The effect of behavioral activation play therapy in adolescents with depression: A study protocol for a randomized controlled trial.

BACKGROUND: Depression is a common psychological problem in adolescents worldwide. Although the World Health Organization recommends that members of this population engage in physical activity to reduce depressive symptoms, compliance with this recommendation is often low. Furthermore, although behavioral activation (BA) is recommended as a treatment for adolescents with depression, the reported effect size is small. Compared with traditional exercises, gamified physical activity (GPA) can be particularly appealing to adolescents because it is perceived as an enjoyable experience. In this study, we integrated BA and GPA to create behavioral activation play therapy (BAPT). We designed a clinical trial to investigate the feasibility, acceptability, and effectiveness of this treatment in adolescents with depression. METHODS: This study is a randomized controlled trial (RCT) with a three-arm, assessor-blinded design, conducted to validate the effectiveness and applicability of BAPT for treating adolescent with depression. We will recruit 258 participants and randomly assign them to a BAPT group, BA group, or GPA group using a ratio of 1:1:1. Based on conventional strategies for treatment and care, the three groups will receive nine BAPT sessions, nine BA sessions, or nine GPA sessions, respectively. We will compare the outcomes of the BAPT with those of the BA and GPA interventions. DISCUSSION: This is the first RCT to explore the effectiveness and applicability of BAPT in adolescents with depression. This study will provide evidence that may help to decrease depressive symptoms in adolescents, and will demonstrate the treatment effectiveness in terms of increasing levels of physical activity, reducing the rate of non-suicidal self-injury behaviors, and improving sleep quality. We will also assess the presence of side effects and the treatment adherence of patients receiving BAPT. TRIAL REGISTRATION: Trial registration: Chinese Clinical Trial Registry, ChiCTR2300072671. Registered on 20 June 2023.

Efficacy of a Remote Play-Based Intervention for Children With Prader-Willi Syndrome.

The current study examines the efficacy of an 8-week pretend play intervention targeting social-cognitive abilities in children with Prader-Willi syndrome (PWS), ages 6-9. PWS is a rare disorder associated with various social, emotional, and cognitive challenges linked to pretend play impairments, and for which interventions are sparse. Nineteen children were quasi-randomized to receive the intervention or be part of a waitlist control group. Participants who received the intervention (n = 10) demonstrated significant improvements in various components of pretend play, most notably in organization of play, which may generalize to broader social-cognitive gains. These findings provide evidence of the intervention's efficacy in enhancing pretend play skills and related social-cognitive abilities during this critical period of development for children with PWS.

Effectiveness of cognitive-behavioral group play therapy on anxiety-based school refusal and behavioral problems in elementary school boys: a preliminary randomized controlled trial.

This study aimed to examine the effectiveness of cognitive-behavioral group play therapy on anxiety-based school refusal and behavioral issues in elementary school boys. A randomized controlled trial design (pretest-posttest with a control group) was utilized. Thirty elementary school boys with school refusal issues were randomly assigned to intervention (n = 15) and control (n = 15) groups. The intervention group received ten sessions of cognitive-behavioral group play therapy. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) questionnaire and Rutter's Children's Behavior Questionnaire were used as assessment tools. Mean scores for anxiety-based school refusal and behavioral problems in the intervention group showed a significant decrease (p < 0.001). Cognitive-behavioral group play therapy is a practical approach to reducing anxiety levels and behavior problems in children with anxiety-based school refusal in primary school grades.

Da ludoterapia não-diretiva à ludoterapia centrada na criança - desenvolvimento histórico / From non-directive play therapy to child-centered play therapy - historical development / De la terapia de juego no-directiva a terapia de juego centrada en el nino - desarollo histórico

