Play Intervention

Running head: PLAY INTERVENTION AND SOCIAL SKILLS 1

Examining the Use of Play Activities to Increase Appropriate Classroom Behaviors

Kallie LeBrasse

University of St. Thomas

Research Professor: Catherine R. Barber, Ph.D.

December, 2012


Table of Contents

Abstract 4

Chapter 1: Introduction 5

Self- Reflection and Background Information 5

The Current Study 9

Justification 10

Chapter 2: Literature Review 13

Introduction 13

Play Therapy Techniques for Young Children 13

Structured play therapy 14

Non-directive child-centered play therapy 19

Multicultural Considerations 21

Play Therapy within Schools 26

Influence of Play Therapy on Children’s Behavior and Social Skills 31

Behavior 31

Social skills 34

Summary 38

Chapter 3: Method 40

Participants 40

Measures 41

Design 42

Procedure 43

Baseline period 43


Treatment period 43

Posttest period 44

Data Analysis Plan 45

Ethical Issues 46

Chapter 4: Results 47

Chapter 5: Discussion 50

Strengths and Limitations 51

Recommendations and Action Planning 52

References 55

Appendix 59


Abstract

This one group pretest-posttest experimental study investigated the importance of addressing a

child’s social needs at school to increase the occurrence of socially appropriate classroom

behaviors. This study observed five groups of boys’ interaction with each other during small

group play activities and guidance lessons within classroom. Throughout their play, the boys

were given mini social skills lessons to help facilitate and practice appropriate behaviors during

the play activities. The entire Kindergarten class, consisting of 26 students, was involved in the

lessons and activities. The 20 participants were gathered through the signing of an informed

consent form allowing me to utilize their data in my report. During the play activities, the boys

were observed within their classroom to document the occurrence of the noted behaviors during

baseline, midpoint, and posttest periods. Results indicated that the participants’ verbal, motor,

and passive off-task behaviors significantly decreased from baseline to posttest observations.

Strength, limitations, and implications of the results are discussed, and future research is also

recommended.

PLAY INTERVENTION AND SOCIAL SKILLS 5

Chapter 1

Introduction

Self-Reflection and Background Information

The importance of play in a child’s life is based on the developmental

understandings according to Piaget (as cited in Landreth, Ray, & Bratton, 2009). In order

to acquire a complete understanding of children, their world, and their experiences, it is

necessary to understand the framework from which they work. Piaget described two

stages in which most elementary-aged children function, preoperational (2-7 years) and

concrete operational (8-11 years) (as cited in Landreth et al., 2009). In a typical

Kindergarten classroom, the students can be expected to enter at a preoperational stage

and few may progress into the concrete operational stage by the end of their first grade

year. Most young children experience significant challenges during their transition from

pre-Kindergarten classes to Kindergarten, which may be observable through changes in

their external or internal behaviors (Sink, Edwards, & Weir, 2007). During this

transition, more focus is placed on academics than previous experienced by these

students.

During the preoperational stage, the stage most associated with Kindergarten

students, children are acquiring essential language skills (Landreth et al., 2009). The

preoperational stage is often categorized as the magical thinking stage, in which

children’s play behaviors are imaginary, as they attempt to explain things for which they

do not have an understanding. During this stage, children lack the understanding of their

own and other’s emotions and feelings. At a young age, a child’s most effective means

of communication is through play, allowing for creative expression and processing.


Because of the limited communicative ability during the preoperational stage, children

must be given the opportunity to express themselves and their experiences in a constraint-

free environment that promotes effective communication.

Within my current school, a private boys’ Catholic school, the boys’ first

experience with formal learning is in Kindergarten. These children are expected to meet

or exceed necessary academic standards by the end of each grade, as determined by state

and national standards (Blanco & Ray, 2011). The pressure placed on teachers to ensure

that all students succeed inhibits the time necessary to teach social skills, allow for

developmental processing time, and provide appropriate activities, such as free-play.

Social skills are essential in Kindergarten, as children are developing through the

preoperational stage. Children in this stage are beginning to reason logically, but have

not yet developed necessary verbal skills to adequately express their thoughts, feelings,

and behaviors (Hall, Kaduson, & Schaefer, 2002; Landreth et al., 2009). Schools expect

their students to meet necessary academic gains despite the child’s limited ability to

communicate his needs. Play can help a child make a connection between his concrete

understandings, the experiences learned and understood, and abstract events, such as

thoughts and feelings (Landreth et al., 2009). Through play, children are given the

opportunity to overcome emotional and social limitations that could potentially impede

their academic achievement (Blanco & Ray, 2011).

In order for play to be an effective means of communication, many factors must

exist. Expression through play can only be effective when presented in a safe, caring

environment (Lawver & Blankenship, 2008). This safe environment helps the child work

on self-esteem and social anxieties without the fear of breaking rules or pleasing the


teacher. Due to the constraints necessary to promote and maintain acceptable behavior, a

classroom environment often fails to provide the safe space in which children can work

on self-esteem and social anxieties (Partin, Robertson, Maggin, Oliver & Wehby, 2010).

Therefore, children need a different, constraint-free, environment where they can express

feelings and act out experiences. The establishment of a positive, safe environment

where students have the opportunity to express themselves helps support children’s

behavior and academic needs (Partin et al., 2010).

Within a safe environment, the child needs to be actively involved in building a

relationship with the teacher or school counselor as the play is occurring. The school

counselor must employ empathy and acceptance throughout the interaction with the

students while they play. Empathy on the part of the school counselor helps the child feel

understood and is another important factor while facilitating play (Beaty-O’Ferrall,

Green, & Hanna, 2010). The school counselor models empathy and acceptance and, in

turn, teaches these skills to the children within the group. As children play in their group,

they also begin to build empathy for each other, as they familiarize themselves with and

relate to each other’s experiences.

Without the use of play to bridge concrete and abstract thoughts, a child may

become overly frustrated with the stressors found in school environments. These external

stressors, along with other emotional factors, could result in classroom misbehaviors,

such as verbal, motor, and passive off-task behaviors, as well as out-of-seat behaviors.

Children with disruptive behaviors, as explained above, present difficulties for their peers

and teachers (Cochran, Cochran, Nordling, McAdam, & Miller, 2010). Until recently in

my current school setting, interventions and activities to help children alleviate


misbehaviors or express emotional or social needs were not available. Due to a lack of

attention to the emotional and social needs of children, many elementary-aged students

are likely to become unhappy while at school, as they face their increasing emotional and

social pain without support or guidance (Blanco & Ray, 2011; Cochran et al., 2010). In

an attempt to express his needs, a child will misbehave to gain control of his unresolved

emotional and social difficulties.

There is evidence that suggests that childhood disruptive behaviors lead to

academic failure, which elevates the risk for a depressed mood and continued

misbehaviors (Cochran et al., 2010). Therefore, schools must work to implement an

effective intervention that addresses emotional and social concerns and disruptive

behaviors, thereby increasing student learning. Currently, disruptive behaviors that occur

within the classroom are handled through various classroom management techniques,

such as token reward systems, color-coded rating scales, punitive punishments, and

teacher-managed/directed interventions. Various researchers have demonstrated the

effectiveness of the above techniques, yet these techniques are teacher-managed and

based on extrinsic rewards; they do not facilitate personal growth within the child. These

extrinsic rewards work to temporarily eliminate undesirable behaviors, but behaviors

categorized as being good, such as respect and responsibility, are not internalized.

Therefore, as a student continues to misbehave, despite the efforts of the teacher, the

teacher begins to lessen interactions with the student to avoid triggering or escalating the

current misbehaviors (Partin et al., 2010). The child inadvertently learns that he is not

worthy of respect, attention, or a caring relationship, which can directly affect the child’s

developing self-worth.


Through play, the focus is switched to the preceding problematic behaviors or

emotions, thus allowing a child self-expression (Kern & Clemens, 2007). Self-expression

helps the child become aware of his choices and therefore promotes self-direction

(Cochran et al., 2010). When a child sees that he has the ability to overcome and control

his own behaviors, in a supportive caring environment, he is developing a positive sense

of self-worth. The purpose of play is two-fold, to be proactive in nature allowing children

the opportunity to communicate in their own way before problematic behaviors present

themselves and reactive as a means to express feelings and concerns that have arisen due

to the inability to communicate effectively within the classroom.

