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Autism Spectrum Disorder: Promoting Communication & Socialization Skills
Autism: Teaching Parents How to Prompt Communication & Socialization

Section 14
Theraplay for Children with Autism Spectrum Disorder

CEU Question 14 | CEU Test | Table of Contents | Autism
Psychology CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs, Nurse CEUs

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In the last section, we discussed 4 Parts to Making Friends and Play Dates.  This included finding someone with potential, the initial phone call, starting short and planning a longer play date.

In this section, we will discuss 5 Parts to Playing with Others.  This will include play initiation and joining in, taking turns, play termination, winning and losing and sports.

Lola, age 38, was mother to Felix, age 10, who had autism.  Lola stated, "Felix gets very upset when he loses games.  He’ll throw a full-out temper tantrum if he loses at his videogames.  Beyond that, when he wants to play something more tangible, like dodge-ball, he just goes up to other students and drops the ball in front of them!  He’s never been very verbal, I guess…but, you know, the other students just pick up the ball and play without him!  How do I teach him to be a good sport about losing and to play well with others?"

5 Parts to Playing with Others

♦ Part 1 - Play Initiation and Joining In
I stated, "First, let’s discuss play initiation.  As always when teaching a child a new and difficult task, remember to keep it as rewarding as possible for Felix by beginning with activities that the child already enjoys.  Prompt Felix to go up to other children and ask if they want to play.  Even with language delays, simply saying ‘Play ball?’ or ‘Play slide?’ has often worked, in my experience.  As you are likely aware, the time will come when Felix will be turned down.  I have found, in my other clients’ experiences, that if an adult stays nearby when a child asks nicely to play and looks the other child straight in the eye, that child will almost always say yes. 

"If the child does still say no,
teach the child with autism to persevere and approach another child.  You should also encourage Felix to seek out the children who are most likely to say yes, so that he doesn’t get frustrated.  You can also set Felix up for success by asking another child if yours can play with him before you prompt him to try.  Finally, if children do seem to be rejecting Felix, you may want to ask them why.  You may get information you didn’t expect." 

In a later session, Lola stated, "You know, I was able to drop in on a little of Felix’s recess once, and I asked a little girl why no one seemed to play with him.  She said it was because he picked his nose in class!  Of course, I wouldn’t have known that, so we worked on it at home, and now, apparently, children are more willing to play with him!"

♦ Part 2 - Taking Turns
Lola asked, "How do I teach Felix about taking turns?"  How might you have responded regarding taking turns? 

I stated, "When teaching turn-taking, you may want to start out with games that don’t have a lot of rules, so you can just focus on the one important one.  As you are aware, many children with autism like toys that create visual or auditory stimulation, such as ramps that a ball can roll down or a toy that plays music.  These kinds of toys work well for turn-taking, because they’re simple, the turns aren’t too long, and it’s gratifying to be a spectator, too. 

"The first time you teach turn-taking, you can be the other player.  Keep your turn extremely short at the very beginning—one quick moment, and then it’s back to the child.  Gradually add to the length of your turn as your child is able to tolerate longer and longer periods.  Also, try to make sure that Felix is still watching the game when it’s not his turn.  Wait to go until you’re sure he’s watching, prompting or redirecting him as necessary.  There tends to be a strong pull toward disengaging for kids with autism—they may revert to self-stimulation or simply zone out, but they need to learn that an important part of interacting is showing interest in what’s happening with the other person. 

"Again, if Felix is just starting to learn how to play with others, don’t worry if you only get one turn in.  This is a good start.  The next day or week you can work on two turns, and so on, until Felix can play for an extended period.  Once Felix has learned how to take turns and will play socially for a while, you can try other, more difficult games.  But, remember, always try to find games that your child will enjoy, so just getting his own turn will reward him for waiting through yours."

♦ Part 3 - Play Termination
Lola asked, "How might I prevent Felix from blowing up when he loses?  Can he be taught to catch his own anger rising before he erupts?" 

