Children who have been diagnosed with symptoms associated with autism spectrum disorder (ASD) experience the world in a unique manner. ASD can (and does) vary from one person to the next in terms of both indicators as well as behaviors. There are two main categories of traits that make up this diagnosis – social communication and sensory integration.
This collaborative post from four ChildSavers therapists might help you gain a better understanding of how this diagnosis presents itself in the life of someone you love.
Play Therapy and Autism – Improving Social Communication
At times, individuals with ASD may have difficulties in communication including reading social cues, expressing emotions, responding in social situations, repetition in language, and struggling with eye contact. As a result, there may be miscommunication or misunderstanding as they have not interpreted their social environment in the manner intended.
The child’s guardians, educators, and mental health professionals can support growth in this area through modeling healthy behavior and emotional responses to include facial and verbal expression and supporting the development of positive and effective communication skills. As play therapists, we do so through expressive arts, consistent facial expressions, using puppets, and stories to help support this development. When these behaviors are exhibited in the classroom, it can appear as disruptive or oppositional, when someone with an ASD diagnosis is actually struggling with being able to identify their feelings and ask for support.
Using Sensory Play to Address Sensory Challenges with ASD
Additionally, children with ASD may experience sensory challenges depending on what is going on around them: temperatures, smells, foods, or noise, for example. If you’re a neurotypical person, imagine not being able to ignore some sensory input that you would otherwise typically take for granted. This could easily cause difficulties in coordination, social withdrawal, impulsivity and overall challenges, especially when adjusting to new situations with lots of unfamiliar sensory inputs.
When these behaviors are exhibited at home or in the classroom, it can appear like disruption or opposition. In reality, a child with an ASD diagnosis is just experiencing a high amount of stress and anxiety. This might mean they find it difficult to express emotions and ask for support. Soft sounds, music, a quiet room, or a safe person might assist an overwhelmed child to relax and re-regulate.
Play therapists might also utilize water and sand through sensory play to accomplish the same purpose. To support a child’s difficulty with decision making in an overwhelmed moment, helpful adults may wish to reduce sensory inputs, follow-through on previously agreed-upon expectations, assist with organization, and demonstrate a willingness to place the child’s needs above their own.
Activities that can help boost and build a child’s resiliency in this area could include social stories, setting one- or two-step goals, creating a plan with visual aids, and maintaining a realistic schedule and routine both during the day as well as at home. The support of a thoughtful occupational therapist who has experience working with individuals impacted by ASD can also provide invaluable support regarding sensory difficulties.
ASD and Psychotherapy
Working with children on the autism spectrum in a therapeutic context will require the therapist to be especially mindful of their engagement expectations of the client. Establishing a good, strong rapport is essential to therapy. But what does that look like with individuals who express social responses very differently than their neurotypical peers?
Consistency in Therapy = Safety and Security
Individuals (and especially children) on the autism spectrum thrive in a context of consistency, structure, predictability, and security. While connecting with such individuals, a therapist should strive to provide these elements of safety for the client. Children on the autism spectrum often present with a fixated set of interests and hobbies and will gladly engage in repetitive forms of play, such as using the same Lego set each session or following a systematic and literal sequence of events with dolls.
Therapists may feel pressure to engage the child in varied activities, push the child to expand their areas of focus, or challenge the child to consider their play with a “more imaginative” perspective. Resisting these urges and instead supporting a child in repetitive, systematic play provides the child with safety, security, and predictability. In this context, the child can establish internally understood “laws” about what occurs within their play space and can avoid the anxiety of uncertainty, which is often overwhelming for a child on the spectrum.
Setting Expectations: Relationship Between ASD Client and Therapist
Therapists used to working with neurotypical children may feel challenged by the lack of expressive engagement provided by a child on the spectrum. Frequently, children on the spectrum display a flat affect, minimal positive feedback about relationships, and corrective communication when the therapist makes a “wrong” choice. (“Wrong” here means a choices that does not fit within the child’s internally understood laws governing the play.)
The process of rapport-building will be much slower than is typical of most neurotypical children. The child on the spectrum will likely be content to engage in independent play and very slow to incorporate the therapist into their work. They may engage in minimal verbal responses or seem combative, as they correct the therapist’s attempts to connect with them verbally. These responses should be accepted and affirmed, providing a child with feedback regarding his or her mastery over their environment.
Additionally, a therapist can reduce uncertainty by providing clear structure within the playroom, such as predictable time prompts. The therapist should also be prepared to engage in highly repetitive engagement with the child. This will manifest in a variety of forms, such as themes within the play and repetitive practicing of skills, such as recognition of non-verbal communication.
Ultimately, therapeutic work with children on the spectrum is extremely rewarding. Therapeutic growth is hard-earned, requires significant patience, and attendance to counter-transference with greater urgency than many of our other clients. Caregivers, families, and even providers may feel impatient due to the time required to support meaningful therapeutic growth. Children on the spectrum often struggle with rigid perspectives about themselves, others, and the world around them, so change is a slow process.
Brandon’s Story: An Example of Therapy for A Child with Autism (ASD)
Consider the story of 6-year-old Brandon*, a child who received ASD behavioral therapy over two years at school. Brandon initially displayed frequent emotional and behavioral meltdowns, involving physical and verbal outbursts. In addition, Brandon rarely engaged in collaborative play with peers without becoming hostile, seeking to manage his environment, and control the terms of the play.
During his therapeutic treatment, Brandon frequently drew draw similar scenes of city streets with traffic lights, road signs, and lines. His therapist drew a connection. Using a playroom mat with cartoon scenes of city streets and buildings, Brandon was able to engage in group activities. Brandon and his peers were given clear guidelines, specific materials, and verbal scripts to use in specific situations. He worked with his peers to build a city scene on the play mat using masking tape, discarded boxes, and plastic cups. This intervention and others built on Brandon’s interests and strengths to gradually reduce outbursts, reduce aggression toward peers, and improve his academic performance and his occasional signs of affection.
Additional Resources for Caregivers of Children with ASD
Autism spectrum disorder is a spectrum, including a rich diversity of families and individuals. We hope you are lucky enough to have someone in your life living on the spectrum, and that this post gives you some encouragement and insight to maintain that relationship. We trust that you will discover, as we have, how much these incredible humans have to offer the world.
We hope this post provided some insight into the behavioral therapeutic needs of children with ASD. Additional helpful resources for caregivers looking after children with ASD include:
- Resource Guide from Autism Speaks – Find ASD resources for children in your area.
- The Autism Society’s Online Resource Database – Additional database for ASD resources near you.
- Autism Speaks YouTube Channel – Great training and tips for caregivers of children with autism.
This post is brought to you by ChildSavers therapists Bob Nickles, Emily Taylor, Erin Delp, Zachary Gibson, and Brie Jordan-Cooley. ChildSavers is a children’s mental health clinic in Richmond, Virginia that provides trauma-informed therapy to kids in the Greater Richmond area. We also coach child care providers and provide them with the skills and tools needed to provide quality care.
We understand that children with autism can experience trauma, stress, and big life events in a different way.
*Name and details have been altered to protect the identity of this child.