O desenvolvimento da Abordagem Centrada na Pessoa foi dividido em fases que apresentam as atitudes que fazem parte da relação terapêutica, independente do público atendido. Contudo, na especificidade da psicoterapia infantil, o desenvolvimento teórico e prático da própria abordagem aponta para a existência de peculiaridades. Este estudo tem como objetivo apresentar, através de uma revisão narrativa de literatura, fundamentada na hermenêutica filosófica de Gadamer, as possíveis características relativas ao atendimento de crianças a partir de um retorno às fases da ACP. Discutimos os fundamentos iniciais do atendimento com crianças em Rogers ena perspectiva clássica de Axline, compreendendo como a ludoterapia com crianças se caracteriza nas fases não-diretiva, reflexiva, experiencial e pós-rogeriana. Discutimos sobre propostas contemporâneas nos contextos europeu, estadunidense e brasileiro. Concluímos que essa delimitação do atendimento infantil possibilita uma percepção mais clara das mudanças e aprimoramentos em relação aos trabalhos pioneiros de Rogers e Axline, sempre tendo como eixo a dimensão relacional e a tendência ao crescimento como motor do processo terapêutico.

The development of the Person-Centered Approach was divided into phases that presents the attitudes that are part of therapeutic relationship, regardless of the public served. However, in the specificity of child psychotherapy, the theoretical and practical development of the approach points to the existence of peculiarities. This study aims to present, through narrative literature review, based on Gadamer's philosophical hermeneutics, the possible characteristics related to the child therapy, starting from a return to the PCA phases. We discuss the foundations of child therapy in Rogers and Axline's classic perspective, understanding how child play therapy is characterized in non-directive, reflective, experiential and post-Rogerian phases. We discuss contemporary proposals in the European, American, and Brazilian contexts. We conclude that this delimitation enables a clearer perception of changes and improvements amongst to the Rogers and Axline's pioneering work, always having as its axis the relational dimension and the tendency to growth as a motor of the therapeutic process.

El desarrollo del Enfoque Centrado en la Persona se dividió en fases que presentan las actitudes de la relación terapéutica, independiente del público. Sin embargo, en la especificidad de la psicoterapia infantil, el desarrollo teórico y práctico del enfoque en sí mismo apunta la existencia de peculiaridades. Este estudio tiene como objetivo presentar, a través de una revisión narrativa de la literatura, basado em la hermenéutica filosófica de Gadamer, las posibles características de la psicoterapia con niños, desde el retorno a las fases de ECP. Discutimos los fundamentos de la psicoterapia con niños en Rogers, la perspectiva clásica de Axline, comprendiendo como la terapia de juego com los niños se caracterizan em las fases no directiva, reflexiva, experiencial y pos-rogeriana. Discutimos propuestas contemporáneas en los contextos europeo, estadounidense y brasileño. Concluimos que esta delimitación permite una percepción más clara de los cambios y mejoras en relación con los trabajos pioneros de Rogers y Axline, teniendo siempre como eje la dimensión relacional y la tendencia al crecimiento como motor del proceso terapéutico.

Efectos del juguete terapéutico instructivo en la terapia intravenosa en niños hospitalizados / Effects of the Instructive Therapeutic Toy on Intravenous Therapy for Hospitalized Children

Introducción: El juguete terapéutico instructivo puede revelar las necesidades implícitas al paciente y ayudarle a comprender las metodologías, diagnósticos y terapias a las que será sometido, lo que promueve su tranquilidad, seguridad y acuerdo con el tratamiento, además de proporcionar una mejor interacción con los profesionales de la salud. Objetivo: Analizar los efectos del uso del juguete terapéutico instructivo en la preparación del niño hospitalizado para realizar la terapia intravenosa. Métodos: Estudio cuasi-experimental de enfoque cuantitativo, realizado en un hospital pediátrico público de la ciudad de Juazeiro do Norte- Ceará, Brasil. La población de estudio fue compuesta por 31 niños en edad preescolar y escolar. La recolección de datos se realizó de julio a septiembre de 2019, a través de la observación, y el análisis se realizó a través del programa Statistical Package for the Social Sciences, por medio de la Prueba t y McNemar. Resultados: Hubo una reducción estadísticamente significativa de todas las variables que indican una menor aceptación del niño a la terapia intravenosa, con la excepción de la variable colabora pasivamente. Si bien hubo un aumento estadísticamente significativo en algunas variables que indican una mayor aceptación del niño a la terapia intravenosa. Conclusión: El juguete terapéutico instructivo se establece como una herramienta tecnológica fundamental para la promoción de la responsabilidad, la autonomía y la corresponsabilidad del cuidado de la salud, valoración del sujeto/usuario como un ser humano singular, y la deconstrucción de prácticas de salud deshumanizadas, especialmente en enfermería pediátrica(AU)