The Current Study

This study investigated the outcome of teaching social skills strategies practiced

through play activities to address a child’s social needs at school. Specifically through

these mini-lessons, it was anticipated that the boys would choose classroom behaviors

that promoted learning and achievement. The behaviors that were observed for this study

are recognized as a decrease in motor off-task, verbal off-task, passive off-task, and out

of seat behaviors, and therefore an increase in on-task behaviors. Students met in small

groups to practice these social skills through play activities. The play activities are

designed to promote appropriate interactions and communication as the children interact

during play. Throughout their play, the boys were also given mini social skills lessons to

help facilitate and practice appropriate social interactions during the play activities. The

participants’ sessions, in total, focused on the development of social skills, limit setting,

and self-expression.


I predicted that by addressing the social needs of children through play, teachers

could expect to see an increase in on-task classroom behaviors and a decrease in motor,

verbal, and passive off-task behaviors. This quantitative study used a one group pretest-

posttest experimental design that utilized a coded observational form, that documented

the occurrence of on-task, motor off-task, verbal off-task, passive off-task, and out of seat

behaviors among the participating Kindergarten boys during the baseline, midpoint, and

posttest periods.

Justification

This study presented educators with an alternative to temporary behavior

modification techniques and an option for developmentally appropriate interventions.

This study gave educators necessary understandings about play in the elementary school

setting and how the opportunity for play could potentially address the emotional and

social needs of students, thus promoting appropriate classroom behaviors and increasing

student achievement.

In their study about school children’s play, Gmitrova, Podhajecka, and Gmitov

(2009) described play as a “well-established curriculum component of childhood

education” (p. 339). Gmitrova et al. also made a connection between a child’s cognitive

competence and his quality of play. Pretend play, as described by these authors, is the

ability to transform objects symbolically and act out emotions or experiences. According

to Gmitrova et al., which supports Landreth et al.’s (2009) study, pretend play is an

integral component of helping a child develop language skills and cognitions. Therefore,

play is important for academic readiness and success in school.


Harpine, Nitza, and Conyne (2010) studied how group prevention for disruptive

behaviors helps children understand that they are not alone in their experiences,

emotions, or struggles. As children play, they recognize the similarities between their

inner struggles and those of other group members. Harpine et al. noted that prevention

group interventions are helpful in acquiring new skills, such as social skills practiced

during play. The research done by Harpine and colleagues highlighted the interactive

involvement between children as they play, providing a hands-on learning experience

with a focus on their new social skill. Higher academic achievement has been seen in

elementary-aged children who participated in prevention groups due to the early

intervention for a child’s emotional and social distress (Harpine et al., 2010).

In a preventative playgroup, children learn essential social skills similar to the

ones promoted in Landreth et al.’s (2009) study. Landreth and colleagues list six essential

skills discovered and developed during play. Their list includes skills necessary to accept

and respect themselves, assume responsibility for themselves, be creative and resourceful

in confronting problems, maintain self-control and self-direction, and make choices, as

well as being responsible for these choices. As children play together, they live out their

moments with toys. The play represents past experiences and the feelings (Landreth et al.,

2009). Therefore, the counselor can facilitate and promote the use of appropriate social

skills as the children play and relate to each other.

Through group play, children begin to understand that they all share similar fears,

emotions, experiences, and problems (Harpine et al., 2010). Group play intervention is

also a culturally sensitive approach, as the child has the freedom to communicate through


play in a way that is most comfortable and typical for his culture and experiences

(Landreth et al., 2009).

I was interested to observe how applied interventions in my school community

could help support students’ emotional and social needs. As the students’ needs were

met through a group play intervention, I was hoping to see a decrease in their off-task

behaviors within the classroom, thus helping the participants make necessary adaptations

to the school environment and letting them experience success.


Chapter 2

Literature Review

Introduction

In an attempt to address the social, emotional, and academic needs of all children,

research has been done to assess the effectiveness of various techniques used by teachers

and school counselors. Studies have examined play therapy’s effectiveness, as opposed to

temporary behavior modifications frequently seen throughout elementary schools. With

an attempt to view the strengths, limitations, and implications for future research within

the area of play therapy, the current review of the literature focused on play therapy

techniques for young children, multicultural considerations while using play as a

counseling method, play therapy in regards to the school setting, and play therapy’s

influence on behavior and social skills.

Play Therapy Techniques for Young Children

The importance of play, as well as the use of play therapy in clinical settings, has

been highly researched. The different techniques chosen by a therapist during a play

therapy session are selected based on the extensive variety of developmentally

appropriate play approaches that focus on helping the child become aware of and express

his or her feelings, improve self-control and self-direction, and increase empowerment

and problem-solving skills (Hall et al., 2002). Play therapy techniques should promote

the use of play to help children develop the verbal skills necessary to process through

their feelings, thoughts, and behaviors (Hall et al., 2002). Due to a lack of time in

schools, school counselors may find it beneficial to integrate various theories,

approaches, and techniques within one play session. School counselors may also find it


beneficial to use this variety of approaches and techniques to address the different needs

of the students seen in a counseling group or individually. Some techniques require a

more structured approach in the playroom, while others are child-centered; both

approaches will be reviewed here to assess their use with students.

Structured play therapy. Structured play therapy (SPT), as described by Jones,

Casado, and Robinson (2003), is directed and facilitated by the therapist, in which the

therapist presents specific activities that address issues important to the development of a

child. Jones et al. describe the role of the therapist in SPT as using structured activities to

direct the therapeutic process and create structure in the play session; this way the child is

led in a direction that will be most beneficial. In SPT, the therapist designates a goal for

each session and designs specific activities to address the child’s difficulties (Jones et al.,

2003). Throughout SPT, Jones et al. remind the therapist to be cognizant of the timing in

which he or she focuses on certain issues. Jones et al. warn therapists to only focus on

themes that the child is prepared to overcome. In order to avoid pushing the child too

quickly, Jones et al. recommend planning for and choosing appropriate structured

exercises; the timing of exercises cannot be overemphasized in SPT. Throughout the

course of therapy, the therapist must be mindful of the child’s readiness to approach new

themes/difficulties (Jones et al., 2003). Jones et al. propose a flexible framework that

allows the child to focus on activities when they deem ready.

Jones et al.’s (2003) ultimate goal of SPT is to help children learn new skills,

express their feelings, acknowledge difficulties, and deal with painful situations in a safe

environment. Although many structured activities exist, therapists must remain mindful

that little research has been done to address appropriate sequencing of activities (Jones et


al., 2003). Jones et al. emphasize the effectiveness of SPT with reluctant children and

adolescents older than seven years of age, who have the cognitive development to focus

and process through the therapy session. The authors present SPT as an effective therapy

focusing on symptom relief and specific themes/issues that result in the child’s

misbehaviors.

Hall and colleagues (2002) chose fifteen therapist-directed effective play therapy

techniques that they believed to address pertinent problems in school-aged children, such

as anxiety, depression, impulsivity, distractibility, and noncompliance. Hall et al. outlined

the therapeutic rationale, description, and application of their chosen techniques. Many

activities chosen by Hall et al. focused on the opportunity for children to communicate

their feelings in a safe environment. Other activities focused on specific feelings, most

commonly anger. The activities helped the child understand what emotions are and how

to express them appropriately.

The feeling word game is an example of a structured technique that allows

children to communicate their feelings in a non-threatening manner (Hall et al., 2002).

During this game, children are to name feelings that a child their age may have. The

counselor then writes these feelings on a card. The counselor lines up the feeling cards

and hands the children a set of poker chips. As the counselor tells a story about himself or

herself, the children place the chips on the appropriate feeling cards. Another example of

a structured game illustrated by Hall and colleagues is the mad game. This game is

designed to show children that anger is a common and acceptable feeling. This game

allows children to verbally and kinesthetically express their anger. During the mad game,

children will be given blocks. Each person will place a block on top of a previously


existing block when it is his or her turn. Each time they place a block on the tower, the

children will express something that makes them angry. Once all of the blocks are

stacked, the children are asked to think of one last thing that makes them angry and

knock down the stack of blocks. These illustrated techniques are only a couple creative

and directive play therapy strategies that encourage a child’s emotional acceptance and

expression.

Hall et al. (2002) emphasize the importance of acquiring a greater number of play

therapy techniques to ensure that the therapist will have the “right tool” for assisting the

individual student. Hall et al. recognize the need for future research in this area to assess

the significant gains they believe to be associated with these various techniques, as well

as the creative potential of play therapists and the play therapy theory.

The use of games in the playroom is another commonly utilized form of

counselor-directed therapy. Swank (2008) describes directive game play as an approach

that incorporates games into the play therapy process to develop social skills, self-

discipline, cooperation, socialized competition, concentration, leadership, emotional

control, tolerance, and problem solving. Swank emphasizes the use of game play with

older students to help engage them at their own developmental play level. As children

play games, they develop a social setting in which they are practicing social rules and

boundaries, thus allowing social learning to occur (Swank, 2008).

