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International Journal of Developmental Disabilities logoLink to International Journal of Developmental Disabilities
. 2018 May 7;65(4):285–292. doi: 10.1080/20473869.2018.1466509

An inquiry into the effectiveness of bibliotherapy for children with intellectual disability

Mahsa Mehdizadeh 1,✉, Zohreh Khosravi 1
PMCID: PMC8115521  PMID: 34141349

Abstract

Background

The present study was aimed at developing a grounded theory on how bibliotherapy influences children with intellectual disabilities.

Method

Participants were selected among the students of four primary schools in Tehran. They received, for 3 years, a special bibliotherapy intervention provided by the public library in cooperation with a team of experts; The bibliotherapy sessions were held once a week during the academic year. 10 teachers, 4 mothers, and 4 agents (librarians) were selected using a purposeful sampling method, and were interviewed using in-depth interviews.

Result

Data analysis was performed using the grounded theory. ‘Improvement of skills necessary for adjustment to disability’ was identified at the core of grounded theory.

Conclusion

Bibliotherapy, as a guided learning method and an add-on therapy, based on an accurate identification of intellectually disabled children’s needs and behaviors, providing them with supplemental education materials, empathy, and cooperation among experts from different fields.

Keywords: children with intellectual disabilities, storytelling, bibliotherapy, qualitative research

Introduction

Bibliotherapy is the use of reading for emotional change and personality development. It plays an essential role in the formation and modification of human values. The fundamental assumption is that this effect indicates a special and predictable change in attitude or behavior (Russell and Shrodes 1950). Bibliotherapy has three parts: Identification, catharsis, and insight. Identification, through characters, situations, and elements of the story, enables the reader to see their problem from a different perspective, thus gaining hope and getting free from tension (Lenkowsky and Lenkowsky 1978). Richardson Lack (1985), believes in two forms of bibliotherapy: developmental and clinical; this classification is based on how children are engaged in reading books. In the developmental bibliotherapy, the focus is on the development of personality as a whole, but clinical bibliotherapy is focused on special issues (emotional or behavioral problems).

In fact, being a self-therapy, bibliotherapy is in fact a strategy for attitude change, a method for better understanding the personal feelings, and also a strategy for fulfilling emotional or social needs. Here, we first introduce the benefits of bibliotherapy for children in general, and then for children with disabilities in particular.

Bibliotherapy creates and improves three important skills in children and adolescents: imagination, social skills, and problem-solving; the acquired skills finally lead to changes in the behavior (Doll and Doll 1997). Bibliotherapy can also help in guiding the thinking process in children and forming their behavior (DiSturco 1984). In this method, using different books, children are helped to change their problematic thoughts and subsequent behaviors (Heath and Cole 2012). In a study titled, ‘The Use of Bibliotherapy in Natural Environments to Develop Social Skills in Young Children,’ Chai (2011) showed the efficacy of bibliotherapy in improving problem-solving and social skills in children. Olsen (1975), considered bibliotherapy as a useful method in familiarizing children with the real problems of today’s world.

