Play-Based Interventions for Autism Spectrum Disorder and Other Developmental Disabilities

Robert Jason Grant

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317327615
• Edition: 1
• Topic: Psychologie
• Subtopic: Geschichte & Theorie in der Psychologie

Play-Based Interventions for Autism Spectrum Disorder and Other Developmental Disabilities contains a wide selection of play therapy interventions for use with children and adolescents with autism spectrum disorders, dysregulation issues, or other neurodevelopmental disorders. The structured interventions focus on improvement in social skills, emotional regulation, connection and relationship development, and anxiety reduction. Special considerations for implementing structured interventions and an intervention tracking sheet are also presented. This valuable tool is a must have for both professionals and parents working on skill development with these populations.

1
Treatment Considerations

Autism Spectrum Disorder and Developmental Disabilities

This book is not intended to provide a thorough or in-depth presentation of autism and developmental disorders. The following brief is presented to help practitioners have a better understanding of autism and other developmental disorders as it relates to implementing directive play-based interventions. A suggested reading list is offered in the Appendix for those who desire to increase their knowledge about autism and other developmental disorders.

Autism spectrum disorder (ASD) is a Diagnostic and Statistical Manual diagnosis that is usually given after a thorough psychological evaluation where the evaluator measures the child’s or adolescent’s behavior across a myriad of tests, assessments, and observations. The disorder is considered a spectrum disorder meaning that symptoms vary in intensity from severe to very mild in individuals who have an ASD diagnosis. Common terms used to describe the variance include high or low functioning and severe or mild impairment. Children and adolescents with an ASD will likely have similar problem areas, but the severity of their difficulties and the presence or absence of other features (fine motor clumsiness, normal intelligence, increased or decreased verbal output) will vary (Coplan, 2010).

Children and adolescents with ASD can and usually do exhibit multiple symptoms. The most common symptoms that manifest for each child at some level include impairments in social skills and functioning; impairments in communication; impairments in the ability to self-regulate and modulate emotions; difficulties establishing and creating meaningful relationships and connections with others; restricted, repetitive, and stereotyped patterns of behavior, interests, and activities; sensory processing issues; and difficulties handling transitions and change (Exkorn, 2005).

In regard to play skills, children and adolescents with ASD usually struggle in the areas of pretend or imaginary play and peer or group play. In regard to peer or group play, children and adolescents with ASD typically do desire to have friendships and interact with others peers but simply lack the social ability and skills to interact successfully. Thus, most attempts at some type of interaction usually are met with rejection and anxiety for the child with ASD. Repeated attempts to engage with peers only to be met with rejection can lead to what others may perceive as a lack of interest in connecting with peers. In reality, this may be a learned behavior to avoid further rejection. Directive play interventions can help children and adolescents learn social skills to interact more successfully with peers and participate more fully in group and peer play.

Pretend and imaginary play skills may also be increased in children with ASD but present a greater challenge. Due to the deficit in pretend and imaginary play, practitioners should avoid play-based interventions that rely heavily on abstract concepts, pretend play, and metaphor (unless specifically working on improving this skill). Play-based interventions should be concrete and clearly communicated to the child and should be literal in addressing the child’s issues.

The following example highlights a play approach with a child with ASD. A child with ASD is struggling with a bully at school. In neurotypical play, the practitioner might conduct a puppet show with a frog and fox acting out a bullying scene with the fox bullying the frog and the frog ultimately addressing the issue with an appropriate response and learning some coping skills. For the child with ASD, this may be too much based on metaphor, and the child may not apply the information to his or her situation. A better approach with a child with ASD would be to choose two human puppets and label one the child and the other the child’s bully. The practitioner can then act out a bullying scene that actually happened to the child at school and include an appropriate response to the bully. The practitioner can then follow up with the child to make sure he or she understood the story is about him or her and understood the response that he or she could give to the bully. Children and adolescents with ASD are typically concrete and literal thinkers, and they may not apply to themselves or connect with play interventions that rely on metaphor or abstract presentation.

The fifth edition of the Diagnostic and Statistical Manual (2013) categorizes ASD as a neurodevelopmental disorder. Other disorders in this category include attention deficit hyperactivity disorder and Tourette’s syndrome. There are several other developmental disorders/disabilities that exist as well. The Centers for Disease Control (2014) states that developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person’s lifetime. Common developmental disorders/disabilities include cerebral palsy, fragile X, and Down syndrome. Whether categorized as neurodevelopmental disorders, developmental disorders, or developmental disabilities, these various conditions often share similar symptoms in terms of social function and emotional regulation struggles. Play-based interventions can be helpful in addressing and improving symptom areas associated with these conditions.

