The Effectiveness of Polyvagal Theory-Based Therapy on Social Skills and Behavioral Problems in Students with Developmental Intellectual Disabilities
Volume 15, Issue 59, Summer 2026, Pages 163-201
https://doi.org/10.22054/jpe.2025.85937.2825
Zahra Abbasi Kerdabadi, Amir Ghamarani
Abstract Developmental delays in brain growth significantly limit the academic, social, emotional, and behavioral abilities of individuals with intellectual disabilities. In recent years, Polyvagal Theory has emerged as a robust framework for addressing various psychological challenges. Therefore, the aim of this study was to investigate the effectiveness of Polyvagal Theory-based therapy on social skills and behavioral problems in students with developmental intellectual disabilities. This quasi-experimental research employed a pre-test, post-test design with a control group. A convenience sampling method was used to select 30 students with developmental intellectual disabilities, who were then assigned to either the experimental or control group. The experimental group underwent 10 sessions of 90-minute interventions (two sessions per week). The research tools included the Social Skills Rating Scale (SSRS) by Gresham and Elliott (1990) to assess social skills and behavioral problems. Data were analyzed using analysis of covariance (ANCOVA) in SPSS software. The results indicated that the Polyvagal Theory-based intervention package significantly improved social skills (F = 19.94, p = 0.001) and reduced behavioral problems (F = 16.43, p = 0.001) at a significance level of 0.05. According to the findings of this study, Polyvagal Theory-based therapy had a significant impact on enhancing social skills and reducing behavioral problems in students with developmental intellectual disabilities. These findings offer positive outcomes for children with special needs.
The Relationship Between Sensory Processing and Behavioral Problems/Social Interactions in Children with Autism Spectrum Disorder: The Mediating Role of Anxiety
Volume 14, Issue 56, Autumn 2024, Pages 1-38
https://doi.org/10.22054/jpe.2025.81187.2719
Dhulfiqar Abdul Mahdi Lafta, khodamorad momeni, jahangir karami, Haider Hatem Alijrish
Abstract Abstract
This correlational study investigated the relationships between sensory processing, behavioral problems, and social interactions in children with autism spectrum disorder (ASD), examining anxiety as a mediating variable using structural equation modeling. Participants included 200 parents of children with ASD in Kermanshah (2023), selected through convenience sampling. Measures comprised the Dunn Sensory Profile (2014), Bellini and Hopf Social Skills Questionnaire (2007), Achenbach and Rescorla Child Behavior Checklist (2001), and Rogers Anxiety Scale (2016). Results revealed: (1) a significant negative relationship between sensory processing and behavioral problems mediated by anxiety (β = -., p <.01), and (2) a significant positive relationship between sensory processing and social interactions, again with anxiety mediation (β =., p <.01). These findings indicate that sensory processing difficulties substantially impact both communication skills and behavioral challenges in children with ASD through anxiety pathways. The study highlights the need for comprehensive interventions addressing sensory regulation, emotional control, and social communication differences in ASD populations.
Keywords: sensory processing, behavioral problems, social interactions, anxiety, autism spectrum
Extended Abstract
Introduction
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by persistent deficits in social communication and interaction, alongside restricted, repetitive patterns of behavior, interests, or activities (Siu et al., 2020). As one of the most prevalent neurodevelopmental disorders, ASD affects approximately 1 in 68 children worldwide (Agaz et al., 2018). Clinical presentations frequently include comorbid conditions such as intellectual disabilities (31%), epilepsy (20%), enuresis (15%), and attention-deficit/hyperactivity disorder (ADHD) in 30-50% of cases (Mohammadi et al., 2019). Core features typically manifest as atypical language comprehension, impaired social communication, and differences in nonverbal gestural interactions (O'Hearn et al., 2013).