Bibliotherapy can help children deal with their problems. It has been shown to be effective in the work with children with divorced parents (Pehrsson et al. 2007), and adolescents of parents with mental disorders (Tussing and Valentine 2001) and alcohol dependency (Strom 1989). It has also been shown to improve children’s self-concept and behavior (Sridhar and Vaughn 2000), reduce their fear and anxiety (Lewis et al. 2015), and enhance their coping and academic skills, including their reading ability (Smith 1991). On the other hand, Cornett and Cornett (1980), maintained that bibliotherapy can improve perception of personal values and progresses, consequently improving social behaviors, interpersonal relationships, and acceptance of individual differences. In addition, student groups in bibliotherapy programs have shown improvement in interpersonal relationships (Smith 1998). Positive effects of group bibliotherapy have been shown for problems like bullying and harassment and improvement of problem-solving skills (Elias and Clabby 1992). It has also been effective in enhancing friendly relationships, social skills (Ford et al. 2000), and ability to deal with problems (Tu 1999, Heath et al. 2005). In another study it was found that bibliotherapy-based interventions were effective in reducing social anxiety symptoms and improving adjustment to illness (Tu 1999, Heath et al. 2005). Another study also showed the efficacy of bibliotherapy-based interventions in reducing social anxiety symptoms and improving adjustment to illness (Betzalel and Shechtman 2010). Story books are effective in stimulating changes in attitude and behavior and improving knowledge when used to teach children and parents about Alzheimer disease (Sakai 2014). Few studies have focused on the use of creative bibliotherapy for children and adults from a psychosocial perspective (Fanner and Urquhart 2008). Creative bibliotherapy is the use of stories, poems, and movies for the prevention or treatment of affective and behavioral problems. Bibliotherapy is believed to have its positive effects though a cognitive-behavioral process. In other words, it leads to behavioral changes through identifying maladaptive thoughts, challenging their meanings, and replacing them with realistic ones (Shinohara et al. 2013). A review study showed that bibliotherapy had low to moderate preventive or treatment effects on internalizing or externalizing social behaviors in 5–15 year old children. It also showed that most studies on the efficacy of bibliotherapy had been conducted with normal children; had not mentioned participants’ intelligence; most of them had not considered the role of other factors such as group participation, and had reading as their sole independent variable; and no study had mentioned the type of bibliotherapy used; however, all studies were somewhat based on the cognitive-behavioral approach (Montgomery and Maunders 2015). Tussing, H. L., & Valentine, Bibliotherapy may also help in solving children’s personal and social problems or improving their attitude toward others, but its effectiveness in improving self-concept is not completely clear. Although not based on strong evidence, bibliotherapy has been shown to be useful in social changes (Heitzmann and Heitzmann 1975). DiSturco (1984), found that bibliotherapy has an important role in children’s personal and social development. A review study showed the effectiveness of bibliotherapy in improving self-concept and reducing aggression in students with challenging behaviors (Taft et al. 2016). In overall, researchers believe that the use of bibliotherapy, especially for children, needs more research evidence (Pehrsson and McMillen 2010).

For example, contrary to the above-mentioned studies, some studies have failed to show the effectiveness of bibliotherapy, especially when it has been used as the only method of therapy. For example, in a previous study, bibliotherapy was not effective in reducing stress and anxiety of students. In some other studies, bibliotherapy has failed to change the attitude of students toward adults (Zeleznick 1985) or to improve their social skills (Monasch 2003).

Children with disabilities (including those with learning disorders, behavioral problems, and intellectual disability) can benefit from bibliotherapy in learning active problem-solving1. In this regard, Aiex (1993) has described bibliotherapy simply as using books for solving problems. Aiex recommends the use of bibliotherapy by teachers for several reasons: Bibliotherapy shows the person that they are not the only one with that problem, engages them in a free conversation regarding their problem, helps in designing useful courses containing strategies for problem-solving, improves personal self-concept, removes mental and emotional pressures, fosters realistic self-evaluation, creates a way of getting out of oneself, and increases personal understanding of human behavior and motivation.

Limper and another by Zaccaria have shown that bibliotherapy is useful in improving self-efficacy and productivity in children with disabilities (as cited in Lenkowsky and Lenkowsky 1978). Mentally and physically disabled children are more vulnerable to social risks, and forming effective relationships with peers and adults can protect them against these risks. Educational programs like bibliotherapy are aimed at reducing these risks, and creating opportunity for successful interaction with peers and adults. By talking to their peers about books, children can improve their relationship skills, and also benefit from their support and cooperation in times of stress and pressure (Doll and Doll 1997).

Intellectual disability (ID), in addition to bringing deep changes in the children’s development, leads to multiple problems for the families. Currently, intellectual disability is characterized not only by the intelligence quotient, but also based on the child’s functioning (American Psychiatric Association 2013). Bibliotherapy is also useful for students with severe disabilities, those who experience many difficulties, or those with the problems discussed in the literature (McCarty and Chalmers 1997). This way of using bibliotherapy is what Doll and Doll (1997) describes as developmental bibliotherapy, because it helps children adjust to their developmental needs (Forgan 2002).