Practitioners who work with children and adolescents with ASD or any other developmental disorder should become thoroughly educated about the many aspects related to these complex conditions before implementing play-based interventions or any treatment. Practitioners are encouraged to learn more about ASD and other developmental disorders from diagnosis, to common symptoms, to treatment approaches, to how these conditions affect a child or adolescent and his or her family in a myriad of ways. Proper education about these disorders will enhance and elevate the implementation of play-based interventions for greater success. For editing purposes, this book will often refer to ASD when discussing symptomology that tends to apply to most developmental disorders. The play-based interventions in this book address the commonly shared deficits and struggles that accompany most developmental disorders. These struggle areas include social skills and functioning, emotional regulation, and appropriate relationship connection. Each developmental disorder contains specific and unique characteristics and struggles. Practitioners are encouraged to increase their awareness of the specific developmental disorder that has been diagnosed in the child that he or she is working with.

Relationship Development and Rapport

Regardless of the intervention being used, the practitioner-child relationship is central to the child’s realization of treatment goals. The rapport that develops between the practitioner and child forms the foundation for therapeutic success. In building a therapeutic alliance, the practitioner must create an atmosphere of safety in which the child is made to feel accepted, understood, and respected (Lowenstein, 1999). Play-based interventions lend themselves to creating a very structured and directive session with a child or adolescent. The directive element of play-based interventions should not displace the importance for the practitioner and the child to develop good rapport and relationship.

As with any therapeutic approach, it is essential that relationship building be a central focus. Practitioners should spend time in the beginning of treatment and throughout treatment building relationship with children and adolescents, and the parents they are working with. Implementing directive instruction, no matter how great the instruction may be, will be much less effective without proper relationship and rapport between the practitioner and the child. Essentially, it is the relationship that gives the intervention value. Engaging with interventions in the right frame of mind will yield better results.

Treatment Planning and Goal Setting

It is important for practitioners to understand psychological theories and have a theoretical framework from which to work (Cavett, 2010). Directive play-based interventions should always be grounded in a theoretical approach. The interventions in this book align with the AutPlay Therapy protocol for directive play-based interventions to address a child or adolescent with a developmental disorder who is experiencing skill deficits. AutPlay is a treatment approach for children and adolescents with ASD and other developmental disorders. The AutPlay approach is a blending of developmental and behavioral methodology. The foundations of the AutPlay approach include cognitive behavioral therapy, behavioral therapy, and play therapy approaches such as cognitive behavioral play therapy, filial therapy, and Theraplay. Further, AutPlay Therapy incorporates elements from various social skill enhancement programs.

Directive play-based interventions should be specifically chosen to address issues or skill deficits with which an individual child or adolescent is struggling. Interventions should be a component of the child’s treatment plan and align with established treatment goals. Practitioners should be able to communicate why interventions are chosen for a specific child, how the intervention will help address the child’s identified issues or skill deficits, and how the intervention addresses the child’s treatment goals. Practitioners should also implement evaluation procedures to assess that the chosen play-based interventions are actually helping the child improve targeted skill deficits and that the child is making progress toward his or her established treatment goals.

Creating Developmental Disorder Interventions

The play-based interventions listed in this book for ASD and other developmental disorders are purposefully designed to be 1) simple in instruction, 2) low prop based, 3) easily implemented across various environments, and 4) targeted toward specific skill acquisition.

1. Simple in instruction: Children with ASD are less likely to focus on, or engage in, an intervention if the instructions are too long or complicated or involve too many steps to complete the intervention. For interventions that may have multiple steps, it is sometimes helpful to present each step one at time and allow the child to complete a step before presenting the next step.
2. Low prop based: Children with ASD or other developmental disorders may become distracted or over stimulated with too many toys, props, and expressive art materials around them or available to them. Keeping props simple and focused on the intervention being presented will aid in helping the child maintain focus and engagement and ultimately aid in successful completion of the intervention. Practitioners may even want to present the intervention in an environment that is somewhat sterile and low on possible distractions.
3. Easily implemented across various environments: Many different practitioners in various settings work with children with ASD and other developmental disorders. The interventions in this book are designed to be able to transfer across many environments such as a playroom, a school counselor’s office, and even an in-home setting where a practitioner or parent may be implementing the interventions.
4. Targeted toward specific skill acquisition: The interventions in this book are grounded in a theoretical base and should be chosen for a child or adolescent specifically to address skill deficits or issues that a particular child or adolescent is struggling with. Interventions should align with and be part of the greater treatment plan and goals for the individual child or adolescent involved in therapy.