Swank (2008) recommends that therapists use a beginning, middle, and end

structure when implementing game play. The therapist must be conscious of choosing a

game that addresses the therapeutic issue identified for the student. The beginning of the

session introduces the game to the student and engages the student’s interest. During


game play, the therapist assists the student in processing through issues that may arise.

The session ends with the therapist and student processing the game play experience and

relating the experience to the student’s own life.

Three categories of games were introduced in Swank’s (2008) study. Games

involving physical skill, strategy games, and chance games were discussed, as well as

limitations of their use. Physical skills games were used with children recognized as

having hyperactivity and impulsive behaviors. Swank recommended the use of darts or

tag for these children. The space limitations with physical skills games must be noted,

especially within schools, where confidentiality could be breached in an open-area.

Swank utilized strategy games as a means to teach socialization, problem-solving, and

responsibility for choices and consequences. Strategy games such as chess or checkers

require that the child have an appropriate cognitive ability and the focus necessary to

understand and follow the rules of the game. Therapists must be aware that strategy

games have the potential to take away from the therapeutic factor during game play due

to the concentration required to play the game. Games of chance are used to introduce the

child to the use of games in the playroom. Because the results of chance games are

uncontrolled by the child, Swank recognizes the risk of non-responsibility in one’s

control of the game outcomes. Swank also cautions therapists to use games carefully to

ensure that the games used have a clear therapeutic purpose and the identified goals are

clear. The focus of the session should remain on the process during game play and not on

the outcome of the game.

Therapists have only reported effective game play during discussions about their

experiences, as opposed to actual scientific research (Swank, 2008). Further research will


be needed to examine the specific processes and outcomes of game play during play

therapy sessions, as well as their effectiveness as an intervention.

Taylor (2009) examined the effective use of combining solution-focused and sand

tray therapies to work with children. This author describes solution-focused therapy as a

verbal therapy that uses carefully worded remarks that acknowledge a client’s strengths

and utilizes these strengths to solve current and future problems. Taylor explained how

the application of solution-focused therapy with children differs from its application with

adults in its use of developmentally appropriate language and the reliance on play

approaches. Solution-focused therapy, as portrayed by Taylor, emphasizes the clients’

abilities and coping skills, brings these skills into the awareness of clients, and develops

these skills to overcome past and current difficulties.

Taylor (2008) also illustrated the use of sand-tray therapy as a nonverbal

communication tool that utilizes small miniatures within a sand-tray to facilitate a client’s

healing and strengthen the client’s existing resources. Taylor described the use of sand-

tray as a way for children to build and express their existing experiences in a kinesthetic

manner.

In addition to analyzing the characteristics of solution-focused and sand-tray

therapies, Taylor (2008) also explained their similarities. In Taylor’s review, the

principles of each technique were examined and a list of similarities was generated.

Taylor outlined similarities such as empowering the client to become a master of his own

life, capitalizing on the client’s strengths and resiliencies, allowing room for the client to

express painful memories, and promote healing within self.


Solution-focused therapy contains five stages: the client describes the problem,

the client explores the exceptions, the client develops his goals, the therapist gives

feedback at the end of the session, and the therapist evaluates the client’s progress

(Taylor, 2008). Taylor described each stage and demonstrated how sand tray and

solution-focused therapies could be integrated. With the integration of solution-focused

and sand-tray therapies, Taylor emphasized the opportunity for clients to experience the

positive and empowering approach of these two techniques. Yet, Taylor also recognized

the need for further research to determine the efficacy of this integrated approach with

specific problems and specific age groups. Limitations may be found when incorporating

this technique with younger children, clients who have a lower cognitive ability, or those

with poor abstract reasoning skills.

Non-directive child-centered play therapy. Conversely, Guerney (2001)

presents child-centered play therapy (CCPT), a therapy based on the assumption that

therapy will be most effective when the child is allowed to take responsibility for the

direction of play. CCPT aims to create a supportive environment in which the child

experiences self-direction and growth (Bratton, Ray, Edwards, & Landreth, 2009).

Guerney (2001) explains the importance of the therapist trusting the child to direct the

course of therapy to best fit his or her inner self. Therefore, the child begins to develop a

stronger self-concept, leading to more mature behavior, without ever having to target the

presenting issues overtly (Guerney, 2001).

Bratton et al. (2009) recognize the need for the therapist to identify specific play

behaviors of the child to highlight the underlying problems and gain insight into the

child’s world. In this model, the perception of the child’s reality is accepted and followed


by the therapist without challenges, which distinguishes CCPT from SPT (Bratton et al.,

2009). Bratton et al. describe the child as the expert of his or her life and therefore the

child will lead the therapy in the direction that will best meet his or her needs with the

full support of the therapist. CCPT emphasizes the development of an empathetic,

accepting relationship between the child and therapist that helps to facilitate an

atmosphere that allows free expression. CCPT also emphasizes play therapists’ ability to

recognize and accurately reflect on the child’s feelings, thus gaining insight into the

underlying problem and promoting the child’s inherent ability to solve his own problems.

As CCPT develops, the therapist understands the necessity for therapy to progress

gradually. It is important that the therapist establishes limits only when absolutely

necessary to allow the child control of the experience. Yet, the use of limits helps

illustrate the child’s responsibility within the therapeutic relationship (Bratton et al.,

2009; Guerney, 2001).

Although CCPT is child directed, Guerney explains the degree of predictability

with which children will move through the stages of play therapy. Guerney labeled the

stages as warm-up, aggressive, regressive, and mastery stages. During the warm-up

stage, Guerney observes children beginning to adjust to the playroom, therapist, and

leadership role to which they have been assigned. Guerny describes the aggressive stage

as one in which the children begin to feel secure enough to begin dealing with the

problems that are masked by their external or internal behaviors. Guerney describes the

regressive stage as the point in which the child uses the nurturing toys to regress into a

developmental stage that they have already mastered. Finally, the mastery stage is

categorized by the child’s change in roles from being the aggressor or regressing, to


being the hero, or showing progress toward the verbalization of his feelings and increased

self-worth.

According to Bratton et al. (2009), CCPT has a long history of research to support

its use in dealing with children’s difficulties. Bratton et al. indicate that with 60 years of

research, play therapy is most likely the longest researched intervention for children.

Most recently, Bratton et al. demonstrated that the research has found CCPT to positively

impact internal and external behavior problems, self-efficacy, self-concept, anxiety,

stress, and depression among children. Although the research supports the efficacy of the

use of CCPT with children, Bratton et al. recognize the restrictive generalizability of

CCPT research as it is limited by small sample sizes. Therefore, the effectiveness of play

therapy is often studied with meta-analyses of various related studies.

Multicultural Considerations

There is an increase in the growth of ethnic and racial diversity in the United

States as evidenced by the United States Census (Chang, Ritter, & Hays, 2005; Hinman,

2003). In order to meet the social and emotional needs of all people, The Association for

Multicultural Counseling and Development (AMCD) established multicultural

counseling competencies in which counselors must be trained (Chang et al., 2005). The

framework presented by AMCD guides the counselors’ knowledge of their own cultural

values, the clients’ worldview, and appropriate implementation of culturally appropriate

intervention strategies (Chang et al., 2005). Along with this, Hinman (2003) emphasizes

the need of play therapists to provide culturally sensitive and appropriate services to

children within various cultures. Regardless of a child’s cultural background, play

therapy literature suggests that play therapy is the developmentally appropriate form of


therapy for all children (Ritter & Chang, 2002). The Association for Play Therapy (APT)

and AMCD suggest that therapists begin to develop their own cultural identities, identify

any biases, and gain necessary knowledge about their clients’ cultural framework, in

order to work effectively with clients from a variety of cultures (Chang et al., 2005).

Chang et al. (2005) describe the importance of fostering a culturally sensitive and

appropriate environment within the playroom and modifying play language and toys for

multicultural children. Therefore, a play therapist can communicate acceptance to the

child, including any cultural aspects within that relationship (Chang et al., 2005). By

exploring the child’s cultural identity, the counselor can develop an understanding of the

child’s experiences and how they may influence current difficulties (Hinman, 2003).

Research has suggested that play therapy within schools is effective with diverse

populations, yet Chang et al. (2005) address the limited research and literature about

multicultural issues in counseling, especially within play therapy.

Hinman (2003) discusses multicultural considerations that must be made during

the delivery of play therapy services. According to the author, play therapists can

improve their effectiveness with multicultural children in various ways. The play

therapist must extend his or her knowledge about specific cultures, especially those

cultures in which the therapist serves (Hinman, 2003). Hinman describes how a basic

knowledge about the child’s culture can help the therapist deliver effective services and

join with the parents in providing necessary resources and information about the culture.