Introduction: The instructive therapeutic toy can reveal the needs implicit to the patient and help them understand the methodologies, diagnoses and therapies to which they will be subjected, which promotes his peace of mind, safety and agreement with treatment, in addition to providing better interaction with healthcare professionals. Objective: To analyze the effects of using the instructive therapeutic toy in the preparation of the hospitalized child prior to performing intravenous therapy. Methods: Quasiexperimental study with a quantitative approach, carried out in a public pediatric hospital in Juazeiro do Norte City, Ceará, Brazil. The study population consisted of 31 preschool and school-age children. Data collection was carried out from July to September 2019, through observation, and the analysis was carried out by means of the Statistical Package for the Social Sciences program, using t-test and McNemar's test. Results: There was a statistically significant reduction in all the variables that indicate the child´s lower acceptance of intravenous therapy, with the exception of the variable they collaborate passively. However, there was a statistically significant increase in some variables that indicate the child's greater acceptance of intravenous therapy. Conclusion: The instructive therapeutic toy is established as a fundamental technological tool for promoting responsibility, autonomy and co-responsibility of health care, valuating the subject/user as a singular human being, and the deconstruction of dehumanized health practices, especially in pediatric nursing(AU)

Fostering Innovation in Prevention and Treatment of Obesity in Youth: Digitally Mediated Physical Play as an Exemplar.

Novel approaches to obesity prevention among youth are needed. Accordingly, the Office of Women's Health, Department of Health and Human Services, sponsored a challenge to create an interactive video game for obesity prevention. Our team took a theory-based, evidence-informed approach to increasing physical activity in girls. Our approach-digitally mediated physical play-allowed us to include computing-based strategies that promote activity without keeping players in front of a screen. Our prize-winning prototype app, Frolic, helps girls choose the perfect game to play in any context, engaging parents for support. The app is used to highlight some opportunities and challenges for interdisciplinary collaboration. However, much work remains to be done to deploy innovative digital obesity interventions and fully capture the contributions of these tools. In order to accelerate advances, funding is needed for projects that combine engineering design principles with traditional obesity research paradigms.

Believing in Make-Believe: Efficacy of a Pretend Play Intervention for School-Aged Children with High-Functioning Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder marked by socio-emotional deficits, and difficulties with pretend play skills. Play skills are related to processes of adaptive functioning and emotion understanding. The present pilot study implemented an in-person pretend play intervention to school-aged children (ages 6 to 9 years, intervention group = 18, control group = 7) diagnosed with high-functioning ASD (HF-ASD), to increase children's cognitive and affective play skills, and emotional understanding abilities. The intervention consisted of 5 weekly sessions, 15-20 minutes each. The intervention group significantly increased in imagination and cognitive play skills, which generalized to increased skills in emotional understanding. Findings demonstrate the positive impact of a short, easily facilitated, accessible play intervention for school-aged children with HF-ASD.

Can I Learn to Play? Randomized Control Trial to Assess Effectiveness of a Peer-Mediated Intervention to Improve Play in Children with Autism Spectrum Disorder.

Play is often used in interventions to improve social outcomes for children with autism spectrum disorders (ASD). Play is a primary occupation of childhood and, therefore, an important outcome of intervention. The Ultimate Guide to Play, Language and Friendship (PLF) is a peer-mediated intervention for 6-11-year-old children with ASD. A total of 68 dyads were randomized to either a 10-week treatment first or waitlist control group. Results revealed a significant moderate intervention effect from pre- to post-intervention, which was maintained to the 3-month follow-up clinic session and generalized to the home environment. The findings support that the PLF intervention can be used to positively improve play in 6-11-year-old children with ASD.Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ (ACTRN12615000008527; Universal Trial Number: U1111-1165-2708).

Randomised Controlled Trial of a Therapeutic Playgroup for Children with Developmental Delays.

