Play Therapy

What is play therapy, and how do I do it?

If your child is on THE SPECTRUM or delayed in other ways, you’ve probably heard of “play therapy” by now.  Play therapy became popular in the 80s and 90s as professionals found out that getting down on the carpet with their autistic-type 2yr olds, and engaging them, actually made progress.  You’d think this would be obvious, but it wasn’t something that the professional community had necessarily thought of before—at least, not given at regular doses like “therapy.”  Before that, professionals were… well, professional.  They sat in chairs and had nice offices with toys, but they administered tests, tried verbal exercises, and had children do activities mostly in chairs and desks.  Not exactly the comfort and freedom a child is used to.

Early Intervention is essentially “play therapy,” often mixed with speech therapy.  A trained special ed person comes to your house and plays with your little guy for about an hour.  She has a bag of toys with her and knows what’s she’s doing, but it is essentially play to engage your child with his or her weaknesses right where s/he’s most comfortable… on the living room carpet. Genius, right!

Well, the good news is you can do play therapy yourself too.  If you suspect your child is having developmental problems, if you know they do, or if they don’t but you’re just looking for some more educational time with them, play therapy is a great option.

For the bible on the subject, check out Stanley Greenspan’s book (

Amazon.com: Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think (A Merloyd Lawrence Book) (9780738210940): Stanley I. Greenspan, Serena Wieder: Books

).   But if you don’t have time for that kind of thing, here’s basically what you need to do. (For ages 0-5).

1) Pick a space and time to do it.  Mostly for you so you’ll stick with it, but also because the routine will minister to your child if they are hostile to the idea at first.  Most kids love one-on-one time, but some don’t!   Make sure it’s a nice comfortable place with space to play.  Also make sure it’s not a naturally grumpy time for your child.

2) Set aside some special toys for the time. You don’t have to spend a fortune at Toys R Us, but do consider getting some things that will make the playtime special and familiar.   And imaginative since that is usually an area most playtime kids have trouble with.  Sometimes this means just some props that you think of using a dozen different ways (i.e. a paper towel tube).  Sometimes this is a favorite toy that a child will love going back to (i.e. a little Bob the Builder set or Dora figures).   There is merit in some of those toy companies like Imaginarium and Alex that make educational toys for kids, but use your own judgment.  (Try not to pick anything too complicated or messy, which will discourage you or your child from wanting to do it again!)

Also, check out a book like Jane Oberlander’s “Slow and Steady, Get Me Ready” (

Slow and Steady Get Me Ready

) Her book is based on daily different activities you can do with ordinary household items.  You can incorporate a couple of these into your routine and change them out as necessary.  Love it, love it.

3)  Start with about 10 minutes for a reluctant child and work up to about an hour.  Start a couple times per week (i.e. MWF) and work up to every day (or even twice a day) depending on the severity of your child’s diagnosis.  Think of it like little doses of preschool.  It is the concentrated attention regularly that constitutes “therapy” just like at a real therapist’s office.

4)  Ok, just start playing with your child. Bring out one toy and set them in front of it, to see what they’ll do.  This is child-guided play where you facilitate.  Don’t jump in with your whole script and ideas.  You’re “peering” here.  And you’re building off what your child does.

It helps to have some goals in mind before you start, so know whether your focus is going to be physical, emotional/social, imaginative, language, memory, etc.  Your child may have a combination of goals, but try to target no more than two in a session.  When your child gets frustrated with a toy or can’t use it, then try another.  Don’t go through your props like you’re trying to please the child’s whims, but don’t exasperate them either.  You’re going to eventually spend time with everything you’ve got, so do some stretching.

5)  Engage their attention. Play therapy is especially good for children with social, emotional, attention, and empathy problems.  They may not recognize or want you there in their space, and that’s fine.  That’s part of the therapy.  What you want to do is engage them, or sometimes gently confront them, especially if they are autism spectrum.  If they jump their little horse up and down, you jump yours up and down near them.  If they get stuck spinning wheels, you crash your little car into them (gently) saying “Vroom vroom!”  Try to get them out of their world and into yours.  If they’re verbal but hostile to you, or turn away, aim for the gentle but stubborn approach.  It helps to do this in a room where you can close the door so they can’t run away.  Make sure you hide other toys too, so they can focus on you and the props you have chosen.

