Originally published in the The Theraplay® Institute Newsletter of Spring, 1994

Group Theraplay for Children with PDD

Susan Bundy-Myrow, Ph.D.

Buffalo, New York

Children with Pervasive Developmental Disorders (PDD) have a variety of social-emotional and sensory needs that "beg" for Theraplay interventions. This article describes the use of Group Theraplay with five PDD children within a heterogeneous group of ten five year olds at the Language Development Program.

Language Development Program is a private, non-profit school in the Buffalo, New York area serving speech impaired pre-school and school-aged children. Some children have the additional classification of Multiply Handicapped, including Learning Disability, Autism, Emotional Disturbance, or Other Health Impairment.

The five children diagnosed as having PDD, we will call Charles, Jimmy, Jesse, Joe and Mary. Although each child varied in temperament, apparent cognitive ability, expressive language, communicative intent and behavioral adjustment, similarities pertinent to Group Theraplay goals existed as well. All needed to increase awareness of peers, tolerance for physical proximity, and comfort accepting positive attention. In addition, they needed to learn how to initiate contact with peers and adults. Rather than work with the five PDD children alone, we decided to include them with five more socially responsive children to make a total of ten. The needs of all the children for stimulation and involvement were addressed by implementing the four rules of Group Theraplay: the adult is in charge, stick together, no hurts, and have fun!

The Theraplay group met weekly from October to June (1992-93). Sessions were one-half hour in length. The group was composed of an intact class of six children (which included Charles, Jimmy, and Jesse), and four children selected from two other classes (which included Joe and Mary). My co-leader was School Psychologist Maggie Buckley and we were regularly assisted by two classroom team members from the intact class. Review and processing followed each meeting.

The format for each session included a consistent welcome and closing sequence (which grew in complexity as the year went on), with one or two new activities in the middle. Each of the children made progress toward individual and group goals. Mary increasingly became able to stay involved with the group after she took her turn receiving a snack. Most significant was her passing a coveted "goodie" to a friend whom she had selected. Charles could tolerate our group activities for increasingly longer per-iods before rocketing to the farthest corner of the room. It was so difficult for him to participate interpersonally that it was momentous when he acknowledged a "hurt" ("boo-boo") and responded "Me!" to the question, "Who needs some lotion?" Joe too, showed more involvement. Although initially showing little affect, he joined the group by smiling and dancing to a "popcorn" song during the eighth session. Jimmy was initially very protective of himself, rejecting touch and any food offered to him. At mid-year he participated in all activities, consistently accepted snacks, and was reported in class to enjoy being tickled by a classmate! Jesse also became more tolerant of contact with peers. Sensitive to auditory stimuli, he might hold his ears or bite his wrist if over stimulated. During the one time when this behavior occurred, he permitted me and another child to nurture the hurt and gently tell him, "No hurts." Our five other members also showed positive change.

Although ten-member Theraplay groups are not considered large, the special needs of the five children with PDD required particular attention to the degree of structure provided, as well as to the type and length of activities. We found the following ideas were helpful in keeping the children involved. Cube-type chairs provided more security and boundary definition than sitting on a rug. Short, relatively fast moving activities provided initial success in "sticking together" for children with poor attending skills. To decrease the waiting time in an activity, we often addressed two children simultaneously. As the group sang, for example, "Where, oh, where are Jesse and Michael?" my co- therapist and I made sure that each child was "discovered" by a neighbor. Exciting, whole-group activities worked best. Our version of blanket football was apropos for group members and Buffalo Bills fans alike: since all are required to hold the blanket to put the ball into play, even Charles, our best runner, could not resist the challenge to "stick together." Last but not least, unless you want your supply box to be the focus of your group, sit on it!

Dr. Bundy-Myrow is a Counseling Psychologist at the Language Development Program, 300 Fries Rd., Tonawanda, NY. She also maintains a private practice using the Theraplay model with individuals, groups and families.