Investigation of the Effect of Clay Therapy on Stereotypic Behaviors in Children with Autism Spectrum Disorder

Öz

The aim of this study was to examine the effect of clay therapy on stereotypic behaviors of children with autism spectrum disorder (ASD). The sample of the study consisted of 6 children diagnosed with atypical autism between the ages of 4-9. In the study in which a one-group pretest-posttest experimental design was adapted, the Repetitive Behaviors Scale (TEDÖ-R-TV) consisting of 6 subscales was used to evaluate stereotypic behaviors. The clay therapy program was implemented twice a week for 8 weeks in 40-minute sessions. Within the scope of the program, activities such as free play with clay, finding objects hidden in clay, creating geometric shapes, making human faces and household objects were carried out. The video recordings of the first and last sessions of each participant were examined separately by 3 expert observers according to the scale items and each of the experts independently entered the data. For data analysis, Wilcoxon Signed Rank Test was used to compare the pre-test and post-test mean scores of stereotypic behaviors, self-harming behaviors, compulsive behaviors, sameness-uniformity behaviors, and limited behaviors subscales using SPSS 20.0 Package Program. As for results, it was determined that the clay therapy program was effective in decreasing the stereotypic behaviors of children with ASD and that this therapeutic approach can be used as an alternative method in the treatment process of children with ASD.

Anahtar Kelimeler

• Clay therapy
• autism spectrum disorder
• stereotypic behaviors

Otizm Spektrum Bozukluğu Olan Çocuklarda Kil Terapisinin Stereotipik Davranışlar Üzerindeki Etkisinin İncelenmesi

Öz

Bu çalışmanın amacı, kil terapisinin otizm spektrum bozukluğu (OSB) olan çocukların stereotipik davranışları üzerindeki etkisini incelemektir. Araştırmanın örneklemini, 4-9 yaş arasında atipik otizm tanısı almış 6 çocuk oluşturmaktadır. Tek grup ön test-son test deneysel desenin kullanıldığı çalışmada, stereotipik davranışların değerlendirilmesi için 6 alt ölçekten oluşan Tekrarlayıcı Davranışlar Ölçeği (TEDÖ-R-TV) kullanılmıştır. Kil terapisi programı 8 hafta boyunca, haftada iki kez 40'ar dakikalık seanslar şeklinde uygulanmıştır. Program kapsamında kil ile serbest oyun, kil içerisinde gizlenmiş nesneleri bulma, geometrik şekiller oluşturma, insan yüzü ve ev eşyaları yapma gibi etkinlikler gerçekleştirilmiştir. Her bir katılımcının ilk ve son seanslarına ilişkin video kayıtları, 3 uzman gözlemci tarafından ölçek maddelerine göre ayrı ayrı incelenmiş ve uzmanların her biri bağımsız olarak veri girişlerini gerçekleştirmiştir. Verilerin analizinde SPSS 20.0 Paket Programı kullanılarak, stereotipik davranışlar, kendine zarar verme davranışları, kompülsif davranışlar, aynılık-tekdüzelik davranışları, sınırlı davranışlar alt ölçeklerinin ön test ve son test puan ortalamalarının karşılaştırılmasında Wilcoxon İşaretli Sıralar Testi uygulanmıştır. Araştırma sonucunda, kil terapisi programının OSB'li çocukların stereotipik davranışlarının azaltılmasında etkili olduğu ve bu terapatik yaklaşımın OSB'li çocukların tedavi sürecinde alternatif bir yöntem olarak kullanılabileceği belirlenmiştir.