I stated, "Third, in addition to play initiation and taking turns, let’s discuss play termination.  Just as Felix needed to learn the appropriate way to enter a game, he needs to learn the appropriate way to end one.  You’ll have to teach him the right things to say, based on the situation.  For example, if Felix simply doesn’t want to play anymore, he’s reached the end of his ability to play appropriately at that moment. Prompt him to say, ‘Could we finish the game later?’ before running off.  If the game is over, and he’s won, he could learn to say, ‘Good game!’  If he lost, maybe he could say, ‘I did so badly that time!’  This is another area where it can be helpful to observe the other kids and see what they’re likely to say under these situations."

♦ Part 4 - Winning and Losing
Lola asked, "What about Felix being a sore loser?" 

I stated, "Fourth, for Felix, it might be helpful to start with games or activities that he doesn’t seem to mind losing.  You may want to develop a hierarchy of games, those that Felix has to win, those that Felix doesn’t care if he wins, and those in between.  Then you can start with a game that Felix enjoys, but doesn’t seem to care if he wins loses.  You can point out that he lost the game, but it’s no big deal; You win some and lose some. 

"Once you’ve practiced on these neutral games, and he seems ok with the idea of losing, then you can start fading in games that had previously caused a problem.  If one particular game continues to cause a problem, you may want to warn Felix that he won’t be able to play it any longer if he can’t accept losing at it now and then.  After that, if he still can’t control his anger, then you might want to discard that game and go on to others. 

"That’s rare, though—most kids have learned to deal with it by that point.  Sometimes it works to reward children to control their anger by giving them a reward for not being angry after losing a game.  After a while, you may fade out the reward.  I once had a client who had a child with autism who taught him to cheer wildly for the other person who won the game.  This completely distracted him from the fact that he lost."

♦ Part 5 - Sports
Lola asked, "Do you think I should get Felix into sports at all?  Would that be a good channel for him?"  

I replied, "In my experience, organized sports can be difficult for children with autism, as they require social interaction, following rules, and then demonstrating appropriate behavior.  Many coaches have little or no experience with children with disabilities and can be competitive.  You could end up with someone yelling at your kid instead of rewarding him for his efforts.  But if you can find a sport that Felix is willing to work for, it can be a great opportunity for teaching. 

"You can help Felix during free time at home, by priming him on the rules and traditions of the game and by having him practice what to say and how to interact with his teammates and coaches.  You might record the practices so that you can go over them at home with Felix.  You may have to try less competitive activities like karate, track or swimming.  Some children excel at jump rope or hopscotch, but find quick-moving sports like basketball more difficult.  Keep trying those that already exist.  Of course, some kids just aren’t great at sports, so you may have to work hard to find something that Felix likes and can be successful at." 

In this section, we discussed Playing with Others.  This included play initiation and joining in, taking turns, play termination, winning and losing and sports.  Do you have a client with an autistic child you are currently seeing who might benefit from listening to this section in a session? 

Peer-Reviewed Journal Article References:
Guest, J. D., & Ohrt, J. H. (2018). Utilizing child-centered play therapy with children diagnosed with autism spectrum disorder and endured trauma: A case example. International Journal of Play Therapy, 27(3), 157–165.

Hiles Howard, A. R., Lindaman, S., Copeland, R., & Cross, D. R. (2018). Theraplay impact on parents and children with autism spectrum disorder: Improvements in affect, joint attention, and social cooperation. International Journal of Play Therapy, 27(1), 56–68.

MacCormack, J. (2019). Part 1: Why child-centered play therapists should care about play-based social interventions for youth with ASD. International Journal of Play Therapy, 28(3), 157–167. 

Simeone-Russell, R. (2011). A practical approach to implementing theraplay for children with autism spectrum disorder. International Journal of Play Therapy, 20(4), 224–235. 

Online Continuing Education QUESTION 14
What are 5 parts to playing with others? To select and enter your answer go to CEU Test.

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Autism: Teaching Parents How to Prompt Communication & Socialization

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