Brief Report: Emotion Regulation in Autism Is Improved in a Single-N Pilot Intervention Study Combining Child-Centered Play Therapy and Rhythmic Relating

Background: Rhythmic Relating is an approach to supporting social timing in therapeutic play with autistic children (Daniel, Laurie and Delafield-Butt, 2024) and can be used as a stand-alone approach or to augment child-centered therapies. Aims: A combination of Child-Centered Play Therapy and Rhythmic Relating is evaluated in its therapeutic potential to enhance Emotion Regulation outcomes (over 10 months; 32 weekly sessions), in a case study of a 5-year-old autistic girl. Materials and Methods: Mean Start and Finish scores were recorded for the parent-rated Emotion Regulation Checklist (Shields and Cicchetti, 1997). For all subscales, we calculate percentage-change-over-time values and, using percentiles, these values are compared and statistically ranked with respect to two different comparison groups:. 1. “Autistic children without concurrent cognitive impairment, not receiving psychological or behavioral therapies” (n = 77). 2. “Autistic girls without concurrent cognitive impairment, not receiving psychological or behavioral therapies” (n = 9). Results: As compared to both Comparison Groups 1 and 2, our participant's overall Emotion Regulation improvements (over 10 months) are statistically highly likely to be due to her participation in therapy (p < 0.01). Discussion: Practical implications for therapeutic practice with autistic children are discussed, including the emphasis on good-enough self-regulation as outcome priority, the emphasis on social timing for co-regulation as route to good-enough self-regulation, and the emphasis on Emotion Regulation as outcome measure in accordance with outcome priority. Possibilities for future larger-scale intervention studies addressing scalability and generalizability issues are discussed, including current modality-combination studies (i.e., Rhythmic Relating and Child-Centered Play Therapy) - multi-site/practitioner, multiple baseline single case design, or considerably larger N intervention groups compared with the current ERC comparison groups, or generating new comparison groups - and/or studying the efficacy of other potential modality combinations (Rhythmic Relating combined with Music Therapy, Dance Movement Therapy, DIRFloortime etc.). Conclusion: The current study was designed to retest and build on the hypothesis, method and knowledge base of a previous intervention study (Daniel et al, 2023). Together, these two sets of results show early positive potential for this combination of therapeutic modalities to support the regulatory well-being needs of young autistic children, unconventional communicators, and autistic people who have additional learning needs.