INTRODUCTION:

The majorgoals ofthe nurseinhealth promotionisto helpfamilies andtheir childrenstrive for higherlevelofwellnessand topreventillness. The nurse is concerned not only with individual families but also with high risk groups of children. The nurse can fulfil these goalsthrough individualor groupeducationofparents, children, schoolteachers, andother groupswhoseconcernis for the health of the youngestsegment ofourpopulation.

The leadinghealthindicators, the ‘healthy people 2010’ provides a frameworkforidentifyingessentialcomponentsofchildhealthpromotionprogrammes, designedto preventfuture healthproblemsin ournation’schildren (Department of health and human service, 2007). The present total population of children in the world is 2.2 billion where in India, 13.1 percent of the population are children (Census, 2011).

One of the most distressing handicaps among the children in any society is mentally challenged children. A recent World Bank study noted that the proportions of disabled children in developing countries are generally higher than developed countries. Nearly 80 million of world population is estimated to be mentally disabled and in India 2 percent of the total population is suffering from mental disability and about 3 percent of children are mentally challenged. Among them 20 per 1000 are in rural and 16 per 1000 are in urban set- up (Census, 2001). The percentage of mental disability in Tamilnadu was 0.3 percent (NSSO on Survey Disability, 2002).

The prevalence of mental retardation was 94 persons per 1 lakh population. Among mentally retarded population, about 20 million persons are mildly retarded and about 4 million are moderately and severely retarded (Mental Retardation Discovery Publication, 2000).

Mental retardation is defined as sub-average of general intellectual functioning which originates during developmental period and is associated with impairment in adaptive behaviour. The causes of low intelligence or mental handicap are difficulties and injuries during labour, severe illness or injury in early life, premature birth, epilepsy or fits caused by fever during early life, biological and genetic disorders, drinking alcohol, smoking or drug intake by the pregnant mother, severe malnutrition and emotional trauma(Dorfman, 1951).

Child development is a process in which many areas exist, it includes physical development, which is the most recognized and observable change in the life of a child and it largely depends on the child’s health and motor development. Cognitive development means to acquire the ability of understanding, recognizing, problem solving and logical thinking. Social and emotional development entails the acquisition of skills needed to play and work with peers to communicate with adults, be aware of the social customs within one’s community. Language development consists of several subsystems that have to do with sounds, meaning and speech over a period of time. Self care and daily living skills or adaptive development refers to the ability of the developing child to care for him or herself appropriate for their age (Centre for Improvement of Child Caring, 2000).

Mental retardation causes drastic consequences on life of the children. The consequences are developmental delay in cognitive, social, and emotional development, speech and language development, fine motor and gross motor skill development (Landreth, et al., 1991). Social development means acquisition of the ability to behave in accordance with social expectations, where as motor development means acquisition of the ability to do the activities. Cognitive development means the ability to learn and solve problems, and speech and language development refers to the ability to understand and use language (Pati et al., 1996).

Play is a spontaneous natural activity of children as breathing. It is universal expression of children, and it can transcend difference in ethnicity, language or other aspect of culture (Drewes and Atheena, 2009). For children, play act as a means of communicating with their world. Play therapy is a treatment of choice for helping children who are experiencing emotional difficulties. Child specialist seems to agree that naturally occurring play is important for physical and motor development, social and emotional development of children (Ginsburg, 2007). Play can improve the child’s sense of power and control that comes from solving the problems and mastering new experiences, ideas and concerns. As a result, it can help to build the confidence and accomplishment. Play and social development go hand in hand. Play therapy is one of the specific types of therapy that has proven to be beneficial for children with mental retardation (Moor, 2002).

Non-directive play therapy is one of the specific types of play therapy for children evaluated by past research. Non-directive play therapy is based on Carl Rogers ‘person centred therapy’ which adapts the ideation that people have the ability and capacity to strive towards growth and self actualization when given nurturing conditions (Gueerney, 1976). The objective of non-directive play therapy is to help the child become self aware and self directed. Non-directive play therapy allows children themselves to determine contents and action in the play room, within basic limits set by researcher (Dorfman, 1951).

