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Blanco, Muro,Holliman,Stickley, & Carter(2015)Stulmaker & Ray(2015)Cheng & Tsai(2014)*Individual CCPT1630 minutesIndividual CCPTR 12-1630 minutesIndividual CCPT10First gradersN 59Ages 6-76% African American17% Hispanic/Latin69% Caucasian2% Asian AmericanChildren who scored inclinically anxious rangeN 53Ages 6-821% African American21% Hispanic/Latin45% Caucasian2% Asian11% BiracialChildren identified as sociallywithdrawnN 7Ages 9-10100% TaiwaneseMeany-Walen,Bratton, &Kottman (2014)Ojiambo &Bratton (2014)Individual AdlerianPTR 14-1730 minutesGroup activity PTM 1650 minutesChildren with disruptivebehaviorsN 58Ages 5-919% African American48% Hispanic/Latin33% CaucasianDisplaced orphans in Ugandawith behavioral problemsN 60Ages 10-12Children who participated in CCPT demonstratedstatistically significant improvement on academicachievement as compared to children in thecontrol group. All children demonstratedstatistically significant improvement onperformance anxiety.Children who received CCPT significantlydecreased their overall levels of anxiety andworry when compared to an active control group.Children in the CCPT treatment groupdemonstrated statistically significant decrease insocial withdrawal but no significant change inself-concept. Authors employed non-parametric analyses dueto low participant numberChildren in therapy demonstrated statisticallysignificant decreases in disruptive behaviorproblems as compared to children in activecontrol group. Teachers also reported astatistically significant reduction in teacher-childrelationship stress for children in theexperimental group.Results demonstrated statistically significantdecreases in behavioral problems with moderateto large effect sizes over children in activecontrol group.100% AfricanRay, Stulmaker,Lee & Silverman(2013)Individual CCPTR 12-16 sessions30 minutesChildren with clinicalimpairmentN 37Ages 5-832% African American38% Hispanic/Latin30% CaucasianCCPT group demonstrated decreased levels ofimpairment with medium effect size whereaschildren in the delayed-start control group hadconsistent or increased levels of impairment.Association for Play Therapy, Inc., 401 Clovis Ave., #107, Clovis, CA 93612 USA, (559) 298-3400, Fax (559) 298-3410, a4pt.orgPage 5 of 20

ko, &Jones (2013)Schottelkorb,Doumas, &Garcia (2012)Individual CCPTR 17-2130 minutes42% African American39% Hispanic/Latin18% CaucasianIndividual CCPTM 1730 minutesBlanco & Ray(2011)Individual CCPT1630 minutesFarahzadi,Bahramabadi, &Mohammadifar(2011)*Gestalt PT1090 minutesJalali & Molavi(2011)*Children with disruptivebehaviorsN 543-4 years oldRefugee children with traumasymptomologyN 26Ages 6-1368% African American16% Middle Eastern10% Asian6% OtherAcademically at-riskN 431st grade17% African American34% Hispanic/Latin46% CaucasianChildren with social phobiaN 124th gradeChildren in CCPT demonstrated statisticallysignificant decreases in disruptive behaviors overchildren in active control group.Results indicated that both CCPT and TF-CBTwere effective in reducing trauma symptomsaccording to child and parent report.Children in the CCPT treatment groupdemonstrated significantly significantimprovement on academic achievementcomposite score over children in delayed-startcontrol group.Children in play therapy decreased scores of thediagnosing and severity factors of social phobiasymptoms.100% from TehranGroup PT6Children with separationanxietyN 30Ages 5-11Authors found that children who participated ingroup play therapy demonstrated statisticallysignificant reduction in separation anxiety ascompared to no-treatment control group.100% from IsfahanNaderi, Heidarie,Bouron, & Asgari(2010)Activity-based PT101 hourChildren diagnosed with ADHDand anxietyN 80Ages 8-12100% IranianRay, Henson,Schottelkorb,Brown, & Muro(2008)Individual CCPT1630 minutesChildren with emotional andbehavioral difficultiesN 58Pre-K-5th grade7% African American41% Hispanic/Latin45% Caucasian7% BiracialChildren in therapy demonstrated statisticallysignificant decreases in symptoms of ADHD andanxiety as compared to no-treatment controlgroup. Children in therapy demonstratedstatistically significant improvement in socialmaturity as compared to control group.Results indicated that both intervention groups(short and long-term play therapy) demonstratedsignificant improvement in teacher-studentrelationship stress. Post hoc analyses indicatedthat the short-term intensive interventiondemonstrated statistical significance and largereffect sizes in overall total stress, teacher andstudent characteristics.Association for Play Therapy, Inc., 401 Clovis Ave., #107, Clovis, CA 93612 USA, (559) 298-3400, Fax (559) 298-3410, a4pt.orgPage 6 of 20

