Originally published in the The Theraplay® Institute Newsletter of Winter 1999/2000

THERAPLAY FOR CHILDREN WITH AUTISTIC SPECTRUM DISORDERS

Susan Bundy-Myrow, Ph.D.,

Private Practice, West Seneca, New York
Sandra L. Lindaman, M.A., M.S.W.,
The Theraplay Institute, Chicago, Illinois

How can Theraplay help my child with Autistic Spectrum Disorder (ASD)?

Regardless of age and developmental level, a child with ASD needs ways to engage with others in pleasurable, social interactions. Neurological problems including severe sensory reactivity and processing difficulties interfere with the child’s ability to engage in reciprocal social interactions. He has difficulty sending out signals to which others can respond, and then has trouble receiving information; i.e., comprehending social cues, and learning from experience. Theraplay is a focused way to play with the child. It gives the child experience interacting with another, and gives the parents tools for engaging a child who may find it more comfortable to withdraw.

What actually happens in a session?

The therapist and child usually sit on the floor across from one another, to allow maximum eye contact and physical interaction. The therapist leads the child through a series of engaging, playful activities such as blowing and popping bubbles, squishing soap-foam balls, pulling slippery lotioned hands, catching a bean bag dropped off the head, playing a push-me-over, pull-me-up game, guiding the child through a song with hand motions, rocking in a blanket, or feeding the child a treat. Parents join the session and are encouraged and coached to complete the same activities.

My child would prefer to play alone or with certain toys; is it good to force her to play this different way?

Most children with ASD are distressed at first when we attempt to interact with them and guide their play. We believe that allowing them to withdraw only deepens their isolation and gives them less experience with others. Theraplay therapists are very sensitive to the child’s reactions. When a child is upset, we soothe and gently encourage her. We have found that if we are persistent and playful as we try to engage the child, he will show brief signs of enjoying the interaction even during the first session and usually overcomes his discomfort within a few sessions.

Is Theraplay a kind of behavior modification?

Theraplay does attempt to change behavior, but in a more social way than many behavior analysis programs. Theraplay goals include: increasing eye contact, increasing attending and turn-taking, adjusting to transitions, finding ways to soothe and comfort the child, determining the optimal level of arousal to promote engagement, and stimulating communication. A behavioral specialist who worked with several children after they attended Theraplay sessions commented that these children were more ready to work with her than children who had not attended Theraplay.

My child attends many different therapies, how does Theraplay differ from them?

Children with ASD usually receive various kinds of special assistance including speech-language therapy, occupational therapy, sensory integration treatment, tailored educational services, and behavior modification programs. These programs have their own important goals, but may not focus as directly as Theraplay on social interaction. The skills that Theraplay treatment focuses on are necessary for participation and success in other kinds of treatments. Children may receive Theraplay as their first kind of treatment; they may receive Theraplay at the same time as other services with all treatments carefully coordinated; or children may come to Theraplay later when parents and other specialists realize that social skills are not progressing adequately.

What evidence do you have that Theraplay works?

Theraplay has been used with children with ASD since its development thirty years ago and we have a great deal of positive clinical experience. There have been published accounts of single case studies and a recent controlled study of parent-child Theraplay in Korea. Currently, research data on Theraplay is being collected across the U.S., in Canada, and in Finland. Parents, therapists and teachers regularly report significant progress made by children when Theraplay is introduced; for example, special education teachers have reported that children who had received Theraplay in their primary school-aged class the previous year entered their new class better able to adjust to routines, “bond” with the teachers, and be cooperative with peers.

Is Theraplay ever done in a group or at school?

Direct work with the child and her parents has the greatest impact and usually is conducted first. As Theraplay progresses, sometimes siblings participate in treatment sessions to help them interact more effectively and have more fun with their brother or sister with ASD. As you can imagine, other children usually are “natural” Theraplay therapists. As the child with ASD increasingly becomes aware of self and others and predictably finds comfort and pleasure in the structure of his environment, goals may extend to include peers through Group Theraplay. Theraplay for groups of older children can offer the opportunity to give and receive in a safe, accepting setting, increase comprehension of social conventions, and practice social competence in a fun, friendship-enhancing context. Theraplay for children with ASD has been conducted in private practice, community based centers, and public schools by psychologists, social workers, counselors and teachers trained in the Theraplay method.