Axline, (1947) assumes that children are able to arrive at therapeutic insights and instigate therapeutic changes for themselves and do not require suggestions, interpretations and direction from therapist under permissive conditions and he applied non-directive play therapy principles which emphasised the attitudes and personal characteristics of the therapist as a essential factor in promoting change known as child centred or non-directive play therapy. Therapeutic relationship based on genuiness, authenticity, unconditional positive regard, acceptance, and empathetic understanding of the child, in order to support psychological development and growth, decreased emotional and intellectual problems of mentally challenged children.

NEED FOR THE STUDY:

Enhancing the quality of young children’s lives is now a national and international priority. Early childhood development emphasize a holistic approach focusing on the child’s physical, emotional, social as well as language development from conception to age of five. Child development is a process in which many areas exist, it include physical development, cognitive development, social and emotional development, language development, self care and daily living activities or adaptive development (Centre for Improvement of Child Caring, 2000).

Developmental delay is a condition that occurs during the developmental period of child’s life. It is characterized by lower intellectual functioning and is accompanied by significant limitations in communication, self care, vocational, academic skills, health and safety. Developmental delay has many different causes which ultimately affect the functioning of the central nervous system. The common signs consist of delayed acquisition of milestones, fine/gross motor difficulties, poor social skill, aggressive behaviour, communication problems and limited reasoning (Centre for Improvement of Child Caring, 2000).

Play can be nearly as important as food and sleep and is a natural means of expression for children. Symbolically through play, children can begin to understand and express their world. Play is not only central but critical to childhood development. Through play the child grows, develops, learns, and ultimately matures. Play is promoted by United Nations 1989 convention, as a right of child (Roopanarina, and Johnson, 1994).

Play has several benefits to children with mental retardation. It can help the children to develop social skills and friendships. When children develop appropriate play skills, they learn how to interact with their environment and the people within it. In case of mentally challenged children, play help to develop social skills, self care skills and language skills (Frederic, 1992).

Play therapy is a developmentally responsive modality uniquely suited for children to help and resolve psychosocial difficulties and achieve optimal growth and development (Black et al., 2002). Play therapy means of creating intense relationship experiences between therapist and children, in which play is a principle medium of communication (Wilson Kate, 2000). Play therapy is effective for children who are experiencing a wide variety of social, emotional, behavioural and developmental problems including anxiety, aggression, depression, ADHD, low self esteem, social withdrawal, post traumatic stress and developmental delay (Liles, and Packman, 2009).

There are two approaches in the play therapy that are directive approach where the researcher assumes responsibility for guidance and interpretation of the play interactions and non-directive approach where the researcher leaves the responsibility and direction of the therapeutic process to the child (Rasmussen, and Cunningham,1995). Non-directive play therapy is a mode of therapy that helps children to understand painful experiences and upsetting feelings. Play is child’s natural form of expression which allows them to communicate at their own level without even using a words having put into words. Play allow the child to release needs, fears, wishes, it also help them to address emotional and behavioural difficulties.

Mentally challenged children lack cognitive ability to communicate meaningfully with their thoughts, feelings, and experiences through the abstract means of verbal language. The concrete objects like toys, art and other play based experiences are provided through play therapy and encourage them with emotionally safe means to express their difficult experiences as a developmentally responsive modality for the mentally challenged children.

Community health nurse’s responsibility is not only helping the families and the communities but also to care the high risk groups of children for higher level of wellness and make them as productive citizen. Play therapy is such an intervention helps in the development of mentally challenged children. Hence, based on the above cited information and literature, the researcher planned to take an effort to conduct a study to assess the effect of non-directive play therapy on development among mentally challenged children.

