Effective Play Therapy Techniques for Children with ASD

1. Play Time: Play Therapy Techniques for Children with ASD Dr. Shenae Whitehead, PhD, MA, LPCS, RPT-S

2. Objectives • Identify and review symptoms of ASD • Discuss play typical of children with ASD • Discuss benefits of play for children with ASD • Review various play interventions • Identify play tips for parents

3. Definition of Play Therapy • Play therapy is: “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.” -from the Association of Play Therapy

4. Common Issues for Children in Play Therapy • ADHD • ASD/DD • Adjustment D/O • Anxiety • Depression • Anger • Grief/Loss • Poor Impulse Control • Low Self-Esteem • Trauma • Parental Divorce/Separation

5. Benefits of Play Therapy • Integral part of child development • Social skills (e.g. sharing, cooperation, taking turns) • Enhanced social language and self-esteem • Friendship building • Cognitive enrichment • Emotional growth • Explore societal roles and rules

6. Children with ASD

7. Diagnostic Criteria for ASD • 299.00 (F84.0) • A. Persistent deficits in social communication and social interaction across multiple contexts • B. Restricted, repetitive patterns of behavior, interests, or activities • C. Symptoms must be present in the early developmental period • D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning • E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level

8. Criteria Continued….. • Severity Levels: • Level 1- Requiring Support • Level 2- Requiring Substantial Support • Level 3- Requiring Very Substantial Support

9. Criteria Continued…. • Specify if: • With or without accompanying intellectual impairment • With or without accompanying language impairment • Associated with a known medical or genetic condition or environmental factor • Associated with another neurodevelopmental, mental, or behavioral disorder • With catatonia

10. Play and Children with ASD • Many children with ASD do not play in a manner that is beneficial to development due to skill deficits and interfering problem behaviors • May engage in inflexible, repetitive play patterns • May not exhibit symbolic or pretend play • May not develop play scripts or understand the scripts of other children • Solitary play, lack of understanding thoughts/feelings of others, restricted/unusual interests, and peer exclusion

11. WHY TEACHING CHILDREN WITH AUTISM PLAY IS IMPORTANT? • Play is a child’s “work”. It’s what they do in order to learn about their world. •  Play allows a child with autism to learn and practice new skills in all areas. •  Play provides a vehicle to interact with people and objects in their environment. •  Play promotes independence during “down time”. •  Play builds confidence and competency. •  For a child with autism learning how to play appropriately with toys can replace non-functional play •  Most important, PLAY IS FUN!!!

12. Play Therapy Techniques for Children with ASD • Applied Behavioral Analysis (ABA) • Floortime • Child-Centered Play Therapy • The Play Project • Integrated Play Groups

13. ABA

14. ABA • ABA is the application of the principles of learning and motivation from Behavioral Analysis • It focuses on the reliable measurement and objective evaluation of observable behavior • Vague terms such as anger, aggression or tantrums are redefined in observable and quantifiable terms, so their frequency, duration or other measurable properties can be directly recorded • Fosters basic skills such as looking, listening, requesting and imitating, as well as complex skills such as reading, conversing and understanding another person’s perspective

15. Floortime

16. Floortime • Developed by Stanley Greenspan, M.D. And Serena Wieder, PhD • Premise is that adults can help children expand their circles of communication by meeting them at their developmental and building on their strengths • Challenges children with ASD to push themselves to their full potential • It develops “who they are,” rather than “what their diagnosis says”

17. Floortime • Aims to help children reach six developmental milestones crucial for emotional and intellectual growth • Self-regulation and interest in the world • Intimacy, or engagement in human relations • Two-way communication • Complex communication • Emotional ideas • Emotional thinking

18. Child-Centered Play Therapy • Full acceptance of the child by therapist • Nonverbal focus of the intervention • Focus being placed on the child for who he or she is and where he or she is in the moment • Child is given a distinct experience where the therapist enters the child’s reality on the child’s own terms • Full acceptance of the child, or unconditional positive regard, shows the child that he or she is seen as an equal

19. The Play Project

20. The Play Project • Developed by Richard Solomon, MD • It is a parent implemented, intensive early intervention program for young children with ASD that is evidence-based • Findings: • PLAY parents are more sensitive, more responsive, and more effective • PLAY parents showed a significant reduction in depression compared to control parents • PLAY children markedly improved their ability to interact and be social, and substantially reduced their ASD symptoms

21. Integrated Play Groups

22. Integrated Play Groups • Developed by Pamela Wolfberg, PhD • Designed to provide intensive guidance for children with ASD to engage with neurotypical and neurodivergent peers/siblings in mutually enjoyed play experiences • IPG model maximizes each child’s developmental potential and intrinsic motivation to play, socialize and form meaningful relationships with peers • Play activities include pretending, constructing, movement, interactive games, art, music, drama, video, and other creative pursuits

23. Play Benefits for Children with ASD • Help children better control sensory needs and alleviate related distress • Improve their sense of calm and security • Decrease their stimming behaviors (rigid/repetitive)

24. Teaching Toys for Children with ASD • Pick out toys that are related to the child’s INTERESTS. • If your child engages in “non functional behavior” choose toys that provide the same sensory input but in a more appropriate way • Choose toys that correspond to your child’s developmental level.

25. ASD Teaching Tips • Don’t be afraid to “change the rules” or use only some of the pieces to simplify the play in the beginning • Remember to teach “one step at a time”. Small steps will lead to BIG gains! • Program for success! Provide “prompts” as need- ed in order to ensure that your child continues to be successful and motivated • Structure the play time in “small time frames” frequently throughout the day • Know when to end a play session!

26. Helping an ASD Child Play with Another Child • Use floor-time principles to follow the children’s lead, looking for opportunities to encourage interaction, between the two. • Use your voice to help each child pay attention to what the other child is doing. • Get both children involved in problem solving. • Help both children become aware of each other’s feelings. • Help the children engage with each other. • Try to hold each child’s attention for as long as possible in order to delay them moving away.

27. Help both children understand the other’s behavior by translating that behavior into simple words. • Help the children interact by using shared interests • Help the children stick with their play by helping them bypass tangential ideas. • Help each child notice the feelings and actions of the other by reiterating what each one said or did. • Help the children share symbolic ideas. • Pick up on highly emotional themes (such as separation, fears, body damage, and aggression), and help the children play these issues out symbolically. • Identify each child’s coping strategies and solutions, and offer symbolic solutions to difficult situations. • Help the children resolve conflicts together • Create opportunities for the children to work together.

28. Play Tips for Parents • Begin where the child is • Mirror what the child is doing • Add small actions to expand on their play • If child gets frustrated, slowly, but steadily increase the amount of interaction you have • Provide encouragement and feedback • Offer things as much as you can • Have fun and be fun!!!! Be your child’s cheerleader!!!

29. Resources • Autism Institute on Peer Socialization and Play. (2018). IPG model. Retrieved from http://www.autisminstitute.com/ipgmodel.html • Center or Autism and Related Disorders. (n.d.). Retrieved from http://www.centerforautism.com/aba-therapy.aspx. • Morgenthal, A. H. (2015). Child-centered play therapy for children with autism: a case study. Retrieved from https://aura.antioch.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1230&context=etds • Nedelcu, C. M., Chicos, P. L., & Dobrescu, I. (2010). Play therapy and autism. 4(3-4), 52-57. • Play Project. 2018. Retrieved from https://www.playproject.org • Sulzer-AzaroffB., & Mayer, R. (1991). Behavioral analysis for lasting change. Fort Worth, TX: Holt, Weinhart, & Winston, Inc.

30. Questions????