Brief Report: Emotion Regulation in Autism Is Improved in a Single-N Pilot Intervention Study Combining Child-Centered Play Therapy and Rhythmic Relating

Abstract

Background

Rhythmic Relating is an approach to supporting social timing in therapeutic play with autistic children (Daniel, Laurie and Delafield-Butt, 2024) and can be used as a stand-alone approach or to augment child-centered therapies.

Aims

A combination of Child-Centered Play Therapy and Rhythmic Relating is evaluated in its therapeutic potential to enhance Emotion Regulation outcomes (over 10 months; 32 weekly sessions), in a case study of a 5-year-old autistic girl.

Materials and Methods

Mean Start and Finish scores were recorded for the parent-rated Emotion Regulation Checklist (Shields and Cicchetti, 1997). For all subscales, we calculate percentage-change-over-time values and, using percentiles, these values are compared and statistically ranked with respect to two different comparison groups:

1. “Autistic children without concurrent cognitive impairment, not receiving psychological or behavioral therapies” (n = 77).

2. “Autistic girls without concurrent cognitive impairment, not receiving psychological or behavioral therapies” (n = 9).

Results

As compared to both Comparison Groups 1 and 2, our participant's overall Emotion Regulation improvements (over 10 months) are statistically highly likely to be due to her participation in therapy (p < 0.01).

Discussion

Practical implications for therapeutic practice with autistic children are discussed, including the emphasis on good-enough self-regulation as outcome priority, the emphasis on social timing for co-regulation as route to good-enough self-regulation, and the emphasis on Emotion Regulation as outcome measure in accordance with outcome priority. Possibilities for future larger-scale intervention studies addressing scalability and generalizability issues are discussed, including current modality-combination studies (i.e., Rhythmic Relating and Child-Centered Play Therapy) - multi-site/practitioner, multiple baseline single case design, or considerably larger N intervention groups compared with the current ERC comparison groups, or generating new comparison groups - and/or studying the efficacy of other potential modality combinations (Rhythmic Relating combined with Music Therapy, Dance Movement Therapy, DIRFloortime etc.).

Conclusion

The current study was designed to retest and build on the hypothesis, method and knowledge base of a previous intervention study (Daniel et al, 2023). Together, these two sets of results show early positive potential for this combination of therapeutic modalities to support the regulatory well-being needs of young autistic children, unconventional communicators, and autistic people who have additional learning needs.