Ray (2007)Ray,Schottelkorb &Tsai (2007)Individual CCPT1630 minutesIndividual CCPT1630 minutesChildren with emotional andbehavioral difficultiesN 93Ages 4-1113% African American41% Hispanic/Latin42% Caucasian4% BiracialChildren with Attention DeficitHyperactivity (ADHD)symptomsN 60Ages 5-1117% African American38% Hispanic/Latin45% CaucasianFlahive & Ray(2007)Danger &Landreth (2005)Garza & Bratton(2005)GroupSandtray/PlayTherapy1045 minutesGroup CCPT2530 minutesIndividual CCPT1530 minutesChildren with behavioraldifficultiesN 56Ages 9-129% African American62% Hispanic/Latin28% CaucasianChildren who qualified forspeech therapyN 21Ages 4-619% Hispanic/Latin81% CaucasianChildren demonstratingbehavioral problemsN 29Ages 5-11100% Hispanic/LatinPackman &Bratton (2003)Humanisticallybased activitygroup/play therapy1260 minutesChildren with learningdisabilities and behavioralproblemsN 244th & 5th gradeResults demonstrated significant decreases inteacher child relationship stress with large effectssizes in total stress for all three treatment groups(play therapy, teacher consultation and playtherapy, and teacher consultation only).Results indicated that both conditionsdemonstrated statistically significantimprovement on ADHD, student characteristics,anxiety, and learning disability. Children in CCPTdemonstrated statistically significantimprovement over active control children onstudent characteristics, emotional stability andanxiety/withdrawn.Children in sandtray/play therapy groupdemonstrated statistically significant differencesas rated by teachers in total, externalizing, andinternalizing behaviors when compared todelayed-start control group. Parents ratedsandtray/play participants significantly differenton externalizing behaviors.Results revealed that children in CCPTdemonstrated increased receptive languageskills and expressive language skills with largepractical significance over children in the notreatment control condition.Compared to comparison group (evidence-basedschool intervention), children receiving CCPTshowed statistically significant decreases inexternalizing behavior problems and moderateimprovements in internalizing behavior problemsas reported by parents.Children in therapy demonstrated decreases inexternalizing and internalizing problems withlarge effect sizes over the no-treatment controlgroup.4% African American4% Hispanic/Latin92% CaucasianAssociation for Play Therapy, Inc., 401 Clovis Ave., #107, Clovis, CA 93612 USA, (559) 298-3400, Fax (559) 298-3410, a4pt.orgPage 7 of 20

Fall, Navelski &Welch (2002)Individual CCPT630 minutesChildren identified for specialeducationN 66Ages 6-1098% Caucasian2% UnidentifiedJones &Landreth (2002)Individual CCPT1230 minutesChildren with diabetesN 30Ages 7-113% African American7% Hispanic/Latin87% CaucasianShen (2002)Group CCPT1040 minutesChildren at high-risk formaladjustment following anearthquakeN 30Ages 8-12Results demonstrated no difference between thegroups in self-efficacy but teacher ratingsshowed decreased problematic behavior andless social problems for the experimental groupas compared to the no-treatment control group.Both groups improved anxiety scores; theexperimental group showed a statisticallysignificant increase in diabetes adaptation overthe no-treatment control group.CCPT group demonstrated a significantdecrease in anxiety, as well as a large treatmenteffect, and significant decrease in suicide risk ascompared to the no-treatment control group.100% TaiwaneseTyndall-Lind,Landreth &Giordano (2001)Individual & groupCCPT1245 minutesChildren living in domesticviolence shelterN 32Ages 4-1039% African American21% Hispanic/Latin40% CaucasianChildren in sibling group play therapydemonstrated a significant reduction in totalbehavior, externalizing, and internalizingbehavior problems, aggression, anxiety,depression and significant improvement in selfesteem. Results indicated that sibling group playtherapy was equally effective to intensiveindividual play therapy.R Range of number of sessions; M Mean number of sessions; N Total number of children in study; CCPT Child centeredplay therapy; TF-CBT Trauma-focused cognitive behavioral therapy*Details limited due to study published in language other than English. Information taken from abstract.Observational StudiesObservational studies (N 25) provide credible evidence that play therapy is effective when exploring its application with singlecase experimental designs (6 single case studies using baseline measures for control and data analyses), quasi-experimentalstudies (3 studies using comparison or control groups, measurement, and data analysis but do not use random