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Posted: January 30th, 2024
This journal article A practical approach to implementing theraplay for children with autism spectrum disorder by Russell, S. is taken from International Journal of Play Therapy. It is a qualitative research study to helping other teachers to develop skills in using Marschak Interaction Method (MIM) Model (Jernberg & Booth, 1999) which consists of Structure, Engagement, Nurture, Challenge to enable autism students to participate in Group Theraplay, especially for the kindergarten mainstreamed classroom setting. The approach used the existence of resources in school, for example, teachers, toys. The research examined the effectiveness of Group Therapy in this setting compared to the use of alternative therapeutic approaches. A sample of 60 children, age range from 2 years to 6 years of age, diagnosed with severe behaviour and communication disorders with approachability, cooperation and attention improvement. This research was carried out in Heidelberg of Germany, which is a small city. Another research study conducted in Germany and Austria using a wider range of client populations diagnosed with behaviour disorders and speech-language delays/deficits from years of age of 2 to 6. In this research, mild, moderate, and severe symptom groups of children are used with a wide range of assessments. In Wettig, Coleman, and Geider (2011), children with shyness/withdrawn and language disorder symptoms are studied. These two studies were conducted in one region of Germany with 60 children diagnosed with both communication and behavior disorders. In addition, another study was conducted in an urbanized area in Hong Kong with 46 children with internalizing behaviours in a mainstreamed elementary school.
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The author of this article used several case studies and MIM model to effectively implement the Independent Study Process in this Group Theraplay as illustrated below:-
Fosters a child’s self esteem
MIM Analysis
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To develop the feeling of being connected and accepted within one’s family and community
Teaches to take care of others
To increase and help to develop trustiness
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Provide necessary assessments tools
Identify audience
Evaluate study
The criteria for selection of students for this study were that they must be diagnosed with autism spectrum in the mainstreamed classroom. By the end of their studies, students participating in theraplay showed improvements in self-confidence, social skills and communication skills.
Jernberg (1979) became Clinical Director of the mental health programme and developed Theraplay® in 1967 to cater to the children with special needs. It has numerous positive results in parenting and early-intervention programmes in day care centres and pre-schools, mental health practice and children with autism spectrum. Jernberg and Booth (1999) continue to establish and modify the model and make it as widely used as possible. Theraplay has also proven the effectiveness with younger children with language disorders (speech) and severe behaviour disorders, autism and developmental problems.
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Theraplay is a proactive, intensive, relationship focused parent-child theraplay, which is developed according to the parent-child interaction in a healthy and natural way. It helps to develop secure attachment and lifelong mental health. Theraplay is a guided interaction and reflection focused on the parent becoming more available, responsive and attuned to the child.
Initially, the therapist will conduct an intake interview without the child and using Marschak Interaction Method (MIM). Then, the therapists will feedback to the parents before the weekly treatment begins. Parents will observe the sessions and then gradually participate more and more. A periodic parent meeting is essential.
Structure:
In the child-parent relationship has shown adult helps child becomes physically regulated. The adult is in charge to set limits and rules, and helps to complete a sequence of activities. The structure programme helps to control the child as well as a feeling of safe. For example, Simon Says, holding traffic lights up to start a name activity.
Engagement
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The adult is attuned to the child’s state and responds in a way that helps the child’s regulate and integrate physical and emotional states. Adult focused on child in an exclusive way providing sensitively timed soothing and delightful interactions. For example, if a child is unable to comply by playing simple game.
Nurture
A child who has experienced such caring will feel loved, important, responded to, safe, and comfortable, and will begin to respond to the caregiver-parent. He/she will establish eye-contact and transfer this safe and comfortable feeling to the rest of the world.
Nurturing is a significant element in Theraplay and is expressed through activities that are soothing, calming quieting, and reassuring, such as rocking, feeding cuddling, and holding. The world will become more predictable, safe, secure and warm. Child develops expectation ‘people will take care of me” and “good things happen to me”.
Challenge
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Challenge is an important aspect of Theraplay sessions, especially with children who are particularly fearful of new experiences. The activities are designed in a playful, physical ways that help the child to extend him or herself a little bit, appropriate to the child’s level of functioning. It also allows child to master tension arousing experiences, for example, extend finger to grab.
It is proved with positive results that Theraplay training is a successful way to produce or achieve intended results to teach special needs children with different disorders and to improve child and the parent/teacher relationships.
MIM (The Marschak Interaction Method) is a well-organised method to observe and assess the people-relationship between 2 persons. It is the assessment tool unique to Theraplay that is the basis of the treatment planning process. MIM assessment evaluates parent/teacher capacities from setting limits and providing order, child’s states and reactions to the sessions, encouraging and supporting the child’s effort and make it to be effective by providing suitable soothing, attention and care On the other hand, MIM assessment evaluates child capacities through the respond and accepts the parent’s/teacher’s attuned attempts to engage, to accept limits, order and directions, to accept parent’s/techer’s attention, soothing and caregiving and to participate in activities that support and encourage their efforts to advance developmentally.