Anahtar Kelimeler

• Kil terapisi
• otizm spektrum bozukluğu
• stereotipik davranışlar

Kaynakça

1. Albadawi, S. (2022). The impact of antecedent physical exercises on increasing on-task behaviors and decreasing restricted and repetitive behaviors in elementary students with high functioning autism spectrum disorder in Saudi Arabia [Doctoral dissertation, Duquesne University].
2. American Psychiatric Association. (2012). Neurodevelopmental disorder, A09, Autism spectrum disorder proposed revision. http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=94
3. Bassols, M. (2006). Art therapy, an accompaniment in creation and transformation. Arteterapia, 1, 19–25. http://revistas.ucm.es/index.php/ARTE/article/view/ARTE0606110019A.
4. Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: comparisons to mental retardation. Journal of autism and developmental disorders, 30(3), 237–243. https://doi.org/10.1023/a:1005596502855
5. Büyüköztürk, Ş., Kılıç-Çakmak, E., Akgün, Ö. E., Karadeniz, Ş., & Demirel, F. (2016). Bilimsel araştırma yöntemleri. Ankara: Pegem Akademi Yayıncılık.
6. Cook, J. L., & Rapp, J. T. (2018). To what extent do practitioners need to treat stereotypy during academic tasks? Behavior Modification, 44(2), 228-264. https://doi.org/10.1177/0145445518808226
7. Diehl, E. R. M. (2007). Definitions and positions. American Horticultural Therapy Association. https://ahta.memberclicks.net/assets/docs/final_ht_position_paper_updated_409.pdf
8. Evans, K., & Dubowski, J. (2001) Art therapy with children on the autism spectrum: Beyond words. Jessica Kingsley Publishers, London.