Hinman explains that a working relationship with the child’s parents is established when

the play therapists increase their understandings about cultural influences on a child and

the impact of these various experiences. As the play therapist’s understandings of


different cultures increases, the therapist will begin to understand how the child copes

with difficulties. As a result, Hinman presents play therapy as a safe environment in

which children can explore the meaning of their cultural framework and identity.

Hinman (2003) illustrates the limitations of a play therapist while working with

multicultural children. Hinman advises therapists to have open communication about

cultural limits, as it helps develop a mutual learning experience with the child and the

child’s family. Play therapy is an effective tool that serves children from a variety of

cultural backgrounds; if play therapists continue to educate themselves about the cultures

in which they serve, they can develop a practice that effectively works with each client

(Hinman, 2003).

Chang et al. (2005) conducted a study to gain knowledge about play therapists’

perceptions of multicultural trends in play therapy and methods by which play therapists

address cultural diversity in their playrooms. Chang et al.’s study surveyed 505 play

therapists who were registered with the APT and were recruited through a purposive

sampling procedure. The survey in the study asked two open-ended questions and

included a seven item demographic form; the questions were analyzed, and results were

grouped based on a variety of characteristics.

Results from Chang et al.’s (2005) study indicate that respondents were more

likely to reply about toys used to address multicultural issues, as opposed to what trends

they noticed among multicultural clients. Chang et al. commented on the noticeably high

occurrence of respondents’ observations about the increase of multicultural play items,

which are now available from vendors. Despite this increase in multicultural play items,


Chang et al. noted that many children, no matter their culture, would most often use

animal families when depicting their own.

Chang et al.’s (2005) study reported that several play therapists observed no

multicultural trends in their playrooms, while others observed an influx in their

multicultural clients, as well as differences among children in their play. These same

respondents in the study recognized their clients as culturally diverse and emphasized the

need for all play therapists to acknowledge cultural issues. Although the survey data

collected by Chang et al. indicated that the majority of play therapists observed

differences in play among multicultural children, the authors could not draw a conclusion

about whether play therapists actually conduct their sessions differently with

multicultural children compared to their Caucasian peers. Further research must evaluate

the modifications made for multicultural children. Additionally, Chang et al. recommend

that a qualitative study be conducted to provide more information about which techniques

or materials play therapists find effective with their multicultural children.

Chang et al. (2005) also described the various limitations in their study. These

limitations include how the self-report nature of the survey could have swayed the

respondents to respond in a socially acceptable manner as opposed to reporting their true

practices. The survey’s rate of return and the lack of follow-up with respondents were

also limitations recognized by Chang et al. The authors revealed that neither the survey

nor demographic questionnaire addressed the multicultural background of the play

therapist.

In a quantitative study by Ritter and Chang (2002), 134 registered play therapists

were surveyed to explore their self-perceived multicultural competencies and adequacy of


multicultural training. Ritter and Chang distributed The Multicultural Counseling

Competence and Training Survey consisting of 32 Likert-type questions. Out of the 505

surveys Ritter and Chang distributed, only 149 were returned, and only 134 were

completed accurately enough for analysis, a return rate of slightly less than 30%. Results

of Ritter and Chang’s research suggest that overall play therapists reported being

multiculturally competent, yet perceived their multicultural training as inadequate. The

play therapists’ years of experience appeared to have no association with their perceived

competencies or adequacy of training. However, Ritter and Chang found a significant

difference in perceived competency between play therapists who were enrolled in

multicultural courses and those who were not. Overall, the more multicultural classes in

which play therapists had participated, the more adequate they rated themselves and the

more highly they rated their trainings (Ritter and Chang, 2002). Ritter and Chang suggest

that the play therapists surveyed were most competent with multicultural awareness and

terminology and less competent with racial identity development.

Ritter and Chang recognize their main limitation as the rate of return for their

distributed surveys. The results gained from the limited sample would be hard to

generalize. Ritter and Chang realize that these results are a foundation for further

research. These authors similarly recommend play therapists to become aware of their

own limitations and seek additional training when necessary. Ritter and Chang

recommend that future research in this area be done qualitatively to examine how a play

therapist becomes multiculturally competent, and to gain information regarding specific

weaknesses that were not self-reported.


Play Therapy within Schools

The use of therapeutic play originated in clinical settings and was seen as a viable

counseling option for children (Shen, 2008). In recent school counseling literature,

researchers are encouraging the use of play therapy as a counseling method for

elementary school counselors (Ray, Muro, & Schumann, 2004). Research has

documented that elementary school children respond positively to creative interventions

utilized in schools (Green & Christensen, 2006). Play therapy is a counseling method that

demonstrates a creative process that encourages a child’s academic, social, and emotional

development (Green & Christensen, 2006). Researchers have studied the use of play

therapy in elementary schools as a part of the responsive services component within the

school’s comprehensive school guidance program (Green & Christensen, 2006; Ray et

al., 2004). The role of play therapy, as a remediation intervention, is implemented to help

decrease maladaptive behaviors associated with academic, social, and emotional

development within a child (Green & Christensen, 2006). The recommended

incorporation of play therapy into a school’s guidance curriculum has been seen in

various research studies, yet Ray et al. (2004) indicate that many school counselors only

integrate play therapy into the remedial portion of the school’s program. School

counselors need to integrate the skills and knowledge from play therapy trainings into all

components of the existing school guidance program (Ray et al., 2004).

Ray et al. (2004) conducted a study that described a yearlong play therapy

program provided to an elementary school of approximately 750 students of a diverse

population. The study attempted to provide a description of the strengths and limitations

associated with using play therapy in an elementary school setting. The authors of the


study along with seven other play therapists used a child-centered play therapy approach

while working within the school. Ray and colleagues also took on the roles of consultant

to the counseling program, coordinator of the playroom and play therapy program, and

clinical consultant for the social workers, school counselors, teachers, and administrators.

The study was broken into three components: play therapy, filial therapy for teachers and

parents, and teacher education. Ray et al. addressed the strengths and limitations of each

component within their study.

Due to the nature of the current study, the child-centered play therapy component

in Ray and colleagues’ study (2004) will be the focus of this review. This component of

Ray et al.’s study was met with various limitations due to the nature of the school setting,

yet implications for future research were also found. Before participants were gathered,

Ray et al. and the seven other play therapists needed to address restrictions, such as the

teachers’ willingness to allow 30 minutes of the child’s instructional time to participate in

play therapy, locations of playrooms, as well as the availability and space allotment of

these rooms, cost of materials, and lastly, the use of the term “therapy” within the school

system. Once the limitations of child-centered play therapy within the school were

addressed or recognized, Ray et al. began to gather participants through parent or teacher

referrals. In this study, parents were asked to contact the school counselor if they felt

their child needed remedial services for behavioral or coping difficulties. It should be

noted that the study did not specify what constituted a behavioral or coping difficulty. If a

child was referred for play therapy, Ray et al. advised the school counselor to send home

a permission slip for the parents to sign. In the end, the study gathered 32 children who

would attend the play therapy sessions.


Ray et al. (2004) attempted to collect data that quantified the progress made by

the children through their experience with play therapy, yet the data were compromised

due to transition among students and teachers. However, Ray et al. did analyze and

document office referrals for behavioral disturbances and found a decrease in the amount

of referrals among the children that participated in play therapy compared to their records

prior to the intervention. In addition, final teacher interviews conducted by Ray and

colleagues demonstrated positive changes in classroom behaviors among the play therapy

children.

During Ray et al.’s study (2004), the play therapists expressed challenges with the

shift of their roles from mental health professionals to school interventionists. The study

also indicated a challenge with communication between the play therapists and teachers.

Due to the lack of a control group, it is difficult to determine whether the therapy was

responsible for improvements among participants. In future research, an increase in

communication between therapist/school counselor and the teacher may increase the

teacher’s understandings of the child’s struggles, the awareness about why change may

be occurring within the classroom, and the escalated or subdued behaviors exhibited by

the child (Ray et al., 2004).

In light of the positive implications of Ray et al.’s study (2004), Shen (2008)

researched the reasons that prevented elementary school counselors from implementing

play therapy into their guidance curriculum. Shen examined the influencing reasons

preventing Texas school counselors’ use of play therapy in school using a quantitative

survey method. The participants for Shen’s study were selected through systematic,

stratified sampling that distributed a questionnaire to 960 Texas school counselors, of


whom only 239 responded. The results of the study indicated that school counselors

apply play therapy for many positive reasons, such as intervention advantages, rewarding

counseling outcomes, and empirical data. In contrast, school counselors surveyed in this

study also indicated counselor competencies and resource constraints as reasons to avoid

implementation of play therapy. Although the study specified more positive reasons for

implementation, the negative reasons hindering the counselors dominated the school

counselors’ ability to confidently apply play therapy techniques.