Practitioners wanting to create their own play-based interventions for children with ASD or other developmental disorders are encouraged to follow the guide listed above and utilize the worksheet located in the Appendix. Some additional points to consider:

• Interventions should be structured, directive, and incorporate a playful approach as much as possible.
• Ideally, interventions should be able to be taught to parents and implemented in the home setting by the parents.
• Consider that interventions may be repeated several times and that the same skill may be addressed with several different interventions.
• Interventions should be adjustable from simple to more complex, should advance in complexity as the child advances, and be applicable to children at different functioning levels.
• Interventions should be concrete and about the child or the child’s situation; metaphor and abstract interventions should be avoided.
• Ideally, interventions should incorporate more than one element (social, emotional regulation, anxiety reduction, sensory processing, connection, etc.).
• The practitioner should be flexible in regard to involvement in facilitating the intervention and teaching of new skills; a psychoeducational model is typically implemented.

2
Implementing Directive Play-Based Interventions

The Power of Play

Play is considered the language of all children (Landreth, 1991). The benefits of children engaging in play include cognitive development (learning, thinking, and planning, etc.); social skills (practicing social interaction, roles and routines); language (understanding and talking to others, turn taking, etc.); problem solving (negotiation, asking for help, solving difficulties, etc.); and emotional development (managing feelings, understanding others, empathy, etc.). Children with play skills are more likely to be included with their peers, and play is a key learning tool through which children develop social skills, flexibility, core learning skills, and language. Play also provides opportunities for children to practice events, situations, and routines in a safe place, with no pressure to “get it right” (Phillips and Beavan, 2010).

Sherratt and Peter (2002) suggest that play interventions and experiences are extremely important to children with ASD. They state that simultaneously activating the areas of the brain associated with emotions and generative thought while explicitly teaching children with autism to play will lead to success. Further, Thornton and Cox (2005) conducted individual play sessions with children with ASD specifically to address their challenging behaviors. They incorporated techniques that included relationship development, gaining attention, turn taking, enjoyment, and structure. Their research found that play interventions did impact the child’s behavior with a reduction in negative behavior following the structured play interventions.

Cross (2010) stated that no matter what type of play—constructive, outdoor, physical, or cooperative—play helps children learn and developmentally thrive, and the health and productively of a child’s play greatly affects later learning. Moor (2008) proposed that play with children with ASD is about structure. In the play context, choice, freedom, and discovery are simply not the things that motivate children with ASD to play in the way they motivate neurotypical peers. Children with ASD need structure because, despite their many differences, in general, they have impaired motivation to interact, learn, and play. They have rigid and repetitive patterns of thinking, and therefore of talking and playing, and are often motivated to preserve sameness.

Many play therapy and play-based treatments can be appropriate interventions in working with children with ASD especially when working with children who have little in the way of social skills and poor communication (Parker and O’Brien, 2011). Play-based interventions are gaining more and more valid research as effective treatment approaches for children and adolescents with ASD and other developmental disorders. Play-based interventions of many types—outdoor, movement, art, music, games, and prop based—provide the opportunity for practitioners to individualize treatment and engage the child in both a playful and structured approach that other ASD treatments may not offer.

This book presents a preferred guide in regard to the play-based interventions listed, indicating what level is appropriate for each intervention. The levels are listed as child, adolescent, or both child and adolescent. Most of the interventions in this book could be used for children ages 3–18 as long as content was adjusted adequately to reflect the child’s age. Also, the child’s developmental level should be considered as most children with ASD or other developmental disorders will likely present at a younger developmental age than his or her chronological age.

Practitioners should not be hesitant about trying any of the interventions listed in this book with any of the children and adolescents they work with. It will be clear if an intervention is too advanced for the child’s chronological or developmental age, and likewise, it will be clear if the intervention is too basic. If a practitioner realizes the intervention is too advanced or too basic, then adjustments can be made to fit the intervention to what is appropriate for that child.

Practitioner Role and Level of Involvement

Children and adolescents with ASD and other developmental disorders will present on a wide continuum in regard to functioning level and ability to understand and complete various directive play-based interventions. The practitioner should be aware of this variance and be prepared to meet each child or adolescent where he or she is in terms of functioning level. The practitioner’s involvement in the facilitation, completion, and processing...