6) Use toys vicariously, to get them to verbalize their experience. If they don’t talk, this might be one of your main goals: to get them to “talk” with their pieces. There are some ways to play with toys if your child is having trouble with language or imagination that I have listed in other posts on speech.  This is the first level of play therapy, to get them to be verbal. (i.e. please keep in mind that age-appropriate speech varies widely, and you shouldn’t be making speech a huge goal if your child is under two.)

The second level of play therapy occurs when your child becomes (or is already) verbal.  Now you want to use their toys as “counselors” or “mouthpieces.”  Don’t talk to them directly, use your piece.  Get them to talk back with their piece.  Kids will tell you all kinds of things if you let them talk through their pieces, about all kinds of things that upset them.  You can also teach all kinds of things through your pieces that they wouldn’t listen to you, their mom, about.  Now the playtime isn’t a teaching time, it’s an understanding time.  But a good therapist DOES use toy “mouthpieces” therapeutically, say to discuss the toilet or a source of a bad dream, etc.  Use your imagination.  Keep it pretend and in the realm of playing a game.   And if you’re going to teach or talk about something, stick to one theme per session so the child doesn’t feel lectured.

Hooray!  You’re a play therapist!

“Your son might be Autistic… or he’s just a boy.”

http://www.childrenshospital.org/dream/summer09/arresting_autism.html

http://today.msnbc.msn.com/id/26184891/#30009205

Does anyone else think this kind of thing is a tragedy?  These kind of clips embody what’s wrong in the world about autism right now.  Now just FYI, my children and I actually took part in this exact study mentioned here in the videos (i.e. the Infant Sibling Project in Boston.)  So I am not speaking flippantly.  I have experience with this field, with the kinds of experiments done, and even some of these researchers now.  I also have a child with whom I was sucked into this autism scare tactic before I knew better.

*

I have written a lot of posts which touch on this subject so I’m not going to repeat myself much here.  But I am just fuming these days over the mothers in these clips who feel better now that their oldest boys have a diagnosis.  There is a reason why those maxims that “he’s just a boy” or “he’ll outgrow it” are true.  Because it’ true.  There’s a whole crop of children out there (many of whom are eldest boys) who grow up with these delays and social awkwardness.  The symptoms are real.  The delays are real.  But labeling them all autistic is inaccurate.  Mothers are now being torn apart by, yet strangely taking comfort in, this diagnosis.  Maybe because now the confusion is gone, the fears are validated, and there is an action plan?  But the stigma is now on the child and it will take about six years of weirdness to outgrow.  That is, IF all the years of therapy, IEPs, and parental weirdness doesn’t fulfill the prophecy.

After going through this myself with my oldest, I still get upset when mother after mother who tells me the story of their preschool pathologizing their little boys.  “He’s developmentally delayed,”  “He’s socially awkward,”  “He’s not communicating,” “He’s not following directions.”  “Maybe he’s PDD-NOS.”  Except for the diagnosis of Oppositionally Defiant Disorder, there is probably nothing which irritates me more than all these little boys being put on THE SPECTRUM (the autism spectrum that is).

Now don’t get me wrong.  I am not against preschools, I am not against early intervention, I am not against special ed, and I am not against autism research.  I have a classically autistic cousin.  I’ve seen it, and I’ve seen how much the special education sector has helped her.  They’ve given her a quality of life she probably wouldn’t have had otherwise.  So I am not against more attention being given to autism and autism-like disorders.  I think this is awesome.

What I AM against is the constant confusion of gender with autism.  And I bet if I knew more girls having the problem, I would broaden my position (I just don’t know of many yet).  It is simply the case that many boys have the tendency to develop later, more awkwardly, less socially, less verbally, less imaginatively.  This does not put them on THE SPECTRUM.  It makes it important to teach boys these things.  It makes gender and birth order more important than the personality icons they currently are.

First of all, there is a cultural schizophrenia going on in our culture about boys.  On one hand, gender doesn’t matter and girls and boys are put together in the same daycare, preschool, and kindergarten classrooms like they’re all the same.  But on the other hand, boys will be boys and people treat girls and boys accordingly.  Expecting a little girl to fold her hands and sit quietly, for example (many don’t).  Or expecting boys to be wild and ill-mannered (many are not).  It isn’t just the difference between professionals and playground moms… both attitudes often come from the same people.  Boys make moms throw up their hands in irritation as they make silly faces, get into things, and generally act as though they’re in their own social universe.  So we reinforce boyhood stereotypes sometimes… but we don’t usually TREAT boys differently than girls.  In our egalitarian society, that’s not kosher.  (The same kind of argument can be made for girls, for that matter).  We may harbor more resentment toward boys—studies have shown that teachers and strangers tend to elicit more positive responses from girls—which is totally unhealthy of course.  But we still throw them in the same classrooms and have the same developmental timelines.

