1. EFFECT OF TRANSDISCIPLINARY APPROACH IN GROUP THERAPY TO DEVELOP SOCIAL SKILLS
FOR CHILDREN WITH AUTISM SPECTRUM DISORDER
Authors: RAJEEV RANJAN, KAJAL RAY PRADHAN, JOYCE WONG
Society for the Physically Disabled
Singapore
ABSTRACT
The social impairments in individuals with Autism spectrum disorder (ASD) are diverse and involve speech, linguistic
conventions and interpersonal interaction. 5 male children with ASD in the age range of 8 to 10 years were selected
randomly. All the children were attending mainstream schools, receiving individual speech therapy and occupational therapy
(45-minute session every fortnight) and were having difficulty in social interaction. The children were placed in a 3-hour group
therapy program for 6 sessions, which were facilitated by two professionals, a speech–language therapist and an
occupational therapist at our center i.e. (Society for the Physically Disabled). The rating score was performed by parents and
therapists. The comparative pre and post therapy score among the two groups, that is by parents and therapist shows that the
objectives for the group therapy were rated higher after the completion of the group therapy. Wilcoxon Signed Ranks Test
shows there is significant difference (P<0.05) observed between pre and post group therapy rating scale by parents and
therapists.
INTRODUCTION
Autism is a processing disorder that disrupts the ability to understand and utilize language, RESULTS
organize incoming auditory and visual information. It is usually accompanied by repetitive motor
movements, a need for routine and sameness (Siegal, 1996) and significantly poor social skills. The study aimed to see the effectiveness of incorporation of occupational therapy and speech language therapy treatment approach
This disorder affects the individual’s ability to socialize with others in an appropriate fashion. during group therapy session. The rating scoring was performed by parents and therapists.
Individuals with Autism Spectrum Disorder (ASD) suffer direct and indirect consequences related
to social interaction deficits. Socialization deficit is a major source of impairment regardless of
cognitive or language ability for individuals with ASD (Carter, Davis, Klin & Volkmar, 2005). The Table 1. Parents’ Rating Score
Parents’
social impairments in individuals with ASD are diverse and involve speech, linguistic conventions Parents’ Scores
and interpersonal interaction.
Pre Therapy Post Therapy
Ch. Ch. Ch. Ch. Ch. Ch. Ch. Ch. Ch. Ch.
Aim:
Objectives Ma Jo Al Ve Je Ma Jo Al Ve Je
1.To incorporate the Occupational therapy and Speech-language therapy treatment approach into
1.To Speech-
the group therapy session.
Listen and Follow instructions 2 3 3 2 4 4 4 4 3 4
2.To work on the standardized treatment DIR/Floor Time and Sensory Integration in a team and
2.To
follow up on the affectivity progress in the child’s social interaction development in a group.
child’
Interact with other children in the group 2 1 3 1 3 3 3 4 3 3
METHODS Initiate in the activity 2 2 3 2 2 3.5 3 4 2 3
5 male children with ASD in the age range of 8 to 10 years were selected randomly. The children Initiate and maintain interaction 2 1 2 2 2 3 3 3 3 3
were in lower primary, that is Primary 1-4. All the children were attending mainstream schools and
receiving individual speech therapy and occupational therapy (45-minute session every fortnight) Initiate and complete activities 2 2 2 2 2 3 3.5 3 3 3
and having difficulty in social interaction. The children were placed in a 3-hour group therapy Chart 1. Comparative Column Graph for Objectives Chart 2. Comparative Column Graph for Client Progress
program for 6 sessions, which were facilitated by two professionals, a speech–language therapist
and an occupational therapist at our center (Society for the Physically Disabled). Parent Rating (Pre and Post) Client Progress (Pre and Post)
There were 5 objectives for the group therapy program :
1.Listen and follow the instructions 4
Pare nt Sc ore s from the R ating
P arent Scores from Rating
4
2.Interact with other children in the group
3.5 3.5
3.Initiate in the activity
3 3
4.Initiate and maintain interaction
5.Initiate and complete activities 2.5 2.5
Pre-Therapy
scale
Sc ale
Pr e-Therapy (avg)
Each objective was scored on a 4-rating scales which also indicate the percentage of achievement 2 2
Post-Therapy
for the particular objective such as 1 - 25% (The child who needs maximum prompts - visual, 1.5
Post - Ther apy (avg)
1.5
verbal and physical guidance from the therapist), 2 - 50% (The child who needs moderate prompts 1
1
- visual and verbal cues from the therapist), 3 - 75% (The child who needs minimal prompts – 0.5
0.5
verbal cues from the therapist) and 4 - 100% (The child who does not need any prompt and able to
0 0
perform himself/herself). The percentage was considered as total percentage of the performance
for the particular child in the group. The rating scale was scored by the parent of each child and O.1 O.2 O.3 O.4 O.5 Ch.Ma Ch.Jo Ch.Al Ch.ve Ch.Je
therapist before and after group therapy session. The scores were compared pre and post Objectives Client's Name
therapy to monitor the overall performance of the child for each objective.