School is more than a place for knowledge transfer. It is a place in which students get an opportunity to experience the mental and emotional processes that are part of human development, and this makes them able to become an integral part of the society (Baratz and Kass 2007). School may be one of the best places for conducting bibliotherapy in order to prevent mental disorders or reduce their negative effects. Children need to understand themselves, others, and their environment, a need that most school unfortunately do not fulfill, and this need is less fulfilled in the children with intellectual disabilities compared to that in normal children. Characters and situations in the book can facilitate the fulfillment of this need. It also helps them discover new ways of living and interacting with peers and adults (Redding et. al 2008).

Bibliotherapy can also contribute to the personality and social development of children, improve their attitude toward others, and facilitate coping with everyday problems in the blind children and children with psychical problems (Lenkowsky and Lenkowsky 1978). In order to use books, teachers must have a good command of different materials, such as stories, myths, history books, and other genres of children’s books (Catalano 2017), but without the help of librarians, children’s books specialists, and psychologists, choosing proper books for children is very difficult.

Appropriate books for children with special needs, including those with intellectual disability are not adequately published, and interdisciplinary efforts between librarians and psychologists for choosing appropriate books are seldom. Having a proper strategy for bibliotherapy requires interdisciplinary efforts between librarians and psychologists. Using their knowledge of children’s and adolescents’ books, librarians can help in choosing proper books, and mental health professionals can also facilitate interaction with children and adolescents with severe problems. For the first time in Iran, in 2001, the public library conducted a bibliotherapy program in several special needs schools in Tehran. In this program, bibliotherapy was provided using poems, stories (textile and printed books), and also audio books; it was provided weekly during the academic year. During the present research, cooperation among psychologists, librarians, and teachers of special needs schools was realized. In the present study, effects of bibliotherapy on children with intellectual disabilities was examined using a qualitative research method.

Methods

Successful bibliotherapy depends on books according to the needs and characteristics of children with special needs, including those with intellectual disability. The first step in this intervention is identifying the needs of the target population, including their limitations, psychopathology, and stressors. In the next steps, the important things are having a good command of the materials, professional training, and cooperation among professionals, including psychologists and librarians. The present study was conducted from 2014 to 2017. At the start of this project, the executive team including a psychologist and four librarians became familiar with the psychological needs and cognitive limitations of these children through training programs and contact with experienced teachers. During monthly group sessions, proper published (printed or non-printed) materials in terms of images, content, length, and font were examined by the executive team, and selected materials were added to the set; if necessary, in order for the children to gain a better understanding of the books, supplemental materials, including simple puzzles or paper dolls were provided. Because parents of children with intellectual disability are often under severe stress, and may not have enough time to read books for their child due to their multiple needs, the books were audio recorded on CDs that were given to children along with printed version of the books.

As indicated by research studies, when using bibliotherapy to facilitate students’ success and development, teachers and librarians choose reading materials based on the unique needs of each student.

The program was provided weekly during the academic year for 270 preschoolers to six graders (80 boys and 190 girls aged 6–15 years old) in four exceptional children’s schools in Tehran, Iran. For each class consisting of 3 to 5 students, each session of bibliotherapy lasted for 20 to 30 min. In each session, the program’s agents performed a theater based on a story (the tactile version of the book was also given to the children in which the story’s characters and situations were shown using various cloths; these books, in addition to improve the manual ability of children and enhancing the development of their sensory-tactile abilities, were designed for children with intellectual disabilities to use their full senses in order to have a better learning and understanding), and in most cases, the children themselves participated in the theater by the help of the agentsm, and performed puppetry or took the role of a character in the story. In addition, during storytelling, questions like ‘Who can say what Little Red Riding Hood did?’ were asked to keep the child focused on the storyline. Children’s conception of the story was also assessed using related questions in order to assess children’s understanding and to form group activities. Finally, books according to the level of understanding and learning ability of students in each grade were put in the desk, and children could choose one of the books along with its CD and keep it for one week; this was done every week. In some cases, volunteer students shared their own perception of the story with their classmates by providing a painting of the story or a summary of it. The students received the program for three years (96 weeks), and children in each classroom had approximately similar and educable IQs.

