Journal of Childhood

Introduction
Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by persistent deficits in reciprocal social interaction and social communication, and restricted patterns of behavior. Studies show that parents of children with ASD are more exposed to psychological stress and anxiety than parents of children with other psychological disorders. Some therapies that can help improve the problems of children with ASD and their parents are Floortime play therapy and the Son-rise program. The latter is a comprehensive, home-based program that helps families and caregivers teach children with ASD in the areas of learning, development, and communication.
One of the variables that can be affected by Floortime play therapy and the Son-rise program is communication skills, which are those skills through which individuals can engage in interpersonal relations and communication. A study examined the effect of floortime play therapy on 200 children with ASD and showed that 58% of these children had improvement in autism symptoms. In another study, 45% of these children improved from good to very good in emotional development. Also, another study examined the use of the floortime therapy in interactions between the mother and the child with ASD, and the results showed a significant difference in the number of communication circles during the intervention period. This study aimed to compare the effectiveness of Floortime play therapy and the Son-rise program in improving the communication skills of children with ASD.

Research Methods
This is a quasi-experimental study with a pre-test/post-test design using a control group. The study population comprised all children with ASD referred to medical centers in Sari, Iran, in 2020. Among them, 45 children were selected through convenience sampling and randomly assigned to two intervention groups (Floortime and Son-rise, each with 15 children) and one control group (n=15). The instrument was the Gilliam Autism Rating Scale–Second Edition (GARS-2) developed by Gilliam (1994). This test has 3 subscales, each with 14 items. The subscales include stereotyped behavior, communication (verbal and nonverbal), and social interaction. The items of each subscale are scored from 0 to 3, with a total score ranging 0-42. A high score indicates the severity of the disorder, and a low score indicates its mildness. Interventions were held in 26 sessions, each for 20 minutes, three days a week. Floortime play is rule-based. This type of therapy is specifically designed for children with ASD to strengthen their social interactions, emotional connections, and cognitive skills. The Son-rise therapy program is designed to enhance children's verbal and nonverbal communication skills. The Shapiro-Wilk test was used to assess the normality of the data distribution, and Levene’s test was used to examine the equality of variances. Also, the homogeneity of the regression slope was evaluated. Then, the research hypotheses were tested using multivariate analysis of covariance (ANCOVA) and Bonferroni’s post hoc test in SPSS software, version 26.

Results
Of the 45 children, there were 10 girls and 5 boys in the Floortime group, 9 girls and 6 boys in the Son-rise group, and 9 girls and 6 boys in the control group. The mean communication skills in the Floortime group were higher than in other groups. The results of multivariate ANCOVA showed that both the Floortime play therapy and the Son-rise program had a positive and significant effect on improving the communication skills of children with ASD. There was a significant difference in the post-test scores of communication skills among three groups. The results of Bonferroni’s post hoc test showed a significant difference between the two intervention groups, where the Floortime group showed greater improvement than the Son-rise group.

Conclusion
The results showed that both the Flortime play therapy and the Son-rise program are effective in improving communication skills in children with ASD. However, there is a significant difference between their efficacy. Flortime play therapy is more effective. The principles of Floortime therapy facilitate the child's movement toward transformational development by focusing on the foundations of communication, emotional exchange, and meaningful application of ideas. The main goal of Floortime is to help children with ASD regulate their emotions, become interested in communicate with others, engage in purposeful two-way interaction, solve complex problems, and think and develop abstract ideas. These factors make Floortime play therapy more effective in improving the communication skills of children with ASD than the Son-rise program.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Islamic Azad University, Sari branch (Code: IR.IAU.SARI.REC.1400.083). The study objectives and methods were explained to the participants, and the confidentiality of their information was maintained. 

Funding
This article was extracted from the thesis of Iman Shahbazi in the field of Psychology at the Islamic Azad University, Sari Branch. The research has not received any financial support from governmental, private, or non-profit organizations.

Authors contributions
The authors contributed equally to the preparation of the manuscript. All authors read and approved the final version of the manuscript for submission.

Conflicts of interest
The authors declare no conflicts of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation and time.



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