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Characteristics of interventions
All studies aimed at decreasing externalized EBD such as conduct disorder, antisocial behavior or disrup-tive behavior, or at increasing social and/or emotional skills (see Table 4). Furthermore, all studies report-ed a different way of using play as an intervention approach, regarding the play settings and the materials used. Child-Centered Play Therapy is a formal play therapy approach that is based on Carl Rogers’s (1942) person-centered theory and is one of the most frequently used interventions employed by play therapists. The content of the intervention in study I and II only differed in the fact that in study I the intervention was implemented in an individual setting and in study II the intervention focused on a group setting. However, both interventions oriented on the guidelines of “Child-Centered Play Therapy”. These guide-lines include the free and child initiated play with provided and selected toys and other materials which should encourage a child’s expression (Axline, 1947; Landreth & Bratton, 1998). The play therapist is an interactive member of the therapy and gets the possibility to view “the inner dimensions of the child’s world” (Landreth & Bratton, 1998). The aim of this therapy is that children play out their feelings and learn to regulate them (Axline, 1947). Child-Centered Play Therapy and Child-Centered Group Play Ther-apy takes place in a separate room equipped with selected toys and materials. The population of the intervention in study I consisted of children with disruptive behaviors.
The sessions took place in a special room in the child’s preschool, which was equipped according to play ther-apy guidelines, which have been mentioned above, and also included culturally and ethnically representa-tive materials. The participants had the freedom to direct their own play and express their inner world through the self-directed play with the provided materials and toys. The intervention in study II used a separate room equipped according to play therapy guidelines as well. Here the participants displayed apparent or emerging deficits in the social and emotional behavior which have not been explained in more detail. Again the children had the freedom to direct their own play and to express their inner world, but as this intervention (study II) used a group setting,the focus also was on the interaction between the participants.
The intervention in study III was a “Buddy-Program” which was about randomly pairing children of one preschool classroom and giving them the opportunity to play, stay and talk together during a spe-cific time period which was determined by the preschool teacher. In this intervention the preschool chil-dren of a special education classroom were randomly paired by the preschool teacher. The timeframe dur-ing which the paired children were supposed to stay and play together was set according to the children’s age and abilities but lasted at least ten minutes. During one day the preschool teacher assigned new pairs for a few times. However, the teacher considered to pair children which have not been in pairs before that day. At the time when the pairs were supposed to play and stay together they either got play instructions by the teacher or were supposed to decide for something they wanted to do together.
This approach aimed at increasing the social skills through peer interactions. The intervention in study IV used sensory play time to support the emotional development of the children. Sand and water tables were used as materials for the sensory play. To use this approach for sup-porting emotional skills is based on the theory that emotional development occurs when children explore and discover through the use of play (Maynard et al., 2009). Children get the opportunity to explore while playing at the sand and water tables. During the time when children were playing at these tables an inter-ventionist implemented different activities such as a “stop/start games”, a “direction following” game and a “freeze” game. Children were free to choose how much time they wanted to spend at the sand and water tables and how long they wanted to take part in the implemented activities. The interventionist drew at-tention to children who displayed excitement or disappointment during the activities.
This approach aimed at supporting the child’s emotional development in parts of emotional recognition and regulation. The “Playing-2-gether”-intervention in study V used teacher-child interaction as a setting and method to reduce externalizing EBD. The preschool teacher and the child were supposed to play together over a time period of 15 minutes. The preschool teacher had planned play sessions for two time points during a week when child and teacher played together. This play sessions could for instance be board games or drawing together. However, it could also be activities in which the teacher asks the child to help with something. This intervention aimed at improving teacher-child relations and at improving the child’s social interaction skills. The intervention of study VI used cooperative play as a way to increase emotional skills. This was done in group setting in a preschool classroom including children with and without externalizing EBD.
The intervention was carried out including all children of the class. All children including the preschool teacher and an external professional were first sitting together. Each session had a different focus such as emotion recognition and emotion regulation. In the beginning the counselor introduced the topic of a day by reading a story or showing pictures to the children. Afterwards children were supposed to meet in little groups or pairs and were asked to participate in cooperative play and describe their feelings during the play. The aim of this study was to increase emotional recognition, regulation and expression. And at the same time the intervention aimed at using this emotional skills for decreasing aggressive responses in so-cial interactions.
Intervention implementation by internal and external professionals
By comparing the studies it became obvious that there is an equal number of interventions carried out by the preschool teacher themself (thus, an internal preschool professional) (studies III, V, VI) or a psy-chologist, counselor or researcher (an external professional) (studies I, II, IV respectively). Of course it must be taken into account that some interventions in the studies were carried out for a specific research and hence were implemented by an external professional. This does not exclude the opportunity that also the internal preschool teacher could carry out the intervention (study IV). Another reason that interven-tions were not carried out by the preschool teachers themselves might be the requirement of special li-censes or trainings for the permission to carry out for instance CCPT. Also the fact that there is already a high pressure on the preschool teachers and a lack of time makes it often difficult for them to carry out extra interventions, especially when the intervention needs to be implemented in an individual setting (studies I, VI).
1 INTRODUCTION
1.1 Social-emotional development
1.1.1 Social development and competence
1.1.2 Emotional development
1.1.3 Factors that support social-emotional development
1.2 Emotional and Behavioral Difficulties (EBD)
1.2.1 Externalizing behavior
1.2.1.1 Disruptive behavior
1.2.1.2 Conduct disorder and aggressive behavior
1.2.1.3 Antisocial behavior.
1.2.2 Risk factors for social-emotional development
1.3 Social-emotional development and participation
1.4 Play interventions
1.4.1 Intervention setting: Preschools
1.5 Aim
1.6 Review questions
2 METHOD
2.1 Procedure
2.2 Inclusion and exclusion criteria
2.3 Selection process
2.3.1 Title and abstract screening
2.3.2 Full text screening
2.3.3 Quality assessment
2.4 Data extraction
3 RESULTS
3.1 Study description
3.2 Interventions supporting children with externalizing EBD
3.2.1 Types of interventions
3.2.2 Characteristics of interventions
3.2.2.1 Intervention implementation by internal and external professionals
3.3 Outcome on social-emotional development
3.3.1 Social development
3.3.2 Emotional development
3.4 Outcome on the child’s participation
3.5 Facilitators
3.6 Involvement of family and environment
4 DISCUSSION
4.1 Outcomes on the social-emotional development
4.2 Evaluation of participation
4.3 Evaluation of facilitators
4.4 The involvement of family and the environment
4.5 The intervention setting
5 LIMITATIONS
6 METHODOLOGICAL ISSUES
7 FUTURE RESEARCH
8 CONCLUSION
References
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Play interventions supporting the social and emotional development of preschool children with externalizing emotional and behavioral difficulties A systematic literature review from 2000 to 2017