Another important factor in bibliotherapy for children with intellectual disability is the tone of the storyteller and her ability to have a good rapport with children. Therefore, in the present program, the storytellers received necessary trainings, and their participation in the program was completely voluntarily. (Malchiodi and Ginns-Gruenberg 2008).

The present study had a qualitative design based on the grounded theory using a purposeful sampling method, and individual, in-depth and semi-structured interviews were conducted with 10 teachers, 4 mothers whose children had participated in the study, and 4 agents (librarian). Teachers and parents were in the program as informants and supervisors.

The interviews were conducted by the first author. The main interview themes that had been determined in advance, were mainly focused on the impact of bibliotherapy on children. The first author is a PhD student in psychology with experience in working with children with special needs. Each interview question was followed up according to participants’ answers in order to get a deeper understanding. The interviews were aimed at obtaining a full description of participants’ experiences.

Eleven interviews were conducted by previous arrangements and setting appropriate dates, and also by the informed consent of the interviewees. Most questions in the individual interviews were focused on how the program had affected the skills, behaviors, and feelings of the children. Depending on the circumstances and cooperation of the participants, each interview took 20–40 min (Mean = 32 min) to complete.

By the informed consent of participants, each interview was recorded using a digital voice recorder and converted to audio files that could be transferred to PC. In the next step, the audio files were transcribed verbatim. The main criterion for duration and number of interviews was theoretical saturation.

Data analysis

Data analysis was based on the ground theory. The study data were gathered, coded, and analyzed (Glaser and Strauss 1967, Strauss and Corbin 1990, 1998). The Strauss and Corbin’s coding paradigm was used to analyze the data. According to this method, the analysis was performed in three stages: open, axial, and selective coding. During the open coding process, the raw data were divided into smaller parts that were discrete and meaningful, and were given codes that represented the essence of the statements. During the process of axial coding, the individual parts were reassembled, and categories were linked to subcategories and other categories based on their properties to constitute a more accurate and complete account of the phenomenon in question. Selective coding included a process of theory integration and refinement, during which a core category was selected to represent the relationships between categories and subcategories. The core category consisted of the essence of the research, and incorporated all categories with different properties (Strauss and Corbin 1998). In addition, constant comparison was used in all the stages of analysis, and differences and similarities between the primary codes were determined. Similar codes were put in one category, and were conceptualized. The codes were reciprocally analyzed and, if necessary, modified. The individual interviews were analyzed, and interviews were compared to each other. The relationships between the main classes and the central class were also determined during the axial and selective coding (Strauss and Corbin 1998) and as a result, the model showing how bibliotherapy affects children with intellectual disability was developed. The reliability of the items was examined by the second author.

Results

Model of the efficacy of bibliotherapy in improving the skills of children with intellectual disability developed From 22 interviews with 3 groups of participants. As can been seen in Fig. 1, a central phenomenon, 3 main sets, and 3 main strategies to reach them, along with 2 categories of interfering factors were identified almost in all interviews. Descriptive numbers were used to show the number of interviewees in each main set (0–7 = low, 8–15 = some, 15–21 = many, and 22 = all).

Figure 1.

Figure 1

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Grand theory of how bibliotherapy affects children with intellectual disability.

Improving social skills

Nearly all the participants (n = 17) reported improvement in students’ social skills, including respecting other people and etiquette, understanding the feelings of others, relationship with peers, awareness of rules and regulations, taking part in group activities, relationship with family members, learning the concept of trusteeship, self-esteem, awareness of personal feelings, and also understanding the best ways to express emotions in group activities (Joining the group, participation in discussions, and learning group work through theaters and group plays).