Communication and language impairments represent core challenges in Autism Spectrum Disorder (ASD), with many children initially referred for evaluation due to parental concerns about delayed language development. Research emphasizes the critical importance of early language acquisition, particularly achieving functional communication skills by age five, as this significantly predicts long-term developmental outcomes (DiStefano et al., 2016; Eigsti et al., 2011). The DSM-5 delineates two diagnostic criteria for ASD: (1) persistent deficits in social communication and social interaction across multiple contexts, and (2) restricted, repetitive patterns of behavior, interests, or activities (American Psychiatric Association, 2013; Özért & Alikak, 2018). These communication difficulties manifest across various domains, including verbal and nonverbal expression, social reciprocity, and pragmatic language use.
Language development in children with ASD shows considerable heterogeneity in severity and progression. While some children acquire language without significant delays, approximately 25% fail to develop functional language skills over time (Klinger et al., 2003). These variations are clinically significant, as language concerns represent one of the most common reasons parents seek initial evaluations. Notably, early pragmatic language abilities - particularly the functional use of language in social contexts - serve as strong predictors of long-term developmental outcomes and adaptive functioning (Tager-Flusberg et al., 2005). Understanding this spectrum of language development is crucial for early identification and intervention planning.
Atypical sensory processing - including both hyper-responsiveness (over-sensitivity) and hypo-responsiveness (under-sensitivity) - is a common feature of ASD that significantly impacts multiple developmental domains (Feldman et al., 2020; Williams et al., 2018). This fundamental neurological process organizes sensory information from internal and external environments, enabling appropriate behavioral responses. Hyper-responsiveness, characterized by heightened or aversive reactions to sensory stimuli (Siu et al., 2020), often co-occurs with other clinical challenges. Research consistently links sensory processing differences in ASD with sleep disturbances, impaired social-communication skills, reduced adaptive functioning, and elevated anxiety symptoms (Ben-Sasson et al., 2009; Mazurek et al., 2013). These associations underscore the cascading effects of sensory dysregulation on daily functioning and quality of life.
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ASD is characterized by two essential features: (a) persistent deficits in social communication and social interaction across multiple contexts, and (b) restricted, repetitive patterns of behavior. These characteristics typically appear early in childhood and result in challenges in daily life (Özçetin & Alıkak, 2018). Language development levels in children with ASD can vary greatly; while some children do not experience any language delays, functional language does not improve in 25% of cases (Klinger et al., 2003). Understanding the differences in language development in ASD is crucial, as parents often cite delayed language development as a primary concern. Additionally, early language pragmatics are closely tied to long-term outcomes (Tager-Flusberg et al., 2005).
Research Question:
Does anxiety mediate the relationship between sensory processing difficulties and (a) behavioral problems and (b) social interaction challenges in children with autism spectrum disorder?
Literature Review
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by challenges in social interaction and restricted, repetitive patterns of behavior, interests, or activities (Siu et al., 2020). As one of the most prevalent neurodevelopmental conditions, it affects approximately 1 in 68 children (Agaz et al., 2018). Research indicates that 86% of individuals with ASD experience at least one comorbid condition, including intellectual disability, epilepsy, enuresis, or attention-deficit/hyperactivity disorder (Mohammadi et al., 2019). Characteristic features include differences in language comprehension, social communication difficulties, and atypical gestural interactions (O'Hearn et al., 2013). The acquisition of functional language skills by age five represents a critical developmental milestone that significantly influences long-term outcomes (DiStefano et al., 2016; Eigsti et al., 2011). Additionally, sensory processing differences, particularly hyper-responsiveness and hypo-responsiveness to environmental stimuli, are commonly observed in ASD and may substantially affect adaptive functioning (Feldman et al., 2020).
Sensory processing difficulties in ASD are consistently associated with sleep disturbances, impaired social skills, reduced adaptive functioning, and elevated anxiety (Ben-Sasson et al., 2009; Mazurek et al., 2013). Existing research demonstrates that sensory challenges may adversely affect mental health outcomes, highlighting the need for further investigation in this domain (Ben-Sasson et al., 2009). Importantly, sensory differences show significant associations with both behavioral difficulties and anxiety symptoms, with evidence suggesting that sensory processing patterns and anxiety may mediate the relationship between core ASD symptoms and functional impairments (Green et al., 2012; Khaledi et al., 2022). The current study seeks to address critical gaps in the literature by examining the interrelationships among sensory processing, social interaction challenges, and behavioral problems, with particular emphasis on anxiety's mediating role in children with ASD.
