Effects of Theraplay on Behavior and Caregiver Relationships in a Child with Chiari Malformation

Chiari malformation (CM) is a type of chronic illness that can present with physical and psychological symptoms. While chronic illnesses such as CM can put stress on the entire family, it is essential to provide support to family members as well as the affected individual. The current single-case study involves an analysis of archival data for a 12-session Theraplay intervention that was implemented with a 7-year-old child and her parents. Theraplay is a unique form of play-based therapy that focuses on the dyadic relationship between caregiver and child. Prior to the intervention, the child displayed significant externalizing and internalizing behavior problems and parents reported strained relationships with the child in the home setting. It was hypothesized that the Theraplay intervention would significantly decrease levels of Anxiety, Depression, Somatization, Hyperactivity, Aggression, and Conduct Problems as measured by the Behavior Assessment System for Children, Third Edition (BASC-3). Additionally, it was hypothesized that the intervention would significantly improve specific aspects of the parent-child relationship, as measured by scales on the Parenting Relationship Questionnaire (PRQ). An AB design was utilized to examine parent pre- and post-rating scales. Statistical analyses were conducted to examine significant and effect size (Cohen's d). In regard to changes in externalizing and internalizing behavior as measured by the BASC-3, there were no significant differences between Phase A and B that cannot be explained by the standard error of measurement. Contrary to the hypothesis regarding benefits to the parent-child relationship as measured by the PRQ, the Theraplay intervention was not effective in improving aspects of the parent-child relationship. The area of maternal Parenting Confidence was the only scale to show a statistically significant change that was also clinically significant, as the mother's ratings showed a severe decrease in perceived parenting abilities. The results of the study highlight the need for further research on the effectiveness of Theraplay with special populations, such as children with chronic illness. Additionally, the study demonstrates a need to incorporate multiple and repeated methods of progress monitoring in children to determine if physical symptoms may affect problematic behaviors and intervention effectiveness.