Introduction
As of 2020, the number of children with disabilities is 75,482 (0.98%) out of 7,710,946 children in total, and the ratio of children with disabilities has been steadily increasing since 2014. There are 35,517 children with intellectual disabilities (47.1%) and 15,454 children with autism spectrum disorder (20.5%) among developmental disabilities, accounting for approximately 70% of all children with disabilities (Korea Disabled People’s Development Institute, 2021). Children with developmental disabilities face a wide range of difficulties in terms of capacity and daily life from birth to adulthood due to developmental imbalances such as developmental delays and peculiar developmental patterns as well as problems in information processing and control in the brain (Kim and Ko, 2019). In particular, cognitive developmental delay, difficulty in communication, and lack of emotional expression lead to defects in adaptive ability, resulting in interpersonal problems, depression, and anger that cause problems in emotional development and behaviors (Lee et al., 2013). Moreover, continuous control, overprotection, and disregard from parents and people around them lead to a latent negative psychological state that they are not acknowledged, which causes stress and develops into problem behaviors (Lee and Choi, 2000; Shin, 2020). Problem behaviors refer to all behaviors that attack oneself or others, damage the physical environment or objects, and interrupt acquisition of new skills, thereby ultimately isolating oneself from the society (Iwata et al., 1994; Kim and Kim, 2018). Due to the prolonged COVID-19 pandemic, the number of problem behaviors (challenging behaviors) increased due to reduced outdoor activities of people with disabilities, and the crisis in family care was raised as an issue (Lee and Lee, 2020; Lee, 2020). Problem behaviors result in deteriorating of the quality of life of not only oneself but also people around them (Kazdin et al., 1993). If left unattended or not intervened, problem behaviors become more serious and diversified, resulting in poor academic performance, difficulties in peer relationships, and deprivation of educational opportunities, thereby performing a dysfunctional role in living as a member of the community in adulthood (Kim and Kim, 2018; Shin, 2020). Childhood, the period in which problem behaviors mostly occur, is the most important period for human behavioral development. It is necessary to develop intervention and prevention programs for problem behaviors for different characteristics of school-age children with developmental disabilities in particular, so that they can actively participate in the program to properly relieve energy and stress and have a positive experience of emotional stability (Park and Sim, 2010; Baek, 2015; Jo, 2017; Lee et al., 2017; Shin, 2020).
The plant environment, which has a physiological and psychological healing effect on humans, turned out to be effective in relieving stress and tension, providing emotional stability for children, alleviating problem behaviors, alleviating impulsive and aggressive behaviors, reducing depression and anxiety, and improving sociality and self-confidence (Song et al., 2004; Lee and Kim, 2007; Shin et al., 2007). A garden is a space that is made beautiful in form by planting plants, and it brings psychological benefits to humans (Kaplan, 1973; Shoemaker, 1982). The natural environment can improve the mental health of children with developmental disabilities, and activities in a garden can stimulate the vitality and diversity of materials and sensory organs, enabling repetitive year-round programs to feel a sense of achievement through the results of the activities (Son, 1997). DeMarco et al. (1999) argued that behaviors are improved when the garden is the venue of learning in a report on the role of school gardens, and Simon and Straus (1998) claimed that turning over garden soil, removing weeds, and raking fallen leaves are effective ways to alleviate aggressive behaviors of participants. As such, gardening activities enable children that are far from nature to recover their relationship with nature in life, and can help them gain psychological benefits and mental health.
Therefore, this study investigates the effect that a program based on gardening activities has on changes in problem behaviors in the garden of a university campus, which is the natural environment of the community, by applying the program according to the characteristics of children with developmental disabilities.
Research Methods
Procedures
To ensure the ethics of the research method and design after formulating the research plan and investigating the research necessity and theoretical background, we conducted the experiment after the deliberation and approval of the Institutional Review Board (IRB) (CUIRB-2021-0032).
