old children of Tehran. The validity, reliability, retest reliability coefficient and Cronbach's alpha of this rating scale are 0.48, 0.83, 0.90 and 0.76, respectively. Based on the findings of this research, Page 1208

4 the reliability of this questionnaire, using Cronbach's alpha and split-half method, was 0.74 and 0.71, respectively. Method At first, the target centers of holding the tests and playing therapy sessions were determined and the given sample group was selected by the respective test. This way, 40 children (who were diagnosed with hyperactivity by a psychiatrist) were selected and randomly assigned to an experimental group and a control group. Following the pre-test, ten 60-min sessions of group play therapy were presented for the experimental group during 5 weeks, which were followed by a post-test. Details of the play therapy sessions First session: introduction; getting to know each other; and taking the pre-test. Second session: playing the targeting game; throwing the ball into the ring; and bowling (aiming at enhancing concentration). Third session: throwing darts and bouncing balance game; and doing the practices of previous session (aiming at creating motor skills and enhancing concentration). Forth session: walking on one foot and jumping on a given place (aiming at keeping balance and sensorimotor coordination). Fifth session: playing with puzzles, Legos, magnets, and a card game related to memory and concentration (aimed at creating delicate skills of hand fingers, enhancing patience, mood and concentration. Sixth session: playing with PENTAGO, Lonpos and Tangram (aiming at enhancing spatial concentration, patience, and concentration). Seventh session: forward and backward memories-related games; at first, the student had to count the given numbers in forward; then he was asked to count new numbers in backward while playing the balance games (aimed at reducing impulsive behaviors, iterations, and reinforcing sensorimotor skills). Ninth session: playing the eye-to-eye game; the child puts his/her hands in the therapist's hand and looks into his/her eyes; the therapist keeps asking questions and the child should not answer them, unless the therapist presses his/her hands (aimed at enhancing concentration and attention). Tenth session: a review of previous games and learned skills; taking the post-test. It should be noted that the control group received no interventions. ANCOVA and descriptive statistics were used for analyzing the collected data. Results The table of distribution of the hyperactivity variable in experimental and control groups is as follows: Table 1 distribution of hyperactivity variable in two sample groups and in two genders Group Gender Test Max. Min. average SD experiment Boy Pre-test Girl Total Boy Post-test Girl Page 1209

5 Total Control Boy Pre-test Girl total Boy Post-test Girl total As the above table shows, the pre-test scores of hyperactivity of the experimental and control groups were almost counterparts. Table 2 distribution of attention deficit in two sample groups and in two genders Group gender Test Max. Min. average SD experiment Boy Pre-test Girl Total Boy Post-test Girl Total Control Boy Pre-test Girl total Boy Post-test Girl total As the above table shows, the pre-test scores of attention-deficit of the experimental and control groups were almost counterparts. According to the reviews and above results, altogether the results of ANCOVA for comparing the scores of pre-tests and post-tests of hyperactivity an attention-deficit of experimental and control groups suggest the confirmation of the given hypotheses. Our first hypothesis suggested that play therapy results in decreasing the excessive activity and restlessness of school age children. In order to examine the accuracy of this hypothesis, according to the rating scale (interval) and differential susceptibility and the necessity of adjusting for group effect in examining the differences between hyperactivity pre- and posttests, ANCOVA was used. The results are presented in table 3. Table 3 summary of hyperactivity ANCOVA Source Df Mean square F Sig. Corrected model Intercept Pre Group Error Corrected total 40 Page 1210

6 As table 3 shows, according to F= and p= 0.000, the effect of training is significant; that is, there is a significant difference between pre-test and post-test scores. Likewise, according to F= and p= 0.000, the effect of group is significant; that is, there is a significant difference between the experimental and control groups, regarding the impact of play therapy on hyperactivity. The second hypothesis suggested that play therapy causes reduction of the symptoms of attention-deficit disorder in school age children diagnosed with attention-deficit disorder. In order to examine the accuracy of this hypothesis, according to the rating scale (interval) and differential susceptibility and the necessity of adjusting for gender effect in examining the differences between attention-deficit pre- and post-tests, ANCOVA was used. The results are presented in table 4. Table 4 summary of attention deficit ANCOVA Source df Mean square F Sig. Corrected model Intercept Pre Group Error Corrected total 40 As table 4 shows, according to F= and p= 0.000, the effect of training is significant; that is, there is a significant difference between pre-test and post-test scores. Likewise, according to F= and p= 0.000, the effect of group is significant; that is, there is a significant difference between the experimental and control groups, regarding the impact of play therapy on attention-deficit. Discussion and Conclusion The aim of the present study was to examine the effectiveness of group play therapy on decreasing hyperactivity and attention-deficit symptoms in school age children. The results showed that the given intervention is effective on decreasing hyperactivity and attentiondeficit symptoms in school age children, and its effectiveness is significant. Our findings were consistent with Kar Ahmady et al.'s study (2011) on the impact of cognitive-behavioral group play therapy on social phobia of 5-11 year-old children. They showed that play therapy reduces social phobia in post-test and follow-up phases. In another study on effectiveness of cognitive-behavioral play therapy on decreasing behavioral problems of children, Zare' and Ahmadi (2007) found that play therapy resulted in the diminishing of behavioral problems, including hyperactivity. A child explores and experiments through playing; he/she discover how to interact with the surrounding environment; how to adjust to life issues and master skills and symbolic processes in his/her own way. When the child becomes self-confidant, he/she would be ready to learn new skills and accept less accepted patterns (Landreth, 1982). Reviewing past experiences, the child adjust them with concepts and patterns of his/her new life. He/she also attempts to resolve his/her problems and conflict through playing. Throughout these functions, the child constantly rediscovers himself/herself, refines his/her self-image, and revises his/her relationships with the surrounding world (Amster, 1982). In fact, imagination Page 1211

