Final Research Paper

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Dec 6, 2023

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Final Research Paper Jordan M. Weatherly Division of Counseling Education and Psychology, Delta State University CED 635: Methods Counseling Research and Statistics Dr. Stephanie Bell December 1, 2021

2 Introduction Within this research paper, the study that is being researched is, on children with ADHD and how play therapy affects them as an individual. Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurobehavioral disorders diagnosed in children (Hashemi et al., 2018). Within this research paper, this will conclude to see the difference in play therapy with children who have ADHD and see if this type of therapy affects them in a positive or in a negative way and how their behavior is affected. This research problem is that children with ADHD, receive no help with letting their emotions out and talking through thigs in a way that’s easy for children. Play therapy is a method for children who have ADHD to express their emotions and talk/ play with what is happening in a child’s life. Play therapy allows children to play with toys such as; animal toys, legos, books, kitchen set, dress up, etc.. Children who attend play therapy can choose what to play with; and within that time span, they express their emotions within their toys; which allows the children to express how they feel and use their voice later on. Play therapy is a type of therapy and counseling treatment for children that have a hard time speaking, explaining their feelings or telling others what is happening in their life. This therapy helps children not only express their emotions with toys and activates but it helps improve their communication and solve problems (Schottelkorb et al., 2009). For this paper, play therapy with children who have ADHD will be studied, and how much play therapy improves their emotions, and how play therapy can help with ADHD symptoms. Children who are diagnosed with attention deficit/ hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children starting at a young age of three years old and symptoms at twelve years old (Schottelkorb et al., 2009). In an article discussing about

3 ADHD symptoms and their reduction to elementary students, the authors state that the students with this disorder have behavioral problems associated with attention deficit and have different ongoing behaviors (Schottelkorb et al., 2009). With play therapy and child centered play therapy (CCPT); is an “empirically supported counseling intervention that is grounded in child development principles, including the essential role of play in children’s holistic development” (Wei Lin and Bratton, 2015). What I have found during my research of play therapy with children who have ADHD; one article shows and explains data on two important research questions. The first research question states the effectiveness on child centered play therapy, and has it identified ADHD behaviors in the three first grade students that are being researched? The second research question was, how satisfied was the teacher of CCPT? In this data base research paper it sates about dependent measure, procedures, treatments, and the outcomes of the three participants. These questions and findings are relevant to the research due to if play therapy is affected to children and if there is a positive outcome due to the therapy time that is given (Wei Lin and Bratton, 2015). Why is this research topic an issue? When you research about play therapy with children, not many articles come up with children who have ADHD, and how play therapy could benefit them and their diagnosis. An article discusses about how children attend play therapy who have ADHD, and their outcome after their therapy session is very positive. The authors, Portrie- Bethke et al., (2009), use adventure-based counseling (ABC) which creates therapeutic encounters in which children learn through a hands on approach (Portrie-Bethke et al., 2009). The hypothesis for this research study, is that play therapy can help children with ADHD with being able to use their emotions with using toys and learning how to find their voice and

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4 express themselves in different ways. This method helps children not only with being interactive with other individuals; play therapy helps with attentiveness and learning in different ways. Literature Review Discussing about how ADHD is important, to treat ADHD requires involvement of many specialists, including doctors, psychologists, educational experts, social workers and play therapists. For years, each of these specialists treated ADHD by themselves and had their own definitions and ideas for evaluation and treatment (Hashemi et al., 2018). The short-term play therapy is a combination of different clinical strategies tested with a multi-dimensional approach that is used for children of ADHD to help treat them more efficiently. (Hashemi et al., 2018). This multidimensional perspective requires parents to be educated on the nature and diagnosis of the disorder as weekly parental training, education on medication therapy if necessary, classroom interventions, social skills training, and individual play therapy (Hashemi et al., 2018). In this research article, the authors discuss a study that will be done on children with ADHD from the ages of 7-12 years old; they were selected by a parent rating scale of the results from an interview followed by a personal questionnaire. The results of the study indicated that short-term play therapy for children is effective in reducing attention deficit hyperactivity disorder. To explain this result individuals can say that through playing, children naturally express their inner self. Therefore, the treatment that uses play for children provides a good growth environment for communication and excellence (Hashemi et al., 2018). The cause of ADHD is unknown, but there are some factors that plays a role such as: being born prematurely, having a low birth weight and smoking, alcohol or drug abuse during pregnancy. However, there is no complete cure for ADHD, but it can be managed with play

