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Heni Sumastri, Marta Pastari. (2022). The Effectiveness of the

Combination of Play Therapy and Speech Therapy on the Behavioral

Development of Children With Autism Spectrum Disorder (ASD).

Journal of Eduvest. Vol 2 (9): Page 1676-1686

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Eduvest – Journal of Universal Studies

Volume 2 Number 9, September, 2022

p- ISSN 2775-3735 - e-ISSN 2775-3727

THE EFFECTIVENESS OF COMBINATION OF PLAY

THERAPY AND TALK THERAPY ON THE BEHAVIOR OF

CHILDREN WITH AUTISM SPECTRUM DISORDER (ASD)

Heni Sumastri

, Marta Pastari

Health Polytechnic Ministry of Health, Palembang, Indonesia

Email: [email protected],

[email protected]

ABSTRACT

This study aims to analyze whether the combination of play

therapy and speech therapy effectively affects the behavioral

development of children with Autism Spectrum Disorder

(ASD). This study uses a quantitative method with the

population in this study are all children with autism who are

regular visitors of speech therapy at NU_Kids Integrated

Therapy 1 and 2. The collection of samples in this study used

purposive sampling method. The results showed that most of

the children who were given treatment only with speech

therapy (Group I) had severe autism, namely 11 people

(68.8%) then most of the children who were given

combination treatment, namely combined speech therapy

with play therapy (flash cards and puzzles) (Group II) also

experienced severe autism, namely 9 people (56.3%). This

shows that children with severe autism really need speech

therapy to deal with the behavior disorders they experience.

KEYWORDS

Play Therapy, Speech Therapy, Autism Spectrum Disorder

This work is licensed under a Creative Commons

Attribution-ShareAlike 4.0 International

INTRODUCTION

Autism is a developmental disorder characterized by repetitive behaviors,

whether communication, interaction, social, or emotional behavior.

Characteristics of children with autism that can be observed in daily life are:

Behavioral disturbances include 1) ignorance of the environment, 2) undirected

behavior (pacing, running, climbing, turning, jumping, etc.), 3) Attachment to a

specific object, 4) non-directional behavior, 5) fascination with rotating or moving

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objects; social interaction disorders include 1) reluctance to interact (mismatched

eye contact, facial expressions, postures, and gestures, 2) difficulty interacting

with others or peer play, 3) lack of empathy, behavior is for interest or pleasure, 4)

lack of reciprocal social and emotional interactions (Fadlillah, 2019).

Globally, between 1.8 and 200 million children under the age of five are

stunted each year, 86 percent of them in developing countries such as India,

compared with just 8 percent in advanced economies. Meanwhile, data from

developed countries show that 10% to 15% of children under the age of 5 are

reported to be stunted, and 1% to 3% of children under the age of 5 are stunted

globally. (Fernando, 2021). Other data show that approximately 16% of children

(infants) under the age of 5 in Indonesia have mild to severe neurological and

brain developmental disorders, 2 in 1,000 infants have motor development

disorders, and 1 in 100 1 with low intelligence and language delay (Solama &

Hipson, 2021).

National data from the Ministry of Health of Indonesia as many as 11.5 %

of children under five in Indonesia have growth and development disorders.

Survey data from the Indonesian Pediatrician Association (IDAI) shows about 5

to 10% of children experience development that is not in accordance with age, so

it is necessary to carry out an early assessment of the development of toddlers

(Iskandar & Indaryani, 2020). In Palembang City, of the 85 toddlers who attend

kindergarten , 36.5% of toddlers experience abnormal growth and development

(with special needs) (Purwasih, 2020).

One of the children with special needs is a child with autism spectrum

disorder. The disorder causes children to be limited in communication, social

interaction, and behavior. Therefore, it is necessary to address this issue in the

individual planning and special education of parents of children with autism

(Ismet, 2019). In contrast, autism in children is a pervasive developmental

disorder that affects social interaction, communication, and behavior and is

observed before age 3. Universal meaning means that the disease affects a person

very widely, intensely and deeply. People with autism have different symptoms,

hence the term GSA (autism spectrum disorder) for people with autism has

emerged in recent years (Purwasih, 2020).

To avoid delays, Verbal Behavioural Intervention (VB), also known as a

form of treatment for children with autism spectrum disorder, was administered.