Shen’s results support the idea that elementary school counselors’ lack of time

and training, as well as the out-of-pocket costs associated with the play therapy materials,

contribute to their lack of confidence in practicing play therapy techniques. Implications

for growth, as indicated by Shen, could help facilitate the use of play therapy within

schools. Shen recommends that school counselors attend play therapy workshops, and

that play therapy classes be added into counselor training programs at universities. Shen

also recommends that administrators seriously consider releasing non-counseling duties

and allocate more of their budget to the school counselors, in order to meet students’

counseling needs. Lastly, this study encourages further research in the area of play

therapy in schools to provide empirical data on its effectiveness (Shen, 2008).

Elementary school children’s perception of play therapy in the school setting is an

important aspect of the research and literature concerned with play therapy. Green and

Christensen (2006) conducted a study to investigate elementary school children’s

perceptions of play therapy when utilized by their school counselor. Green and

Christensen studied seven elementary school children who were currently engaged in

play therapy with their school counselor. Due to the nature of the study, Green and


Christensen conducted qualitative research and collected data using interviews, personal

observations, and document reviews.

The results of the study done by Green and Christensen (2006) were divided into

three categories: therapeutic relationship, emotional expressiveness, and creative play.

The participants indicated several factors within the therapeutic relationship to which

they attributed their successes in play therapy. These factors include their freedom to

choose whether they preferred to play or verbalize their emotions and experiences, the

empathy and acceptance of the school counselors while the children played, and the

collaborative problem-solving between counselor and student. The students indicated

their comfort in knowing that someone (the school counselor) accurately understood their

problems and could help to find solutions (Green & Christensen, 2006). The children also

indicated different factors within Green and Christensen’s category of emotional

expressiveness. The participants in the study perceived emotional expressiveness in terms

of safety, fun, and their process of change. The process of change, as described by the

children, was linked to their perceptions of how they made better choices, experienced a

decrease in anxiety, changed their misbehaviors, experienced an increase in self-worth,

and noticed an increase in empathy for others. Participants in Green and Christensen’s

study then identified the most enjoyable play activities as sand play, role play/drama, and

artwork/drawing.

Green and Christensen (2006) also indicated limitations and future research

implications for their study. The study’s limitations are inherent with a qualitative study,

such as the researcher’s biases and the inability to generalize the findings to the entire


population. Another problematic restriction within in this study was the school

counselors’ lack of adherence to the strict protocols placed on play therapy modalities.

Influence of Play Therapy on Children’s Behavior and Social Skills

Behavior. Children demonstrating social incompetence may display

misbehaviors and emotional instabilities, thus making it harder to relate to their peers.

Therefore, creative interventions must not only address social deficits, but behavioral

ones as well. Through play therapy, toys become the child’s primary means of

expression, giving the child the ability to project his feelings onto ambiguous stimuli.

Trotter et al. (2003) describe toys as giving different symbolic meanings to each child’s

struggles. Toys are a way for the child to express either negative or positive feelings. The

child’s play is not make-believe, but will actually reflect his subjective reality (Dougherty

& Ray, 2007). An intervention for children exhibiting misbehaviors is essential in helping

decrease the children’s need to externalize problematic behaviors, helping to create more

solid relationships with their peers (Ray, Blanco, Sullivan, & Holliman, 2009).

Within play therapy, a child is encouraged to express feelings symbolically, but

not behaviorally (Trotter et al., 2003), which highlights the importance of therapeutic

limit setting, helping the child develop self-control and self-discipline. When the therapist

sets limits, the child is taken out of their pretend play and necessary boundaries within the

playroom are created (Trotter et al., 2003).

Similarly, Cochran, Cochran, and Cholette (2011) discuss the importance of only

setting limitations that are necessary in anchoring the play into reality and making the

child aware of his responsibilities within the playroom. Cochran et al.’s (2011) study

provides an analysis of two kindergarten-aged boys’ limit testing behavior and limit


setting during their play therapy sessions. The two boys attended a large, urban

elementary school with occurrence of high poverty and Title I funds. The kindergarten

teachers and school administrators referred the boys for play therapy. Both boys

exhibited severe and persistent defiant and aggressive behaviors that were noted as

different from their peers. Cochran and colleagues also noted that both boys had

experienced abrupt changes, trauma, and stress. The boys attended play therapy for 30

minutes twice a week. This study chose a treatment model that created limitations to

ensure a safe environment for self-expression and continued to anchor play into reality.

The study provided three sources of data: reports of child’s behavior from school

administrators, therapist observations, and teacher ratings on the Teacher Report Form

(TRF) on the Child Behavior Checklist (CBCL). The study suggested that play therapy

provided an effective environment for testing limits and its association with positive

regard from the therapist. The study found that limit setting during play therapy allowed

the boys the opportunity to express themselves within a safe environment. Cochran et al.

explain the curative powers of limit testing followed by limit setting in strengthening the

therapist-child relationship. Even though Cochran et al. found their study to be

successful, limitations to the study included the inability to generalize the findings to a

large population, clients missing sessions, and an abrupt ending to the session of one

client. Further research can examine the aspects of how and why limit setting in play

therapy helps in the development of a child’s social and emotional self.

Cochran et al. (2010) presented another study that similarly observed two case

studies of child-centered play therapy (CCPT) for two first grade boys who were

described as having highly disruptive behavior, specifically attention problems and


aggression. These boys also attended play therapy for 30 minutes twice a week. Similar

to the previous study, the TRF was used to measure problematic behaviors, as well as

recorded observations by the therapist about her thoughts on the presenting problems and

explanations about why and how play therapy seemed to work. The overall results for

both boys indicate the usefulness of play therapy for children demonstrating disruptive

behaviors. Yet, Cochran et al. (2010) advise the reader not to make generalizations based

on single case study designs.

Similarly, Ray et al. (2009) conducted a qualitative study to explore the use of

play therapy with children described as having aggressive behaviors. The study observed

42 students from two elementary schools. The students were identified using the

definition of aggression as provided by the Child Behavior Checklist (CBCL). Students

were systematically placed into either a no intervention control group or a play therapy

treatment group. Originally, Ray et al. intended that the students be placed randomly into

each group but due to school requests random assignment was not used. Nineteen

students were assigned to the play therapy group and attended 14 sessions that occurred

during a seven-week period. Ray et al. had planned to offer 16 session of play therapy, as

research yields significant differences in behaviors after 11 – 18 sessions of play therapy

and even greater changes in 19 or more sessions. Yet, due to scheduling conflicts, the

study had to reduce the number of sessions. Ray et al.’s study used similar data

collection techniques as Cochran et al.’s (2011) study. Teachers in this study were asked

to complete the Teacher’s Report Form (TRF) of the CBCL. Results from the study were

not statistically significant and showed only a moderate decrease in aggressive behaviors

between children in the treatment group and control group. Teachers’ data reported a


significant improvement in both groups, and parents’ data reported no significant changes

in the groups’ behaviors. In future studies, Ray et al. recommend that a larger sample

sized be used, as well as more insistence on parental participation, to allow for increased

statistical power and generalization. Ray et al. also believe it would be beneficial to

replicate the study with a randomized sample of students during the middle, as opposed

to the beginning, of the school year.

Social skills. Social competence is often used to describe a child’s social

acceptance, social behaviors, the use and understanding of social skills, and the absence

of problematic behaviors (McAloney & Stagnitti, 2009). Socially competent children are

observed to play well with others by entering into play groups appropriately, initiating

play with others, meeting age appropriate social goals, and responding appropriately to

other children (McAloney & Stagnitti, 2009). LeGoff (2004) began developing engaging

interventions for children’s social skills when he noticed the lack of social skills

programs within schools. During observations of existing social skills programs, LeGoff

noted that the interventions seemed difficult, irrelevant, and un-engaging for the children.

Literature regarding social skills interventions recommends that the intervention be

customized to the individual’s needs (LeGoff, 2004). LeGoff (2004) also cited research

suggesting that utilizing a child’s interests and adapting these to help promote the

development of social competence and play skills. Two studies examined the use of play

as it relates to the development of social skills through the observations of a child’s

behavioral or social issues.

