Play Therapy with Autism Spectrum Disorders

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Play Therapy with Autism Spectrum Disorders Powered By Docstoc
					 Elizabeth Bing, PhD
Clinical Psychologist
   Play is the primary childhood occupation
    (Case-Smith & Miller Kuhanek, 2008)
   Play is an indication of developmental level
    (Sparling, Walker, & Singdahlsen, 1984)
   Play has been linked to growth in memory,
    self control, symbol identification, oral
    language, and increased academic & literacy
    abilities Leong & Bodrova, (2005).
   Play skills have been linked to language in
    typically developing children (Lewis, Boucher,
    Lupton, & Watson, 2000)
   Reciprocal interaction between language and
    play (Sigman & McGovern, 2000)
   Play skills are important in the development
    of social competence (Stone & LaGreca, 1986)
    by allowing children to explore social roles
    and rules (Sroufe, Cooper, & DeHart, 1996)
   Although typically developing children
    naturally engage in play, children with autism
    do not engage in play activities that stimulate
    their development (Lantz, Nelson, & Loftin,
Primary goal: developing social competence

 ◦   Improving reciprocity in social interactions
 ◦   Boundaries and limits
 ◦   Cooperation
 ◦   Communication (reciprocal language/pragmatic
   Additional Goals:

    ◦ Developing a sense of mastery, positive self-esteem
    ◦ Improvement of positive affect through absorption
      in activities
    ◦ Developmental: cognitive, speech/language,
      fine/gross motor, functional leisure skills
   Particular ASD diagnosis
   Age/developmental level
   Cognitive functioning
   Speech/language abilities
   Gross/fine motor abilities
   Sensory issues
   Play skills & level of play: solitary, parallel,
   Associated mental health issues: mood
    instability, behavioral issues, oppositionality,
    anxiety, depression, low self-esteem
   Interview parents

   Observe the child with and without parents
   Read school records

   Read Evaluation Team Reports

   Read mental health records
   Goals   Current Status   Desired Outcome
      Client: Luke Rogers
      Date: 4/20/10
      Play Therapy Goals

Goal                         Current Status                         Desired outcome
Improve social competence    Controlling; rigid                     Improvements in reciprocity
Improve oppositionality      Tends to resist outside intervention   Accepts intervention
Improve play behaviors       Controlling & rigid in play            Improve ability to observe incorporate play
                                                                    behaviors of therapist
       Client: Annie Walker
       Date: 10/28/10
       Play Therapy Goals

Goals                                   Current Status                         Desired Outcome
Improve social competence               Problems in reciprocity, eye contact   Improvements in reciprocal play, improved
                                                                               eye contact
Improve play skills                     Client has limited play behaviors      Improve variety of play behaviors
Improve communication/social language   Client has limited verbal skills       Improvements in receptive/expressive
                                                                               language during play
   1) Nondirective Play (Landreth): child-
    directed, observing, tracking, reflecting
   2) Semi-Structured Play
   3) Directive or Structured Play

   Use of Scaffolding in semi-

   Blend the techniques to address goals that
    you have selected
   Scaffolding is a concept originated in Vygotsky’s
    work, although he never used the term

   Definition: interactional support and the process
    by which adults mediate a child’s attempts to
    take on new learning has come to be termed
    “scaffolding.” Scaffolding represents the helpful
    interactions between adult and child that enable
    the child to do something beyond his or her
    independent efforts.
   A scaffold is a temporary framework that is put up for
    support and access to meaning and taken away as needed
    when the child secures control of success with a task.

   Cazden (1983) defined a scaffold as “a temporary
    framework for construction in progress”. For example,
    parents seem to know intuitively how to scaffold their
    children’s attempts at negotiating meaning through oral
    language. The construction of a scaffold occurs at a time
    where the child may not be able to articulate or explore
    learning independently. The scaffolds provided by the
    tutor do not change the nature or difficulty level of the
    task; instead, the scaffolds provided allow the student to
    successfully complete the task.
   Involves the use of prompts:
      Verbal
      Point
      Touch
      Physical (partial to full)
   Physical assistance to build a block tower that
    matches the child’s ability to stack, provision
    of the most minimal assistance necessary to
    provide for a successful stack.
   Pointing to game board spaces during
    counting for a child who does not understand
    one-to-one correspondence enough to move
    their game piece.
   Minimal verbal prompts or models to
    encourage a child to label the name of the toy
    with which he is playing
   Partial assistance in opening or manipulating
    toys when fine motor skills are not sufficient
    to play successfully.
   Providing a child with a social model for how
    to take turns while playing, encouraging them
    to look and listen to what you are doing as
    well as their own activity.
   Providing a verbal cue regarding social skills –
    “friends play with the ball together” to
    encourage this understanding
   Select toys based on the child
   Basic ideas:
    ◦   Blocks
    ◦   Sand
    ◦   Small dolls & dollhouse
    ◦   Simple games
    ◦   Board games
    ◦   Toy animals
    ◦   Drawing tools
    ◦   Clay or playdough
    ◦   Manipulative/sensory toys for younger
        ages/developmental levels
   Follow the child: watch and listen
    ◦   Be a good observer
    ◦   Look at strengths and weaknesses
    ◦   Look for a chance to intervene with structure
    ◦   Take it one level up (scaffolding)
    ◦   Observe the effects of your intervention and
        respond accordingly

   What Goals will this address?
   Know your limits and boundaries
    ◦ Enforce them consistently
    ◦ Enforce them compassionately

   What goals will this address?
   Pace Your Interventions and interactions

    ◦ Watch for opportunities to introduce new/different
      interventions or tasks
    ◦ Make communications important, interesting, and
    ◦ Observe the child & how he/she is responding and
      change your behavior accordingly

   What Goals will this address?
   Exhibit positive coping skills when there are
    difficulties or adverse reactions
    ◦   Encourage a change of task
    ◦   Make a task easier
    ◦   Assist in distracting the child
    ◦   Be positive in your verbalizations & interactions

   What goals will this address?
   Have the child finish a product successfully to
    encourage mastery, however small
    ◦ Encourage finishing a block tower
    ◦ Encourage completing a drawing
    ◦ Encourage finishing a game or stopping at a
      designated point

   What goals will this address?
   Provide positive reinforcement
    ◦ Praise improvements for achievements
    ◦ With verbal children, verbally identify their
    ◦ Use judiciously, not constantly

   What goals will this address?
   What goals did I address?

   What improvements did I observe?

   Were any new goals identified?