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Play and Therapy

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Example of pretend play sequence in a therapy session

Play and Therapy

The importance of play and playing

Play is an important part of every child’s life and skills learned through play are essential to development across a range of areas. For children with ASD, learning how to play is particularly important as there are often gaps in the natural stages of play development due to the nature of ASD.

There are different types of play and it is important that your child has opportunities to engage in all types of play, with a range of objects and equipment, and where necessary facilitated by a good ‘play role-model’ such as a therapist. Play is complex, involving many different skills often overlooked by adults. The need for explicit teaching of the different skills involved in play may be necessary for children with ASD who have difficulty learning by imitation alone.

Playing creates a safe place where your child can experience situations that are not always on their terms, making it an excellent way to address restricted interests and practice social skills. Through play, children learn how to socially interact with others, they discover the enjoyment of learning new things and playing with peers, and they learn about how they fit into the world.

Types of play

Play is a broad term often used to describe many types of play including:

  •  Manipulative and exploratory play: when children explore objects, toys, and their environment. They are learning how their body can be used to change the environment and how to use their hands and fingers to manipulate objects.
  •  Sensory play: playing with objects that have different types of smells or sounds or texture (soft, hard, smooth, rough, wet, dry, slimy, furry etc.). This type of play helps children understand and interpret sensory information from their environment.
  •  Pretend play: giving meaning to imaginative play scenarios including imitation of everyday events (e.g. pretend eating or drinking at a tea-party or pushing a train and picking up passengers along the way). Pretend play also includes using an object to represent something else (e.g. pushing a block across the floor pretending it is a car). This type of play is linked to language development, self-regulation, and social understanding. Through pretend play children can improve their language (number of words and use of words/phrases in different contexts).

How a therapist might use play in therapy

A therapist might use play in therapy in two main ways.

The first is when your child is working on developing different play skills as part of their therapy plan. Pretend play, in particular, is often a missing ability in children with ASD and they need to be explicitly taught how to play. When learning how to play is the focus of therapy, the therapist and child (and maybe the parent) are on the floor and the therapy session is focussed on play sequences such as the child having a cup of tea with the therapist, or pushing a truck and parking it, or using a car mat with one or two cars, or playing shops. When therapy focusses on the play, changes in language and social turn taking also begin to occur alongside the child’s increasing play skills.

The second way a therapist might use play is as a means to engage your child in other activities that are the focus of their therapy.

For example, a therapist might teach your child how to play with different tactile objects as a way to help them tolerate a range of sensory feelings on their skin. Play is a powerful motivator when trying to engage children in new or challenging activities and it can also help to extend your child’s level of focus or attention during an activity.

The importance of parents learning to play with children at home

Children like to spend special times with their parent and playing with your child at home can be one of those special times. Because children with ASD may not naturally enjoy play, you need to demonstrate or ‘model’ your enthusiasm for play. You can show excitement through the use of your voice, facial expressions, and gestures. You can encourage your child to join you in playing. Children often initially engage in play only because they are following you. However, as you repeat the play activity several times while your child is interested, your child will begin to understand that the play itself can be fun and interesting. Your therapist will be able to assist you with how simple or complex the play should be; the types of play activities to start with; and how to keep engaging your child in the play activity. By playing with your child, you are creating a safe space where you enjoy your child’s company and it is wonderful when they relax, enjoy being themselves and begin to laugh and enjoy the play!

Interactive timetable

To see how many opportunities you already have in your everyday schedule for using strategies learnt in therapy, drag and drop the tiles below into the timetable and watch the hours add up!!

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon
Evening

Activities

Total hours: 0

Anxiety is a state of worry or fear about a real or perceived threatening event or situation, which often impairs physical and psychological functioning.

Articulation is how one makes sounds in words.

Auditory processing is the ability to perceive, interpret and respond to sound (auditory) stimuli. For example; a child who experiences difficulty processing auditory stimuli may be respond negatively to noise that you would not typically expect to bother someone, such as a vacuum cleaner. Alternatively, a child may have a decreased awareness of auditory stimuli and may not respond when their name is called.

A baseline is a measurement taken at one point in time against which future scores will be compared to measure progress. For example, before speech therapy begins, a therapist might measure how many objects a child can name. They might then measure this again one month, two months and three months after therapy has started to see how much progress the child has made.

Body awareness is the ability to recognise different parts of your own body, and their relative position.

Cognition refers to the mental process of acquiring knowledge.

A child’s developmental age will indicate where a child is socially, emotionally, physically, and intellectually on their path of development, as compared to typical behaviors and characteristics of that age.

Early intervention means doing something, or intervening, as early as possible to work on your child’s development and support needs.

Explicit teaching involves setting aside a block of time to work on a specific skill or task.

Expressive language is how one expresses their needs, wants, thoughts, and feelings.