5 therapy and educational support for parents and affected children beside medication if necessary (El-Nagger et al., 2017). The treatment plan should include guidance, assessing parental knowledge about treatment, and help both parents and teachers. It is important that child with ADHD feels safe to communicate about different issues, thus through play children are able to build self-esteem, trust, become more regulated, and connect with others in a meaningful and authentic way (El-Nagger et al., 2017). With children and social interaction, play therapy developed out of the realization that traditional talk forms of counseling did not seem to be effective with young children due to their developmental levels and capabilities (Schottelkorb and Ray, 2009). Children with exhibiting behavioral problems associated with ADHD inattention, hyperactivity, and impulsivity; are a common concern of teachers, parents, and elementary school counselors (Schottelkorb and Ray, 2009). Children under the age of 10 have not developed the cognitive and verbal abilities to participate fully in talk forms of counseling and instead their natural form of communication occurs through play (Schottelkorb and Ray, 2009). Because ADHD is the most com- mon diagnosis of childhood, it is imperative that elementary school counselors be aware of specific interventions they may use to help decrease the ADHD symptoms. These symptoms can negatively impact student learning. In this article, the authors review the results of a single-case design study examining the effectiveness of play therapy for elementary students with ADHD symptoms (Schottelkorb and Ray, 2009). As an adjunct to play therapy and other forms of child counseling, elementary school counselors often use teacher consultation to assist with a student’s problematic behaviors at

6 school (Schottelkorb and Ray, 2009). In this research study, there were four students that the authors used the DOF (Direct Observation Form) three times per week to assess student on-task behavior. Although the DOF provides scores in on- and off- task behavior, internalizing and externalizing behavior, total problems, and six syndrome scales, only the on/off-task portion of the DOF was analyzed in this study (Schottelkorb and Ray, 2009). Children who are born with attention deficit/hyperactivity disorder (ADHD) have a diagnosis that makes them have trouble paying attention , controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active. To enhance children's success in dealing with social pressures, classroom expectations, and changing environmental expectations, this article integrates adventure-based counseling (ABC). Adlerian play therapy is also brought up as well to provide a strength-based approach for mental health counselors working with children diagnosed with ADHD (Portrie-Bethke et al., 2009). Using play has been reported to provide children with a natural environment to communicate feelings and insights about self, others, and the world (Portrie-Bethke et al., 2009). With the Adlerian play therapy, there are four different phases that discuss how the process goes. Phase one focuses on building a relationship with the client, phase two involves using play therapy techniques to slowly introduce them, phase three uses play techniques for the children to gain insight, and lastly phase four involves problem solving and teaching children practice skills (Taylor and Bratton, 2014). Within the ABC approach, this would embody a combination of the necessary components to more effectively treat children with ADHD. Most children with ADHD have serious social and play deficits; commonly rejected by peers and have few friends in their lifespan (Docking et al., 2013). Within this article it discusses about play of children with ADHD, play based intervention, and play and language. Play skills

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7 significantly improved post- intervention. No significant differences were observed for pragmatic skills while prediction skills, an aspect of problem-solving, significantly improved pre- and post- play-based intervention. The authors of this research paper mention a language screener which is used for children who have speech problems and in this article they mention how children need it more than they think and how the children progress in a learning setting. A study was done on children with ADHD at the age of 5-10 (10 males, 4 females) (Docking et al., 2013). In this research study, the authors did a test of playfulness and problem solving skills/ study questions to see where each child was at with their age and with their symptoms with ADHD (Docking et al., 2013). Language abilities of children with ADHD are put at a disadvantage in a learning, emotional and social environment. In this article, it discusses about play therapy and the intervention for children with ADHD; embraces five important principles; motivation of children to address the motivational demand of children with ADHD, development of inter-personal empathy by using decentering technique, including a single regular playmate to offset social demands, active parent involvement, and therapist modelling (Cordier et al., 2013). Play based intervention consisted of seven forty minute sessions to help children with day by day challenges and develop a child/ therapist relationship. Developing the social and pragmatic skills of children with ADHD is important, as such skills are required for peer play and social interaction (Cordier et al., 2013). Research Design & Methods The single case research design will be used for this research study; ABA design to show the effectiveness in play therapy to children who have attention deficit hyperactivity disorder (ADHD). The ABA design will be shown with observing children (first grade-fifth grade) with

8 ADHD, then introducing play therapy, then removing the intervention (play therapy) to see if children’s ADHD observations are different compared to their baseline measurements. “Researchers using applied behavior analysis (ABA) methodology have recently made major contributions to the field of instructional research, an area heretofore dominated by researchers using traditional group designs and statistical analyses. Unlike group design and methodology, applied behavior analysis methodology focuses upon the behavior of individual students” (Sindelar et al., 1985). From this author, the individual focuses on behavior and how behavior can change. Within ABA design; this approach is used for positive reinforcement and learning skills (Sindelar et al., 1985). Independent variable and operational definitions: play therapy (helps children with motor skills, express themselves using toys with how they feel, social-affective skills, and express emotions). Dependent variable and operational definitions: children who have ADHD (school counselor access to children’s files; who is medically diagnosed to ADHD). This will be within grades of first-fifth grade. Flyers and consent forms will be sent to the school counselor to give to the children who are medically diagnosed with ADHD within grades first-fifth grade; to give to the parents to receive permission/consent to be observed in this study. The flyer will have a description of the study, the purpose, and the possible emotional harm within the study may cause. Use recording data; frequency and event recording- to observe children with ADHD in their classroom and how it effects their learning. Such as; how hard it is to follow along with the teacher, how many times does a student get side tracked, does the student have to fidget around in their seat.