A single-blind randomised control trial investigated the effectiveness of the Learn, Engage and Play (LEaP) playgroup. Seventy-one children with developmental delay were randomly allocated to an 8-week LEaP playgroup or control group and followed up at 12 and 28 weeks. On the primary outcome measure, LEaP demonstrated significant within group changes at 28 weeks (parenting distress p = 0.018) but no between group changes. On secondary outcome measures, at 12 weeks LEaP produced significantly better outcomes than control in goal achievement (performance p = 0.022; function p = 0.008) and family-support (p = 0.024), with LEaP continuing to demonstrate significantly better goal achievement (child performance p = 0.042; function p = 0.012) at 28 weeks. Findings indicate LEaP may assist in improving family-support and goal achievement outcomes for children with developmental delays.

Diversidade humana e interseccionalidade: problematização na formação de profissionais da saúde / Human diversity and intersectionality: problematization in the education of health professionals / Diversidad humana e interseccionalidad: problematización en la formación de profesionales de la salud

Inspiradas em intervenções lúdicas no campo da Educação, relatamos a construção de um jogo de tabuleiro com personagens que apresentam algumas características de privilégios e desigualdades econômicas, sociais e históricas. Trata-se de um relato de experiência que objetiva descrever uma estratégia pedagógica, visibilizando a diversidade humana com graduandos de cursos da Saúde de uma universidade no Nordeste brasileiro. Foram debatidos temas relativos a diversidade, interseccionalidade e relações de poder, dialogando com o racismo, o machismo, o capacitismo, a operacionalização das políticas de saúde e sua influência na prática profissional. Consideramos que a estratégia pedagógica demonstra que essas questões são invisíveis nas práticas de saúde e quão, muitas vezes, são sustentados discursos que legitimam as desigualdades tomando-as como naturais, o que demonstra a importância da problematização dos temas abordados para a formação do profissional de saúde. (AU)

Inspired by game-based learning interventions in the field of education, we describe the development of a board game with characters who have characteristics representing privilege and historical social and economic inequalities. This article is an experience report aimed at describing a pedagogical strategy that makes human diversity visible developed with undergraduate health students at a university in the northeast of Brazil. Topics related to diversity, intersectionality and power relations were debated in dialogue with racism, machismo, capacitism and the operationalization of health policies and their influence on professional practice. The pedagogical strategy demonstrates that these questions are invisible in health practices and just how much discourses that legitimize inequalities are often sustained, making them normal. This demonstrates the importance of problematizing the topics addressed by this study in the education of health professionals. (AU)

Inspiradas en intervenciones lúdicas en el campo de la educación, relatamos la construcción de un juego de mesa con personajes que presentan algunas características de privilegios y desigualdades económicas, sociales e históricas. Se trata de un relato de experiencia cuyo objetivo es describir una estrategia pedagógica que visibiliza la diversidad humana ante los alumnos de graduación de cursos de salud de una universidad en el nordeste brasileño. Se discutieron temas relativos a la diversidad, interseccionalidad y relaciones de poder, dialogando con el racismo, el machismo, el capacitismo y la puesta en operación de las políticas de salud y su influencia en la práctica profesional. Consideramos que la estrategia pedagógica demuestra que esas cuestiones son invisibles en las prácticas de salud y hasta qué punto, muchas veces, se sostienen discursos que legitiman las desigualdades, viéndolas como si fueran naturales, lo que demuestra la importancia de la problematización de los temas abordados para la formación del profesional de salud. (AU)

Minnesota multiphasic personality inventory of school sandplay group therapy with maladjustment behavior in Korean adolescent.

School sandplay group therapy is a useful clinical treatment method for adolescents who cannot adapt to school due to various emotional and behavioral problems. In this study, we conducted 10 weeks of group therapy in 70 adolescents referred to as maladjustment behavior problem in the school. The purpose of this study was to evaluate the clinical effects of sandplay therapy on the emotions and behaviors objectively through minnesota multiphasic personality test -2. There was a statistically significant difference in clinical scales such as depression, masculinity- femininity, social introversion, anger, subjective depression, need for affection, somatic complaint, and internal/external alienation after school sandplay group therapy. Sandplay therapy is estimated to have clinical effects not only on the emotional problems of maladapted high school students but also on physical problems.

Playback theatre in adult day centers: A creative group intervention for community-dwelling older adults.

