Play Therapy and Autism

Play therapy can help both kids and parents

Nonverbal Autism
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Young children learn through play. Typically developing children use play to build physical and social skills, to try on different personalities and characters, and to forge friendships. Autistic children, however, may play in very different ways. They are more likely to play alone, and their play is often repetitive, with no particular goal in mind. Left to themselves, autistic children often stay stuck in a rut, unable to explore their own abilities or interests.

Play therapy is a tool for helping autistic children become more fully themselves. It can also, under the right circumstances, be a tool for helping parents learn to relate more fully to their children on the spectrum.

What Is Play Therapy?

Play therapy was originally conceived as a tool for providing psychotherapy to young people coping with trauma, anxiety and mental illness. In that context, play becomes a way for children to act out their feelings and find coping mechanisms.

This type of play therapy is still popular; however, it is not the same thing as play therapy as used for children with autism.

Many specialists offering something called "play therapy" to children with autism are actually providing something akin to Floortime Therapy. Floortime is a play-based technique which builds on autistic children's own interests or obsessions to develop relationships and social/communication skills.

The Play Project is another therapeutic approach which uses play as a tool for building skills in autistic children. Like Floortime, it builds on children's own interests.

It is possible to be officially credentialed in Floortime therapy through a certification program that includes a wide range of content.

This certification is offered through the Interdisciplinary Council on Developmental and Learning Disorders (ICDL), but is not recognized by any of the national therapeutic associations. Thus, most "play therapists" are not so much credentialed as they are experienced and/or trained. Of course, as with all autism treatments, the onus is on the parent to investigate the therapist's background, training, and references, and to closely monitor progress.

Why Would a Person With Autism Need to See a Play Therapist?

Autism is largely a social-communication disorder. Children with autism find it extremely difficult to relate to others in typical ways. Instead of, for example, pretending a doll is really a baby, they may focus intensely on objects, use them for self-stimulation, and become entirely self-absorbed.

Play is a wonderful tool for helping children (and sometimes even adults) to move beyond autism's self-absorption into real, shared interaction. Properly used, play can also allow youngsters to explore their feelings, their environment, and their relationships with parents, siblings, and peers.

Very often, too, play therapy can allow parents to take an active role in their autistic child's growth and development.

Play therapy can be taught to parents, and, over time, parents can become their child's therapist while also building a stronger, more meaningful relationship.

What Does a Play Therapist Do for People with Autism?

A good play therapist will get down on the floor with your child and truly engage him through the medium of play. For example, the therapist might set out a number of toys that a child finds interesting, and allow her to decide what, if anything, interests her. If she picks up a toy train and runs it back and forth, apparently aimlessly, the therapist might pick up another train and place it in front of the child's train, blocking its path.

If the child responds, whether verbally or non-verbally, a relationship has begun.

If the child doesn't respond, the therapist might look for high-interest, high-energy options to engage the child. Bubble blowing is often successful, as are toys that move, squeak, vibrate, and otherwise DO something.

Over time, therapists will work with the child to build reciprocal skills (sharing, turn-taking), imaginative skills (pretending to feed a toy animal, cook pretend skills) and even abstract thinking skills. As a child becomes better able to relate to others, additional children may be brought into the group, and more complex social skills are developed.

Many parents find they can do play therapy on their own, using videotapes and books as a guide. Others rely on the experience of trained play therapists. And still others choose to simply bring their children to a play therapist or have the therapist come to their home. In any case, play therapists can provide parents with tools to connect with and have fun with their children on the autism spectrum.

How Can I Find a Qualified Play Therapist?

Play therapy may be offered through a local early intervention program as a free service, or it may be incorporated into a special needs preschool program. It's unlikely to be incorporated into a school-age public school program, though it may be possible to make the case that such a program is appropriate for your child. Outside of these programs, it is unlikely that play therapy will be covered by any kind of insurance, so it is up to the parent to find and pay for the therapist.

If you are looking for a certified Floortime specialist, go to the Floortime website (www.floortime.org) and look for a local therapist. If you don't live near a major city, it's unlikely you'll find such a person nearby, which means you may need to travel and/or work with the therapist at long distance. This is accomplished through a combination of shared videos and telephone conferences; while not ideal, this can be helpful.

If you're looking for someone local with experience and skills in play therapy in a more general way, you might find just what you're looking for in an occupational therapist or child psychologist with a specialty in autism. You might even find a play therapy program (usually a group program) offered through autism clinics, hospitals, or private service providers.

Sources:

Hess, Esther. DIR®/Floortime: Evidence based practice towards the treatment of autism and sensory processing disorder in children and adolescents. Int J Child Health Hum Dev 2013;6(3):00-00.

Solomon, Richard. PLAY Project home consultation intervention program for young children with autism spectrum disorders: a randomized controlled trial. J Dev Behav Pediatr 35:475–485, 2014.

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