Methodological considerations for a directive play therapy approach for children with autism and related disorders

Research to investigate the efficiency, appropriateness, and feasibility of a directive play therapy approach for children with complex needs must consider methodological issues that impact on internal and external validity. This paper discusses methodological issues that arose when research was concerned with a directive play therapy approach called Learn to Play Therapy with children with autism and related disorders. The example of a small study of 3 children with autism and related disorders, who undertook twenty-two 1-h sessions of Learn to Play Therapy, is used to discuss methodological issues such as choice of therapy, the adaptive functioning of the child, matching the outcome measure to the therapy, definitions of play and replication of studies, variability in children's developmental levels, acceptability of treatment to the child, feasibility, treatment fidelity, researcher bias and bias in sample selection, sample size, clinical significance, and the need for independent monitoring of therapy. The paper concludes that when appropriate consideration for methodological issues is given, in depth analysis of individual children's responses to Learn to Play Therapy can inform effectiveness of the outcomes of therapy.