Methodology
The present study is a descriptive-correlational investigation utilizing structural equation modeling (SEM). The statistical population includes all children with autism spectrum disorder (ASD) in Kermanshah in 2023, with a sample selected through convenience sampling. Accounting for a 10% dropout rate due to incomplete or damaged questionnaires, we distributed questionnaires to 200 participants. Sample size determination followed established guidelines: Stevens' analysis recommends 15 cases per predictor variable in regression analyses, while Loehlin suggests that models with 2-4 factors require at least 100 cases (preferably 200), confirming our sample's adequacy for path analysis (Momeni et al., 2022). Inclusion criteria were: (1) DSM-5 ASD diagnosis confirmed by a psychiatrist, (2) GARS-3 score >54, (3) parental consent, (4) untreated anxiety with no treatment in the past year. Exclusion criteria included visual impairment, hearing loss, and epilepsy. We administered four instruments: the Anxiety Scale for Children with ASD (ASC-ASD), Child Behavior Checklist (CBCL), Social Skills Inventory, and Sensory Profile 2.
After obtaining ethical approval and confirming the study proposal, questionnaires were distributed across ASD rehabilitation centers. Participants received detailed information about research objectives, confidentiality protocols, and data anonymity. Researchers verified inclusion criteria through preliminary screening questions and medical record reviews, with ASD diagnoses confirmed using the GARS-3 scale. Collected data were analyzed using SPSS-26 and Amos-24 software. Four standardized measures were employed: (1) the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD) for anxiety symptom assessment, (2) the Child Behavior Checklist (CBCL) for evaluating emotional/behavioral problems, (3) the Social Skills Inventory for measuring social behaviors, and (4) the Sensory Profile 2 for assessing sensory processing patterns. This methodological approach facilitated comprehensive data collection and analysis to examine relationships between sensory processing, behavioral challenges, and anxiety symptoms in children with ASD.
Results
Researchers evaluate model-data fit using goodness-of-fit indices, with the chi-square statistic (χ²) serving as the primary indicator of discrepancy between the hypothesized model's covariance matrix and the observed sample's matrix. The null hypothesis assumes perfect fit between model and data. However, χ²'s sensitivity to sample size necessitates supplemental indices: χ²/degrees of freedom (χ²/df) ratio, Goodness-of-Fit Index (GFI), Adjusted GFI (AGFI), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Standardized Root Mean Square Residual (SRMR), and Root Mean Square Error of Approximation (RMSEA). Acceptable model fit is typically indicated by RMSEA/SRMR values <0.08 and CFI/TLI values >0.90. Following initial analysis, we improved model fit by adding covariance relationships between error terms, resulting in final fit indices demonstrating acceptable model specification.
The path analysis revealed three key findings: First, sensory processing demonstrated a significant negative direct effect on anxiety (β = -0.056, p <.05) but no significant direct effect on behavioral problems (β = -0.032, ns). Second, sensory processing showed a significant positive direct effect on social interactions (β = 0.094, p <.05). Third, anxiety exhibited strong opposing effects - a significant negative impact on social interactions (β = -0.883, p <.001) and a significant positive effect on behavioral problems (β = 0.731, p <.001). Crucially, bootstrap analysis confirmed that sensory processing significantly influenced both behavioral problems (indirect effect = -0.041, 95% CI [-0.078, -0.012]) and social interactions (indirect effect = 0.049, 95% CI [0.018, 0.088]) through its mediation via anxiety, accounting for 56.2% and 34.3% of total effects respectively.
