These observations are made from the most recent comprehensive meta-analytic literature review of published play therapy research (Bratton, Ray & Rhine, 2005).
View the Meta-Analytic Literature Review
Anxiety disorders are one of the most common kinds of mental health concerns in children and adolescents. Anxiety can best be described as "worrying" or being "scared." Anxiety disorders generally fall into one of these categories:
- Generalized Anxiety Disorder: Symptoms of generalized anxiety disorder that parents and child care-caregivers need to know about include fidgeting, short temper, being uptight, or getting tired easily. The child may have a hard time keeping his or her mind on what they are doing. The child may not sleep soundly.
- Separation Anxiety Disorder: Symptoms of separation anxiety disorder may include hanging on to parents to keep parents from leaving, doing things to keep from having to go to school, or afraid to sleep in their own room alone.
- Social Phobia: Symptoms of social phobia include the child who may be extremely shy, not want to talk to people outside of his or her family, or not wanting to eat outside his or her own home. The child may become very afraid to be with unfamiliar people or in new places. Two other types of anxiety disorders are sometimes seen in children:
- Obsessive-Compulsive Disorder: A child with obsessive-compulsive disorder may want to repeat an activity over and over again that may seem unnecessary. An example is for a child to wash his or her hands so much that the skin becomes raw. The child may do these activities to help stop thinking about things that upset the child.
- Post-Traumatic Stress Disorder: A child who has had something very bad or scary happen to them may develop post-traumatic stress disorder. The child may dream about what happened, may not be able to not think about what happened, or may act out what happened when the child is playing. Not enough people have studied these two kinds of disorders in children to know how well any therapy works. Adler-Nevo and Manassis (2005) found that, of 742 PTSD studies, only 10 were about children. Of those 10, play therapy was among the treatments used. Play therapy has been used to work with children with OCD, but how it compares to other treatments has not yet been reported.
Children may become sad, tired, "bored," or seem to be having a bad day from time to time. Usually when the child becomes engaged in an activity, the feelings seem to pass in a short period of time. However, when these feelings persist and keep the child from going about his or her regular day, clinical depression may be the cause of the "moodiness." Depression is said by the federal Center for Mental Health Services to present in about one in every 33 children. That figure would mean that just about every classroom of children would have one child that was clinically depressed. Depression can lead to low achievement, social isolation, and problems getting along with friends and family. Depressed children can take their own lives. Once the child has had a serious period of time with clinical depression, the child is at risk for serious depression again over the next five year. Most depressed children become depressed adults.
The child may have serious depression if more than one of these following behaviors last more than two weeks:
- The child appears sad, tearful, or to cry easily.
- The child appears or says that he or she feels hopeless.
- The child withdraws from friends and usually enjoyed activities.
- The child doesn't want to do anything or cannot get anything done.
- The child complains about being tired or doesn't have usual energy.
- The child's eating and sleeping patterns change.
- The child may be "moody" with increased irritability, agitation, anger, or hostility.
- The child may complain of headaches or stomachaches.
- The child may not be able to concentrate.
- The child may have feelings of worthlessness or problems with feeling guilty.
- The child may take rejection or failure unduly hard.
- The child may draw or paint dark pictures.
- The child may engage in play that has aggressive themes directed toward themselves or others.
- The child may talk or think about suicide, death, or other self-destructive behavior.
Long term depression can result in very poor self-concept. Depression is treatable. Play therapy has been found in eight (8) of nine (9) studies to be show significant improvement. In some cases, your pediatrician may prescribe medication and support therapy. Play therapy is one form of support therapy that has been used to treat depression.
Attention Deficit Hyperactivity Disorder (ADHD)
Problems with attention and activity levels are one of the major reasons children are referred to mental health services. In the average school classroom, one to two students will have attention deficit hyperactivity disorder. Boys are more likely to have this disorder, but both boys and girls may have ADHD. The child with ADHD may just seem to never pay attention, may seem to do something without thinking or may do both of these.