Participants
This study was conducted on 13 children with developmental disabilities living in D Metropolitan City and G City. The participants selected were students in the special class of a general elementary school or a special education school with intellectual disabilities, autism spectrum disorder, and borderline intellectual functioning who have no problem walking. We selected 13 students who understood the purpose, content, method, period, and safety of research among the consent approved by the IRB and who voluntarily agreed to the consent form. As for the children’s type and severity of disability, there were 5 children with intellectual disabilities (2 mild, 1 moderate, 2 severe) and 5 children with autism spectrum disorder (1 mild, 1 moderate, 3 severe). There was also 1 child with severe multiple disabilities of both autism spectrum disorder and intellectual disabilities, and 2 children with borderline intellectual functioning. There were 10 male and 3 female participants, and 6 were 7–10 years old and 7 were 11–13 years old, showing an average age of 10.5 ± 2.1.
Tools
Program design
The program includes activities such as observing nature and walking on the pine grove trail and cherry road on campus, creating and maintaining a garden that is specifically made for children with developmental disabilities to do gardening activities, plant and tend plants, and create craftwork using garden plants. The program was organized for children to relieve stress and naturally express their emotions by providing pleasure and comfort with activities that enable them to interact with nature using the garden and plants as materials. The gardening program is designed to have total 30 sessions, including visiting the garden, learning about garden plants, planting plants, expanding the garden family (propagation), managing plants, keeping records about the garden, designing the garden, organizing the garden, making crafts using plants produced in the garden, enjoying the garden (art of expressing oneself through physical actions such as observing the garden, taking a walk, and exercising), understanding the garden and the program, and learning about animals, birds, and insects in the garden (Table 1).
For the plants in the garden, we selected familiar and colorful autumn herbaceous plants we can often see in seasons among those appearing in the special curriculum, as well as Korean native Chrysanthemum morifolim and bulbaceous plants; herbs and aquatic plants that can stimulate the senses with fragrances and bring psychological stability; and vegetables that children are familiar with as food and that show rapid growth (Table 2), for which we sowed the seeds for each. Moreover, we planted climbing plants such as Hedera helix and Trachelospermum asiaticum on the gate structure to design the garden and planted Nandina domestica with fancy red leaves and fruits to create a hedge.
Program implementation
The program was implemented from August 21 to November 27, 2021 at D University Campus in G City, Gyeongsangbuk-do, twice a week on Wednesday afternoons (15:00–18:00) and Saturday mornings (09:00–12:00), 180 minutes per session. The first 30 minutes of each session were introduction that prepared for gardening activities (mood check using the smiley face rating scale, physical exercise, getting dressed), followed by 120 minutes of gardening activities, and then wrap-up in the last 30 minutes (cleanup, break, mood check using the smiley face rating scale). In the 120 minutes of the main activities, we repeated 40 minutes of activities and 20 minutes of break twice, considering the physical safety of children.
Discrete Trial Training (DTT, or Lovaas Method), a behaviorism theory-based program, was applied as an intervention method to gardening activities to reduce and prevent problem behaviors. The three-step guided compliance training method was used when instructions had to be followed by the participants, such as planting plants. This is a method that has the participants perform tasks through a three-step process of vocal prompt, vocal plus model prompt, and vocal prompt plus physical guidance. The participants are praised if they follow the instructions during vocal prompt and vocal plus model prompt, and not praised during vocal prompt plus physical guidance (Kim and Kim, 2018). DTT was to help the positive interactions between the teacher and the child. Moreover, the teacher showed interest and praised even minor actions during the activities, selecting social reinforcement methods such as vocally praising while patting on the shoulder and saying ‘Well done’ and ‘You’re the best!’ (Kim and Choi, 2008) (Figs. 1 and 2).
Activity spaces
A healing garden was created for children with developmental disabilities in a part of the training center for the Department of Landscape Architecture on D University campus, and the program was implemented in three types of spaces, with the forest trail as Green Exercise Garden (1), and around the cherry road and the octagonal pavilion garden as Green Exercise Garden (2) (Table 3, Fig. 3).
The main activity space for children’s gardening program was the ecological experience garden within the healing garden, with 8 beds arranged so that 2 children can face each other on 1 bed. The size of each bed was 180 × 90 × 25 (cm), and the vertical length was divided in half to create a private garden. In addition, it was used as a space for gardening activities and rest in the outdoor learning and resting area within the healing garden.
