What are the Types of Child Therapy Available?

Autism spectrum disorder (ASD) is a highly complex psychiatric and developmental condition that impacts many children.  When behavioral and emotional problems are present in a child with ASD, it can be difficult to find the right type of treatment approach that will help them develop social skills, regulate their emotions, and improve their behavior. 

Fortunately, as we begin to learn more about ASD and similar disorders, there are many different types of therapies that may be used to treat ASD-specific behaviors so that children may better participate in activities that are important for them. Read further about some of the most common types of approaches that are used for child therapy. 

Psychodynamic therapy

• Thoughts
• Emotions
• Beliefs
• Early Life Experiences

If a client has developed unhealthy defense mechanisms (denial, rationalization, repression) in how they approach their relationships with others, the therapist takes steps to help guide changes to those established behavioral patterns. The therapist and client develop a healthy relationship to allow the client to speak openly and freely to help access the unconscious and to stimulate positive change. 

Although psychodynamic therapy has been used for individuals with a wide variety of mental illness, this approach has proven beneficial for children with ASD in specific areas such as:

• Communication
• Socialization
• Life skills development
• Behavioral and emotional regulation

Each child’s response to psychodynamic therapy will vary depending on their age, their communication capacity, co-existing psychiatric and medical conditions, where they lie on the spectrum in severity, and their current support systems (family, school, etc.). 

Occupational therapy

• Acute and inpatient hospital settings
• School settings
• Outpatient clinics
• In-home health
• Group and nursing homes
• Community integration settings

OTs customize intervention plans based on the child’s specific needs and their parent’s or guardian’s concerns, including behavioral problems, emotional dysregulation, sensory issues, cognitive deficits, motor discoordination, and cognitive deficits. OTs use a top-down approach, acknowledging the occupation-based goal that the child would like to achieve and then working through the deficits or barriers little by little through skilled intervention. Some of those goals may include:

• Getting dressed independently
• Feeding themselves with a utensil
• Drinking from a straw
• Writing their own name
• Having no tantrums at school
• Making a friend
• Playing on the playground without falling
• Having no potty accidents during the day
• Going to the grocery store with mommy without any meltdowns

OTs promote client-centered care, placing the child at the center of the plan who is the driving force behind all of the selected interventions. Additionally, OTs encourage adults who are actively present in the child’s life to attend interventions so that there is consistent carryover and greater chance for success. 

Speech therapy

Speech therapists, or speech language pathologists (SLPs) work with individuals across the lifespan to improve their communication abilities. They are specifically licensed to prevent, assess, diagnose, and treat speech deficits, language disorders, social communication, cognitive communication, and swallowing disorders. Similarly to disciplines such as physical therapy and occupational therapy, SLPs can be found working in multiple settings, including:

• Hospitals
• Schools
• In-home health
• Community-integration settings
• Group homes
• Nursing or assisted living homes
• Outpatient clinics

For child therapy, SLPs commonly work with children with ASD who present with communication deficits due to underlying cognitive problems. The SLP evaluates the child to determine the root cause, which could include issues with:

• Speech production
• Auditory processing
• Language processing
• Higher cognitive processes such as executive function

Once the SLP can determine a diagnosis, then they can develop a therapy intervention plan to help the child improve their communication skills, whether that be oral, written, or both. Interventions are generally appealing and age-appropriate such as flashcards, memory cards, board games, incorporating the use of toys, video games, social stories, etc. If the child’s communication issues are a result of multiple problems, the SLP may choose to cotreat with an occupational therapist, an auditory specialist, or other relevant child therapy discipline. 

Vision therapy

Vision therapy is a highly effective, non-surgical treatment used by licensed optometrists to address common visual problems. For children, visual disturbances may go unnoticed for years, especially for those with ASD who struggle with communicating or describing the challenges they face at home or at school. 

For children to start vision therapy, their parent or guardian schedules an initial consultation with an optometrist so for an appropriate eye examination. Once any eye diagnoses have been established, the optometrist will assign specific eye exercises that will be conducted during supervised in-home office visits and at home for several weeks or months depending on the child’s needs. These vision therapy exercises may be paired with other visual correctors, such as:

• Eye patches
• Corrective lenses
• Prisms
• Balance boards
• Electronic targets
• Filters

Take a look at the following scenario:

Jeremy is a 4 year old boy with ASD and a seizure disorder. During the first few days at preschool, his teacher noticed that Jeremy is very fearful of the playground and often refuses to play on it. The playground is older and has quite a few steps. Jeremy is sometimes willing to use the playground if he can hold his teacher’s hand and is allowed to walk slowly and stare intently at his feet. Jeremy is referred to a local optometrist who conducts an assessment and determines that Jeremy struggles with depth perception. They are sent home with visual exercises to help improve Jeremy’s depth perception. 