Discussion
This study examined anxiety's mediating role in relationships between sensory processing and both social skills and behavioral problems in children with ASD. Our results demonstrate that sensory processing influences behavioral and social outcomes primarily through anxiety pathways. These findings align with established literature, particularly regarding anxiety's mediation between sensory processing and social skills (Machado et al., 2024; Khaledi et al., 2022; Tsuji et al., 2022). Klynek et al. (2016) specifically found that children with ASD showing better sensory processing exhibited superior academic and communicative performance, with sensory scores positively correlating with most communication measures. Their work further revealed distinct sensory processing patterns in ASD that significantly correlate with communication impairments. Notably, social relationships showed strong positive associations with all sensory processing patterns, underscoring sensory processing's crucial role in shaping social communication abilities (Klynek et al., 2016). These collective findings, including supporting evidence from Watson et al. (2011) and Baker et al. (2008), substantiate that sensory processing patterns significantly contribute to ASD symptom severity profiles.
The findings suggest a potential shared mechanism between sensory processing difficulties and communication challenges in children with ASD. Consistent with previous research (Lane et al., 2010), sensory hypo-responsiveness was associated with poorer communication and social functioning. Our results revealed significant negative correlations between social relationship scores and all anxiety subscales, indicating a bidirectional relationship where anxiety reduction may improve social functioning and vice versa - a finding that aligns with Davis et al. (2011). Green et al. (2012) proposed that anxiety stems from maladaptive sensory processing patterns; specifically, sensory avoidance behaviors may limit participation in daily activities, while hyper-responsiveness can create barriers to engagement (Miller et al., 2007; Lane et al., 2012). Notably, communication skills demonstrate complex relationships with anxiety, where increased communication deficits may either alleviate or exacerbate anxiety depending on individual profiles. These findings underscore the clinical importance of addressing both sensory processing patterns and social relationship factors in ASD interventions (Khaledi et al., 2022).
Conclusion
The observed mediating role of anxiety in the sensory processing-behavioral problems relationship aligns with previous findings (Lane et al., 2012; Green et al., 2012; Wigham et al., 2015; Moore et al., 2021). Although behavioral problems frequently occur in children with ASD, their association with anxiety remains understudied. While existing research has established connections between behavioral problems, sensory difficulties, and anxiety in ASD populations, our study represents the first Iranian investigation employing cross-sectional methodology to examine these relationships. The characteristic link between sensory differences and behavioral problems - likely stemming from sensory processing challenges - constitutes a core feature of ASD (Siu et al., 2020). Our results demonstrated significant negative correlations between all sensory processing patterns/subscales and anxiety subscales, supporting Green et al.'s (2012) conclusion that sensory processing abnormalities directly contribute to anxiety development in this population.
These findings suggest that clinical interventions for anxiety in children with ASD should prioritize assessment and modification of sensory processing patterns. This approach is supported by Delapiazza et al. (2018), who demonstrated significant negative correlations between overall sensory scores and all anxiety subscales in ASD. The results indicate that heightened anxiety levels in children with ASD are associated with exaggerated responses to sensory stimuli. Importantly, these children manifest anxiety through diverse behavioral presentations, including internalizing, externalizing, and non-social behaviors - a phenomenon that remains understudied in ASD populations. This study investigated the interrelationships among communication differences, behavioral problems, sensory processing difficulties, and anxiety in children with ASD. The results indicate that children with ASD experiencing communication and behavioral challenges often demonstrate impaired sensory modulation, with sensory processing deficits showing significant associations with heightened anxiety. Importantly, anxiety mediated the relationship between sensory processing issues and both communication differences and behavioral problems. These findings highlight the need for multimodal interventions addressing sensory regulation, emotional control, and communication development in ASD.
Several study limitations warrant consideration. First, the exclusion of children receiving anxiety treatment limits generalizability to this population. Second, our reliance on volunteer participants with service access may not represent the broader ASD community. Third, the cross-sectional design precludes causal inferences about the observed relationships between sensory processing, anxiety, communication, and behavioral outcomes. Future longitudinal research could help establish temporal relationships and causal pathways among these factors.
Acknowledgments
The authors extend their deepest appreciation to the participating families for their invaluable contribution to this research. We are equally grateful to the collaborating rehabilitation centers for their support and to the clinical professionals who generously shared their expertise throughout this study.
