Differential Impact of Play Therapy on Developmental Levels of Children Article Review

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Piaget and Play

What is / are the research questions explored in this article? Dougherty and Ray

(2007) report that an estimated 20% of children and adolescents in the United States have treatable mental health problems and two thirds of these children do not receive the services they need. With respect to make-believe play, Piaget hypothesized play was a consequence of a maturing brain occurring in the preoperational stage that was able to engage in more symbolic or representational thought from the previous sensorimotor stage. Thus, make-believe play becomes less self-centered, more detached from real-world situations, and includes more complex combinations of schemes as the child matures. Play shifts from egocentric to social as the child moves from the preoperational to the concrete operational stage. Child centered play therapy (CCPT) applies clinically relevant techniques to working with children as children prefer play to talking. Previous research has indicated that CCPT has been effective intervention for children across these age groups, but the impact on parent-child relationship stress is not well documented. Moreover, previous research has not addressed the differential effects of CCPT on children in the preoperational and concrete operational stages. The study addressed these two issues.

Who are the research participants? The research subjects were 24 children from three to eight years of age who had previously been treated with CCPT in a university mental health clinic. The parents of the children were also participants as the parents completed the measures (the dependent variable) on which the researchers were interested. We are not told which parent or if both parents completed the measures.

What is the research design (describe groups or conditions)? First of all this is an archival study based on clinical data that was previously collected and recorded by the clinicians treating the children. The groups/conditions of the study (the independent variable) are subject variables and were determined after the actual data collection took place. Children of different biological ages were the groups (and their parents). There were two groups of children: preoperational (ages three to six) and concrete operational (ages seven to eight) based on Piaget's model (there were a total of 12 children in both groups). There were no control groups, no comparative therapeutic methods, and no random assignment. The research would qualify as quasi-experimental.

What exactly is presented to the participants (e.g., what does a participant see)? The children participants were treated with CCPT interventions. CCPT applies the Rogerian principles of empathy, genuineness and unconditional positive regard in counseling children and deals with the particular child's developmental needs by allowing for the opportunity to use play as a form of communication to reveal the experiences and emotions. The children received up to 23 CCPT sessions.

The parents, from whom the actual data was collected, completed the Parenting Stress index (PSI), which is a 120 item instrument designed to identify parent-child systems that are under significant risk for stress or problematic parent/child behavior. There are three scales in the PSI: the Child Domain Scale, which are child characteristics; the Parent Domain Scale, which are parent characteristics; and the Child and Parent Domain Scales which are the other scales combined to get a total stress score. Upon initiation of the treatment the parents completed background forms and the PSI. Parents completed the PSI twice more, once at the midpoint of treatment (8-12 sessions) and again at the end (post-treatment following 19-23 sessions).

Is this research design appropriate for this study? The quasi- experimental design is appropriate given the independent variable (cognitive developmental stage of the child as defined by the child's age) cannot be subject to random assignment. However, the archival nature of the study rules out using a control group and a comparative form of treatment (such as some traditional therapeutic treatment). In addition, there are no tests or measures to indicate the actual developmental stage that the child was in (preoperational or concrete operational).

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Piaget's theories did not indicate that age is the determining factor of the cognitive developmental stage of the child, but instead the child's ability to reason and solve problems. The ages were general guidelines as to when most children would reach the stage; some reach the stage earlier, some later. Therefore the conclusions of the study might be confounded since some of the children in each group may actually be in a different developmental stage. Moreover, follow-up research on Piaget's ideas has determined that many of his conclusions were found to be inaccurate when the stimuli or dilemma was presented to the child at the child's level of understanding. Piaget may have been presenting dilemmas or asking questions at too sophisticated of a level than the child was able to understand. Thus, when difficulty levels are controlled for in regards to the maturity of the child, the child is actually capable of more symbolic thought than Piaget had believed. Later research determined that symbolic thought develops in relation to the experience of the child (a finding that is in line with some of the tenants of behaviorism), whereas Piaget saw it as a biological process much like physical growth. What is the response being measured? The responses being measured are the parent's answers on the items of the PSI. There is no direct data from the children, just parental impressions.

What are the results? There are several conclusions. There were pretest differences in the groups on the Parent Domain scale and the total scale with the parents of the preoperational children reporting more stress. When evaluating all the children over time there were significant decreases in the Child Domain and the total stress score form pretest to post-test (but the midpoint measurement did not statistically differ from the pretest scores on all measures).

With respect to the group differences, the groups did not differ on Child and Parent Domain scores across time, but did differ on overall stress (as measured by Repeated Measures ANOVAs); however, partial eta squared calculations indicated large practical differences in the Child Domain scores between the groups with the concrete operational children demonstrating more improvement.

Using clinical significance as a method of understanding change in the PSI scores it was found that nine of fourteen children in the study were who rated in the clinical range on the Child Domain Scale at pretest had dropped into the normal range by post test (four of seven children in the preoperational group and five of seven in the concrete operational group). Thus, from this standpoint the treatment was equivalent across groups.

Do these results answer the proposed research question(s)? In an overall sense, yes the results indicate that CCPT may have some benefit in treating children with clinical issues at both the preoperational and operational stages. The study also answered the question regarding differences of the groups in response to CCPT. In this study the level of cognitive development (as determined by chronological age) did not make a difference in the child's response to play therapy when considering clinical significance (practical changes as opposed to statistical ones). In terms of statistical significance the preoperational children did not demonstrate the effect on the Child Domain Scale and the authors discuss that this may be due to them having less-developed abstract and relational capabilities, more egocentric play, and less-developed social abilities. There were no significant changes on the Parent Domain scores in any of the analyses and the authors speculate that direct treatment for the parents of these children may be warranted (interesting conclusion). The change in the overall stress index was mediated by changes in the Child Domain scale, further supporting the researchers' conclusions regarding treatment for the parents.

What are the conclusions from this research study? Overall the conclusions are: CCPT is beneficial to children; CCPT may be more appropriate for older, more cognitively developed children (however.....

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