The literature indicates that theatre and drama-based interventions have the potential to improve older adults' well-being and health. The goal of the current study was to characterize the process of a creative group intervention in adult day centers (ADCs), which integrates playback theatre and life-review principles. Our objective was to provide an evidence-informed framework for drama therapy interventions, which would allow older adults to bring up and explore their life-stories in a dramatic creative process in their own community. A total of 27 participants ranging in age from 63 to 91, took part in one of three playback theatre groups. The playback theatre group intervention comprised 12 weekly sessions. All sessions were videotaped to capture the lived experience of the creative process and were analyzed in post-intervention interviews. In addition, focus group meetings were conducted with 13 ADC staff members to decipher further the effects of the participation as perceived by people outside the groups. Three types of potential transformation were identified in the qualitative analysis: the evolution of life stories, evolution of playfulness, and expansion of social engagement. The results indicate the potential of the integrative framework to serve as a creative intervention in ADC communities, as well as its potential to bring about a personal transformation and expand it to enable a person's social engagement in the community. The findings imply the potential benefits of using playback theatre groups to supplement the routine care provided in ADCs.

Effectiveness of a home-based early cognitive-motor intervention provided in daycare, home care, and foster care settings: Changes in motor development and context affordances.

BACKGROUND: Appropriate opportunities within the context are crucial to affect the motor trajectory positively. OBJECTIVE: To investigate the effectiveness of professional-parental/caregivers' early motor-cognitive intervention on infants' motor development in Daycare (DC), Home Care (HC), and Foster Care (FC). Secondary objectives were to examine if parents and caregivers modified the context to meet the infants' needs and if making modifications was positively associated with infants' development. METHODS: Participants were 176 infants (DC = 48; HC = 58, FC = 70). Infants' were randomly assigned to intervention (IG) or comparison (CG) groups within each context. The Alberta Infant Motor Scale and Affordances in the Daycare and Home Environment for Motor Development were used. A cognitive-motor intervention was provided for infants in the intervention groups; and, a home-based support protocol for all caregivers and parents. RESULTS: IGs showed higher motor scores at post-test than CGs (p values from 0.018 to 0.026) and positive changes were observed from the pre-to-post intervention for all IGs (p ≤ .0001), and for two CGs (DC p ≤ .0001; HC p = .028). Maternal daily care and home opportunities improved for all infants. CONCLUSIONS: Parents/caregivers' protocol combined with the cognitive-motor intervention lead to better motor outcomes and changes in the context for the IGs. Only the parent/caregivers' protocol was not strong to improve CGs motor outcomes, although changes in context were found. Intensive intervention is need for infants living in vulnerability.

Trauma-informed art and play therapy: Pilot study outcomes for children and mothers in domestic violence shelters in the United States and South Africa.

BACKGROUND: While intimate partner violence (IPV) has well documented impact on women and children, few interventions have been tested for mothers and children in the domestic violence shelter system. OBJECTIVE: We used mixed methods to explore effects of a pilot intervention combining trauma focused cognitive behavior therapy (TF-CBT) (verbal therapy method) with art and play therapy (non-verbal therapy methods) in New York City and Johannesburg, to compare efficacy between high and low-middle income contexts. PARTICIPANTS AND SETTING: School-aged children and their mothers from one domestic violence shelter in each city were invited to participate. METHODS: Children were screened for depression and post-traumatic stress disorder (PTSD). Children participated in a weekly group session lasting 1-2 hours over 12 weeks and mothers received 3 group sessions. Quantitative data comprised pre-and post-intervention child self-reports (n = 21) and mother's report (n = 16) of child depressive and PTSD symptoms. Qualitative in-depth interviews were conducted with children (n = 11) and mothers (n = 8) who completed the intervention. RESULTS: At baseline, children showed high rates of symptoms of probable depression and probable PTSD (33 % and 66 % respectively). By endline, depressive symptoms significantly reduced (mean of 13.7-8.3,p = 0.01) and there was a non-significant trend towards PTSD improvement (40.0-34.4, p = 0.21). Children revealed the art helped them express difficult emotions and experiences with their mothers. Multiple children felt it assisted in managing challenging behaviours. CONCLUSION: This pilot trauma-informed art and play therapy group intervention holds promise in mitigating the effects of IPV for children and mothers in domestic violence shelters.

Understanding the dramatic therapeutic play session: a contribution to pediatric nursing.

