Playtime gives us an abundance of knowledge about children and their developing skillsets. Children learn, through trial and error, how to get along with others and enhance their cognitive, motor, emotional, and social capacities via the use of meaningful, fun activities. What better way to assess, guide, and improve their abilities to communicate and problem-solve than to utilize play as a form of therapy?
Play therapy has grown as an innovative method to help children and their families, especially those with autism spectrum disorder (ASD) and other developmental disabilities. Children with ASD often struggle with socially connecting with others and carrying out typical patterns of play, which can impact their functional activities well into adulthood. The following information includes an introduction to play therapy for children with autism as well as tips and case scenarios to help parents and caregivers carry out play therapy with their kiddos at home.
What is play therapy?
When children can’t verbalize their feelings and thought processes, observing how they play tells the story instead. According to the Association for Play Therapy (APT), play therapy is described as “the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development.” Play therapy is also described as a “dynamic interpersonal relationship” designed by a trained therapist who selects play materials to help the child feel safe and the allowance to fully express him or herself during intervention.
Erik Erikson, one of the most renowned theorists known to the world of psychology, describes play as a period of planning and experimenting so that children can master skills necessary for the real world. Play therapy offers kiddos a chance to develop skills that they will need to effectively communicate with and work with others, including:
- Expressive and comprehensive communication
- Emotional regulation
- Motor (movement-based) skills
- Social participation
- Problem-solving
- Attention
Play therapy is highly customized and the therapist selects skills to work on with the child based on their personal goals, the goals of the family, and the severity of each case. There are two methods by which play therapy is broken down: directive play and non-directive play.
What is directive play versus non-directive play?
Non-directive play
Non-directive play is less influenced by the therapist and more unstructured to allow for children to guide themselves and work through problems independently. For example:
Adam is a 7-year-old child with autism spectrum disorder who can understand what most people are saying to him but struggles with verbally expressing himself. During the first session of play therapy, the therapist allows Adam to select his own toys to play with while sitting back and observing his behavior. Adam hesitates for a while but settles on playing with a baby doll and a stroller. Adam spends a few minutes pushing the baby around the room in the stroller, pretending to change her diapers, and gives her a bottle and blanket to comfort her.
Directive play
Directive play is a guided approach where the therapist is more selective about what activities the child participates in during intervention. The therapist may encourage the child to switch activities, select new toys, or communicate with the therapist to initiate some conversation or reciprocal play. An example of this would be:
The therapist selects a drawing activity for Adam to participate in. Adam spends the first few minutes drawing a puppy. The therapist asks Adam questions while he continues drawing, mostly about the puppy he’s drawing, the name, the color, how old he is, etc. The therapist asks Adam if she can draw a puppy too to stimulate conversation and non-verbal interaction with the therapist. Adam gives the therapist paper and a few crayons to indicate that he would like her to draw with him.
Non-directive and directive play techniques are often used in combination over several play therapy sessions. Well-trained play therapists want to have a fair amount of time to observe the child in how they conduct themselves and their unique forms of expression while at the same time giving the child a little nudge to move the session along and to challenge them.
The first five stages of development are the most important to enable children of all abilities to receive health care to grow and develop. All children need to be able to reach the social, emotional, speech, motor, and educational milestones required to live a full and functional life.
What are floor time sessions?
Floor time sessions refer to a common approach used in play therapy to set up a situation where the child and therapist play together. The therapist gets down on the floor with the child and plays with the toys or games that the child or therapist has selected. Floor time encompasses 6 goals for the child to achieve:
- The child understands the mechanics of the toy or game.
Adam understands how to dip the bubble wand into the soap bottle, pull it out, then blow through the wand to make bubbles.
- The child actively engages with the therapist.
Adam takes turns bubble-blowing with the therapist, placing the wand in front of her mouth.
- Two-way communication (verbal or non-verbal) is achieved.
Adam says, “Ready, set, blow!” before the therapist blows a bubble through the wand. When it’s Adam’s turn, the therapist does the same thing for him.
- The child is aware of their own wants and needs with the play activity.
The therapist gives Adam a choice between the blue bubble bottle and the pink bubble bottle. Adam picks up the blue bubble bottle and starts to play.
- The child can gesture to communicate their wants and needs.
Adam shakes his head when offered the pink bubble bottle and points to the blue bubble bottle to indicate that is the one he wants to play with.
- The child can calm themselves after getting upset.
When the bubble juice runs out, Adam is sad. However, after a few seconds, Adam moves on to another toy and appears to be happy again without the therapist intervening.
Accomplishing these goals may take several sessions and great amounts of creativity, especially for children who have more severe, maladaptive behaviors being addressed.
How does play therapy compare to ABA?
Although Applied Behavior Analysis (ABA) targets the same developmental skills as play therapy, there are a few differences. ABA therapy is a type of behavioral therapy for autism that is based on techniques that increase positive behavior while decreasing negative behavior. In short, ABA uses a 3-step approach:
- Antecedent
This is an environmental trigger or a request/demand made by the therapist such as “Give me the toy, please.”
- Behavior
The behavior happens directly after the antecedent in reaction to the trigger or request such as the child hitting the wall while clutching on to the toy.
- Consequence
This happens after the behavior, good or bad. In reaction to a bad behavior, the therapist may take the toy and say, “Okay, toys are all done now.”
Unlike play therapy, ABA focuses heavily on positively reinforcing good behavior while providing consequences for negative behavior in everyday situations, which can also include playtime. Play therapy facilitates positive behavior by creating a relationship and play scenario that depicts typical conversations, behaviors, or reactions.