9. Ferreira, J. P., Ghiarone, T., Júnior, C. R. C., Furtado, G. E., Carvalho, H. M., Rodrigues, A. M., & Toscano, C. V. A. (2019). Effects of physical exercise on the stereotyped behavior of children with autism spectrum disorders. Medicina (Kaunas, Lithuania), 55(10), 685-703. https://doi.org/10.3390/medicina55100685
10. Flick, K.M. (2012). The application of a horticultural therapy program for preschool children with autism spectrum disorder. Journal of Therapeutic Horticulture, 22(1):38-45. https://www.jstor.org/stable/10. 07/24865213
11. Hanley, G.P., Iwata, B.A., & McCord, B.E. (2003). Functional analysis of problem behavior: A review. Journal of Applied Behavior Analysis, 36(2):147-185. https://doi.org/10.1901/jaba.2003.36-147
12. Himmelheber, S., Mozolic, J., Lawrence, L. A., & Thorbecke, L. (2018). Why camp? Evaluating the impact of a horticulture therapy camp for adolescents with ıntellectual and developmental disabilities. Journal of Therapeutic Horticulture, 28(2), 3–14. https://www.jstor.org/stable/26598047
13. Hogan, S. (2001). Healing arts: The history of art therapy. Jessica Kingsley Publishers, London.
14. Kaduson, H., & Schaefer, C. E. (1998). The therapeutic powers of play: An introduction to the special issue on play therapy. International Journal of Play Therapy, 7(2), 1–16.
15. Kellman, J. (2001). Autism, art, and children: The stories we draw. US: Greenwood Publishing Group.
16. Koo, J., & Thomas, E. (2019). Art therapy for children with autism spectrum disorder in India. Art Therapy, 36(4), 209–214. https://doi.org/10.1080/07421656.2019.1644755
17. Krippendorff, K. (2004). Reliability in content analysis: Some common misconceptions and recommendations. Human Communication Research, 30(3), 411–433. https://doi.org/10.1111/j.1468-2958.2004.tb00738.x
18. Kuo, N., & Plavnick, J. B. (2015). Using an antecedent art ıntervention to ımprove the behavior of a child with autism, Journal of the American Art Therapy Association, 32(2), 54–59. 10.1080/07421656.2015.1028312
19. Lai, C. K. Y., Ho, L. Y. W., Kwan, R. Y. C., Fung, C. Y. Y., & MAK, Y. W. (2017). An exploratory study on the effect of horticultural therapy for adults with intellectual disabilities. Journal of Therapeutic Horticulture, 27(1), 3–15. https://www.jstor.org/stable/26111988
20. Lipska, J., & Leś, K. K. (2023). Art therapy for children with autism spectrum disorder. Aktueln Neurol, 23(2), 46–51. 10.15557/AN.2023.0008
21. Molina, S.S., Muñoz-Luna, R., & Jurado-Navas, A. (2017). Working through the senses: Art therapy for autism spectrum disorders students. Huria: Journal of the Open University of Tanzania, 24(1), 64–73.
22. Morris, P., Hope, E., Foulsham, T., & Mills, J. P. (2023). Dancing out for a voice; A narrative review of the literature exploring autism, physical activity, and dance. Journal of Bodywork and Movement Therapies, 33, 202–215.
23. Osborne, J. (2003). Art and the child with autism: Therapy or education? Early Child Development and Care, 173(4):411–423.
24. Ökçün Akçamuş, M. Ç., Bakkaloğlu, H., Demir, Ş., & Bahap Kudret, Z. (2019). Otizm spektrum bozukluğunda Tekrarlayıcı Davranışlar Ölçeği-Revize Türkçe sürümünün geçerlilik ve güvenilirlik çalışması. Anadolu Psikiyatri Dergisi, 20(Ek Sayı 1), 65–72.
25. Özcan, M. (2015). Zihinsel engelli bireylerde görsel sanat eğitimi. Istanbul Aydin Universitesi Güzel Sanatlar Fakültesi Dergisi, 1(2):71–83.
26. Pierce, W.D., & Cheney, C.D. (2003). Behavior Analysis and Learning (3rd ed.). Psychology Press. https://doi.org/10.4324/9781410608987
27. Pothukuchi, K. (2004). Hortaliza: A youth “nutritional garden” in Southwest Detroit. Children, Youth and Environments, 14(2), 124–155. https://digitalcommons.wayne.edu/cgi/viewcontent.cgi?article=1002&context=urbstud_frp
28. Talantseva, O. I., Romanova, R. S., Shurdova, E. M., Dolgorukova, T. A., Sologub, P. S., Titova, O. S., Kleeva, D. F. & Grigorenko, E. L. (2023). The global prevalence of autism spectrum disorder: A three-level meta-analysis. Frontiers in Psychiatry, 14, 1071181.
29. Tarr, C.W., Larwin, K., & Rineer-Hershey, A. (2021). Measuring the effects of physical exercise on stereotypic behaviors in autism: Using hierarchical linear model. Journal of Autism, 8(1), Article 1.
30. Turner, M. (1999). Repetitive behaviour in autism: A review of psychological research. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 40(6), 839–849. https://doi.org/10.1111/1469-7610.00502
31. Vrisaba, N. A., & Yudiharso, A. (2021). Systematic review of art therapy in children with autism spectrum disorder (ASD). Jurnal Insight Fakultas Psikologi Universitas Muhammadiyah Jember,17(2), 403–429.
32. Wells, N. M. (2000). At home with nature: Effects of “greenness” on children’s cognitive functioning. Environment and Behavior, 32(6), 775–795. https://doi.org/10.1177/00139160021972793
33. Yücesoy, Y., Bağlama, B., & Tüzel, M. (2020). Art education, therapy interventions and school management in autism. Revista Romaneasca Pentru Educatie Multidimensionala, 12(1), 334–349. https://doi.org/10.18662/rrem/217
34. Yücesoy Özkan, Ş., Ergenekon, Y., Çolak, A., & Kaya, Ö. (2016). Otizm spektrum bozukluğu. Aile ve Sosyal Politikalar Bakanlığı Engelli ve Yaşlı Hizmetleri Genel Müdürlüğü. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://dergipark.org.tr/tr/download/journal-file/27710
35. Zhang, A., Luo, X., Ying, F., Wang, J., & Huang, G. (2025). Collaborative arts therapies as a supportive intervention for autism spectrum disorders: Bibliometric analysis, insights, and directions. Heliyon, 11(1), 1–13. https://doi.org/10.1016/j.heliyon.2024.e41333
36. Zhang, J., Sun, Q., Liu, X., & Yang, F. (2022). Ultra-light clay intervention improves responsiveness and initiates the communication of children with ASD. Frontiers in Psychology, 13, Article 804488. https://doi.org/10.3389/fpsyg.2022.804488.