Verbal behavior interventions are related to applied behavior analysis, by asking

children to learn language through words that correspond to what they want to

convey (Kalalo & Yuniar, 2019). Then, for growth and developmental disorders,

especially the development of cognitive knowledge, communication skills and

social interaction, the researchers chose role-playing therapy, which uses game

mode as an effective medium for exploring freedom and self-expression,

developing cognitive knowledge, and communicating. skills and social

interaction. Play allows kids to be creative and adapt to stressors (Mahdalena,

Shodiq, & Dewantoro, 2020). Children can also adapt to their environment, play

objects, time and space. Types of games that can be used for children with autism

include puzzles, flashcards, role-playing games, and more (SITI, 2021).

In the study, researchers used a combined treatment regimen, speech

therapy and occupational therapy, to train children with special needs to perform

daily activities. I hope that children in the future will be more independent and

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able to participate in various activities (Mud, Sham, & Ali, 2021). Speech and

occupational therapy usually lasts 30-60 minutes at a time, depending on each

child's needs and abilities. Play therapy, writing therapy, sensory integration

therapy, social skills therapy, and behavioral therapy are specific to ergotherapy

(Natalia, 2019). Play therapy methods, particularly the use of jigsaw puzzles and

flashcards for children with autism, have been found to be effective in improving

social interaction skills and reducing behavioral problems in children. Managed

effectively using a combination of puzzles and flashcards, 20 minutes per session,

twice a week for 12 weeks (Fadlillah, 2019).

Aminah's research (2021) also showed that treatment at the Rumah

Mentari Foundation in Sidoharjo District, Pringsewu Regency included the

application of therapists to children, designed to allow the therapist to focus on the

problems the child was experiencing (Santosa, 2019). The treatment takes place in

a small room with tables, chairs, play equipment, and follows a fixed schedule.

Referring to theories on the use of play therapy, almost all children with autism

were able to improve their social interaction with the environment after 3 months

of play therapy.

Then Wahyudi (Mud et al., 2021) Think there are many types of

constructive play such as match-unloading, match-making and free build. One

form of play used in this study is constructive play, where children are free to use

their imaginations (Sari, 2018).

Iskandar et al. (2020) found play therapy as a way to improve social skills

in children with autism. Assessments of social interaction skills before and after

play therapy revealed significant differences in social interaction skills in children

with autism before and after play therapy. Associative play therapy found to be

effective in improving social skills in children with autism (Setiawan, 2019)

(Suci, 2020).

Then the results of the study in the SLB Autism Lab UM showed that

cutting skills had an effect on fine motor skills in children with autism grade VIII,

as indicated by an increase in the mean post-pre-test level..

The results of the (Palakua, 2020) showed that children with autism were

able to overcome problems with putting on and taking off socks after receiving

occupational therapy. While there are many improvements, it is very helpful for

SLB teachers with an occupational therapy level to be able to practice these skills

(Solama & Hipson, 2021).

Then based on late December 2021 at Nu_Kids Integrated Therapy (a

reference center for the treatment of children with autism, which aims to develop

the language skills and independence of children with autism so that they can

become independent individuals and be able to have contact with normal children

by the end of December) Preliminary study to be conducted in 2021). Overall, the

number of children with autism being treated in the future is quite large, with an

average of 50 children (ages 1-12) per month. The average child has difficulty

connecting with other children; 1) Never or rarely makes eye contact; 2) Likes

being alone, somewhat distant; 3) Difficulty expressing needs; prefers gestures or

gestures over words; 4) Echoes (parrot/repetition) words or phrases, not normal

speech); 5) does not respond to verbal cues; acts like a deaf person. Some of the

therapies that speech therapists provide here are 45 minutes/session of speech

therapy, 45 minutes/session of sensory integration therapy, and 45

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The Effectiveness of the Combination of Play Therapy and Speech Therapy on

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minutes/session of occupational therapy. Occupational therapy focuses on

activities for 45 minutes/session to train children's behavior (the child's ability to

understand and correctly point to pictures or objects), allowing these skills to

grow in behavioral development and gradually keep pace with age. Occupational

therapy, one of which is play therapy, is a method by which therapists can

overcome social interaction problems in children with autism through play,

children develop and expand socialization, learn to overcome problems that arise,

and increase moral and ethical values make out. Be kind, learn to distinguish right

from wrong, and be responsible for what you do. Based on the data obtained,

comparative study results and preliminary findings, the researchers were

interested in "The effect of the combination of play therapy and speech therapy in

NU_Kids Integrated Therapy 1 and 2 on the behavioral development of children

with autism spectrum disorder (ASD)." ". .