During play, children develop and strengthen their understanding of appropriate

social norms (McAloney & Stagnitti, 2009). McAloney and Stagnitti describe pretend


play as the child’s way to create imaginary situations that allow the child to test various

social skills and their consequences. McAloney and Stagnitti’s research found that

children who engage in pretend play are more likely to be considered socially component

among adults and peers. The authors investigated the relationship between children’s

performance on a pretend play assessment and their engagement during social peer play.

The study used the Child-Initiated Pretend Play Assessment (ChIPPA) and the Penn

Interactive Peer Play Scale (PIPPS) to test the concurrent validity between the two

measurement devices. The ChiPPA is a standardized play assessment that measures the

quality of a child’s pretend play (McAloney & Stagnitti, 2009). On the other hand, the

PIPPS is a rating scale used to measure children’s interactive peer play competencies.

McAloney and Stagnitti (2009) sampled 53 preschool-aged children from various

socio-economic backgrounds. The researchers predicted that the children’s pretend play

and objects used during play would relate to how well they would socially interact with

their peers, based on the assumption that if a child’s pretend play was elaborate and

developmentally appropriate, then they would relate to their peers well. The results of

this study indicated that children who have elaborate play with both conventional and

unstructured toys were more socially competent with their peers and less disruptive in

their preschool classes. McAloney and Stagnitti also concluded that children who had

low scores in relation to object substitution were more likely to struggle in their

interactions with peers. Teachers interviewed in the study also reported that these

children were socially disconnected from their peers and were not observed to initiate

engagement with others. This study’s findings help develop the understanding about

children’s pretend play ability and their social interaction.


McAloney and Stagnitti (2009) recognize their largest limitation to this study as

only being able to generalize these results for children from one country, Australia. The

authors recommend that a replication of this study be conducted with more children from

various countries to further validate the results. McAloney and Stagnitti also found

discrepancies among parent ratings. They recommend that research be conducted to

compare the reliability and validity for parent ratings to teacher ratings using the PIPPS.

McAloney and Stagnitti (2009) encourage play therapists to develop more

complex pretend play sequences that utilize conventional toys to assist children with their

social peer play. The authors also promote the use of unstructured toys during play

therapy sessions, as this facilitates the development of problem solving skills, flexibility,

and the ability to make connections to reality. As play is emerging as a primary treatment

for children, play therapists are becoming more equipped with skills necessary to engage

and assist children in their behavioral, emotional, social, and academic development.

Another study conducted by LeGoff (2004) assessed the effectiveness of social

skills interventions used for children with Autism Spectrum disorders. LeGoff noticed

that current techniques recommended for use with children diagnosed with Autism

Spectrum disorders utilized peer instruction and peer modeling, which had little to no

impact on the use of appropriate social skills outside of the intervention. It was noted in

LeGoff’s review of the literature that the skills and exercises were learned and could be

reproduced when prompted, but the desired skills were not self-initiated in the classroom

or on the playground. In order to use a child’s natural interests to promote learning and

behavior change, LeGoff began his research with the use of LEGO therapy. During

LEGO group therapy, LeGoff assigned joint jobs to the children; one was given the job of


director, giving verbal directions for assembling the LEGO creation, and the other was

given the job of builder, following the directions given by the director. LeGoff

emphasized the skills of sharing, taking-turns, making eye contact, and following social

rules.

For his study, LeGoff (2004) chose 34 males and 13 females between the ages of

6 and 16. The majority of the children attended public schools and all children were

diagnosed with Autistic Disorder, Asperger’s Syndrome, or Pervasive Developmental

Disorder. It was noted that some of the children were on medications and the use of the

medications throughout the study was monitored to ensure that the dosage was not

changed during the treatment phase. The goal of LeGoff’s study was to improve the

children’s social competencies, which were described as the initiation of social

interaction, duration of social interaction, and development of age-appropriate social and

play behaviors.

LeGoff (2004) used three measures of data for his study. The first was a measure

of the frequency of observed self-initiated social contact during a half-hour playtime

following lunch. The second was an observed duration of social interactions with peers

during a one-hour after-school recreation time. This measure did not focus on whether or

not the interaction was self-initiated, but was more concerned with the type of

interactional exchange and its duration. The last measure was used to reflect the

development of age-appropriate social and play behaviors as characteristic of the Social

Interaction subscale of the Gilliam Autism Rating Scale (GARS-SI). Parents, teachers,

and therapists completed the GARS-SI during the intake and follow-up assessments.


LeGoff’s results indicate improvements in initiation of social contact, duration of

social contact, and decreased scores on the GARS-SI of the participants. The participants’

teachers reported an improvement in confidence and sociability within participants.

LeGoff also reported that the results found no correlation between the cognitive level of

the participants and the outcome of the intervention, as well as no relationship between

the age of the participant and the effectiveness of the intervention.

The observations within the study were not made by blind observers and therefore

may contain observer biases (LeGoff, 2004). Another limitation defined by LeGoff was

psychometric problems with the GARS-SI leaving this measurement questionable for the

study. It should also be noted that the study lacked a control group and therefore it is

difficult to determine if improvements were based solely on the therapy. Nonetheless,

LeGoff also proposed areas for further research. Research to identify aspects of the

intervention that resulted in its effectiveness will assist in determining the extent to which

LEGO intervention improves the social competence of children. Therefore, LeGoff

understands that further research could analyze the aspects of the intervention to

determine the most effective modalities. This understanding may explain why LEGOs

were engaging and promoted change within Autism Spectrum children. LeGoff’s study

supported the use of LEGOs as a therapeutic technique for promoting and developing

social competence with children diagnosed with Autistic Disorder, Asperser’s Syndrome,

or Pervasive Developmental Disorder.

Summary

In order to promote self-exploration, self-control, and self-direction, child-

centered play therapy focuses on letting children deal with the problems most apparent in


their lives. Many externalized behaviors found in elementary classrooms result from

emotions and experiences not expressed by the child. With the opportunity to explore

these feelings in a non-directive, safe environment, children begin to learn limit setting,

self-expression, and social norms. Both quantitative and qualitative studies support the

use of using play therapy with children in schools or in a clinical setting. By offering play

therapy in schools, teachers, counselors, and administrators are enabling children to

become self-monitoring with their behaviors and not dependent upon extrinsic rewards

through token economies.

The current study used a combination of whole group structured social skills play

activities along with small group directive and non-directive play activities to promote

self-expression, limit setting, behavior regulation, and adherence to social norms. The

current study extended upon the ideas presented by play therapy and adapted them to a

school setting, in which play is being utilized as an intervention for motor, verbal, and

passive off-task behaviors in the classroom, including out-of-seat behaviors. The role of

play interventions in this current study was intended to decrease off-task behaviors

associated with academic, social, and emotional development within a child. Students’

progress was communicated to their teachers so that the teachers could better understand

both the students’ struggles and what appears to work to decrease such struggles.


Chapter 3

Method

Participants

Two Kindergarten classes containing 26 total boys were asked to participate in

this study. The 20 consented Kindergarten participants were obtained after parental

permission was given for the utilization of data in the study. Parents were given seven

days to return the permission form.

The participants’ ages ranged from five to six years of age. The majority of the

participants were Caucasian (55%), while 28% were Hispanic, 11% Mixed-Racial, and

6% Asian. Mixed-Racial was defined as the parent or child’s identification with two or

more races. The selected participants attended a private, Catholic boys’ school with an

enrollment of 261 boys in an urban, affluent community. The participants attended

regular classes that were supplemented with bi-monthly guidance lessons, mini social

skills lessons, and play activities.

It should be noted that participants’ names are not used in this study. Any

behavior exhibited during the study that may result in the identification of a participant

has been changed to describe similar behaviors while reporting observations or other

relevant information.

Group 1 and Group 4 each consisted of four six-year-old boys who meet on

alternating Mondays. Group 2 consisted of four six-year-old boys and Group 5 of three

five-or-six-year boys, both of whom meet on alternating Tuesdays. Group 1 and 2 each

contained a participant diagnosed with Attention Deficit/Hyperactivity Disorder. Neither

participant was taking medication for the condition. The three six-year-old students in


Group 3 met every other Wednesday during the duration of the study. All groups met at

the same afternoon time period, which occurred at the end of the day right before

dismissal. At the conclusion of the study, all groups met for a total of four guidance

lessons and four play activity sessions that incorporated a mini social skills lesson.

Measures

A coded observation form was developed by the researcher to standardize the

recording of indicated behaviors within the classroom. The observation form indicated

the participant being observed, time of day, day of the week, and duration of observation.

The study was conducted so that the length of observation, time of day, day of the week,

and setting of observation were all standardized for the duration of baseline, mid-point,

and posttest periods for each participant. An example of this form is located in Figure 1

(see Appendix).