Parents and other adults may notice that these children may have problems with some of the following things: following directions, completing a job, losing things, forgetting things, make careless mistakes, seems disorganized. These are problems with attention. The behavior problems may include: seems to be constantly moving, running, climbing; talks a lot; cannot play quietly alone; interrupts other people; cannot wait his or her turn; and may get into someone else's space.
Autism or Pervasive Developmental Disorder
Individuals with Disabilities Education Act (IDEA) (PL105-17), which uses the term "autism," defines the disorder as "a developmental disability significantly affecting verbal and nonverbal communication and social interaction, usually evident before age 3, that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences."
Play therapy has been found in two of the two studies done in this area of childhood disorders to be an effective adjunct when paired with traditional structured treatment of autism.
Play Therapy and Academic/Social Developmental Issues
A broad range of childhood problems can be successfully treated with play therapy. These areas of child development do not clearly fall within the definition of disorders; although they are problems associated with concerns about human development. Specifically, these developmental issues that have been found to be influenced by play therapy are:
- Social Maladjustment could be defined as the child having problems getting along with other children and adults in a specific environment. These developmental issues surface usually in situations outside of the home. Twelve of the 14 studies summarized indicated some improvement after the children were in play therapy.
- School Behavior is concerned with how the child behaves in school. Specific problems may be that the child is uncooperative, distracts others, interrupts inappropriately, does not follow directions, does not do his or her work, and many other small but disruptive behaviors that prevents the child from making the most of his or her educational opportunities. Play therapy has been shown in six (6) of eight (8) studies to decrease behavioral disturbances.
- Emotional Maladjustment can be situational or long term. The child reacts to or expresses his or her feelings in inappropriate ways. Some of the emotions that seem to be particularly difficult for children in the social and school setting are anger, loss, grief, rejection, and jealously. All nine (9) studies indicated that play therapy could influence the outcome in a positive direction for these children in the areas of reading, intelligence scores, academic success, and personality adjustment.
- Intelligence Scores are believed to be influenced by the child's emotional state. When a child is emotional difficulties, whether situational as in parents divorcing, sexual abuse, or long term as in a parent's death or abandonment, a child will score lower on measures of intelligence. Play therapy was found to be helpful in six (6) of 10 studies to increase either the intelligence score or related scores. In four (4) of the 10 studies, play therapy did no harm, but did not show significant change in intelligence scores
- Mentally Challenged are those children who are not able to achieve at the same rate as their peers. The comparison of the child's rate of learning compared to his or her peers varies greatly from child to child. However, in all eight (8) studies, play therapy was demonstrated to show improvement for these children in some area.
These disorders describe children who may have many physical problems that may interfere with their daily lives and academic progress. Among those studied were those who had problems with motor skills, skin viruses, allergies, hearing disabilities, speech problems, and general learning disabilities. All eight (8) of these studies showed improvement in one or more areas.
Conduct disorder is best described as the child that physically hurts others and destroys property. Oppositional defiant disorder (ODD) may be the beginning of conduct disorder. ODD is diagnosed when the child refuses to mind one or more people. These two diagnoses do not occur at the same time. Between the ages nine (9) and 17, about 1-4 percent of children may be diagnosed with conduct disorder. The diagnosis is more common for boys than girls; and more common in cities than in rural areas. Symptoms of children with conduct disorder may include:
- The child harms or threatens people or animals.
- The child destroys property.
- The child lies or steals.
- The child skips school or disobeys serious school rules.
- The child uses tobacco, drinks alcohol, or uses drugs
- The child is sexually active.
Children with conduct disorder or ODD have some of these symptoms:
- The child may be depressed, have suicidal thoughts, make suicide attempts, or actually commit suicide.
- The child may have academic problems in school.
- The child may have difficulty in relating to peers or adults.
- The child may develop a sexually transmitted disease.
- The child may have difficulty in foster care, group homes, or when adopted.
- The child may have be more likely to suffer injuries, be expelled from school, or have problems with the law than other children.
Play therapy in all eight (8) studies dealing with conduct disorder, aggression, and oppositional defiant disorder noted a decrease in aggression and an increased ability to express feelings appropriately.