Children with ASD are not exempt from visual disturbances that impact their overall vision, visual perception, and motor coordination. Vision therapy has the capacity to improve visual acuity, eye teaming, visual perception, hand-eye coordination, visual motor integration, and so much more. 

Cognitive therapy

Cognitive therapy, or cognitive behavioral therapy, is a form of psychotherapy that addresses a wide range of psychological issues by focusing on current thinking, behavior, and communication patterns. The therapist identifies cognitive distortions or distorted thinking patterns using standardized cognitive assessments, and then guides the client through adaptive behavioral and thinking patterns. Additionally, the therapist helps the client develop self-help skills to work through real-life issues. 

Cognitive therapy is designed to be very action-oriented and practical, so commonly trained therapists may apply these principles in a functional setting. Here’s an example:

Adam is a 12 year old boy with high-functioning ASD who is fearful about using his schoolbus to get to and from home. He’s worried about the bus missing his stop, and “leaving me at the bus garage overnight”. As a result, he throws a tantrum whenever his teacher or parents even suggest he ride the bus. His therapist has been working with him by applying cognitive therapy strategies to help him work through distorted thinking and behavioral patterns. Rather than throwing tantrums in response to his fears, they’ve been working on rational strategies to make riding the bus a more practical and enjoyable experience, such as asking the bus driver for help, memorizing the route, having his address and phone number on hand for emergencies, and so on. 

Cognitive therapy can be beneficial in promoting positive behavior as well as increasing a child’s ability to interpret and understand their own emotions in any given circumstance to improve their daily function and their relationships with others. 

Applied behavior analysis (ABA)

For a child to start ABA, they’re evaluated by a behavioral specialist who is trained in administering ABA evaluations and interventions. Once it’s determined that the child qualifies, an ABA specialist comes to the home for an intensive intervention over the course of several weeks, up to 40 hours per week. ABA interventions can be adapted to other settings such as school. ABA is applied to the child’s everyday life, their everyday activities, and their everyday interactions.

The ABA specialist uses the ABC layout:

• Antecedent: What occurs before the target behavior (a word, a command, a thought, a feeling, an object)
• Behavior: the person’s response or lack of response to the antecedent.
• Consequence: what comes directly after the behavior, either positive reinforcement or no reaction of an incorrect response to the antecedent.

For example:

Sara is a 7 year old girl with autism who just started ABA in her home with her specialist, Anna. Whenever Sara’s little brother starts screaming for his milk bottle, Sara’s typical response is to walk up and slap him across the face, making him even more upset. In this case, the antecedent is the brother screaming, the behavior is Sara slapping him. The ABA therapist incorporates positive reinforcement over a course of time to encourage an appropriate response. Rather than slapping her brother, Anna encourages Sara to prepare a milk bottle for him or to go get mom. If Sara performs one of these behaviors, she can spend 10 minutes playing one of her favorite video games. 

If properly applied, ABA can:

• Increase communication and language skills
• Decrease problem behaviors like aggression or temper tantrums
• Improve attention and focus
• Enhance social skills
• Improve memory
• Improve academics

Play therapy

Since children may struggle with verbalizing or expressing their behavioral and emotional struggles in conventional ways, play therapy allows them to reveal underlying interpersonal struggles in the form of a self-expressive medium that they are naturally comfortable with…play. According to Play Therapy International, 71% of children referred to play therapy experience positive change. The trained therapist uses play to identify themes or patterns and to gain insight into the child’s key issues through games, imaginary play, drawing, arts and crafts, building blocks, puppets, and other forms of typical play. 

Aside from using play to to help children may sense of the world and real life experiences, play therapy can help:

• Expand their interests
• Enhance their social skills and reciprocation
• Improve their communication and language skills
• Assist with emotional regulation
• Work on problem-solving skills
• Resolve life-based trauma
• Develop new coping mechanisms
• Redirect inappropriate behaviors
• Make sense of new situations or encounters with others
• Help the child explore unresolved trauma.
• Help the kids to learn new coping mechanisms.

Children with ASD and other similar disorders frequently struggle with the typical building blocks associated with childhood play, which leads to disruptions in other activities as they get older. Here’s an example:

Conrad is a 9 year old boy with ASD and has been working with a play therapist to work on developing social participation skills to communicate with his peers at school. The play therapist has been using Conrad’s favorite action figures to understand his social skills challenges and to  create social stories of interactions that Conrad may have with children at school, and has been guiding him on how to reciprocate conversation appropriately.

Having children with ASD presents with many challenges, for them and for their loved ones. Emotional and behavioral issues can disrupt their day and wreak havoc on their home life, social participation, and academic success. Furthermore, it can be difficult to know what type of therapy would work best to meet their needs, especially if parents or guardians are new to the process and don’t know where to begin. Talk to your pediatrician and conduct your own research to gain a better perspective regarding child therapies that are available. Whatever therapy or therapies you choose, just remember that it should be tailored to meet your child’s unique needs. 

Medically Reviewed by: Leah Gross OTR/L