Fine motor skills refer to the use of small muscle of the hands and fingers that allow us to manipulate and control objects and materials. This includes tasks that involve grasping (for example using a crayon or pencil), manipulating objects (using scissors) or activities that require hand-eye coordination (like threading, writing, doing up buttons and zips).

Gross motor skills refer to the use of the large muscle groups of the body that enable us to maintain an upright posture and coordinate the two sides of the body. Gross motor skills allow us to run, skip, climb and jump.

Gustatory processing is the ability to perceive, interpret, and respond to taste (gustatory) information. For example; a child who has difficulty processing taste information may have a self-limited diet, alternatively, they may crave strong flavours excessively such as spicy or sour.

A joint therapy session is when there are two or more therapists working with your child at the same time. This is generally two therapists from different disciplines.

Key word sign is the use of manual signs and natural gesture to support communication.  Key word sign is used to encourage and support language development in children with communication difficulties.

A low registering child does not register sensations at a typical level and does not seek out sensory stimulation. For example, a child that does not register auditory input at a typical level, may not notice when their name is being called.

Motor planning is the ability of the brain to plan and organise an action before it is carried out.

A multidisciplinary team includes members from different healthcare professions with specialised skills and expertise. The members collaborate together to make treatment recommendations for your child.

Non-verbal communication refers to elements of communication such as gesture, facial expression, and body language.

Olfactory processing is the ability to perceive, interpret, and respond to smell (olfactory) information. For example; a child presenting with an olfactory processing issue may smell objects excessively, alternatively, they may be over sensitive to smell information and actively avoid it.

Opportunistic teaching is using everyday ‘opportunities’ or activities to teach and practice the skills outlined in your child’s therapy plan.

Percentile rank is another way of explaining where your child’s score sits in comparison to other children their age. For example, if your child receives a standard score of 85 which is at the 16th percentile, this means that your child’s score was better than or equal to the score of 16% of other children his or her age. Another way of looking at it is that if 100 children completed this test and you lined them up from the person with the lowest score to the person with the highest score, your child would be standing in position 16.

Pragmatic language refers to the social use of language and includes the ability to understand verbal (tone of voice) and non-verbal cues (eye gaze, body language, facial expression)  as well as the social rules of language (turn taking, staying on topic, showing interest in others’ conversation).

Proprioception is the ability to understand where your body is in space. The receptors for this system are located in the muscles and joints of the body. For example; a child who experiences difficulty with the processing of proprioceptive information may have a decreased perception of pain, or seek movement excessively and appear to always be ‘on the go’.

Receptive language is how well one understands language, this includes information that is given verbally or in written form.

Self-care skills can also be referred to as ‘independence skills’. This include skills such as dressing, toileting, bathing, eating, and sleeping.

A sensory avoiding child is one who actively avoids sensory stimuli. For example a child who is sensitive to tactile (touch) information may not be able to wear certain clothing types such as wool.

Sensory processing is the way in which the brain receives, organises and responds to sensory information for everyday use. It also includes our ability to plan our actions and movements.

A child who is a sensory seeker does not register sensations at a typical level so may seek out sensory stimulation with increased frequency and intensity. For example a child who does not register taste information at a typical level may seek out spicy, salty, or very sweet foods.

A sensory sensitive child is easily overwhelmed by small amounts of sensory input. For example: a child with a sensitivity to auditory input may notice sounds that others do not register.

Sequencing is the ability to follow a set of steps within a task.

Skill generalisation is the ability to take a skill learned in one environment and successfully transfer it to another. For example a child first learns to use the toilet at home and then is able to use the toilet at kindergarten.

Social skills enable us to interact with people within our world and understand social rules. For a child, this begins with skills such as turn-taking, saying hello, and waiting.

Spatial awareness is the ability to perceive the position of your body in space.

A standardised assessment is a tool that has been designed to determine a child’s developmental level when compared to other children of the same age. Standardised assessments give a clear score that can be used as a baseline for therapy.

Tactile processing is the ability to receive, interpret, and respond to touch (tactile) information. For example; a child who has difficulty processing tactile information may not tolerate the feel of certain fabrics on their skin. Alternatively, they may not notice touch in the way they would be expected to.

The team around your child is anyone who plays an important role in your child’s development. Starting with the parents/carers, this may also include; therapists, teacher, respite worker, siblings, grandparents etc. The ‘team’ will vary depending on the child’s needs.

Verbal communication refers to speaking, either with or without aids for support.

The vestibular system is located in the inner ear and is responsible for our balance, understanding of motion, and spatial awareness. For example; a child who experiences vestibular processing issues may become distressed when their feet leave the ground, alternatively, they may crave vestibular input and spin or rock excessively.

Visual perception is the ability to understand, interpret and remember what one sees and respond accordingly.

Visual processing is the ability to perceive, interpret, and respond to visual stimuli. For example; a child who has difficulty processing visual information may be easily distracted by visual stimuli within their environment or become focused on a certain part of an object such as watching the wheels of a toy truck spin.