Assessment tool
Child Behavior Checklist for Ages 6–18 (CBCL6–18)
The CBCL6–18 was used to measure the changes in children’s problem behaviors. The subscales were internalizing behaviors (anxiety/depression, withdrawal/depression, physical symptoms), externalizing behaviors (rule-breaking behavior, aggressive behavior), social immaturity, thought problem, attention problem, and other problems to assess psychological emotions and problem behaviors (Kim et al., 2014). There were 113 items in the form of a parent-report questionnaire rated on a 3-point Likert scale, conducted before, during, and after the program. The test before the program was held after the caregiver orientation in Session 1, the test during the program was held after the gardening program in Session 16, and the test after the program was held in the indoor activity room after completing all 30 sessions of the program, conducted by parents and primary caregivers.
Smiley face rating scale
The smiley face rating scale was used to check the current mood as a measure for children’s emotions. The smiley face rating scale was used by Betsy (1978) after changing the ‘African’ faces used in the American Marking Association. The participant’s current mood can be determined by sticking the face that represents his or her ‘current mood’ in the form of a sticker when first beginning the program and after completing the program. The scale was rated on a scale of 1 to 5 points from ‘very happy’ to ‘very unhappy’.
The faces on the stickers were made with reference to the sticker faces used in games of science textbooks in 5th and 6th grades of special education elementary school and the emojis in cell phones that children with developmental disabilities are familiar with. The assessment was held in the indoor activity room at the beginning of the program and after a 5-minute break that followed the wrap-up in order to examine the changes before and after the program.
Data analysis
Statistical analysis of this study was conducted using IBM SPSS Program (19.0). A non-parametric test was conducted by analyzing continuous data (quantitative data). After CBCL6–18 was assessed before, during, and after the program, we analyzed the mean difference within the group with the non-parametric repeated measures ANOVA (Friedman test) using the raw scores for statistical analysis. We used the smiley face rating scale before and after each session of the program and analyzed the mean difference between before and after the program using the Wilcoxon signed-rank test.
Results and Discussion
Changes in problem behaviors of children with developmental disabilities
As a result of analyzing how the gardening program has changed problem behaviors, it was found that problem behaviors including internalizing and externalizing behaviors, social maturity, thought problem, attention problem, and other problems decreased from 39.31 before the program to 32.85 during the program and 31.77 after the program, showing a statistically significant difference (p = .047, Table 4). Internalizing behaviors including anxiety/depression, withdrawal/depression, and physical symptoms scored 7.62 before, 7.23 during, and 6.54 after the program, showing no significant difference (p = .266). Externalizing behaviors including rule-breaking behavior and aggressive behavior scored 9.92 before, 7.62 during, and 7.00 after the program, showing a significant difference (p = .005).
Anxiety/depression among internalizing behaviors scored 3.54 before, 3.08 during, and 3.00 after the program (p = .459), withdrawal/depression scored 2.85 before, 3.00 during, and 2.62 after the program (p = .459); and physical symptoms scored 1.23 before, 0.92 during, and 0.92 after the program (p = .646), all showing no significant difference. Rule-breaking behavior among externalizing behaviors scored 2.46 before, 1.31 during, and 1.46 after the program, showing no significant difference (p = .109), but aggressive behavior scored 7.46 before, 6.31 during, and 5.54 after the program, showing a significant decrease (p = .020). Social maturity scored 6.69 before, 5.70 during, and 5.00 after the program, showing a significant difference (p = .010), but thought problem (p = .472), attention problem (p = .766), and other problems (p = .237) did not show a significant difference.
Problem behaviors were alleviated as a result of applying the gardening program to children with developmental disabilities. Among the factors of problem behaviors there was a significant change in externalizing behaviors, especially aggressive behavior. These results are consistent with the study that aggressive behavior was reduced by applying indoor and outdoor gardening activities to children with intellectual disabilities (Bang and Kim, 2004). In addition, as a result of examining the effect of the forest on maladaptive behavior of students with intellectual disabilities, it was found that the forest also alleviated withdrawal, aggression, and problem behaviors (Park and Sim, 2010).
In particular, the three-step guided compliance training intervention used in this study was effective in improving participation in therapy for children with developmental disabilities (Cho et al., 2013), and also in promoting receptive language in children with Asperger’s syndrome showing slow response (Yoon and Yoon, 2014). As such, this intervention heled children with developmental disabilities actually participate in gardening activities and properly cope with internal and external demands. This helped reduce behaviors and provide significant positive results for aggressive behavior among externalizing behaviors as well as social change.