9 Interobserver agreement to take extra steps to train observers on the use of how the behaviors are being recorder using the same measurement instrument. The train observers will independently observed/record the specific ADHD behaviors at the same time using the same procedures. Interobserver agreement data will be collected to effectively monitor the constantly with what behaviors will be measures during this study. 33% of the total observations will be used together interobserver agreement data. This will allow to estimate the degree of the agreement if what occurred within behaviors and what did not occur. Five children in elementary school will be observed and have data collected. One child will be observed once a day for an hour, for five weeks to establish the baseline. Play therapy will be introduced once a day for an hour with each child, for five weeks. After the intervention, play therapy is taken away; one child will be observed once a day for five weeks. To calculate the interobserver agreement, the kappa (  ) statistic will be used. Graphs will be used to illustrate data found and in the single case research design study. Anticipated Results Within the result of play therapy being beneficial to children with ADHD, with play therapy being in session once a week for five weeks; the results of play therapy with children should be a positive outcome. With play therapy being used with individuals with ADHD; it allows the children to become more transparent in classroom events, in their lifestyle and more confident on who they are. Conclusion In conclusion, children with ADHD, receive no help with letting their emotions out and talking through thigs in a way that’s easy for children. Play therapy is a method for children who have ADHD to express their emotions and talk/ play with what is happening in a child’s life.

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10 play therapy for attention deficit/hyperactivity disorder (ADHD), helps children by expressing how they feel with toys and learning how to speak and feel comfortable. By allowing to use play therapy once a week with children who have ADHD, children will learn each therapy session something new to allow themselves to express their feelings with toys. With play therapy, the outcome shows that children will feel more capable and comfortable to express themselves in every way and allow themselves in school to feel more confident with ADHD.

11 References Cordier, R., Munro, N., Wilkes-Gillan, S., & Docking, K. (2012). The pragmatic language abilities of children with ADHD following a play-based intervention involving peer-to- peer interactions. International Journal of Speech-Language Pathology, 15(4), 416-428. doi:10.3109/17549507.2012.713395 Docking, K., Munro, N., Cordier, R., & Ellis, P. (2013). Examining the language skills of children with ADHD following a play-based intervention. Child Language Teaching and Therapy, 29(3), 291-304. doi:10.1177/0265659012469042 El-Nagger, N. S., Abo-Elmagd, M. H., & Ahmed, H. I. (2017). Effect of applying play therapy on children with attention deficit hyperactivity disorder. Journal of Nursing Education and Practice, 7(5), 104. doi:10.5430/jnep.v7n5p104 Hashemi, M., Banijamali, S. S., & Khosravi, Z. (2018). The Efficacy of Short - Term Play Therapy for Children in Reducing Symptoms of ADHD. World Family Medicine Journal/Middle East Journal of Family Medicine, 16(4), 76-84. doi:10.5742/mewfm.2018.93370 Lin, Y., & Bratton, S. C. (2015). A Meta-Analytic Review of Child-Centered Play Therapy Approaches. Journal of Counseling & Development, 93(1), 45-58. doi:10.1002/j.1556- 6676.2015.00180.x

12 Portrie-Bethke, T., Hill, N., & Bethke, J. (2009). Strength-Based Mental Health Counseling for Children with ADHD: An Integrative Model of Adventure-Based Counseling and Adlerian Play Therapy. Journal of Mental Health Counseling, 31(4), 323-337. doi:10.17744/mehc.31.4.908822151555t5x7 Schottelkorb, A. A., & Ray, D. C. (2009). ADHD Symptom Reduction in Elementary Students: A Single-Case Effectiveness Design. Professional School Counseling, 13(1). doi:10.1177/2156759x0901300105 Sindelar, P. T., Rosenberg, M. S., & Wilson, R. J. (1985). An Adapted Alternating Treatments Design for Instructional Research. Education & Treatment of Children. doi:10.1002/9780470373699.speced0085 Taylor, D. D., & Bratton, S. C. (2014). Developmentally Appropriate Practice: Adlerian Play Therapy with Preschool Children, 205-219. Retrieved November 30, 2021.

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