Play Therapy For Autism

Running head: PLAY THERAPY FOR AUTISM 1

Play Therapy for Autism

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PLAY THERAPY FOR AUTISM 2

Play Therapy for Autism

Autism spectrum disorder (ASP) is a developmental condition that affects the behavior,

communication, interests and social interaction in humans. Autism is detected in children generally

before the age of three. World Health Organization (WHO) facts show that that one in 160 children

has ASD (“WHO Autism spectrum disorders,” 2017). The signs and symptoms of ASD are

repetitive behaviors such as repeating phrases and overly focused interests. Other symptoms

include social communication behaviors such as making inconsistent eye contact and unusual tone

of voice. Scientists believe that genes and other environmental factors are the leading causes of

ASD. Other risk factors include having older parents, extremely low birth weight, having a family

member with ASD and having other genetic conditions such as Downs Syndrome (Carl & Hardan,

2011). In children, the diagnosis of ASD includes two stages. In the initial stage, a pediatrician

checks for general development. The other step involves extra assessment to assess the language

abilities, thinking skills, and other activities such as dressing and eating.

Diagnosing in adults can be hard that in children. However, doctors can carry out an ASD

evaluation that will help to determine the repetitive behaviors, sensory issues, restricted interest

and challenges in social interaction. After one is diagnosed with ASD, it is essential to start

treatment immediately to help the person alleviate the social problems and make life easier. There

is no specific treatment for Autism since it manifests and impacts each child differently. As a

result, several interventions and therapies have been introduced to help deal with different child’s

difficulties. The right combination of the intervention and therapies can involve parents in the

process to help build self-esteem and child’s interests. This paper will discuss the play therapy for

Autism, how it is implemented, special training for implementation, materials needed and the

empirical support for the intervention.

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Play therapy is an evidence-based intervention that helps children learn play skills

through interaction with peers as part of social skills training. Landreth defines play therapy as

“an interpersonal relationship between a child and a trained therapist, and the relationship acts as

an element of therapeutic change” (1996). Many children express themselves through playing

and therefore can help children with Autism connect and create relationships with other people in

a way they can understand. Therapist gathers understandings of what the child’s interests,

motivation, fears and source of happiness are from the sessions. The knowledge accumulated

helps to interpret the actions of the child to understand what he was communicating. The

information also helps to understand what the child is feeling. Play therapy can also help children

with Autism to develop problem-solving skills, express feelings, communicate with others and

learn how to relate to the world around them. Play therapy is a safe activity that allows them to

express feelings and thoughts necessary for their development. In the play, children gain a sense

of control of their world which is required for emotional development (Landreth, 1996).

Play therapy falls into two categories, directive approach, and nondirective approach. The

directive approach includes methods such as Theraplay, and non-directive approach methods are

Child-Centered Play Therapy (Carl & Hardan, 2011). In the non-directive approach, a therapist

leaves the child to guide themselves while will in directive approach a therapist will engage

directly with the child through suggestions and communication. In other words, a play therapist

in a directive approach will assume responsibility and give direction to the child in play while in

nondirective the child has all the responsibility and direction of the process. Theraplay is a

directive play therapy model that is based on attachment-based theories and research. It focuses

on a healthy parent-child relationship through a healthy pattern of interaction, communication,

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and play. Therapists guide parents and children through some activities and to increase

interaction between them. Through the series of playful activities, children with autism get to

develop a new view of the people and world around them. Theraplay has four dimensions

including structure, engagement, nurture, and challenge.

Nondirective approach is also known as child-centered play therapy (CCPT). CCPT was

established on Virginia Axline early works and Carl Roger principals. Roger's principals include

empathy, self-actualization, congruence and unconditional positive regard (Salter et al., 2016). It

is based on creating a non-judgmental and emotionally supportive atmosphere but also with clear

margins that will enhance the safety of the child psychology to allow learning of behavioral and

emotional self-regulation. CCPT is a powerful tool for intervention for children with autism

because it focuses on providing a secure environment with the presence of an accepting therapist.

Through a comfortable and secure environment, children find it easy to express themselves

without using language. A play therapist observes the child play themes and systems to

understand the child's inner world. When CCPT is as an intervention method for children with

autism, some of the changes can be observed in joint attention, a theory of mind and imitation

response (Salter et al., 2016). Research shows that skill gained from joint attention are connected

to social cognition development and language formation. Moreover, studies have shown that

CCPT intervention improves social interactions. Therefore, it is a successful method for

supporting emotional and social development in children with autism. Play helps in many areas

of growth including social, emotional and intellectual growth. Play therapy is beneficial to

children with autism as it helps to improve brain functioning, social interaction and language

development. Supportive and safe conditions during play activities, therefore, help children with

autism to develop motor and social skills. Research shows that play therapy helps the

PLAY THERAPY FOR AUTISM 5

professional therapist to identify unique play patterns such as attention, toy selection,

enthusiasm, goal orientation and exploration. The play therapy intervention process brings

intellectual changes to the child including changing child’s beliefs and expectations (Landreth, &

Bratton, 2002).

