Developing and determine the effectiveness of Adlerian puppet therapy intervention program on modifying empathy skills of high functional Autistic children (HFA)

Abstract

Background: Autism spectrum disorder (ASD) is a behaviorally defined neurodevelopmental disorder associated with the presence of social-communication deficits and restricted and repetitive behaviors. In the latest conceptualization of ASD, these two behavioral dimensions represent the core defining features of ASD, whereas associated dimensions, such as intellectual and language ability, provide a means for describing the ASD heterogeneity. Today, most studies on ASD and people with ASD focus on their social communication because social problems are the basis for their challenging behaviors in communication and social situations. Based on the results of many studies children with autism have many problems in all aspects of development and behavior. One of the most prominent features of autistic children are social communication and empathy skills impairment and social skills impairment specially empathy skills is the cause of many problems in social and communication situations. Many intervention methods have been developed and presented to rehabilitate people with autism. Most of these intervention programs are behavioral and are more to control stereotyped behaviors and less to improve their communication and social skills. Puppet therapy and play therapy are fun for children, they are attractive to them, especially to autistic children who are often isolated. However, in addition to puppet therapy and play therapy as the main intervention method, complementary intervention methods are also needed. Therefore, the present study aimed to design and determine the effectiveness of Adlerian puppet therapy intervention program on the development of high functional Autistic childrenchr('39')s (HFA) empathy skills. Given the importance of empathy skills in the social interactions of people with autism, study and research in this field is very necessary. Methods: The present study in terms of gathering research was experimental design with pre- posttest and follow-up with a control and experimental groups. Of the total target population, 20 available sample from April2 Autism center were selected and randomly placed in two, experimental (n=10 person) and control (n=10 person) groups. The intervention program was Adlerian puppet therapy (According to the studied title and variables, Adler play therapy was the most appropriate method of play therapy for the present study). This interventional package, based on Adlerchr('39')s theory, has been designed and implemented in four steps and ten consecutive steps to develop and improve the empathy skills of children with autism spectrum disorders. This program implemented for two consecutive months in 15 consecutive sessions for the experimental group in April2 autism center. In order to comply with the ethical principles of the research, this intervention program was implemented for the control group and also, testimonial was received from each of the participants in this study, and if they did not want to continue the cooperation, they could leave the research. Auyeung’s Empathy questionnaire applied for assessment of empathic skills. This questionnaire was designed to measure empathy and systemic interest in children with autism spectrum disorder with 55 items on a four-point Likert scale. The reliability of the test was evaluated by retest methods and Cronbachchr('39')s alpha. The reliability of the retest for empathy gain was 0.86 and all coefficients were significant at the level of one hundredth. The internal consistency of the test using the Cronbachchr('39')s alpha coefficient of empathy was 0.93. Data analysis was performed using descriptive and inferential statistical methods such as mean, variance and univariate analysis of covariance (MANCOVA) and Repeated measures test by SPSS-22 software. Results: Depending on the type of research (which was an experimental) as well as the variables of the present study and the time series of pre-test, post-test and follow-up, multivariate analysis of covariance or MANCOVA and repeated measures were used of course, observing their application assumptions. The analyzed results by MANCOVA and Repeated measures showed that Adlerian puppet therapy intervention program, significantly (p<0.05) led to modifying and increasing the empathy quotient of High functional autistic children in experimental group. The results are shown separately in several tables and the full report is presented in detail in the text of the article. It should be noted that in addition to changes in the post-test scores of the subjects, according to their parents, significant changes were observed in their overt behaviors. The results obtained in this study were coextensive with the results of many similar studies. Adverse findings were also obtained because they were not among the objectives of the study and were not reported. Adverse findings could be studied as a new study in the future. Conclusion: Currently, many play therapy methods have been suggested for children, but Adler play therapy is a popular approach to play therapy and includes many interventions that help children move toward healing and adjustment. Considering that the most serious problem of autistic children is a social empathy skills impairment and also due to effectiveness of Adlerian puppet therapy intervention program to enhance empathy skills of the experimental group applying this interventional program in all special autism disorder rehabilitation centers for who are autism disorders recommended It is also suggested that the implementation of this rehabilitation package be done by specialized and trained people. It should be noted that accurate and correct implementation of puppet therapy and play therapy is not very easy and requires an experienced and trained person. The implementation and application of puppet therapy is not limited to children with ASD. It is used for all groups with different problems and diseases in all situations. One of the problems in using puppet therapy is the childchr('39')s dependence on the puppet, during the puppet treatment and also choosing the type of puppet, according to the type of child problem. Also, despite all the measures to neutralize the effect of unpredictable variables, it is possible that the obtained results are somewhat likely to be influenced by other variables. Therefore, the interpretation and generalization of the findings of this study to other situations and statistical communities should be done with caution. Many studies have been done to determine the sustainability of the effect of puppet therapy on improving the problems of children with autism, especially their communication and social problems. However, more studies are neededantibiotic resistance characteristics are determined and appropriate antibiotics are prescribed.