REVIEW OF LITERATURE:

A case study was conducted by Virginia Ryan and Orit Jospi (2000) at United Kingdom, to assess the effect of non –directive play therapy for children with autism. After 16 sessions of play therapy, the study concluded that the child was able to enter into therapeutic Relationship demonstrated attachment behaviour towards the therapist A quasi- experimental study was conducted by Renukadutta and Manjumehta(2006) at AIMS, New Delhi, to assess the effect of non-directive play therapy in management of somatoform disorders. Sample size was 15 children between the age group of 5-11years. After 25 sessions of non-directive play therapy and 3 reflective counselling sessions for parents, the result showed that the mean score of global functioning and social competence increased and symptoms of severity decreased significantly at post assessment. So, child centred play therapy along with reflective parent counselling is an effective intervention for somatoform disorders

A study was conducted by Virginia Ryan (1999) at University of York, United Kingdom to assess the effect of non-directive play therapy with maltreated, neglected and children with delayed developmental milestone. Result showed that non-directive play therapy improve the framework of attachment and cognitive development.An interventional study was conducted by Morrison and Newcomer (1975) to assess the effectiveness of directive versus non-directive play therapy for mentally challenged children below 11years of age. Sample size was 12 and it compared 11 sessions of directive play therapy with that of non-directive play therapy and with non-intervention control group. The mentally challenged children in both treatment groups made improvement on fine motor-adaptive and personal-social skill on Denver Developmental screening test than the control group. No evidence that directive or non-directive was more effective.

STATEMENT OF THE PROBLEM:

Effect of non-directive play therapy on development among mentally challenged children in selected Institutions of Coimbatore

OBJECTIVES:

1 To assess the development of mentally challenged children.

2 To implement non-directive play therapy for mentally challenged children.

3 To assess the development of mentally challenged children after non-directiveplay therapy

OPERATIONAL DEFINITION:

1.Effect:

Effect refers to the change in the developmental level of mentally challenged children after non directive play therapy.

2. Non-directive Play Therapy:

A form of play therapy given for mentally challenged children, where the researcher leaves the responsibility of selecting the play materials to the children and guides them during their play. The play materials included are building blocks, push and pull toys, crayons for colouring pictures, a doll with removable cloths, battery operated toys, toy scissors, threads with beads, rhymes, bowl and spoon, ball, musical toys, attractive objects and picture book.

3. Development:

It refers to the level of communication, self-help, social and motor skills of mentally challenged children, when assessed by developmental delay preschool scale.

4. Mentally challenged children:

The children of 3 to 6 years of age residing at Amrit Centre for Special Needs and Women’s Voluntary School for Special Children (W.V.S) at Coimbatore who are clinically diagnosed as mild, moderate and severe mentally challenged.

HYPOTHESES:

H₀₁:

There is no significant difference between parents and teachers in assessing the development among mentally challenged children.

H₁:There is a significant difference among experimental group on developmentbefore and after non-directive play therapy among mentally challenged children.

H₀₂:There is no significant difference among control group on development before and after non-directive play therapy among the mentally challenged children.

H₂:There is a significant difference between experimental and control group on development after non-directive play therapy among mentally challenged children.

CONCEPTUAL FRAME WORK:

The conceptual frame work used for the study is based on general system theory.

METHODOLOGY:

1.Research design:

The research design selected for the study was Quasi-experimental, Pre-test-Post test Control Group Design

2. Setting:

The study was conducted at Amrit Centre for Special Needs and Women Voluntary School for Special Children managed by private organisation located at Koundampalayam, Coimbatore.

3. Population:

He target population for the present study is mentally challenged children

4. Sampling:

Stratified random sampling technique was adopted to choose the sample. The population was divided into three strata based on the level of Intelligent Quotient (I.Q) such as mild, moderate, and severe mental retardation. Therewasonlyonesampleinthefirststrataandit wasexcludedfromthestudy (mild). The second strata consist of 14 participants (moderate). Third strata consist of 2 participants (severe). On lottery method from each stratum, equal numbers of samples (8) were alternatively allocated toexperimental and control group respectively. The final size of sample was 16

5. Criteria for sample selection:

Inclusion Criteria:

1. Children who are clinically diagnosed as mild, moderate and severe mentally retarded, between the age group of 3 to 6 years.