Play therapists are essential in the play therapy intervention process. However, for one to

become a play therapist, there are credentials that one should possess. The credentials include the

“Registered Play Therapist-Supervisor (RPT-S), School Based-Registered Play Therapist (SB-

RPT), and Registered Play Therapist (RPT) (Carl & Hardan, 2011). Earning all the three

credentials requires a master’s degree in any fields related field to child and adolescent

development. The other requirement is to either have supervised clinical experience amounting to

2000 (SB-RPT and RPT) or 5000 (RPT-S) hours. Another condition is that one should have 150

hours of a particular play therapy coaching from an official Administered Play Therapy provider.

To apply for an RPT or SB-RPT license, one should also have either 600 (SB-RPT), 500 (RPT)

OR 1000 (RPT-S) hours of overseen play therapy-specific experience. A person should then

complete a six hours’ supervisor training to become an RPT-S. The training is vital because it

helps in providing the therapist with skills in leadership and supervision, practical experience in

an autism specific classroom, parent communication, child-centered curriculum development and

problem resolution.

Play therapy includes the use of materials such as toys. Five types of toys that can be used

in play therapy. The first group of toys are family or nurturing toys that help in exploring family

relationships. The second group is scary toys that are used to examine trauma and fears. Aggressive

toys are the third category of toys that are used to investigate control and trust issues. Expressive

toys are the fourth group that allows children to explore their feelings and be creative. The last

PLAY THERAPY FOR AUTISM 6

category is the fantasy toys that are used to learn about relationships and practice new behaviors.

These toys should be adjusted to the player settings.

Play therapy intervention session varies in length depending on the child. Some sessions

last for about 30 to 50 minutes. The success of the play therapy lays mostly in the number of

sessions, the relationship between the therapist and child, and the parents’ involvement.

Researchers recommend that play therapy sessions should be held every week. It is estimated that

30 to 35 play therapy sessions help resolve problems in children with autism (Landreth, & Bratton,

2002). Some children can improve faster than others depending on their level of problems with

autism.

Some empirical studies have been carried out to find out how effective is play therapy. One

of the studies was carried out by Ray and her partners when they combined data from 94

experimental studies. The experimental studies included unpublished studies, journal articles, and

thesis dated from 1940 to 2000 (Reddy et al., 2005). Every study in the meta-analysis had a control

group. The studies participants were children between the age of three and 16 years. The average

age was 7.1 years. 74 of the studies involved nondirective play therapy while twelve studies

involved behavioral -direct play therapy. The rest of the studies, eight studies were not included

due to lack of information. The outcome of the meta-analysis shows that the overall effect of play

therapy was (Effect Size= .80) (ES), which is seen as a significant positive treatment outcome.

The humanistic-non directive category showed an effect size of (ES = .93) while the behavioral –

direct category results were (ES= .73) (Reddy et al., 2005). The unbalanced number of studies in

the two groups caused the difference in results. The study also compared the results of the general

play therapy to that of filial therapy. The outcome indicated that the filial therapy had a more

significant effect of (ES=1.06) than common play therapy (ES=.73). This shows the presence of

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parents in a play therapy intervention increases the impact of the treatment positively. Another

meta-analytic study conducted by LeBlanc and Richie (2001) also showed that play therapy has a

positive effect of .66.

In conclusion, Autism Spectrum Disorder is a developmental disorder that affects how one

communicates and interacts with others. It starts early in childhood and if not treated it can last

throughout the adult life. People with ASD have signs and symptoms of repetitive behaviors and

interests and problems in communication. ASD impacts children differently, and therefore

intervention and therapy methods have been introduced to help make children with autism have a

more comfortable life. One of the intervention is play therapy that has demonstrated to improve

the social interaction and lessen the repetitive behaviors and interest. Play therapy involves the use

of toys in play to help the children transfer fears, guilt, and fantasies to objects. The symbolic

representation helps the children to learn how to cope and relate to the outside world. Professionals

in this field of therapy require adequate training and a master’s degree in therapeutic play.

Empirical studies such as the meta-analysis of the 94 studies by Ray and her partners show that

play therapy has a positive result as a method of treatment for children with autism. Therefore,

play therapy is a useful tool to use as it allows children express themselves fully and improve their

cognitive development.

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References

Carl, F., & Hardan, A. Y. (2011). Autism spectrum disorders. Handbook of Developmental

Psychiatry, 463.

Landreth, G. L. (1996). Play therapy interventions with children's problems. Jason Aronson.

Landreth, G., & Bratton, S. (2002). Nutrition, Health and Safety Play Therapy: The Art of the

Relationship. JOURNAL OF EARLY EDUCATION AND FAMILY REVIEW, 10, 30-34.

Leblanc, M., & Ritchie, M. (2001). A meta-analysis of play therapy outcomes. Counselling

Psychology Quarterly, 14(2), 149-163.

Reddy, L. A., Files-Hall, T. M., & Schaefer, C. E. (2005). Announcing empirically based play

interventions for children. Empirically based play interventions for children, 3-10.

Salter, K., Beamish, W., & Davies, M. (2016). The effects of child-centered play therapy

(CCPT) on the social and emotional growth of young Australian children with autism.

International Journal of Play Therapy, 25(2), 78.

WHO. Autism Spectrum Disorder. (2017). Retrieved April 16, 2018, from:

http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/en/

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