Each observation lasted for thirty minutes. Observations were divided into sixty

30-second intervals, in which the child’s behaviors were recorded as on-task (O), motor

off-task (M), verbal off-task (V), passive off-task (P), or out-of-seat (S). The activities,

independent work (1), small group activity (2), large group activity (3), or large group

instruction (4), were also recorded during the observation of the child. A summary form

for each group and participant was generated to calculate the overall percentage of time

the student was observed doing one of the identified behaviors. Standardization of the

observation time and continued use of the same observer increased the intra-observer

reliability for this measure. During each observation, the classroom teacher and

Kindergarten aid were present.


Design

A one group pretest-posttest experimental design was employed to determine the

relationship between play activities and social skills lessons and students’ behaviors

within the classroom. The independent variable for this study was the boys’ participation

in play activities and social skills lessons. The dependent variable was the number of

observed occurrences of on-task (O), motor off-task (M), verbal off-task (V), passive off-

task (P), or out-of-seat (S) behaviors during the baseline, mid-point, and posttest periods.

This design was chosen to establish baseline data for the identified behaviors, as

well as a mid-point observation to monitor the identified behaviors during the treatment

period. It was intended that for each behavior, the participants displayed fewer instances

of the off-task behaviors observed during the treatment period than during the baseline

period, indicating that the play activities and social skills lessons were helping the student

become properly engaged in classroom lessons.

As with any pretest-posttest experimental design, this study was limited in its

ability to be generalized to the population of interest. The study would benefit from meta-

analyses done in a girls’ private school and/or in a co-ed public school. In order to

increase external validity, this study would need to be replicated and data between studies

would need to be compared. Threats to the internal validity of this study were maturation,

history, and instrumentation. To address history threats, teachers were asked to update the

researcher as to any known events that may have occurred on an observation day that

could potentially skew the data. Maturation threats are small due to the condensed

intervention period. Lastly, instrumentation was standardized to ensure the most

consistent measurement of observed behaviors. Observer reliability and consistency were


defined by only using the researcher to observe identified behaviors during each

observation of the treatment period.

Procedure

Baseline period. Before baseline measurements were taken, students were

divided into five groups and parental permission was gained. It must be noted that the

parents were not permitting their child to participate in the activities; they were only

permitting the use of their child’s data. After the proposed study was presented to the

children’s parents through letters from both the researcher and Headmistress of the

school, 20 participants were identified. After informed consent was gained, the children

were observed in their classroom. The completed observations and summary forms were

compiled and locked in a filing cabinet for further review during the mid-point period.

During the baseline period, each participant was observed on his scheduled day

(e.g. Monday, Tuesday, or Wednesday) in the morning. The time of day differed between

groups due to their school and class schedules, but all occurred before lunch. Baseline

observations began during the second and third week of the school year. During the

baseline observations, participants were not given any extra behavior modifications or

interventions other than standard classroom procedures. During this time, a rapport

building activity was done with each group to ensure proper relationships were built and

promoted.

Treatment period. The treatment consisted of social skills lessons taught during

regular whole group guidance lessons once every other week, which focused on

promoting effective classroom behaviors, especially those pertaining to motor off-task,

verbal off-task, passive off-task, and out of seat behaviors. The participants then attended


a 30-minute play session semi-monthly, which emphasized and reviewed new social

skills in small groups. These sessions allowed the children non-directed child-centered

play in a small group. During play, limit setting and inclusion were promoted and

encouraged when necessary. Therefore, the treatment period consisted of two

components; the whole group social skills lessons and the small group play activities.

This treatment took place each afternoon before dismissal and was consistent for each

group throughout the duration of the study.

Developmentally appropriate activities developed by Richardson (1996) and

supplemented with activities from Jelleberg (2006) were chosen for the whole group

guidance lessons. Each guidance lesson lasted for thirty minutes and occurred once a

week for the duration of the treatment. Participants were observed after two weeks of the

intervention on their regularly scheduled days and times within their classrooms. The

occurrences of on-task, motor off-task, verbal off-task, passive off-task, and out-of-seat

behaviors were recorded on the observation form for each child.

Posttest period. After six weeks of the intervention, posttest observations were

taken on the 20 participants. Improved areas for each behavior for each participant were

noted. In total, this study lasted nine weeks: One week was spent gathering baseline data,

six weeks were used to implement social skills lessons and play activities, one week was

used to gather posttest data, and one week was used for data analysis and comparisons

between baseline, mid-point, and posttest data.

Data Analysis Plan

Data were collected through behavior observations in the classroom. During the

baseline, mid-point, and posttest periods, observations of indicated behaviors for each of


the participants were charted and percentages of occurrences were obtained. The

observation data were analyzed statistically to determine whether there was a significant

change in behavior from the baseline data through the mid-point and into the posttest

periods. The observation notes were secured in a locked filing cabinet to assure

confidentiality. During the time in which the data were stored, the research advisor and I

had access to the information.

Ethical Issues

Permission was given by the headmistress and the lower school principal of the

boys’ Catholic school to proceed with the study as indicated on the school authority

permission form. Parental permission for each participant considered for the intervention

was also obtained through an informed consent form.

There was a risk that participants may have experienced minor psychological

distress by participating in the play activities. This risk could have resulted from

interactions with others or emotional expression during play. Such emotions are normal

reactions to any form of peer interaction. The initial social skills lessons helped to keep

the play intervention partially structured, thus creating an environment for the

participants to monitor their own behaviors and emotions. I was present during both the

social skills lessons and the play activities to intervene when necessary. If a participant

did become upset, he could meet with me privately, speak with the lower school

principal, or meet with the headmistress.

The research was explained to the participants’ parents, who signed the parent

permission form granting the utilization of their child’s data within the study. The

children’s consent was obtained through their parents, but the children were notified in


the first session of their right to leave the group if or when necessary. The children knew

that there were no penalties if they wished to leave or if they wished not to participate in

the group. The participants and I discussed the importance of confidentiality within the

group. Due to confidentiality, the parents did not have access to the data until the study

was presented. The parents were also encouraged not to question their child about the

content of the group meetings or about the other children within the group.


Chapter 4

Results

Prior to the implementation of small groups and observations, a whole group

guidance lesson was given to introduce the counselor and the role of the counselor within

the school. Rapport was established prior to any data collection or interventions. During

the initial week, baseline observation data were obtained each morning before the

students met in their small playgroup, which occurred in the afternoons. The means and

standard deviations of this baseline data are represented in Table 1 (see Appendix).

Observation data was obtained by recording the off-task behavior observed during each

30-second time interval for a period of 30 minutes. Figure 1 (see Appendix) provides an

example of the observation sheet used to collect data. The occurrences of each observed

behavior were then turned into percentages. The percentages were used to find the means

and standard deviations.

Small group play activities continued for four weeks with two guidance lessons

occurring during these four weeks. On the fifth week of the intervention, midpoint data

was collected each morning before the students attended their playgroup. Table 1 (see

Appendix) presents the mean and standard deviation of this set of data. Four more weeks

passed before posttest observational data was collected on the participants. During weeks

five through seven, two more guidance lessons were used to supplement the small group

play activities. During the eighth week, posttest observations were conducted and the

mean and standard deviation are presented in Table 1 (see Appendix). To better help

illustrate the decrease in observational means for each off-task behavior, Figure 2 (see

Appendix) shows the decrease in means from baseline to midpoint to and posttest.


Data analysis focused on determining if there were differences among the means

of each of the identified off-task behaviors (motor, verbal and passive off-task behaviors,

and out of seat behaviors). I conducted a repeated measures analysis of variance

(ANOVA) with each of the four off-task behaviors. By conducting this test, I was able to

identify whether or not a significant difference was found between observation means.

During the research, three time points, baseline, midpoint, and posttest, as well as means

for each off-task behavior were used to determine the ANOVA. The ANOVA showed a

significant difference for the verbal off-task behaviors, F(2, 38) = 4.92, p = .013,

indicating that there was a significant difference between at least two of the means for

this variable. There was also a significant difference found in the motor off-task

ANOVA, F(2, 38) = 7.68, p = .002, also indicating that overall the students displayed

significantly fewer instances of motor off-task behavior from baseline to posttest

observations. One last significant difference was found with passive off-task behaviors,

F(2, 38) = 7.66, p = .002, concluding that these observed behaviors also decreased from

baseline to posttest observations. Lastly, out of seat behaviors were found to be

marginally significant, F(2, 38) = 2.53, p = .093, which is worth analyzing considering

the behavior dropped to nearly zero.