assignment),and cohort groups measured over time (10 repeated measures single group studies).Single-Case Experimental Designs:Rigorous single case experimental designs (SCED) in which researchers utilized baseline control phases, multiple datacollection points, intervention protocols, and current data analysis methods provide evidence that play therapy interventionprovides substantial and effective treatment to children who are not demonstrating improvement prior to treatment.Schottelkorb and Ray (2009) demonstrated positive effect of play therapy on children demonstrating clinical levels of ADHDsymptoms. Swan and Ray (2014) found that CCPT decreased hyperactivity and irritability behaviors for children withintellectual disabilities following treatment intervention. The authors found that these improvements were maintained afterthree weeks of no treatment. Schottelkorb, Swan, Jahn, Haas, and Hacker (2015) explored behaviors of children who werereported to have clinical levels of somatization problems. Analysis revealed that play therapy was highly effective inAssociation for Play Therapy, Inc., 401 Clovis Ave., #107, Clovis, CA 93612 USA, (559) 298-3400, Fax (559) 298-3410, a4pt.orgPage 8 of 20

decreasing somatization problems and improving classroom behaviors. For children who were diagnosed with autism, WareBalch and Ray (2015) found play therapy improved their social-emotional competencies while Garofano-Brown (2010) foundyoung children with developmental delays who participated in short-term play therapy demonstrated improved developmentallyappropriate behaviors and increased developmental age. Finally, Swank, Shin, Cabrita, Cheung, & Rivers (2015) modifiedCCPT for a nature-based intervention and found that three of four participants demonstrated substantial improvement inbehavioral problems during intervention phases. In exploration of the effectiveness of Adlerian play therapy, Meany-Walen &Teeling (2016) reported children who participated in play therapy demonstrated improved on-task behaviors at an effective orhighly effective level.Balch and Ray (2015) found play therapy improved their social-emotional competencies while GarofanoBrown (2010) found young children with developmental delays who participated in short-term play therapy demonstratedimproved developmentally appropriate behaviors and increased developmental age.Quasi-Experimental Designs:Quasi-experimental designs that employed comparison and control groups, as well as pre and post measures, also providedcredible evidence for the use of play therapy. Three of four quasi-experimental designs focused on the exploration of playtherapy with children identified as aggressive. Momeni and Kahrizi (2015) found that preschoolers who completed 10 sessionsof sand play therapy demonstrated significant decreases in aggressive behaviors. They also found that these lower levels ofaggression were maintained for two months post-treatment. Ray, Blanco, Sullivan, and Holliman (2009) found that CCPTshowed a moderate decrease in aggressive behaviors over a control group. Schumann (2010) found that participation in eitherCCPT or evidence-based guidance curriculum resulted in significant decreases in aggressive behavior, externalizingproblems, and internalizing problems. Finally, Kollbrunner and Seifert (2013) explored the use of play therapy with parentconsultations in the reduction of voice disorders in children. After 3 to 5 play therapy sessions, children in the play therapygroup showed less hoarseness, less physical tension, and more willingness to speak while their mothers demonstrated lessneed to talk, persuade the child out of his or her wishes, and less shouting to the child at home.Single Group Designs:Using a repeated measures cohort group design, 10 studies contributed evidence to the effectiveness of play therapy. Muro,Ray, Schottelkorb, Smith, and Blanco (2006) demonstrated significant improvement in total problem behaviors and ADHDcharacteristics following CCPT for children in a school setting. Tsai and Ray (2011) found that individual and group CCPT in acounseling clinic setting resulted in significant improvement on externalizing, internalizing, and total problem behaviors. Theyalso found that children with higher levels of internalizing and externalizing benefited more from CCPT than children with lowerproblem levels. Bayat (2008) also found that children in CCPT demonstrated a significant reduction in internalizing problems.Ray (2008) demonstrated the wide-reaching effects that CCPT can have on a variety of presenting concerns for 202 childrenwho were referred to a counseling clinic, including externalizing problems, combined externalizing/internalizing