Librarian number 3: ‘One of the students was very isolated and initially refused to take the books. I had so much trouble making contact with him. But now he stands in front of the class and tells the other students the story he has read. Many students exchange books with each other and introduce books to other students, and even when a student is absent, the other students select a book for them and keep it until they can give it to them. This accomplished gradually; when I started the program, many students were reluctant to participate, but now nearly all of them take part in the group activities.’

Teacher number 1: ‘These kids read their text books by force, but once they have read a story book, they become very passionate about telling it to others; this helps them overcome their fear of expressing themselves. When they overcome this fear and feel that they have learned something that can now be shared with others, they become more capable of making contact with their peers; this is a very important change. For example, Mohammad had a very low self-confidence, but now he can tell a story in front of other people very skillfully.’

Mother number 3: ‘My daughter had no idea what trusteeship is, but ever since she has borrowed books form here, she knows that she must take care of the books and return them in the right time. It has happened many times that I have bought her a book, but she has only looked at its cover without reading it. But when she borrows a book from here, it is impossible that she won’t finish it before noon, and she sometimes read it with his brother two or three times. When a theater is performed at the school, the students’ mood is changes significantly, and they can quickly memorize the content of the story. When my daughter comes back home, she tells describes her experiences at the school for us.’

Improving self-help skills

Some of the interviewees (n = 15) stated that the program had increased the self-help skills of students, in domains like personal hygiene, independence and individuality, prioritizing and planning, learning alternatives for showing aggression, awareness of dangers and ability to face them, improvement of self-control, and reduction of disturbed behaviors. They considered the following factors as influencing the observed improvements: Varied learning methods, making children happy through theaters and discussions, learning through different senses (the use of tactile books), and learning through discussion (asking questions about the books, and having discussions with classmates).

Librarian number 4: ‘I brought a book on anger management to the school. I described the book in the classrooms, and talked to the students about what they should do when they got angry, how they could find a solution for their anger, and that they should recognize the matter making them angry. This was really effective in our school, for example, when I ask the students what they should do when they get angry, they say “I first take a deep breath, drink a cup of water, count to a number, and then go and talk to my teacher; I have these strategies.”’

Teacher number 7: ‘Through books’ pictures and group discussions, they can remember not to pick their noses, brush their teeth, and many other things. For example, I ask them, do you remember that you read in that book? Do you remember that Hadi said how bad it is to pick your nose; that is, I use the book and its pictures as a master key.’

Mother number 1: ‘For example about aggression or brushing his teeth, I tell him, ‘do you remember? It was also in the book that if you don’t brush your teeth, they will decay.’ When he reads these in a story or a scientific book, accepts them better and pays more attention to them. For example, he himself brushes his teeth before sleep. Even when were are on a journey, he does that; I give him examples from the book.’

Improving academic education

Most interviewees (n = 20) stated that, through the use of supplemental educational materials including scientific books and also encouraging the study of text books, bibliotherpay had been effective in improving the academic achievement of students, including enhancement of their understanding and awareness; improving their reading, speech, auditory, and writing skills (increasing student’s vocabulary); and enhancing the concentration, memory, and motivation of teachers.

Librarian number 4: ‘every other session I introduce an animal to the students. Teachers welcome this and say that this is related to their teaching. They believe I should continue this, because it is something beyond the everyday lessons, is more like telling a story, and the students appear to pay more attention to it than their routine lessons.’

Teacher number 1: ‘These books are both shorter and simpler than the text books, and the students in my class are more interested in reading them. The content of the books is very good, both for my students and myself. When you see as a teacher that simpler contents lead to better learning of your students, you also become more motivated.’

Mother number 4: ‘She loves the books very much, especially when they are compatible with what she studies. For example, they were studying natural science, and the book he barrowed was also about natural science and compatible with the subject of her study, therefore it was more instructive for her.’