2. Child’s parents who are willing to give consent to participate in the study.

Exclusion Criteria:

1. Children with profound mental retardation

2. Autistic children

3. Children with Cerebral palsy

6.Variables of the study:

The independent variable of the present study was non-directive play therapy and the dependent variable is development namely motor, social, communication, and self help skill.

7.Materials for the study:

1.Personal Information:

Personal information consist of child’s age, sex,primary care taker and educational qualification of caretakers, experience in care taking, history of mental retardation and degree ofmental retardation.

2.Developmental delay preschool scale (American speech-language-hearing association in 1983):

The scale was developed by American speech-language-hearing association in 1983, which measures the developmental level of preschool children.This scale consists of twenty seven statements divided under 4 domains -communication, self help, social and motor skills. Communication indicates the child’s ability to communicate verbally and nonverbally. Self help is ability to perform daily activities like feeding, toileting, and grooming .Social skill indicate the child’s skill to socialise with family members and other children. Motor skill consists of fine motor and gross motor activity. Numerous independent studies using the scale for preschool children throughout the world have supported high validity and reliability. Thecontent validityofthe toolwas obtainedfromexperts in thefield of community health department and necessarysuggestionswereincorporatedin the tool.

The response was scored as 0,1,2,3.Score 0- No,indicatethat the child is not able toperformthetask,1- Unsure, indicatethat the childisnotabletoperformtaskcorrectly, 2- Sometimes, indicatethat the child is perform the taskat times and 3- Yes,indicatethat the childableto performthe task.

The maximum score is 81 and minimum score is 0. The score was interpreted as 0-28 severe delay, 29-56 moderate delay, and 57-81 mild delay. The lowest score indicate severe delay and highest score suggest mild delay

3.Non-directive play therapy:

The procedure for non-directive play therapy was adopted from the principles given by Virginia Axline (1947) which was derived from Carl Rogers’s client-centred form of therapy. Non-directive play therapy allows children themselves to determine the contents and action in the playroom under the guidance of the researcher.

RESULTS:

1.Distribution of personal information:

Thistable shows the age distribution of children ranging from 3 to 6 years. In experimental group, 38 % of each were 3 years and 5 years old respectively and 25 % were 4 years old. In control group, 25 % of each were 3 years and 4 years old and 50 % were 5 years old. The gender distribution reveals that there were equal numbers of male and female children in both experimental and control group. The distribution on degree of mental retardation shows that 88 % of children had moderate mental retardation and 12 % had severe mental retardation in both experimental and control group which shows homogeneity in both groups. The distribution of history of mental retardation shows the 50 % of them in experimental and control group had birth difficulties, and in 38 % in experimental group and 25 % in control group had history of preterm birth and 13 % in experimental group and 25 % in control group had family history of consanguineous marriage. The distribution of educational status of care taker (mother) shows that 50 % in experimental and 62 % in control group had primary level education while 12 % in control group had secondary level education. In experimental group 26 % were graduate and 24 % were post graduate while in control group 26 % had post graduation degree. The distribution on experience of mothers shows an equal distribution on years of experience among mothers in control and experimental group.

2. Analysis of variance on development score of teachers and parents of mentally challenged children among experimental and control group:

one way analysis of variance test (anova) was calculated to find out the difference in score given by teachers and parent among mentally challenged children.

Table2.1. Analysis of variance of teachers score and parents score of experimental group (N=8)

Source of variation	Sum of squares	Degree of freedom	Mean square	‘F’
Between the sample	600.16	1	600.16	2.410
Within the sample	3485.48	6	248.96	2.410

The above table shows the calculated ‘F’ value obtained in experimental group 2.410 is lesser than the table value at F_8.(1,6). Thus, there exist homogeneity between the score of teachers and parents.