Current mood based on the smiley face rating scale
We figured out how the gardening program can change the mood of children with developmental disabilities and analyzed mood changes before and after each session of the program using the smiley face rating scale for children with disabilities to measure themselves as they can express their own emotions. The mean score of the moods of children with developmental disabilities increased from 4.2 to 4.5 after the activities in the initial phase (Sessions 1–10), showing a significant difference (p = .020). The mean score in the middle phase (Sessions 11–20) increased from 4.4 to 4.5 without a significant difference (p = .122), but it showed that the improved mood has been maintained compared to the initial phase. The mean score in the last phase (Sessions 21–28) increased from 4.3 to 4.6, showing a significant difference (p = .045). The mean score of the entire program increased from 4.4. to 4.5, showing a significant difference (p = .002, Table 5). Children with developmental disabilities looked more cheerful and seemed to be in a better mood after participating in various gardening activities on campus.
Positive changes in moods were due to the fact that children could secure a broad vision in a broad space due to outdoor activities; relieve stress through many physical movements in the process of running, walking, growing, and managing plants; have emotional stability by encountering plants without aggression during gardening activities; and get many chances of success with active participation and specific experiences, thereby finding their initiative and confidence (Bang and Kim, 2004; Han et al., 2013). With insufficient self-assessment tools for psychological emotions of children with developmental disabilities, the smiley face rating scale could prove its potential as an emotional assessment tool as it allowed children with developmental disabilities to assess their own moods by expressing them.
Emotions are an important part of human psychology but cannot be manipulated, and they may appear in ‘moods’ independently regardless of momentary consciousness or perception every moment. Well-developed emotions and related intelligence can be important factors in life satisfaction and effectiveness (Kim et al., 2016). Emotions develop rapidly in the early stage of childhood, starting with undifferentiated emotions and developing and stabilizing into emotion differentiation (Yu and Son, 2013). It was said that children with developmental disabilities that are often slow in language development need an opportunity to express their emotions through various media of activities other than language (Baek, 2008). Therefore, it can be implied that diverse and direct gardening experiences can be an educational opportunity to feel and express emotions.
Conclusion
This study was conducted to examine the effect that a program based on gardening activities has on problem behaviors by applying the program to children with developmental disabilities according to their characteristics. A gardening program was implemented in the healing garden and two types of gardens on a university campus.
As a result of the implementation, the program had a positive effect on changes in problem behaviors related to aggressive behavior and social maladjustment, which mostly occur in children with developmental disabilities. DTT, a behaviorism theory-based therapy program for reducing problem behaviors, was applied to gardening activities to help children communicate and promote positive interaction with teachers along with the medium of natural materials, such as plants. Moreover, gardening activities also slightly reduced stress, which triggers, problem behaviors, accumulate negative emotions, or is caused by various environmental factors. Follow-up research is needed in that the experience of a gardening program for children with developmental disabilities can help the children’s development as a stress management program in a pandemic. Furthermore, as a result of the smiley face rating scale, which helped children with developmental disabilities look into their own mood changes after each sessions, the mean scores were all ‘happy’ or higher. Children with developmental disabilities looked more cheerful and seemed to be in a better mood after participating in various gardening activities on campus.
Due to the impact of COVID-19, there have been insufficient opportunities for children with developmental disabilities to release energy and stress in a situation with limited outdoor experience activities linked to classes for these children. Accordingly, the gardening program on campus within the community provided leisure time for children with developmental disabilities busy with therapy to participate in outdoor activities in nature, relax, and relieve stress by taking walks and tending a garden that provides beauty. Furthermore, the program had significance as it could help children with developmental disabilities that have limited social life to develop emotions and behaviors by giving them emotional stability with positive interactions with various people such as assistants that are university students.
This study has value in proving the effectiveness of gardening as it could apply the continuous gardening program with multiple sessions despite the relatively few participants. However, follow-up research is needed by increasing the sample size and conducting comparative research with a comparison group or comparatively analyzing the effectiveness of each activity. Furthermore, this study provides the potential of a university campus garden as a public garden aligned with integrated education and welfare programs.
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