The purpose of this study was to analyze whether a combination of play

therapy and speech therapy can effectively influence the behavioral development

of children with autism spectrum disorder (ASD).

RESEARCH METHOD

This study uses a pre-experimental design because variables other than the

independent variables affect the dependent variable. The study design used was a

two-group pre-test design, i.e. two groups of respondents were observed/measured

before treatment (treatment) and the development of respondents was observed

after treatment (treatment) for more accurate results.

The treatments given were; 1) Group I = speech therapy only; 2) Group 2

= speech therapy combined with play therapy (index cards and puzzles).

Continuous treatment for 3 months. This research activity was carried out at

NU_Kids Integrative Therapy 1 and 2 sites.

The population in this study included all children with autism who

regularly participated in NU_Kids Integrative Therapy 1 and 2 speech therapy.

The sample collection in this study adopted a targeted sampling method. Targeted

sampling is a method of designating a study sample based on a specific aspect. In

this study, children with special needs (ASD) were considered; autistic individuals

and families agreed to all prescriptions and treatments for the child following

established procedures and schedules. The number of respondents for this study

was 32 children. Data processing was performed with the aid of a computer using

the statistical software SPSS for Windows version 17.0 and supported by the

Microsoft Excel program. The data collected in this study were tested by

univariate normality test (Shapiro-Wilk), paired difference test (Wilcoxon) and

categorical correlation test (Spearman) and correlation test between variables

(One Way ANOVA/One Way ANOVA). test) to analyze.

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RESULTS AND DISCUSSION

a. Univariate Analysis

1. Frequency Distribution of Group I by Autism Category

Table 1

Autism Category Group I

Autism

Criteria

Amount

Light

12.5

Currentl

18.8

Heavy

68.8

Total

100

From table 1 above, it shows that most of the children who were given

only speech therapy treatment (Group I) had severe autism, namely 11 people

(68.8 % ).

2. Frequency Distribution of Group II Based on Autism Category

Table 2

Category II Autism

Autism

Criteria

Amount

Light

18.8

Currentl

25.0

Heavy

56.3

Total

100

Table 2 above shows that most of the children who were given

combination treatment, namely combination speech therapy with play therapy

(flash cards and puzzles) (Group II) had severe autism, namely 9 people(56.3 %).

b. Bivariate Analysis

1. Normality test

For respondents in Group 1: Speech therapy alone (16 people) and Group 2:

Combined speech therapy with play therapy (flash cards and puzzles) the normality

test was carried out using the Shapiro – Wilk statistical method because the data had

a small sample size. The results of the normality test are shown in;

Table 3

Normality Test Results

Data source

Group

Treatment

Shapiro

Wilk

Decision

Behavioral

Development

Speech Therapy

0.000

Abnormal

Combined Speech Therapy

with Play Therapy ( flash cards

and puzzles )

0.038

Abnormal

Decision-making:

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 If sig count < 0.05, then the data is not normally distributed

 If sig count > 0.05 then the data is normally distributed

From table 5.3, the sig values for both groups are 0.000; 0.038, which are all

< 0.05, it can be concluded that the research data is not normally distributed. Because

the data is not normally distributed, the next method to be used is Non Parametric

Test.

2. Behavioral Development Difference Test

Hypothesis formulation:

H0 : There is no difference in the behavior development of respondents

before and after being given treatment

H1: There are differences in the behavior development of respondents

before and after being given treatment

Decision-making:

 If sig count < 0.05, then H0 is rejected and H1 is accepted

 If sig count > 0.05 then H0 is accepted and H1 is rejected

The data looks at;

Table 4

The Results of the Differences in Behavioral Development of Pre and Post

Treatment

Behavioral

Development

(Pretest and

Posttest)

Wilcoxon Signed

Ranks Test

(asymp sig 2-Tailed)

Wilcoxon Signed

Ranks Test

(asymp sig 2-Tailed)

Decision

Mild Autism

1,000

No difference

0.317

No difference

Moderate Autism

0.083

No difference

0.046

There 's a

Difference

Severe Autism

0.046

There is a difference

0.014

There 's a

Difference

From Table 5.4 it can be seen that;

For respondents in the Treatment (Speech Therapy Only) category (Group 1);

a) a probability value of 1,000 for mild autism (significance > 0.05); b) a probability

value for moderate autism 0.083 (significance > 0.05); c) autism weight probability

value is 0.046 (significance < 0.05). Degrees were in the first group; only children

with the severe autism category showed differences in behavioral development before

and after treatment.