Table2.2 Analysis of variance of teachers and parents score of control group(N=8)

Source of variation

Sum of Squares

Degree of

freedom

Mean square

‘F’

Between the sample

42.24

41.24

0.2556

Within the sample

2251.98

160.85

The above table shows the ‘F’ value obtained in control group 0.2556 is lesser than table value at F_8,(1,6). Thus, there exist homogeneity between the score of teachers and parents.

3. Analysis on development score of mentally challenged children before and after intervention:

Paired‘t’ test was calculated to find out the influence of non-directive play therapy on the development scores of mentally challenged children before and afterintervention of experimental group and control group

Table 3.1 mean, standard deviation, mean difference and ‘t’ value of experimental group (N=8)

Intervention	Mean	SD	Mean Difference	‘t’
Before Therapy	47	14.739	10	3.48*
After Therapy	57	14	10	3.48*

The mean score of mentally challenged children before receiving non-directive play therapy for experimental group was 47 and it increased to 57 after the intervention. This is evident that non-directive play therapy has influenced the development of mentally challenged children. The obtained‘t’ value 3.48 compared with table value 2.365 is found to be significantly higher at 0.05 level with 7 degrees of freedom. Thus, the alternative hypothesis H_1, “There is a significant difference among experimental group on development before and after non-directive play therapy among mentally challenged children” is accepted. While comparing the scores of before and after interventional condition, the result shows that there is a significant increase in the mean score from 47 to 57. Hence, the non-directive play therapy might have contributed in raising the scores of development

Table 3.2.mean, standard deviation, mean difference and ‘t’ value of control group(N=8)

Intervention	Mean	SD	Mean Difference	‘t’
Before Therapy	34	9.816	0.434	2.186
After Therapy	36	10.25	0.434	2.186

The mean score of mentally challenged children in control group of pre-test shows a score of 34, and the post test was slightly increased to 36 without interventions, ’t’ test was used to test if there exists any significance in the mean difference.The calculated‘t’ value 2.186 was compared with table value 2.365 at 7 degrees of freedom with 0.05 level of significance. So, the calculated value was lesser than the table value. Thus, the null hypothesisH₀_,“There is no significant difference among control group on development before and after non-directive play therapy among mentally challenged children” is accepted. While comparing the pre-test and post-test scores of control group, the result shows that there is no significant increase in the mean scores.

4.Analysis of experimental group and control group after non-directive play therapyTable.4.1(n==8)

Group	Mean	Mean Difference	‘t’
Experimental Group	56.5	20.5	2.856*
Control Group	36	20.5	2.856*

*Significant 0.05 level

The mean score of mentally challenged children in control group shows 36 and experimental group shows 56.5. A’t’ test was used to test if there exist any significance in the mean difference. The calculated‘t’ value 2.856, is compared with the table value 2.145 at 14 degrees of freedom with 0.05 level of significance. The calculated value was higher than table value. Thus, the alternative hypothesis H₂, “There is a significant difference between experimental and control group on development after non-directive play therapy among mentally challenged children” is accepted. While comparing the scores in experimental and control group after intervention, it shows that there is increases in the experimental group mean score. Hence non-directive play therapy might have contributed in raising the scores of development. While comparing the pre-test and post-test score of the control group, there is no difference observed, where as the experimental group exhibited a difference in the post-test score. The significant difference obtained in the experimental group between, before and after interventional condition is due to the exposure of non -directive play therapy.