problems, andnon-clinical problems. Results from Ray (2008) indicated that the benefits from CCPT increase with the number of sessions,reaching statistical significance at 11-18 sessions.In exploring the use of play therapy with children who have experienced trauma or traumatic events, several studies havedemonstrated the impact of play therapy. Mahmoudi-Gharaei, Bina, Yasami, Emami, and Naderi (2006) explored the usegroup play therapy with children who had experienced the loss of a family member in an earthquake. Their studydemonstrated a significant reduction in trauma-related symptoms and behavioral problems following group play therapy.Results from a study with children referred for possible sexual abuse found an increased sense of competency over the courseof CCPT (Scott, Burlingame, Starling, Porter, & Lilly, 2003). In working with children who were homeless, Baggerly (2004)demonstrated that children who participated in CCPT had significant improvements in self-concept, competence, negativemood, and negative self-esteem related to depression and anxiety. Additionally, Baggerly and Jenkins (2009) found thatchildren who were homeless and who participated in CCPT were found to have statistically significant improvement on thedevelopmental strand of internalization of controls and diagnostic profile of self-limiting features.CCPT seems to have a positive influence on parent-child and teacher-child relationships. Muro et al. (2006) demonstrated thatCCPT significantly improved teacher child relationship stress. Dougherty and Ray (2007) used CCPT with children whosepresenting concerns were behavioral problems. The study found that children demonstrated statistically significant decreasesin parent-child relationship stress with strong practical effects.Researchers in India demonstrated the effectiveness of CCPT with children diagnosed with somatoform disorders (Dutta &Mehta, 2006). Results from their study indicated that CCPT significantly decreased symptom severity and problem behaviors,with increases in global functioning. Blanco, Ray, and Holliman (2012) found that children who had engaged in CCPTdemonstrated statistically significant improvement on academic achievement.Association for Play Therapy, Inc., 401 Clovis Ave., #107, Clovis, CA 93612 USA, (559) 298-3400, Fax (559) 298-3410, a4pt.orgPage 9 of 20

Observational Study DescriptionsAuthorsMeany-Walen &Teeling (2016)Schottelkorb,Swan, Jahn,Haas, & Hacker(2015)Type, #, &Session LengthGroup & individualAdlerian PTR 10-1230/individual45/groupIndividual CCPT1430 minutesDesignSCEDSample DescriptionFindingsChildren who scoredclinically on off-taskbehaviors and reported tohave poor social skillsN 3Age 1st-2nd gradeAll 3 participants demonstratedimprovement in on-taskbehaviors at an effective orhighly effective level.Children who scoredclinically on somatizationsymptomsN 2Age 4SCEDBoth children demonstrateddecreased somatization andclassroom behavior problems.Analysis of data revealedtreatment as highly effective.2 CaucasianWare Balch &Ray (2015)Individual CCPTR 12-2230 minutesChildren diagnosed withAutism SpectrumDisorderN 5Ages 6-9SCED1 African American1 Hispanic/Latin3 CaucasianSwank, Shin,Cabrita, Cheung,& Rivers (2015)Momeni, K., &Kahrizi, S.(2015)*Meany-Walen,Bullis, Kottman,& Dillman Taylor(2015)Nature-basedIndividual CCPT1430 minutesSand play therapy1045 minutesGroup Adlerian PT645 minutesChildren with behavioralproblems as identified byteacherN 4Ages 6-84 African AmericanSCEDQuasiexperimentalpre/postcontrol groupdesignSCEDChildren in preschooldemonstrating aggressivebehaviorsN 54100% from IranChildren with clinicalexternalizing behaviorproblemsN 3Ages 6All participants demonstratedimprovement in socialcompetence. Three of 5participants demonstratedimprovement in self-regulationand empathy with largest gainsin empathy.Two of four participantsdemonstrated improvement inbehavioral concerns andmaintained behavior during postintervention phase while oneparticipant demonstratedimprovement late in interventionphase.Children demonstratedstatistically significant decreasesin aggressive behaviors. Resultsindicated that results weremaintained for two months posttreatment.Two participants demonstratedhighly effective improvement inon-task behavior duringtreatment but questionable to noimprovement at follow-up. Datanot reporte

Lin and Bratton (2015) conducted meta-analysis with 24 child-centered play therapy studies and concluded that play therapy demonstrated a statistically significant effect. Ray, Armstrong, Balkin, and Jayne (2015) performed . Play therapy RCTs serve as credible evidence that play therapy is effective across ages 3 to 12 years old and with various