I think this is ridiculous.  First of all, boys and girls seem to have very different experiences of life, even as children.  Some of the stereotypes exist for a reason.  In my house, the boys generally respond to action and consequences–my daughter responds to words.  The boys are motivated by something to do, the girl is motivated by someone to be with.  The boys like things that do something cool, my girl likes things that are cute or pretty, or fit a certain function.  The boys always want to know why, or do things better if they understand why; my girl could care less. My boys are more innocent–charming, sweet, inclusive.  My girl is pickier, shyer of strangers and men, and more skeptical of what you want her to do.  My boys don’t tend to deduce things very well—they need things explained logically, step by step, and they won’t fill in blanks if they don’t know the answer (i.e. if I say a word they don’t know, they have no idea what I’m talking about; if I tell them something is in the dresser but it’s actually under it, they won’t look or notice).  My girl takes more time, liberty, and pretty much deduces exactly what I’m talking about, even if I’m using new vocabulary.  She hardly ever asks what something means.  My boys process one thing at a time, individualistically, and very much in context.  My girl processes multiple things, in relationship, through words and can generalize to different contexts naturally. She is the only one of the four (she is 2.5 yrs old, and my oldest son is almost 7 now) who will correct what I’m saying if I don’t guess right the first time (i.e. “not squish, Mom… smush“).  The distinctions come earlier.

So boys definitely process things differently than girls.  It is partly a matter of brain activity, which shows that boys use the non-verbal side of their brains more than girls (who use the verbal).  And that boys develop prefrontal cortex activity later than girls, who use more of their brains earlier.  Some differences are hormonal too, although not much is usually said about pre-pubescent hormones to state definitively.  But in my opinion, from comparing my three boys to my one girl, the main thing I see is that my girl demands attention.  There is no way of getting around her because she’s in my face all the time, talking, bouncing, sharing.  My boys have the tendency to be underfoot, for sure, but they tend to be less sure or confrontational about what they need… I have to notice myself and initiate.  (i.e. sometimes my oldest needs more hugs but he’d never realize that himself or solicit it).

Actually this last example is interesting because I have noticed that my little girl has had more talking and touching in her first two years than my boys probably had in theirs.  Not because I favored her but because she’s always here talking to me, trying to talk to me, trying to look in my eyes and get her to notice her, move her, get her something, etc.  My boys had the normal amount of touching when they were babies of course, but did not elicit the same talking and touching needs as my girl… so I probably did not give it to them.  I am speaking in generalities of course, but to this day I wonder what would have happened if I gave my boys the same talking and touching that my daughter has received (because she demands it).  My oldest might still have had language trouble, and my second might have had sensory problems, but I bet they would have been less severe.  I bet I would have overrun their personal boundaries to fix it—in comparison to the kind of uncertain, reticent posture I had when I was first figuring out how to discern and confront my little boys’ weaknesses.  My daughter has taught me that her overrunning my personal boundaries makes sure she got the stimulation she needed.  Because my boys didn’t approach me in that way, and I did not approach them that way, they may have suffered… at least a little.

I think it continues past the age of three too, since girls tend to be more relational, social, verbal.  This ensures they continue to get the attention and practice they need to engender more skills in these areas.  Boys are often off and away from people at 4, 5, 6… they’re careening around the playground and playing swordsmen, etc.  They aren’t usually interacting with mom about what kind of pretty butterfly they saw and how they need some lemonade.  And do we think they should?  Do we counteract that?  Of course not… we usually reinforce what is natural to them.  But then should we be surprised at the different results?  I am speaking again in generalities of course, but just to make the point: nature plays a role, and then nurture nurtures the nature =)

So I think more research on gender needs to make its way into the mainstream.  I am sure there are all kinds of gender-based studies which have been done that do NOT point to androgynous developmental charts.  But because we can’t segregate our classrooms or playgrounds (nor I am advocating that), there is little point in popularizing this line of thought.  But in the meantime, when experts tell you that your preschool boy is language delayed, socially awkward, or possible on THE SPECTRUM, remind yourself that he could be autistic… or he could just be a boy.