Theraplay was also used in group and kindergarten classrooms to promote engagement and interaction with peers.
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Group Theraplay can be conducted into the mainstreamed classroom with a professional and teacher present, with the participation of all students in the classroom. Group Theraplay can be used to identify different areas like nurture, structure, engagement, and challenge, which are their needs. Apart from these, professional and teachers would be able to identify more children for the study. Professionals and teacher could use the toys or learning centres to conduct Group Therapy.
Case studies
According to Russell and Rachel (2011) reported that Rieff and Booth (1994) research with a child with age of 2, with PDD (Pervasive Developmental Disorder). By providing Theraplay training of eight months, the child has established trustiness with other people, the knowledge of the difference between oneself and other people and a sense of oneself.
Another case study reported by Russell and Rachel (2011) based on Fuller (1995) concerning a girl with age of eight years old diagnosed with autism in a day treatment centre. After participating for 14 months in a Theraplay group, it showed that the child has great and apparent progress in dealing with other people, and start to interact, play and talk to other children.
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It needs minimal supplies of toys in conducting Group Theraplay sessions, for example, a sensory ball, bubbles.
To help the teachers in the classroom to more effectively to use the instructional time.
Theraplay therapist makes appropriate decisions about what is going to happen, what modifications will be made and how the games will be played.
Students are exposed to the interest areas, which are unable to be found in the normal curriculum. Through lectures, demonstrations, movies, interest centers, these areas can be established. These activities showed new ideas to students in a non-threatening environment and providing the opportunity for them to freely explore any new ideas.
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Family involvement
Structures, predictability and routine.
The number of research/studies showing the effectiveness of Group Theraplay for ASD children in the mainstreamed classroom are very limited
It needs to use a well-validated instrument to evaluate the relationship between the parent / teacher / children with ASD and the degree of attachment
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Tools or resources used are already in place in the classrooms. Thus, it is essential to have tools to meet these ASD children’s needs.
Ethical and cultural needed to be considered as ‘touch’ is incorporated in the various activities.
Individual difference in terms of the type of autism and individual characteristics of the child and their families.
Lack of trained professional or teachers to conduct Theraplay in the classroom.
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Theraplay is an effective play therapy that can be conducted individually as well as in group in the mainstream classrooms by using resources that are already in place. Group Theraplay working with ASD children in the mainstream classrooms can reinforce academic and social skills with the teachers and peers.
Engagement Structure, challenge, and nurture – the four dimensions of Theraplay, form a effective supporting structure for children with ASD to achieve these therapeutic goals. For instance, the structured procedures provided safe, secure and predictable situations. Engagement activities could help ASD children into interaction with others. Nurture activities provide an opportunity to feel valued, accepted and loved. Challenge activities provide opportunities for ASD children to explore and try new experiences with high success.
By using MIM assessment tool is not adequate to evaluate the effectiveness of Theraplay. It needs a fully-tested instrument to evaluate the parent / teacher / children with ASD relationship and the degree of affectionate relationship
Number of cases
Age range
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Size of sample
Area(s) Studied
Results
7
2- 6
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improve attention, cooperation, and approachability, interactive behavior, shyness/social anxiety.
Theraplay itself involves toys or play media which is the language of children. They can substitute verbal words and convey vast messages across. By using useful toys or play items in the classrooms, could be regarded as a useful tool for expressive purposes.
Therapist’s or teacher’s in the mainstreamed classrooms job is to make contact with autistic children in a comfortable setting. When Group Theraplay is seen as having meaning, the therapist or teacher is easy to sense the inner rhythm of the child.
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The number of children with ASD is on the rise and therefore teachers’ possibility to work with ASD children are more common than in the past. It is essential to train teachers to conduct Group Theraplay in the classroom to help ASD children.
From the above-mentioned limitations, a research study is needed to demonstrate the effectiveness of using Group Theraplay with ASD in a mainstreamed classroom using a variety of assessment tools to determine the degree of attachment and the parent / teacher / children with ASD relationship. Most mental health professionals were trained using verbal based interactions. Hence, they experience great challenge in communicating or establishing a relationship with children especially ASD children who do not rely on verbal means. Research should be planned with ASD children in the International mainstreamed schools setting. Lastly, studies need to be conducted in a multi-racial setting with different languages and cultures.
Conducting Group Theraplay in mainstreamed kindergarten classrooms could help ASD children to overcome the challenge of change and adjustment to a new environment, participating and interactions with other children, and to enhance a better rapport using the MIM dimensions namely as structure, engagement, nurture and challenge.
To determine the effectiveness of Group Theraplay in mainstreamed setting, it is recommended to use the Achenbach System of Empirically Based Assessment (ASEBA; Achenbach & Rescorla, 2001), the Gilliam Austism Rating Scale (2nd version; Gilliam, 2006), and a 5-point rating scale (Gardner, 2010) for pre- and post interventions. These assessments are recommended for their validity and reliability with ASD population.
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