OBJECTIVES: to understand how the dramatic therapeutic play session occurs within the care of hospitalized children. METHODS: qualitative multiple case study, using theoretical references, such as symbolic interactionism and Vygotsky's theory of symbolic play. Twenty play sessions performed with six children from 3 to 10 years old were analyzed, each corresponding to one case. RESULTS: these sessions demonstrated that a dramatic therapeutic play session is a process of four interdependent and complementary steps: bonding, exploring, dramatizing, and play cessation. They also revealed the imaginary situations externalized by the child, the importance of the exploration step for which they manage the imaginary situation and catharsis, and how her higher psychological faculties are articulated during this process. FINAL CONSIDERATIONS: the results contribute to the understanding of the conduct and analysis of the dramatic therapeutic play session, reinforcing the importance of its use in pediatric nursing care practice.

Systematic review of the impact of unstructured play interventions to improve young children's physical, social, and emotional wellbeing.

This review aimed to examine the effectiveness of unstructured play interventions on young children's physical, emotional and social wellbeing in various community settings. Eligibility criteria of articles included (1) studies which included young children aged three to seven years; (2) intervention studies which involved unstructured, free or loose parts play; (3) experimental or randomized controlled trial designs, with or without random allocation to groups; and (4) target variables of the study should include measurable physical, social or psychological constructs as modifiable outcomes. Electronic searches were conducted from June 2018 to March 2019 in ERIC, MEDLINE, PubMed, ProQuest, Sage Publications, Web of Science, Scopus, and Sociological Abstracts. Data were extracted from the included studies independently by using a pilot form. The study outcome measures of unstructured play in the eight selected articles were categorized into three aspects of children's physical health, social skills and emotional wellbeing. All studies reported positive impacts on children's physical activity level, social engagement and emotional wellbeing. We conclude that our review with identified impacts would assist future research directions and policy implementation in this promising field..

Efficacy of Supporting Play Exploration and Early Development Intervention in the First Months of Life for Infants Born Very Preterm: 3-Arm Randomized Clinical Trial Protocol.

OBJECTIVE: The aim of this project is to study the effect of a physical therapist intervention provided in the first months of life on developmental outcomes of infants born very preterm. Secondary aims are to investigate the impact of intervention timing on the efficacy and impact of the intervention on infants with and without cerebral palsy. METHODS: This study is a multisite longitudinal controlled trial comparing developmental outcomes from infants in the Supporting Play, Exploration, and Early Development Intervention (SPEEDI)_Late or SPEEDI_Early group to a usual care group. SETTINGS ARE URBAN: Urban and rural areas surrounding 2 academic medical centers. There will be 90 preterm infants enrolled in this study born at <29 weeks of gestation. SPEEDI is a developmental intervention provided by collaboration between a physical therapist and parent to support a child's motor and cognitive development. The primary outcome measure is the Bayley Scale of Infant and Toddler Development Cognitive and Gross Motor Scaled Scores. Secondary measures include behavioral coding of early problem solving skills, the Gross Motor Function Measure, and Test of Infant Motor Performance. IMPACT: More than 270,000 infants are born very preterm in the United States each year, 50% of whom will have neurological dysfunction that limits their ability to keep pace with peers who are typically developing. This study is a step toward understanding the impact that intensive developmental intervention could have in this population in the first months of life.

Using the instructional therapeutic play during admission of children to hospital: the perception of the family.

OBJECTIVE: To understand, from the family's perspective, the meaning of admitting the child in the hospital with the use of the instructional therapeutic play. METHOD: A phenomenological research with 12 families of children aged four to nine years old, recently admitted to a public and teaching hospital, in the inland of the state of São Paulo, from October to December 2016. They participated in an instructional therapeutic play session focusing on the procedures performed at hospital admission: weight, height, and vital sign measurements and test collection. The families, in turn, were invited to participate in a phenomenological interview the day after the session. RESULTS: The instructional therapeutic play collaborated in the therapeutic procedures by understanding and modifying the child's behavior. Also stressed by the families was the need for the toy to be incorporated as nursing care. CONCLUSION: Given the benefits to the child, the family believes that this strategy should be performed as a routine nursing care and, therefore, performed systematically during child hospitalization.