Who can administer play therapy?
There are many licensed professionals who are qualified to carry out play therapy, including occupational therapists, physical therapists, speech therapists and pathologists, child counselors, behaviorists, teachers, case managers, psychologists, and psychiatrists. These professionals can become registered play therapists (RPT) as approved by the Center for Play therapy (CPT) if they meet specific criteria and educational requirements. There are also professionals who perform play therapy techniques without the official play therapy registration based on additional training elsewhere and years of experience.
Play therapists can also train parents and caregivers to carry out play therapy techniques with their children at home. To make this effective, parents or guardians are expected to attend their children’s play therapy sessions and to actively participate.
What skills does play therapy address for children with autism?
According to the DSM-5 (Diagnostic Statistical Manual, Edition 5), children with autism spectrum disorder (ASD) display multiple symptoms or psychosocial deficits, including:
- Impaired social communication and interaction
- Poor verbal and/or nonverbal communication
- Deficits in body language (i.e. making eye contact, gesturing for non-verbal expression)
- Difficulty understanding and maintaining relationships
- Challenges with imaginative play
- Inflexibility in routines or insistence on sameness
- Intense fixation on specific interests
- Sensory-related issues
Here’s a short case scenario that might help put the criteria into a more realistic perspective:
Robbie is a 6-year old boy who lives at home with his mom, dad, and older brother. Robbie has trouble verbally communicating his needs with his family. Instead of gesturing for things he wants or needs, like toys or food, he throws himself on the floor and starts screaming. For the most part, Robbie can understand what his brother, Ben, says to him, and follows requests and commands made by his mother. However, Robbie fails to make eye contact with others and does not initiate or participate in conversation typical of his age. Most days, Robbie prefers to play by himself. Robbie meticulously cleans his room every day, and if anyone moves his toys, he gets very upset. Robbie loves playing with Hotwheels cars and has a growing collection of over 100 models. He loves sitting in front of his lava lamp to watch the lights and patterns, but hates being touched without warning.
Play therapy has the potential to address all these issues, including those depicted by Robbie. With a skilled therapist, a customized treatment plan can help Robbie learn to self-regulate when things get hard for him, to communicate effectively with others, and to adapt to changes in his routine and environment.
Is play therapy effective for children with autism?
According to multiple, in-depth studies, play therapy has shown to be effective for children across the autism spectrum. Child-centered therapy shows promise in developing healthy emotional and social behaviors for children with ASD (Hillman, 2018; Salter, Beamish, & Davies, 2016). Intensive play therapy interventions can reduce problem behaviors such as decreased attention, aggression, and inflexibility (Schottelkorb et al., 2020; Guest & Orht, 2018). Play therapy activities that are very movement-based in nature can also address motor coordination issues that are common amongst children with ASD (Phytanza & Burhaein, 2019). Play therapy can be beneficial for children with ASD across a large age span, can be performed by licensed professionals and family members, and can be used across settings including clinics, home, and school.
Is play therapy helpful for other children not on the autism spectrum?
Play therapy can be used for children with all sorts of developmental, cognitive, and psychological conditions. Usually, play therapy interventions are conducted with kids between the ages of 3 and 12; however, older children and adults with moderate to severe cognitive impairments could also benefit. Children who’ve experienced trauma may also find play therapy useful in skill development.
Play therapy has the potential to teach your child:
- How to take responsibility for their behavior, good and bad
- How to create unique solutions for their problems
- How to socialize and build healthy relationships with others
- How to express emotion appropriately in multiple situations
- How to respect themselves and others
- How to cope with difficult situations
If you have a child with ASD or a child who may need a little guidance in their development, then don’t hesitate to reach out to The Therapy Place today. We have a team of expert speech therapist and occupational therapists, and we can help you find out the perfect treatment plan that’s specific to your child.
References
Play Therapy: The Art of the Relationship (3rd ed.), Landreth (2012)
Hillman, H. (2018). Child-centered play therapy as an intervention for children with autism: A literature review. International Journal of Play Therapy, 27(4), 198–204. https://doi.org/10.1037/pla0000083
Schottelkorb, A.A., Swan, K.L., & Ogawa, Y. (2020). Intensive child-centered play therapy for children on the autism spectrum: A pilot study. Journal of Counseling and Development, 98:1. https://doi.org/10.1002/jcad.12300
Guest, J. D., & Ohrt, J. H. (2018). Utilizing child-centered play therapy with children diagnosed with autism spectrum disorder and endured trauma: A case example. International Journal of Play Therapy, 27(3), 157–165. https://doi.org/10.1037/pla0000074
Salter, K., Beamish, W., & Davies, M. (2016). The effects of child-centered play therapy (CCPT) on the social and emotional growth of young Australian children with autism. International Journal of Play Therapy, 25(2), 78–90.
Phytanza, D. T. P. & Burhaein, E. (2019). Aquatic Activities As Play Therapy Children Autism Spectrum Disorder . International Journal of Disabilities Sports and Health Sciences , 2 (2) , 64-71 . DOI: 10.33438/ijdshs.652086
The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) provides standardized criteria to help diagnose ASD.
Brennan, D. (2016). What is Play Therapy? WebMD.
Registered Play Therapist (2022). Center for Play Therapy. UNT College of Education.
https://cpt.unt.edu/registered-play-therapist
Play Therapy (2022). Psychology Today.
https://www.psychologytoday.com/us/therapy-types/play-therapy
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