The Response to Intervention Program of Third Type of Social-Emotional Learning on Behavioral Problems, Alexithymia, School Bounding and Emotional Regulation Disability: A Synthesis-Research Approach
Volume 14, Issue 53, Winter 2024, Pages 229-261
https://doi.org/10.22054/jpe.2023.75356.2605
shahrooz nemati, rahim badri, Mohammad Arshadtaleshmekaeil
Abstract The purpose of this research was to systematic examination and present a meta-combination of the research related to the third kind of socio-emotional learning for elementary students with a specific learning disability. The study was qualitative using a meta-combination with synthesis study approach. The needed data were collected through a search of keywords of socio-emotional learning, specific learning disability, a neuro-developmental disorder in the library resources, theses, and the articles existing in the databases of ERIC, Google Scholars, PubMed, Science Direct, Scopus, Springer, Magiran, Irandoc during 1990-2021. In order to search for the information in the Iranian and foreign databases was used both in separation and in combination. The theoretical bases and the main and combination concepts were extracted, and the concept was analyzed and classified. The results of the examination and analysis of the studies and research showed that the intervention program of the third kind of socio-emotional learning was effective in the fields of psychological problems and disorders. The findings of this research by identifying the nature of the intervention program of the third kind of socio-emotional learning show that regarding the existing theoretical and experimental, this idea could be proposed as an instructional package for the students with a specific learning disability. Keywords: Response to Intervention Program of Third Type of Social-Emotional Learning, Behavioral Problems, Alexithymia, School Bounding, Emotional Regulation. Extended Abstract Introduction A specific learning disability is a neuro-developmental disorder that continuously involves learning and a much wider range of cognitive problems that are often ignored in school (Jabarzadeh et al., 1402). These disorders are identified based on the data obtained from different sources about the emotional or behavioral functions of the person and must appear in at least two different situations, one of which is school (Manuel, 2020). Among the challenges faced by children with specific learning disabilities is alexia (Cerutti et al., 2020), which is used to describe people who cannot identify and express their emotions (Auerbach et al., 2008). Also, they have fewer social skills, and compared to their brothers and sisters, they experience more physical and behavioral problems, they cannot understand and identify their emotions, and instead, they look for their emotional arousal to grow up. and they misinterpret their physical problems (Porcelli et al, 2013). Another concept that is raised in the relationship between the child and the school is the connection with the school, which refers to the relationship that a person has with the school and other aspects of academic life (McDoniel & Bierman, 2022). Different approaches have been made to help this group of children in the field of special learning disorders, but in the new assessment model called the response-based intervention model, the effort is to emphasize the role of the educational environment in the assessment and interventions of education. This model is based on the identification and determination of shortcomings and inabilities and includes a set of decisions that guide interventions at 3 levels as follows: Interventions aimed at the progress of all students (first level). These interventions are deeper and are used for students who are at risk of academic failure (second level) and then more intensive. It is suitable for students for whom second-level interventions are not enough (third level). The level of progress of these students is tracked and finally, students who have special learning needs and should be examined with diagnostic methods beyond the usual psychological tests are identified (Shojaei and Rostami, 2016). Therefore, considering the existence of many psychological problems such as behavioral problems, alexia, school connection, and emotional regulation in children with specific learning disabilities, in the present study, the results of research that has been conducted in the field of social-emotional learning approach are examined. By analyzing and combining the results of this research, we can design a framework and an intervention program based on a qualitative study of the research synthesis type. The findings of the present research lead to the expansion and adjustment of the views related to the social-emotional learning approach and specific learning disabilities, and it is a training package for educational psychologists and therapists of specific learning disabilities. Therefore, the main question of this research is raised as follows: What are the components of the social-emotional learning program for students with specific learning disabilities? Methodology This qualitative study employed a meta-combination synthesis approach to gather data on socio-emotional learning and specific learning disabilities. Information was collected from various library