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Research article - Peer-reviewed, 2022

COMSI (R)-A Form of Treatment That Offers an Opportunity to Play, Communicate and Become Socially Engaged through the Lens of Nature-A Single Case Study about an 8-Year-Old Boy with Autism and Intellectual Disability

Bystrom, Kristina; Wrangsjo, Bjorn; Grahn, Patrik


This case study shows how an 8-year-old boy with autism and mild intellectual disability underwent positive psychological development in terms of play, social communication, and mentalization during a year and a half of group-based therapy using COMSI (R)-(COMmunication and Social Interaction). This eclectic treatment has a relational approach and is based on developmental psychology, knowledge of autism, and the impact of nature and animals on human health. The change in the child was been studied using both quantitative and qualitative methods. His general intellectual capacity was measured using the Wechler Preschool and Primary Scale of Intelligence, and his Mentalization Ability/Theory of Mind was assessed using three tests: Eva and Anna, Hiding the fruit and Kiki and the cat. Throughout the study period, change was documented with the help of the therapists' process notes and the parents' descriptions. The results show that support for the child comes from three different sources: nature, animals, and the therapists. Animals and nature form the basis for episodes of coordinated attention in conversation and play with therapists. The therapists' approach used sensitivity and compliance with the child's needs and focus of interest.


nature-and animal-based treatment; autism; children; joint attention; mentalization

Published in

International journal of environmental research and public health
2022, Volume: 19, number: 24, article number: 16399

      SLU Authors

    • Associated SLU-program

      Built environment
      SLU Urban Futures
      SLU Future One Health

      Sustainable Development Goals

      SDG11 Sustainable cities and communities
      SDG3 Good health and well-being

      UKÄ Subject classification

      Landscape Architecture
      Applied Psychology
      Pedagogical Work

      Publication Identifiers


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