5.Analysis of four domains before and after intervention:

Paired ‘t’ test was calculated to find out the influence of non-directive play therapy on each domains score of mentally challenged children before and after intervention

The above table shows the mean difference of mentally challenged children in each domain. Themeandifferences weretestedusing‘t’ testto analysesthelevelofsignificanceineach domainindividually. The calculated‘t’ valueofself help skill- 2.86, social skill-2.92, motor skill-0.479, and communication skill-1.618 was compared with table value of 2.365 at 7 degrees of freedom with 0.05 level of significance. The calculated‘t’ value was higher in self help skill and social skill. While the other two domains, communication and motor skill value was lesser than the table value. Thus, the results exhibit that non-directive play therapy had influenced in enhancing the self help skills and social skills of mentally challenged children.

6. Relationship between selected personal information and the level of development:

Karl Pearson’s coefficient of correlation was used to assess the influence of selected personal information and development score.

Table 6.1 influence of personal information on development(N= 16)

Demographic variables	‘r’
Degrees of mental retardation	-0.46166

The above results indicate the influence of degrees of mental retardation on development score of mentally challenged children. It is found that, degrees of mental retardation and development was negatively correlated

DISCUSSION:

1. Findingsrelatedto personal information of samples:

In the present study, out of 16 samples, 8 children belong to experimental group and 8 belong to control group. there were 3 years and 5 years children each 38 percent in experimental group and 25 percent were 4 years old. in control group, 25 percent of them are in 3 years and 4 years respectively and 50 percent belongs to 5 years old.withtherespecttogenderdistributiontheequalnumberofmaleandfemalechildrenare there in experimentandcontrolgroup. Based on their educationalqualificationofparents,50 percentinexperimentaland62 percentincontrolgrouphadprimaryleveleducationwhile 12 percentincontrolgrouphadsecondaryleveleducation. Inexperimentalgroup,26 percentweregraduateand24 percentwerepostgraduatewhileincontrolgroup,26 percenthadpostgraduatedegree. Withrespectto the teacher’seducation,100 percentofthemin experimental group had diploma in special education andin control group, 50 percent of teachers haddiplomain special education, and50 percent them were post graduate in special education. The distribution of experience of teachers shows that 75 percent of teachers had 3 years experience and 25 percent of teachers had 7 years experience in experimental group and in control group 50 percent of teachers had 3 years experience and 50 percent teachers had 7 years experience.

The distribution of years of experience of mothers shows that there was equal distribution on years of experience among mothers in control and experimental group. Basedon degreesof mentalretardationofchildren,88 percentofthemhadmoderatementalretardationand 12 percent had severementalretardationinbothgroups. The history of mental retardation reveals that 50 percent of them in experimental and control group had birth difficulties and 38 percent in experimental group and 25 percent in control group had the history of preterm birth and in 13 percent in experimental group and 25 percent in control group had the family history of consanguineous marriage. National sample survey organization (NSSO, 2003) showed that 3 percent of the mental retardation was due to birth difficulties and 2 percent of them due to hereditary related factors in India.

2. Analysis of variance of teacher’s and parent’s score in assessing the development of mentally challenged children:

The‘F’ valueobtainedin ordertofindoutthe significantdifferencebetweenparentsandteachersscore. Thecalculated‘F’ valueofexperimentalgroupwas2.410,controlgroupwas0.2556comparedwith tablevalue4.6001at(1,6)degreesoffreedomwith0.05 levelofsignificance. Thusthecalculatedvalueof experimentalandcontrolgroupwaslesserthanthetablevalue.

Hence, the null hypothesis H_01,“There is no significant difference between parents and teachers in assessing the development of among mentally challenged children” is accepted. Itis provedthatthereisno significantvariationbetweenparentsandtheteachersscore. Thus, there exist homogeneity between the score of teachers and parents.

3.Effect of non-directive play therapy in terms of development of mentally challenged children:

The meanscoreofdevelopmentofchildbefore receivingnon-directive playtherapyfor experimentalgroup was 47anditincreasedto 57after theintervention. This proves that non-directive play therapy shows positive difference in their development of children. The calculated‘t’ value3.48 was greater whencomparedwithtablevalue 2.365at 7degreesof freedomwith 0.05 levelsignificance. Hence, the alternative hypothesis H₁,“There is a significant difference among experimental group on development before and after non-directive play therapy among mentally challenged children” is accepted. The finding is consistent with the study by Morrison, (1974) on effective use of non-directive play therapy had significant effect was found on social and self help skills,among mentally challenged children.