Interfering factors

The interfering factors in accessing the main phenomenon were identified in two categories. Some interviewees (n = 11) named the following factors as facilitating the access to the central phenomenon: agents’ skills (tone of voice, friendly and intimate rapport, paying attention to the child’s disability, patience, and flexibility), knowledge and expertise of teachers, and a happy environment. They (n = 15) also described some other factors as disturbing the process of accessing the central phenomenon, including publication limitations (shortage of appropriate books for different age groups, picture books, and tactile books), higher priority of academic education (time limitation and lack of order due to repeated absences), indirect contact of agents with parents, and society’s discrimination against children with intellectual disability.

Librarian number 1: ‘Our problem is not only the time shortage; teachers have to teach after all, and I am limiting their time by conducting this program, but I may need to have a higher level of cooperation with the children, have more questions and answers, and spend more time together.’

Teacher number 2: ‘The way they treat the kids, even the way they look at them, and the way they tell the stories; the children interpret all these as signs of kindness, pure kindness, from the agents. Young children only want kindness, isn’t it? Their pure kindness and their tone of voice when telling the stories is very effective.’

Mother number 1: ‘Because there were cartoon pictures in the book, he kept saying: “Mom, aren’t these for kids? These are for kids.” My boy is thirteen years old, and should borrow a book compatible to his age and according to his level of understanding, a book that by seeing its pictures he doesn’t feel that they are for children; you can’t find books suitable for teenagers with intellectual disability.’

By analyzing this model, the central phenomenon was identified, and was called ‘Improvement of skills necessary for adjustment to disability.’

Discussion

Some studies have failed to show the effectiveness of bibliotherapy in the improvement of social skills or attitude change (Kohutek 1983, Van Son et al. 1983, Warner 1980). In addition, many studies on the effectiveness of bibliotherapy in the improvement of self-concept and emotional freedom have not led to significant results (Robinson 1980). However, some studies have shown that, when used along with other therapies, bibliotherapy can be effective in the alleviation of patients’ painful emotions (Pehrsson et al. 2007). In another study it was found that bibliotherapy, as part of a larger treatment, was effective in the improvement of self-concept of children who had experienced a change in their families (death, divorce, or move) (Sheridan et al. 1984).

Examination of the literature indicates that bibliotherpay studies often have problems in terms of methodology and research designs, including a lack of reliable instruments, improper control, and small samples (Taft et al. 2016).

There are many factors involved in the effectiveness of bibliotherapy that may be ignored in quantitative studies, and discrepancy in the results of bibliotherapy studies could be attributed to the use of different research methods and lack of comprehensive examinations; we tried in the present qualitative study to address the following questions: Is it just reading the book that improves social and self-help skills and academic achievement? Is it just the content of the book that leads to these effects?

Bibliotherapy is in fact a supplemental or catalyst method that can be used along with occupational therapy, speech therapy, and academic training to make the child more prepared for learning different skills. The results of the present study indicated that books alone cannot work miracle, and they must be used along with other techniques in order to improve the skills of children with intellectual disability. As Cook et al. (2006) pointed out, children relate to a book through its characters that have the same problem as them, and this acts as an incentive for change. The change process in children with intellectual disability requires more varied and more tangible methods, including theater and tactile and audio books.

The study results showed that it is not only the content of the book that can improve children’s skills, and as was pointed out before, a chain of strategies were used to improve each skill. The therapist’s duty is to choose a book according to the child’s cognitive needs, and to design, based on the book’s contents, plays, audio files, tactile books, and group activities to improve the social and personal development of the child. As Shechtman and Ben-David (1999) pointed out, children usually feel less threatened in group sessions, and in these sessions, children can model positive roles. Storytelling in a cooperative manner and in the form of different role-plays can foster a sense of belonging and mutual understanding between the child and their peers, and create an opportunity for the child to increase their understanding of the story themes.

Children with disability are more likely to be ignored and often have fewer friends than normal children (Gilmore and Howard 2016). They also tend to have a more limited social network than their normal peers, and this adds social relationship problems to their physiological difficulties. The isolation of children with intellectual disability is worsened by their motor and relational deficiencies and also by the lack of proper training for them on techniques for relationship building (Zascavage and Keefe 2004). Therefore, in addition to the positive effects of group activities during bibliotherapy, children can benefit from books they read through imagining themselves in different social situations; this can consequently improve their social skills. Therefore, paying attention to children’s individual differences can help further improve their life skills.