7 is the way the child uses to overcome the environmental problems; he/she frequently reviews the problems in his/her mind and reaches a new attitude which ultimately expresses in some level of action and behavior. According to the way we conducted play therapy, one of the findings of the current study is confirmation of the plausibility of conducting group play therapy for hyperactive children. The benefit of group play therapy is that it is cost-effective and easy-to-access for many families. Effective conduct of group play therapy makes its application more common. Furthermore, due to the lack of necessity of using medicines and other expensive or advanced instruments and materials in play therapy, it can be considered as an accessible method, without unpleasant side effects and applicable in small and low-facility towns. Besides the positive and direct effects of play therapy, its side effects, including language development, social skill development, self-esteem and self-concept promotion, catharsis of unpleasant emotions, expressing emotions and unspoken words, should not be overlooked. Play therapy as a rich experience of a constructive therapeutic relationship causes the above effects and its positive consequences are not limited to the treatment of hyperactivity and attention-deficit. In the end, according to the significant difference between experimental and control groups and other consistent studies, it should be emphasized that play therapy can be used as an effective therapeutic method, with no negative and many positive side effects, for children and adolescents with hyperactivity/attention-deficit disorder. The limitations of this study include lack of desirable facilities of play therapy, game room, and a standard space to protect physical safety of children. Furthermore, lack of access to diverse age groups due to the researcher's limitation, makes it difficult to generalize these findings. The findings of the current study suggest paying more attention to the application of play therapy in kindergartens and pre-school centers. Furthermore, using more traditional and native games of Iran in the process of play therapy is suggested. Further research can compare the effectiveness of play therapy with other therapies of hyperactivity, such as pharmacotherapy, cognitive-behavioral therapy, biofeedback therapy and other psychotherapy approaches. Page 1212

8 References Amster, F. (1982). Differential uses of play in treatment of young children. American Journal of Orthopsychiatry,13, Andrea, B. (2012). ADHD: Paying Enough Attention. The National Attention Deficit Disorder Information and Support Service. UK. Associated with Attention- Deficit/Hyperactivity Disorder and Interacting with Maternal Use of Alcohol During Pregnancy.Archives of General Psychiatry, 63 (2), Bollaret, R. (2006). ADHD Europe Contribution to the green paper on Improving the Mental Health of the Population.Center Zitstil VZW Heistraat, 3(2), Brookes, K.-J., Mill, J., Guindalini, C., Curran, S., Xu, X., Knight, J, Taylor, E. (2006). A Common Haplotype of the dopamine Transporter gene. Archives of General Psychiatry, 63(1), Drewes, A.A. (2009, April). Cultural issues in play therapy. Training presented at Play Therapy Days, annual training of the Fordham University Graduate School of Social Services, New York, NY. Faraone, S. V., Biederman, J., Feighner, J. A., and Monuteaux, M. C. (2000). Assessing Symptoms of Attention Deficit Hyperactivity Disorder in Children and Adults: which is More Valid?. Journal of Consulting and Clinical Psychology, 68(5), Jones KD. (2002). Group Play Therapy With Sexually Abused Preschool Children: Group Behaviors and Interventions. J Specialists in Group Work, 27 (4): Kar Ahmadi, Mojgan;Molavi, Hossin;Aghaei, Asghar;Jalali, Salimeh (2011). The effect of cognitive- behavior group play therapy on social phobia in 5-11 years old children; J Res Behave Sci 2011 (18): [Persian] Landreth, G. L. (1982). Child-centered play therapy. Journal of Elementary School Guidance & Counseling, 28 (1), Michaelene, M. O., & Hedda, M. (2010). Helping Children Play and Learn Together. The journal of the national association for the ducation of young children, 17, Mostafavi, Saeideh Sadat; Shoeiri, Mohammad Reza; Asgari-Moghadam, Mohammad Ali; Mahmodi Gharaei, Javad (2009). The effectiveness of training parent-child relationshipbased play therapy to mothers on children s behavioral problems. Contemporary Psychology. 5(1): [Persian] Ray D, Schottelkorb A, Tsai M. (2007). Play therapy with children exhibiting symptoms of attention deficit hyperactivity disorder. J Play Therapy, 16: Page 1213

9 Rebecca R, and Deutscher, B. (2002).Attention Deficit Hyperactivity Disorder in Very Young Children: Early Signs and Interventions. Infants and Young Children, 14(3), Sadrossadat, Sayed Jalal; Hooshyari, Zahra; Zamani, Zahra; Leila Sadrossadat (2007). Determination of Psychometrics Indices of SNAP-IV Rating Scale in Parents Execution , (3) Rehabilitation, 8. [Persian] Watson, D.L. (2007). An early intervention approach for students displaying negative externalizing behaviors associated with childhood depression. A study of the efficacy of play therapy in the school.a dissertation presented in partial fulfillment of the requirements for degree doctor of philosophy Capella University. Weyandt, L. L., Fulton, K. M., Schepman, S. B., Verdi, G. R., and Wilson, K. G. (2009). Assessment of Teacher and School Psychologist Knowledge of Attention Deficit/ Hyperactivity Disorder. Psychology in the Schools, 46 (10), Zare M, Ahmadi S. (2007). Play the effectiveness of behavioral therapy- cognitive decline in children's behavior problems. J Appl Psychology, 1: [Persian] Page 1214