In control group, pre-test mean score was 34 and post-test score was 36. Thecalculated‘t’ value 2.186 was less when compared with the table value 2.365 at7 degreeoffreedomwith0.05 levelofsignificance.Hence, the null hypothesis H_02,“There is no significant difference among control group on development before and after non-directive play therapy among the mentally challenged children” is accepted.

The‘t’ valuewasobtainedin orderto find-outsignificancebetweenthetwo groupafterthenon-directiveplaytherapy.Thecalculated‘t’ value2.856 wascomparedwithtablevalue2.145 at 14 degrees freedom with 0.05 levelsignificance. The calculated value was higher than the table value. Hence,itis foundthatthereissignificantdifferenceintheexperimentalandcontrolgrouppost-testscore.

Hence, the alternative hypothesis H_2,“There is a significant difference between experimental and control group on development after non-directive play therapy among mentally challenged children” is accepted. Thisprovedthatnon-directiveplaytherapyiseffectiveforthedevelopmentofmentallychallengedchildren. These findings are consistent with study by Newcomer, (1975) on effective use of non-directive play therapy has a significant effect among experimental group children than control group children.

4.Comparison of domains score in terms of development:

Thecalculated‘t’ valueindomains were communication skill -1.618, selfhelp skill -2.86, socialskill - 2.92andmotorskill- 0.479, and it wascomparedwithtable value 2.365at 7 degreesof freedomwith0.05levelofsignificance.The calculated value was higher in self-help skill and social skill compared with table value. Whiletheothertwodomain, the calculatedvalue was lesser incommunicationskillandmotorskill compared with the table value, thisindicatethat non-directiveplaytherapyhad moreeffecton self-helpskill and socialskill.

5.Relationship between selected personal information and development:

Karl Pearson’s co-efficient of correlation was calculated to find out the influence of degree of mental retardation and development score among mentally challenged children.

Thisreveals the influence of degrees of mental retardation and development score was negatively correlated (r= -0.461). It is observed that when severity increases (degrees of mental retardation) the level of development score decreases. Similar observation was reported by Pati et al, (1996).

CONCLUSION:

This chapter summarizes the major findings, limitations, implications in the field of nursing education, nursing practice, nursing research and recommendations.

The study was conducted with the objective to find out the effect of nondirective play therapy on development among mentally challenged children. The conceptual framework of this study was based up on Bertanlaffy’s general systemtheory (1980). Review of literature brought out many facts about magnitude of mental disability, play therapy, and non-directive play therapy intervention on development for mentally challenged children.

A quantitative approach was used for the study. This study was conducted at Amrit Centre for special needs and W.V.S for special children at Coimbatore. A Quasi experimental, Pre test- Post test control group design was adopted for the study. Stratified sampling technique was used to select the samples. Total number of samples selected for the study was 16. Developmental level was assessed using Developmental delay preschool scale.Non-Directive play therapy was administered for a period of 21 days and level of development was reassessed with same scale.Paired‘t’ test was used to find out the relation before and after administering nondirective play therapy. This study indicates that the administration of nondirective play therapy improve the development of mentally challenged children.

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Asian J. Nur. Edu. and Research.2017; 7(4): 482-490.

DOI:10.5958/2349-2996.2017.00094.5

Domains	Before		After		Mean difference	‘t’
Domains	Mean	S.D	Mean	S.D	Mean difference	‘t’
Communication skill	17	4.52	18.25	4.83	1.25	1.618
Self-help skill	9.25	8.42	12.75	8.11	3.5	2.86*
Social skill	12.87	3.18	16.62	3.03	3.75	2.92*
Motor skill	7.87	2.40	8.62	4.02	0.75	0.479