Literature has a significant role in expanding the knowledge and development of the verbal skills of the readers and is a powerful tool for understanding the self and others that can be used by all individuals, including children with intellectual disability (Prater and Dyches 2008). Off course, educational materials should be repeated in a simple and comprehensible manner for children with intellectual disability in order to facilitate their learning, and monotone repeats are boring and reduce concentration, therefore this method may not be effective enough. On the other hand, by the use of varied methods and utilizing all the senses of children concurrently, learning process could be facilitated in children with intellectual disability. According to our model, the methods used in the present study that were useful in improving the effectiveness of our program were called ‘Strategies’. It should be noted that although developmental issues could be regarded as intervening factors, the teachers who were interviewed - who had at least 10 years of experience in working with children with intellectual disability - considered the changes as a result of the services provided.

In different societies, children with intellectual disabilities are often deprived from public services available for normal individuals, however in recent years, many countries have tried to reduce this discrimination, for example by providing children with intellectual disabilities with appropriate books other than their textbooks. This group of children do not usually have access to books suitable to their level of understanding or with appropriate font or pictures. This is in part due to the fact that books with these characteristics are rarely published. Provision of appropriate books requires a better understanding of children’s individual differences in terms of cognitive impairment, emotional problems, speech, memory, skills, self-confidence, motivation, and presence of other psychological or physical disorders. In addition, supplementary educational materials, including tactile and audio books and proper plays should be provided for these children. In the present study, this knowledge was achieved to some extent through deep relationships with children and their teachers, and children’s individual differences were considered in choosing proper books and supplemental materials. This improved the children’s self-confidence, and also fostered their cognitive skills. Books compatible to children’s individual characteristics can reduce their frustration and improve their self-worthiness. For example, when the child uses the audio version of a book along with its printed version at home, their dependence on their parents for reading is reduced, and when the child is able to understand the book’s content more easily, the feelings of anger and frustration are reduced in the child and also their parents, and this can also positively affect their relationship.

This method is different from the classic bibliotherapy, because it is more like a guided bibliotherapy that is conducted in an interdisciplinary manner, while classic bibliotherapy is usually conducted by nonprofessionals in schools or libraries (Pehrsson and McMillen 2005, Cook et al. 2006, Chai 2011). Schools are responsible for providing special needs children with the best supportive interventions based on strong empirical evidence. It was shown in the present study that interventions for children with intellectual disabilities are most effective when there are interdisciplinary efforts among professionals. Improper bibliotherapy, like other treatment methods, could be harmful. In fact, this therapy uses many other techniques along with reading books, including theater, group plays, and other group activities, something that makes it somehow similar to group therapy. In other words, in every session with a particular subject, different techniques are used with the goal of improving intellectually disabled children’s capacity for adjustment to their problems and limitations, therefore, applying this method requires precise training and a deep therapeutic connection.

Finally, it can be concluded that in order to improve intellectually disabled children’s adjustment to their disability through bibliotherapy as a supplementary and facilitating approach, we should first have an accurate knowledge of children’s needs, problems, and behaviors in order to bring about a gradual change using proper supplemental education materials and group strategies. Better understanding the children’s needs, selecting books according to individual differences, providing supplemental educational materials, showing empathy, and building a meaningful rapport with children, all require a deeper level of knowledge and also cooperation between psychologists, librarians, and teachers.

Compliance with ethical standards

Ethical Approval: All procedures performed in the present study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent: Informed consent was obtained from all individual participants in the study.

Note

1.

‘Active problem-solving' engages children in confronting their differences and working together to solve their problems. The adult guides children toward solution but does not solve problem for them. Posing open-ended questions, the adult helps keep the child focused so that they can suggest alternative solutions (Gordon and Browne 2013).

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