Because the differences were found to be significant for verbal, motor, and

passive off-task behaviors, the researcher followed up with a paired samples t test to

determine which pair, baseline-midpoint, midpoint-posttest, and/or baseline-posttest, was

significantly different from another. In other words, the paired t test helped indicate

where exactly the differences were found for each off-task behavior. The paired samples t

tests revealed variations between time points. Results overall showed significant


decreases for all three behaviors, verbal, t(19) = 2.66, p = .015, motor, t(19) = 3.47, p

= .003, and passive, t(19) = 3.87, p =.001, from baseline to posttest observations t test.

Additional t test data analyses can be found on Table 2 (see Appendix), including the t

test scores for baseline to midpoint and midpoint to posttest.

Due to the results found with the paired samples t test, the researcher conducted a

Cohen’s d to determine effect size, or the measure of standard deviation units between

baseline and posttest paired t tests for each off-task behavior. The results indicate that

there was a large effect size for all three variables, verbal, d = 1.36, motor, d = 1.59, and

passive, d = 1.78.

The results prompted rejection of the null hypothesis, thus providing support for

the research hypothesis. The hypothesis stated that by addressing the social needs of

children through play, teachers could expect to observe a decrease in motor, verbal, and

passive off-task behaviors. The data indicate a significant decrease in verbal, motor, and

passive off-task behaviors after the eight-week intervention. There was a marginally

significant decrease found for out-of-seat behaviors. This result could be a factor of low

means in the area (means indicate the behavior occurring almost zero percentages of the

time) or perhaps the intervention did not address this concern specifically.


Chapter 5

Discussion

This study performed a one group pretest-posttest experimental design to

determine the relationship between play activities and social skills lessons and students’

behaviors within the classroom. The expectation was that there would be a decrease in

motor, verbal, and passive off-task behaviors by addressing the social needs of children

through play. The findings support the research hypothesis, which is also consistent with

the previous literature. Bratton and colleagues (2005), in a meta-analytic review of play

therapy, found that on average, children who participated in play therapy performed more

than three-fourths of a standard deviation higher than their peers in a control group.

My findings prompted rejection of the null hypothesis, thus providing support for

the research hypothesis. The data, measured through t tests, indicate a significant

decrease (p < .05) in verbal, motor, and passive off-task behaviors after the eight-week

intervention. By comparing the means of each of the four off-task behaviors, findings

indicate a decrease in means overall. Therefore, the findings may conclude that the

difference between pretest and posttest scores was likely to be a true difference in

behaviors from pretest to posttest, rather than due to sampling error. The significant

findings indicate that the improvement observed is likely real improvement that could be

observed in the larger population. Unfortunately, the current study does not indicate if the

improvement was due to the intervention or not. This could only be determined with an

experimental design, which would include a control group.


Strengths and Limitations

Compared to previous literature on this topic, the current study aimed to measure

the effectiveness of play within the schools, as a means of promoting appropriate

classroom behavior. There have been multiple studies performed to study play therapy in

various ways, but many of them are case study reports. My study was unique in that it

brought in the school perspective of adding a play intervention back into the

Kindergarten curriculum to see if children’s ability to play out their feelings would help

increase on-task, appropriate classroom behaviors. Another strength of this study was the

observational protocol, which likely increased intra-rater reliability while also making the

study more replicable.

The current study also experienced a few limitations, which are consistent with

limitations found in similar studies. A notable limitation is the lack of a control group

within the study. A similar limitation was found in Muro and colleagues’ (2006) study on

long-term child-centered play therapy, in which they cautioned the reader to consider

their study only as an exploratory study due to the lack of a comparison group. Similarly,

the current study’s results indicated a decrease in off-task behaviors, thus supporting the

research hypothesis, but due to a lack of a control group it cannot be determined whether

the outcome is a result of the intervention or due to the maturation of the students.

Previous research also indicates that the limited number of play intervention

sessions in the current study may also appear to be a limitation. This limitation was due

to the time period in which the study was performed. According to previous research

done by Ray, Blanco, Sullivan, and Holliman (2009), it is ideal to have 11-18 sessions,

which produces more of a statistically significant difference. It was also suggested that


more than 19 sessions would result in even more gains by the participating students (Ray

et al. 2009). In addition, Muro and colleagues (2006) found that a lengthy duration of

play therapy improved the child’s behaviors and the child’s relationship with the teacher.

More progress could be made if eight to 12 more sessions were allotted and added. Future

research may perform a follow-up study with a larger class size. This would allow the

students to be divided into more groups, including a control group. This could also allow

the possibility of adding more play sessions into the schedule at regular intervals.

Recommendations and Action Planning

A recommendation for future research would be to use a larger sample size and

include a control group. By increasing the sample size, the population of students could

be more generalizable. A study on repetitive symbolic play during play therapy by

Campbell and Knoetze (2010) also recommended the use of a larger sample of students to

ensure that a wider variety of problems was presented, which would assist in making

generalizations to a larger population. This increase in sample size would also allow for a

control group.

Another suggestion for future research would be to compare the social skills

lessons with the play component to see if they are similarly effective or if one is more

effective than the other. This would be helpful for justifying both components in the

intervention, especially given the increased emphasis on academics over play in early

education.

For future educators, I would recommend that teachers, principals, and school

counselors collaborate to establish a social skills curriculum for students in Kindergarten

and first grade that incorporates play. Based on the current study’s findings, students


given the opportunity to learn, model, and practice a set of social skills through play

showed significant improvement in their classroom behaviors over an eight week time

period. Bratton and colleagues’ (2005) research also supports play therapy as a method

for changing behaviors, improving social adjustments, and developing personality. In this

capacity, play therapy in the schools can be viewed as a preventative and consulting

method, not just remediation (Ray et al., 2004). In addition, by giving students a small

group in which to work, rapport and relationship building were promoted. This provided

the students a trusting relationship in which they began to resolve their own problems

through non-directive play (Bratton at al, 2005). Landreth and colleagues (2009) suggest

starting the school year by having staff development training focused on explaining the

importance of play for children, as well as including the emotional, academic, and

behavioral outcomes. Sharing this information helps initiate teacher and administrator

support of such a program.

The current study serves as a starting point for further exploration in the

effectiveness of play interventions within the guidance program, as a whole, at the

elementary level. The strengths of the current study present a base for future research on

play therapy within the schools. The sample size, lack of control group, and duration of

the study prevent generalization to a larger population of students. However, the current

study did show a significant decrease in off-task behaviors within the classroom after the

students participated in the play intervention. As a school counselor, it will be important

for me to continue to update myself on the current trends in play therapy, include these

methods into my play interventions within the guidance program, and document the

changes I see with each class, group, or individual. Documentation and data are essential


for guiding such a program, especially when the school counselor is advocating for the

use of play interventions within the program.


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Appendix

Table 1: Baseline, Midpoint, and Posttest Means and Standard Deviations for Off-Task Behaviors

Table 2: Paired Samples t Test results for Baseline – Midpoint, Midpoint – Posttest, and Baseline – Posttest Time Points for Verbal, Motor, and Passive Off-Task Behaviors

Figure 1:.Data management form for each participant’s observation used during baseline, midpoint, and posttest observations

Figure 2: Pretest, midpoint, and posttest observational means for verbal, motor, and passive off-task behaviors and out-of-seat behaviors


Table 1

Baseline, Midpoint, and Posttest Means and Standard Deviations for Off-Task Behaviors

Baseline Midpoint PosttestVariable N M SD M SD M SDVerbal 20 9.25 8.85 8.90 6.36 3.70 4.81

Motor 20 12.00 8.11 7.45 5.35 4.90 4.92

Passive 20 12.45 8.50 6.65 7.13 5.25 4.19

Out-of-Seat

20 3.30 5.79 2.10 2.49 0.65 1.76


Table 2

Paired Samples t Test results for Baseline – Midpoint, Midpoint – Posttest, and Baseline – Posttest Time Points for Verbal, Motor, and Passive Off-Task Behaviors

Baseline – Midpoint Midpoint – Posttest Baseline - PosttestVariable df t p t p t pVerbal 19 0.190 0.850 2.970 0.008* 2.660 0.015*

Motor 19 2.360 0.029* 1.650 0.116 3.470 0.003*

Passive 19 2.630 0.017* 0.800 0.435 3.870 0.001*

Note: * indicates statistically significant t tests at the p < .05 level.


Figure 1. Data management form for each participant’s observation used during baseline, midpoint, and posttest observations.


Figure 2. Pretest, midpoint, and posttest observational means for verbal, motor, and passive off-task behaviors and out-of-seat behaviors.

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