•Mean and standard deviation was obtained using SPSS version 16 and Wilcoxon Signed Ranks Wilcoxon Signed Ranks Test shows there is significant difference (P<0.05) observed between pre and post group therapy rating
Test was used to see any significant difference among the pre and post therapy rating scores scale by parents in objective 4 and 5. However, there was no significant difference observed pre and post rating scale by parents for
among parents and therapists. objective 1, 2 and 3. Overall, there is significant difference between pre and post group therapy treatment.
Table 2. Therapist rating Score
DISCUSSION
As this study involved only 5 children, the results may not be representative of the population of Therapist Scores
children in the same age group and diagnosis in Singapore. Further studies on a larger scale may Pre Therapy Post Therapy
be required. There were also some variation in inter-child, inter-parent and inter-therapist rating for
Ch. Ch. Ch. Ch. Ch. Ch. Ch. Ch. Ch. Ch.
the performance. A number of researchers have mentioned in their treatment study for children
Objectives Ma Jo Al Ve Je Ma Jo Al Ve Je
with ASD that there is a necessity of an outcome measurement that is socially valid and sensitive
to change. The outcome measurement should have the strength to measure the child’s new Listen and Follow instructions 2.8 3.5 4 3 4 4 4 4 3.6 4
specific skills learnt in context to both treatment and in real environment (White, Koenig & Schill,
2006). Interact with other children in the group 2 2 3 2.75 3 3 3 4 2.8 4
Initiate in the activity 2.4 2.2 3.5 2.5 3 3.4 3.6 4 3.2 4
Chart 2. Comparative line graph for objectives by parents
Initiate and maintain interaction 2 2.2 3 2 2.4 3.2 3.2 3.8 3 4
Progress in Objectives (Pre and Post)
Initiate and complete activities 2 2.2 3 2.25 2.6 3.4 3.4 4 3 4
m e atin cale
4
3.8
aren S res fro th R g S
3.5
3.2 3.1 3.1
3 3
2.5
2.8
Pre-Therapy (avg) Chart 1. Comparative Column Graph for Objectives Chart 2. Comparative Column Graph for Client Progress
2.2 Post-Therapy (avg)
2 2 2
1.8
1.5 Therapist Rating (Pre and Post) Client Progress (Pre and Post)
t co
1
0.5
Therapist Scores from Rating
Therapist Scores from Rating
4.5 4.5
0
P
O.1 O.2 O.3 O.4 O.5
4 4
Objectives 3.5 3.5
3 3
Scale
Scale
2.5 Pre-Therapy (avg) 2.5 Pre-Therapy
Chart 2. Comparative line graph for objectives by therapist
2 Post-Therapy (avg) 2 Post-Therapy
Progre ss in Obje ctiv e s (Pre and Post) 1.5 1.5
5 1 1
herap Scores fro Rating Scale
4.5
0.5 0.5
4 3.92
3.5 3.64 3.56 Pre-Therapy (avg) 0 0
3.46 3.36 3.44
Post-Therapy (avg)
O.1 O.2 O.3 O.4 O.5 Ch.Ma Ch.Jo Ch.Al Ch.ve Ch.Je
m
3
2.72
2.5 2.55 2.41
2.32
2 Objectives Client's Name
1.5
ist
1
0.5 The Wilcoxon signed ranked test shows that there is significant difference among the therapists’ pre and post score for objective
T
0 2, 3, 4 and 5. However, the therapist’s pre and post score for objective 1 is not significant as P value is less than 0.05 for all the
O.1
O.2
O.3
O.4
O.5
Obje ctives children.
CONCLUSION ACKNOWLEDGEMENT REFERENCES
From our study, it is concluded that the individual therapy may have limitation on socialization, Carter, A.S., Davis, N.O., & Volkmar, F.R. (2005). Social development in autism, In F.R. Volkmar,
Our Sincere Thanks to :
R.Paul, A. Klin, & D.Cohen (Eds.), Handbook of autism and pervasive development disorders: vol.1.
whereas a group therapy facilitates a conducive social environment for children with ASD. In the SPD Executive Director, Mr Pal for his kind approval for the clinical study Diagnosis, development, neurobiology, and behavior. Hoboken, NJ: John Wiley & Sons.
and the training grant from Society for the Physically Disabled, Singapore; 1.Siegel, B. (1996). The World of the Autistic child. New York/ Oxford: Oxford University Press.
1.Siegel, Oxford:
group therapy session, children have the opportunities to engage various social interactive skills
All clients and parents for their consent and active participation in the White. S. W., Keonig. K. & Scahill. L. (2006). Social Skills Development in Children with Autism
Development
with other children of their age group in a safe environment. The group therapy environment research study; Spectrum Disorders: A Review of the Intervention Research. Journal of Autism Developmental
Journal
enhances the confidence level of the children to initiate and interact with their peers. Therefore, Ms Joyce Wong, Ms Debbie Chow and Ms Tay Hwee Lin for their guidance Disorders.
http://www.autismweb.com/floortime.htm
transdisciplinary approach in group therapy plays a significant role to develop social interaction and encouragement; http://www.icdl.com/dirFloortime/overview/index.shtml
Mr Kumar for his statistical analysis;
skills in children with autism. It is a platform where the children receive rehabilitation therapies by Mrs Trivedi, Ms Petra and all support staff at SPD for their constant help
different professionals with various treatment strategies. throughout the entire clinical study.
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