Among respondents who received speech therapy combined with play

therapy (flashcards and puzzles) (group 2); a) the probability of mild autism was

0.317 (significance > 0.05); b) moderate autism The probability value of autism is

0.046 (significant < 0.05); c) The probability value of autism weight is 0.014

(significant < 0.05). Graduation took place in the second group; children with

moderate and severe autism showed differences in behavioral development before

and after treatment.

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3. ANOVA test

a. Average Behavioral Development of Groups I and II

Table 5

Behavioral Development Average

Data source

Group

Treatment

mean

Behavioral

Development

Speech Therapy

1.56

Speech Therapy combination Play

Therapy ( flash cards and puzzles )

2.25

From table 5.5 it can be seen that the average behavior development of

groups I and II is different (Group I = 1.56 and Group II = 2.25).

b. Variance Diversity Test

Hypothesis;

H0 : the variance of the two groups is the same

H1 : the variance of each group is not the same

Decision-making;

 If sig count < 0.05, then H0 is rejected and H1 is accepted

 If sig count > 0.05 then H0 is accepted and H1 is rejected

Table 6

Group Variance Variance Test

Data source

Group

Treatment

Sig

Decision

Behavioral

Development

Speech Therapy

0.142

variance

Homogen

eous

Speech Therapy combination

Play Therapy ( flash cards and

puzzles )

From table 6 it can be seen that the variances of groups I and II are

homogeneous (same) (sig = 0.142 > 0.05 ; then H0 is accepted and H1 is

rejected).

c. Anova Test

Hypothesis;

H0 : The difference in the behavior development of the two groups is the

same

H1: The difference in the behavior development of each group is not the

same

Decision-making;

 If F count > F table, then H0 is rejected and H1 is accepted

 If F count < F table, then H0 is accepted and H1 is rejected

Table 7

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Test for Differences in Group Behavior Development

Data source

Group

Treatment

Count

Decision

Behavioral

Development

Speech Therapy

8,768

Significa

ntly

different

Speech Therapy combination Play

Therapy ( flash cards and puzzles )

From Table 7 it can be seen that the inference results; Calculated F value

= 8,768. The alpha value is 5% or 0.05, then Numerator = number of variables –

1, i.e. (2-1 = 1), Denumerator = number of cases – number of variables, i.e. (32-2

= 30). The F table value from the calculation above is 4,17 , which is, the

calculated F value is in the rejection area (F arithmetic > F table), then H0 is

rejected and H1 is accepted. The conclusion is that the combination of play

therapy and speech therapy is very effective in influencing the behavioral

development of children with Autism Spectrum Disorder (ASD).

The results of the data analysis are described in the discussion below;

1. Univariate Analysis

Most children who received speech therapy alone (group 1) had severe

autism, 11 (68.8%), followed by children who received speech therapy combined

with play therapy (flashcards and puzzles) (2nd Group). group)) 9 (56.3%) had severe

autism. This suggests that children with severe autism need speech therapy for

communication impairment and behavioral development.

This study is in line with Ismet (2019), which estimated 0.5-2.5% of children

under the age of 18 with autism in developed countries, especially in Sweden with

severe intellectual disability (severe autism). Speech therapy is considered very

important for children with severe autism, as nearly all children with autism have

difficulty speaking. Speech therapy can help children with autism develop their

behavior.

(Iskandar & Indaryani, 2020) It is also worth noting that one of the important

roles of the speech therapist is to prioritize, design, and deliver therapy to meet the

social communication needs of children that shape adaptive behavior. Speech

therapists aim to enable children with autism to: initiate useful and functional

activities with each social partner and social environment; understand verbal and

nonverbal communication in social, academic, and community settings; communicate

with each other to build friendships and Web; use and comprehend verbal and non-

verbal communication, such as gestures and facial expressions, language or writing,

signs or instructions, images and written or written text, for the perfect development

of adaptive behaviour.

2. Bivariate Analysis

a. Normality test

The results of the Normality Test using Shapiro-Wilk showed that the sig

values for the two groups were 0.000; 0.038, which are all < 0.05, it can be

concluded that the research data is not normally distributed.

b. Behavioral Development Difference Test

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For respondents with Treatment (Speech Therapy Only) (Group I)

category; a) Mild Autism probability value is 1,000 (significance > 0.05 ); b)

Moderate Autism probability value is 0.083 (signification > 0.05); c) Autism

Weight probability value is 0.046 (significance < 0.05). The conclusion is in

Group I; Only children with severe autism category have differences in behavior

development in pre and post treatment.

