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Play. Shamsi Sadeghzadeh, BCBA. What Is Play Therapy?. Play therapy has been originally conceived as a tool for providing psychotherapy to young people coping with trauma, anxiety, and mental illness.

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  1. Play Shamsi Sadeghzadeh, BCBA

  2. What Is Play Therapy? • Play therapy has been originally conceived as a tool for providing psychotherapy to young people coping with trauma, anxiety, and mental illness. • In this context, play becomes a way for children to act out their feelings and find coping mechanisms. • Child-led play therapy has been supported by research as a very effective psychotherapy tool.

  3. Play in Young Children with ASD • Play is the foundation for social, emotional, and cognitive growth in children. • Social interaction, imitation, and communication skills are required components of play. • Social interaction and communication are among core deficits of autism.

  4. Stages of Play • Stage 1, birth to 9 months: Baby places everything in mouth, with possible purposeful actions with toys, shaking toys that make sounds. • Language: Babbling, attempts to imitate sounds, imitates sounds, good eye contact, and possibly beginning of joint attention • Stage 2, 9-12 months: Travels to get what wants, stops mouthing everything, finds hidden toy • Language: , uses performance words such as, choochoo, woo woo

  5. Stages of Play cont., • Stage 3, 13-18 months: Purposeful exploration of toys, discovers how they operate via trial & error, emerge of pretend in relation to self (pretending to fall asleep or eating with a spoon), hands toy to adult if unable to operate, this is the indication of developing of TOM • Language: Functional development in language in regard to: Existence( I am here), Denial(wasn’t me), Action (John took my book), Location(mommy’s in the kitchen)

  6. Stages of Play, cont. • Stage 4, 19-24 months: Symbolic play extends beyond self (feeding toys, brushing doll’s hair), uses more toys in pretend play such as pouring from pitcher to cup • Language: Begins to use possessives(my, mine), makes reference to objects and people not present(huge cognitive acheivement) • Stage 5, 2-2 ½: Pretends at real life activities such as play house or acting like a mom, dad, or baby, engages in parallel play, stacks blocks but not in a symbolic way • Language: Uses short sentences, ing,& pretend language

  7. Stages of Play cont., • Stage 6, 2 1/2 -3: Parallel play, roles shift quickly, Pretends scheme in a sequence such as mixes cake, bakes it, serves it, and washes dishes • Language: Asks & responds to “wh” questions in context, asks “why” questions inappropriately, uses past & future tenses • Stage 7, 3-3 ½: Uses puppets as participants in play, doll is a friend with unique personality(TOM), plays with peer • Language: Concepts such as size, texture, relationship emerge, changes speech depending listeners (real TOM)

  8. Stages of Play cont., • Stage 8 , 3 ½-4: Begins to reason & problem solve (builds enclosure for circus animals & tries to reason the kind of roof needed), builds 3 dimensional structure, engages in acting out scenes with peers or using puppets • Language: Conceptualizes “this should..” or “this won’t”, begins to respond appropriately to “why” & “how” questions

  9. Stages of Play cont., • Stage 9, 4-5 years: Plans a sequence of pretend events and organizes needs in advance-both objects and peers, plans own role & assigns roles to others, full cooperative play • Language: Begins to use relational terms such as “then, when, first, while,..”

  10. Play in Children with ASD cont. Social impairment in children with autism violates typical parent-child interaction Bazhenova & Prges, 2003

  11. Characteristic of Social Interaction in Young Children with ASD • Less likely to show pleasure in shared interaction(shared attention) • Reduced attention to faces & voices • Increased tendency for isolation • Limited social engagement & responsiveness

  12. Characteristics of Communication in Young Children with Autism • May show less babbling & fewer words • Less attention to speech & vocal imitation • Delayed receptive language • Less purposeful use of language

  13. Characteristics of Play in Young Children with Autism • Restricted interests • Less purposeful play • Less lack of turn-taking • Interest in parts of objects • May show repetitive play • Play is less complex, less symbolic

  14. Before teaching, find out: • What does the child with ASD like to do? • What does he NOT like to do? • What makes him laugh? • What frustrates him? • What gives him comfort? • What motivates him? • What is he good at?

  15. Assessing Parent-Child Interaction • Observe parent –child play • Find out their daily routine • Observe activities in different natural environment • Assess parent-child communication: Eye-contact Vocalization & gestures Subtle signs of communication Response to communication

  16. Weaving Communication into Play, Join in • Create an expectation of communication • Recognize subtle communication cues • Be responsive to child’s communication • Talk, talk • Follow child’s lead • Use parallel talk or narration • Imitate child’s activity or sounds

  17. Weaving Communication into Play, Join in • Turn-taking without expectation: in a parallel play join child, label the action, talk about it • Turn-taking with expectation: give prompt & wait 3 seconds but don’t force • Using lots of repetition of actions, sounds, words: Label the child’s sound such as “you are playing with cars, this is your car. • Repeating back what child is saying without correction: If he says ca, repeat by “you said car” • Expansion: “ I see you want a cookie”,or “you want a big cookie”

  18. Joining in, cont • The goal of joining in is to encourage child to tolerate your presence & gradual interaction in a place/setting that is comfortable, using materials that are familiar. • By smooth entrance to child’s play, you eventually become a part of that play.

  19. Exaggerated Responses • Change volume of you voice when saying the target word • Use high intensity interaction when playing beside child, this will naturally direct him to look at you • Use additional reinforcer to make interaction more fun

  20. Play in Children with Autism • In children with ASD, interactive play uniquely addresses the core deficit of relating and communicating as no other approach can. Greenspan, 2003

  21. Parents as educators • Parents are viewed as experts in their children • Ongoing opportunities in teaching/practicing • It does take a village • Find out what their goals and challenges are

  22. Evidence Based Strategies • The most important factor to make teaching and Treatment effective is : MOTIVATION

  23. Evidence Based Strategies cont. • Create opportunities for expectations • Find out what interests him • Look for and recognize communication cues • Respond to communication cues • Talk to the child • Accept & R+ approximation and attempts • Use language when doing things VS. silence • Read to the child

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