resources and databases such as ERIC, Google Scholars, PubMed, Science Direct, Scopus, Springer, Magiran, and Irandoc spanning from 1990 to 2021. Theoretical bases and key concepts were extracted, analyzed, and classified to form the foundation of the study. Results Through the application of research synthesis methodology and the categorization of data from 14 internal and external sources selected based on their alignment with the research's title, purpose, questions, and methodology, this study has identified 16 subcategories and 8 primary articles. The examination of these sources reveals a notable focus by researchers on the educational framework of social-emotional learning that corresponds with the principles and strategies of social-emotional learning. Consequently, an initiative was taken to construct a comprehensive package by integrating elements such as self-awareness, emotional recognition, regulation strategies, empathy narratives, problem-solving skills, stress-coping mechanisms, decision-making processes, and SMART goal-setting. This holistic approach facilitates a thorough exploration of each foundational aspect of social-emotional learning. Discussion The findings of this study shed light on the crucial role of social and emotional learning training for individuals with special learning disorders, advocating for the integration of such interventions by therapists alongside other treatments. This approach not only fosters social integration and enhances interpersonal relationships among peers but also empowers individuals to gain self-awareness, facilitating improved interactions with peers, teachers, family, and society. The research identified limitations related to emotional expression and regulation influenced by educational and cultural factors, as well as interpersonal and social challenges. Future qualitative research could benefit from incorporating the key concepts derived from this study and exploring their application among the parents of these children. Given the robust theoretical and empirical foundation of the educational package designed for students with special learning disabilities, it stands as a valuable tool to support this demographic.
Relationship between early maladaptive schemas and personality traits with behavioral problems in students
Volume 10, Issue 40, Autumn 2020, Pages 211-234
https://doi.org/10.22054/jpe.2021.55178.2216
Jafar Rahmanzadeh Moghadam, Galavizh Alizade, Mohammad Rostami
Abstract Adolescents as one of the vulnerable age groups are exposed to a variety of psychological problems. The aim of present study was to investigate the relationship between early maladaptive schemas and personality traits with internalizing and externalizing behavioral problems. The present study is descriptive and correlational. In this study, 362 male high school students in Boukan city were selected using multi-stage cluster sampling method and completed the questionnaires of Behavioral Problems of Achenbach (1991), Schema Young (1998) and Neo short form (1992). Pearson correlation coefficient and multivariate regression were used to analyze the data. Regression analysis showed that 12% and 26% of the variance of internalizing behavioral problems and 15% and 20% of the variance of externalizing behavioral problems are due to early maladaptive schemas and personality traits in students, respectively. Early maladaptive schemas and personality traits have the potential to predict internalizing and externalizing behavioral problems in students. early maladaptive schemas and personality traits in students, respectively. Early maladaptive schemas and personality traits have the potential to predict internalizing and externalizing behavioral problems in students.
Relationship between Resilience and Happiness in Parents with Behavioral Problems in Elementary School Students
Volume 7, Issue 26, Summer 2017, Pages 159-176
https://doi.org/10.22054/jpe.2017.22110.1567
Somayeh Amini, Mahdieh Sadat Khoshouei
Abstract The study was done to determine the relationship between resilience and happiness in parents with behavioral problems in elementary school students in Isfahan. It was a descriptive and correlative research. The statistical population was all elementary school students that studying in Isfahan during 2014-2015. From statistical population 120 students were selected through multistage cluster sampling. The data was collected using resilience and happiness questionnaires and parent form of child behavior checklist. Pearson’s correlation, simultaneous regression and Multivariate analysis of variance (MANOVA) were used to analyze data. The results showed that there is a significant negative relationship between resilience of parents and emotional, anxiety, hyperactivity and oppositional behavior problems. Happiness of parents was significantly negatively correlated with emotional, anxiety, physical, hyperactivity, oppositional behavior and conduct problems. Resilience of parents predicted hyperactivity problem and happiness of parents predicted emotional, anxiety, physical, oppositional behavior and conduct problems. Also, there were no difference between girls and boys in terms of the dimensions of behavioral problems. This result emphasizes that parents’ traits have essential role in behavioral problems of girl and boy students.