In respondents with Speech Therapy Treatment combination of Play

Therapy (flash cards and puzzles) (Group II) category; a) Mild Autism

probability value is 0.317 (significance > 0.05 ); b) Moderate Autism probability

value is 0.046 (significance < 0.05); c) Autism Weight probability value is 0.014

(significance < 0.05). The conclusion is in Group II; children with Moderate and

Severe Autism categories have

c. Differences in Pre and Post Treatment Behavioral Development.

The findings of this study are supported by Iskandar et al. (2020), who

found that treatment success for people with autism can be achieved through a

variety of approaches, including play therapy. Treatment is provided through

special attention, training and education for children with autism. Allow autistic

children to develop in communication and interaction with their peers.

(Fernando, 2021) Speech therapy exercises have also been found to be

effective in learning pronunciation and behavioral development for autistic

students. The five-step combination therapy, in particular, promotes behavioral

development, including: 1) The child's needs are identified when the child is

enrolled in the autism school, either by observing the child, interviewing parents,

or by studying the child's medical or treatment records . 2) Speech therapy,

performed by professionals and teachers themselves. This concept shows the

inclusiveness of the school, and the head teacher grasps the treatment that must

be given to the children. The homeroom teacher not only provides materials, but

also provides treatment. 3) Information therapy, also performed by a therapist, to

activate the nerves associated with the child's vocalization. 4) Forms of play

therapy; interaction with peers, at each recess and class time, which can give

children a desire to be able to converse as friends; and interaction with the school

environment, every Friday, such as playing puzzles Arrange flashcards and

puzzles.

3. Anova Test

The conclusion is as follows; calculated F-value = 8,768. An alpha value of

5% or 0.05, then numerator = number of variables - 1, so (2-1 = 1), numerator =

number of cases - number of variables, so (32-2 = 30). The F-table value calculated

above is 4.17, that is, the calculated F-value is within the rejection range (F arithmetic

> F-table), then H0 is rejected and H1 is accepted. The conclusion is that a

combination of play therapy and speech therapy is highly effective in influencing the

behavioral development of children with autism spectrum disorder (ASD).

The results of this study and.(Ismet, 2019) They found that play therapy

showed significant effects both before and after associative play therapy in children

with autism. Children with autism have increased social interaction through

traditional cublak-cublak suweng play. This can be seen in eye contact, children can

play happily and overcome the social barriers of children with autism.

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The results of this study are also consistent with Palakua (2020) who found

that the role of parents and speech therapy (combined therapy) had a significant

impact on the development of sock putting on and taking off behaviors in children

with autism.

The results of research by (Fernando, 2021) It has also been shown that the

treatment of children with autism at the Mutia Centre, a combination of language and

behavioural therapy using the ABA approach (Applied Behavior Analysis), has made

fairly effective progress by helping to develop communication skills and significantly

improve resilience. Behavior.

CONCLUSION

Based on the resultsand discussion, the questions and research objectives can be

answered, so it can be concluded that the majority of children who received speech

therapy alone (group 1) had severe autism, 11 (68.8%), followed by older Most children

receive combination therapy, where speech therapy is combined with play therapy

(flashcards and puzzles). (Group 2) also experienced severe autism, 9 (56.3%). This

suggests that children with severe autism need speech therapy to help them cope with the

behavioral problems they are experiencing. The results of the Shapiro-Wilk normality test

were used; the sig value for both groups was 0.000; since the data were not normally

distributed, the next method to use was a nonparametric test. Differences in behavioral

development using the Wilcoxon signed-rank test (asymp sig 2-Tailed) showed that; 1) in

the first group; only children with severe autism showed differences in behavioral

development before and after treatment; 2) then in the second group group; children with

severe and severe autism showed different behavioral development before and after

treatment. The ANOVA test results showed that the calculated F table value was 4.17 and

the calculated F value was 8.78, which were within the rejection range (F count > F

table), then H0 was rejected and H1 was accepted. It was concluded that there were

significant differences in language ability between the two groups, and the combination

of play therapy and speech therapy was found to be highly effective in influencing the

behavioral development of children with autism spectrum disorder (ASD).

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