Davranışsal Konsültasyon Sağaltımı İçinde Bilişsel Davranışçı Oyun Terapisi: Down Sendromunda İçten Başlayan Dışa Yönelik Davranışsal Değişiklikler Yapma

Year 2017, Volume: 3 Issue: 2, 297 - 321, 31.10.2017

Gül Kahveci

Abstract

Bu makale, hafif zihinsel özürlülüğe eşlik eden Down Sendromuna (DS) sahip bir öğrencinin sözel ve fiziksel saldırganlık ile ortaya çıkan duygu kontrolünü hedefleyerek gerçekleştirilen bireyselleştirilmiş Bilişsel Davranışçı Oyun Terapisi (CBPT) müdahalesini sunmaktadır. Bu müdahale, Ankara'da bulunan gelişimsel ve fiziksel engelli çocuklar için kurulmuş özel bir klinikte (özel eğitim ve rehabilitasyon merkezi) gerçekleştirilmiştir. Araştırmada yer alan müdahaleyi değerlendirmek için tek denekli araştırma modellerinden davranışlar arası çoklu başlama düzeyi modeli kullanılmıştır. Down sendromu tanısına eşlik eden hafif zihinsel yetersizliğe sahip hem duygu durum hem de davranış bozukluğu gösteren 14 yaşındaki bir kız öğrencidir. Katılımcının duygu düzenlemedeki zorlukları, diğerlerine zarar vermek, tekmelemek ve bağırmak gibi fiziksel ve sözlü saldırgan davranışlar da dahil olmak üzere, yüksek seviye problem davranışlardır ve hızla artma potansiyeline sahiptir. Müdahaleyi değerlendirmek için tek denekli araştırma modeli olan davranışlar arası çoklu başlama düzeyi modeline yer verilmiştir. Bilişsel Davranışçı Oyun Terapisi (BDOT) içindeki dinamik süreç, değişimleri içten, bilişsel süreçlere müdahale ile başlatarak dışa doğru yani açıkça görülen olumlu davranış değişikliklerinin ortaya konmasına hizmet eden bir yapı şeklinde araştırmada yer almıştır. Sonuçlar katılımcının yıkıcı davranış sıklığında azalma ve iletişim becerilerinde artış şeklinde yorumlanmıştır. Bu çalışma, DS ve hafif zihinsel yetersizliği olan bireylerle çalışan danışmanlar için, özellikle uyum davranışlara yönelik etkin müdahalelerin geliştirilmesi ve onaylanmasına yönelik önemli bir adım teşkil etmektedir. BDOT gibi hibrid yöntemlerin dışavurum davranış sorunları için, farklı yetersizliğe sahip gruplarda davranışsal konsültasyon süreçleri içerisinde araştırılmasına ihtiyaç vardır.

Keywords

Bilişsel davranışçı oyun terapisi, Down sendromu, Hafif zihinsel yetersizlik

Cognitive Behavioral Play Therapy in Behavior Consultation Treatment: Making Behavior Changes from the Inside Out in Down Syndrome

Abstract

This article presents an individualized Cognitive Behavioral Play Therapy (CBPT) intervention, to target emotion dysregulation in verbal and physical aggression with Down syndrome (DS) concurrent with mild intellectual disabilities (ID). A female student participated in this pilot individual and clinic-based CBPT intervention. This intervention was implemented within a private clinic (special education and rehabilitation center) for children with developmental and physical disabilities located in Ankara, Turkey. K is a 14-year-old female student diagnosed with DS with a mild ID and co-occurring mood and behavioral disturbances. Participant’s emotion regulation difficulties had the potential to quickly escalate to severe behaviors, including physically and verbally aggressive behavior like threating to harm others, kicking and shouting. Single-subject methodology utilizing a multiple-baseline design across behaviors was used to evaluate the intervention. The dynamic process in Cognitive Behavioral Play Therapy (CBPT) has been investigated as a structure that serves to reveal positive behavioral changes, by intervening internally, starting from cognitive processes to outside by observing behavioral changes. The results were interpreted as a decrease in the frequency of destructive behavior of the participant and an increase in communication skills. This study represents an important step toward the development and validation of effective interventions for counselors working with individuals with DS and ID to specifically address adaptive behaviors. Further research needs to be conducted to fully determine the effects of the use of hybrid methods like CBPT for extrovert behavior problems, in different disability groups, within behavioral consultation procedures.

Keywords

Cognitive behavioral play therapy, Down syndrome, Mild intellectual disabilities

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