This study reports on a 6-year-old boy with autism spectrum disorder who presented with frequent aggressive and destructive behaviors as well as social difficulties, and who received 12 months of relationship-oriented play therapy. Through continuous documentation and analysis of the intervention process, four stages in the process of rule internalization were identified: rule testing, rule experiencing, rule understanding, and rule internalization. The findings indicate that the child initially tested interactional boundaries through repeated rule-violating behaviors, and gradually developed an experience of and understanding of rules within a stable and responsive relational context, ultimately achieving rule internalization and demonstrating increased behavioral stability and contextual flexibility. Further analysis suggests that rule internalization is not a simple process of behavior acquisition, but rather a developmental outcome constructed within relational interactions, accompanied by the coordinated development of language expression, emotional regulation, and social interaction abilities.
JIA Qian
,
ZHU Feng
. Relationship-Oriented Play Therapy Facilitating Rule Internalization in a Child with Autism Spectrum Disorder: A Case Report[J]. Psychological Communications, 2026
, 9(2)
: 132
-140
.
DOI: 10.12100/j.issn.2096-5494.226020
[1] Ainsworth M. D.S., Blehar, M. C., Waters, E.,&Wall, S. N. (1978). Patterns of Attachment. New York:Psychology Press. doi:10.4324/9780203758045.
[2] American Psychiatric Association.(2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.. doi:10.1176/appi.books.9780890425596
[3] Baker J. K., Fenning R. M.,&Moffitt J. (2019). A cross-sectional examination of the internalization of emotion co-regulatory support in children with ASD.J Autism Dev Disord, 49(10), 4332-4338. doi:10.1007/s10803-019-04091-0
[4] Baron-Cohen, S. (1997). Mindblindness:An essay on autism and theory of mind. Cambridge, MA:MIT press.
[5] Bernier A., Carlson S. M.,&Whipple N. (2010). From external regulation to self-regulation:Early parenting precursors of young children's executive functioning.Child Dev, 81(1), 326-339. doi:10.1111/j.1467-8624.2009.01397.x
[6] Bowlby, J. (1988). A secure base:Parent-child attachment and healthy human development. New York:Basic.
[7] Cai R. Y., Richdale A. L., Uljarević M., Dissanayake C.,&Samson A. C. (2018). Emotion regulation in autism spectrum disorder:Where we are and where we need to go.Autism Res, 11(7), 962-978. doi:10.1002/aur.1968
[8] Diamond, A. (2013). Executive functions.Annu Rev Psychol, 64, 135-168. doi:10.1146/annurev-psych-113011-143750
[9] Garcia de Carvalho Laguna, G., Ferreira Gusmão A. L., Defensor da Silva Santos, L., Silva Sousa G., Calhau Barbosa D., Garcia Lorenzo Aguiar M., & Oliveira e Silva, N. (2025). Playfulness in the early stimulation of children with autism spectrum disorder:A systematic review.Psychol Health Med, 1-17.doi:10.1080/13548506.2025.2571986
[10] Kasari C., Gulsrud A., Freeman S., Paparella T., & Hellemann G. (2012). Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play.J Am Acad Child Psy, 51(5),487-495.doi:10.1016/j.jaac.2012.02.019
[11] Kochanska, G.,&Aksan, N. (2006). Children's conscience and self-regulation.J Pers, 74(6), 1587-1618. doi:10.1111/j.1467-6494.2006.00421.x
[12] Kochanska G., Coy K. C.,&Murray K. T. (2001). The development of self-regulation in the first four years of life.Child Dev, 72(4), 1091-1111.
[13] Kochanska, G., & Kim, S. (2013). Early attachment organization with both parents and future behavior problems:From infancy to middle childhood.Child Dev, 84(1), 283-296. doi:10.1111/j.1467-8624.2012.01852.x
[14] Köymen B., Schmidt M. F. H., Rost L., Lieven E.,&Tomasello M. (2015). Teaching versus enforcing game rules in preschoolers' peer interactions.J Exp Child Psychol, 135, 93-101. doi:10.1016/j.jecp.2015.02.005
[15] Lord C., Brugha T. S., Charman T., Cusack J., Dumas G., Frazier T.,.. Veenstra-VanderWeele J. (2020). Autism spectrum disorder.Nat Rev Dis Primers, 6, 5. doi:10.1038/s41572-019-0138-4
[16] Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children.J Consult Clin Psychol, 55(1), 3-9. doi:10.1037//0022-006x.55.1.3
[17] Mesibov G. B., Shea V.,&Schopler E. (2004). The TEACCH Approach to Autism Spectrum Disorders. New York:Springer US.
[18] Ostfeld-Etzion S., Golan O., Hirschler-Guttenberg Y., Zagoory-Sharon O.,&Feldman R. (2015). Neuroendocrine and behavioral response to social rupture and repair in preschoolers with autism spectrum disorders interacting with mother and father.Mol Autism, 6(1), 11. doi:10.1186/s13229-015-0007-2
[19] Pellicano, E. (2012). The development of executive function in autism.Autism Research and Treatment, 2012, 146132. doi:10.1155/2012/146132
[20] Rakoczy H., Warneken F.,&Tomasello M. (2008). The sources of normativity:Young children's awareness of the normative structure of games.Dev Psychol, 44(3), 875-881. doi:10.1037/0012-1649.44.3.875
[21] Sandbank M., Bottema-Beutel K., Crowley S., Cassidy M., Dunham K., Feldman J. I., … Woynaroski T. G. (2020). Project AIM:Autism intervention meta-analysis for studies of young children.Psychol Bull, 146(1), 1-29. doi:10.1037/bul0000215
[22] Schmidt M. F. H., Rakoczy H.,&Tomasello M. (2012). Young children enforce social norms selectively depending on the violator's group affiliation.Cognition, 124(3), 325-333. doi:10.1016/j.cognition.2012.06.004
[23] Trawick-Smith, J. (2019). Young Children's Play:Development, Disabilities, and Diversity. New York:Routledge. doi:10.4324/9780367198077.
[24] Uljarevic, M., & Hamilton, A. (2013). Recognition of emotions in autism:A formal meta-analysis.J Autism Dev Disord, 43(7), 1517-1526. doi:10.1007/s10803-012-1695-5
[25] Vygotsky L. S.(1980). Mind in Society:Development of Higher Psychological Processes. Cambridge, MA, USA:Harvard University Press. doi:10.2307/j.ctvjf9vz4
[26] Wolfberg P. J.(2010). Play and Imagination in Children with Autism. New York:Teachers College Press. doi:10.65528/9780807771129.