Play Therapy and the Neurodivergent Child: A Parent’s Guide

Play is the natural language of all children regardless of diagnosis, disability, or developmental issue. It is the most organic process for children to express troubling thoughts and feelings that are both conscious and unconscious. Play makes learning an enjoyable and engaging experience and provides the best method to impart information needed by children to overcome struggles (Schaefer & Drewes, 2014). The Association for Play Therapy (APT) (2021) defines play therapy as “the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development.”

The term play therapy refers to multiple theories and approaches wherein play is considered the agent of change and used at some level in the therapeutic process. Play therapy theories and approaches vary in their implementation – how a play session is conducted and how protocol is designed. Child Centered Play Therapy, Filial Therapy, Adlerian Play Therapy, Cognitive Behavioral Play Therapy, Gestalt Play Therapy, Theraplay®, AutPlay® Therapy, Sandtray Therapy, Ecosystemic Play Therapy, and Family Play Therapy are a few of the more common approaches implemented.

Neurodivergent refers to children who have neurotype differences from what would be considered the neurotypical presentation. Often children with a diagnosis such as autism, ADHD, learning disorders, sensory integration needs, and developmental disabilities fall under the neurodivergent category. Some play therapy approaches have more research support for addressing the mental health needs of autistic and neurodivergent children than others (Child Centered Play Therapy), some are more specifically designed for autistic and neurodivergent children (AutPlay® Therapy and Theraplay®), and some incorporate more evidence-based approaches than others (Cognitive Behavioral Play Therapy). The variety of therapeutic response in what is play therapy provides opportunity to uniquely address the mental health needs of neurodivergent children and their families.

Play therapy approaches, in general, are neurodiversity affirming – valuing the child, giving the child a voice, and affirming the identity of the child. Several approaches have shown successful clinical outcomes; most notably Filial Therapy (VanFleet, 2012), Theraplay® (Booth & Jernbeg, 2010), Child Centered Play Therapy (Hillman, 2018), and AutPlay® Therapy (Grant, 2017). Research has also demonstrated the benefits of implementing play therapy to address a variety of mental health concerns that may be present with a neurodivergent child.

Play therapy has been shown to help autistic and neurodivergent children understand social navigation, improve emotional expression and regulation ability (Salter, Beamish, & Davies, 2016), improve reactive and symbolic play communication, and provide improvement in the parent/child relationship (Howard, Lindaman, Copeland, & Cross, 2018). Banerjee & Ray (2013) proposed that some core mental health issues can be addressed through play therapy such as relationship development, and recognition and expression of emotion. Further, they reported that play therapy can be effective for gains in sensorimotor play, constructive play, pretend play, functional play, reducing problem behaviors, and improving self-worth.

AutPlay® Therapy (Grant, 2017) is an integrative family play therapy approach focused specifically on neurodivergent children and their families. Protocol is designed to be neurodiversity affirming and involves both parents and the child as co-change agents/partners in the therapeutic process. Clinical outcomes in AutPlay Therapy have shown positive results in addressing dysregulation issues, trauma issues, depression, social anxiety, and parent/child relationship strain. AutPlay Therapy and other play therapy approaches continue to show increasing support in the effectiveness of working with autistic and neurodivergent children.

It is essential to note that play therapy is an umbrella term and can refer to many different approaches. The Association for Play Therapy (APT) (2021) defines ten seminal and historically significant play therapy theories. In addition, there exists approximately ten additional play therapy theories and approaches. When parents are seeking out a play therapist for their autistic or neurodivergent child, there are a few questions they might ask:

What type of play therapy do you offer and what are your credentials/training for providing play therapy?
What is your experience working with autistic/neurodivergent children and their families?
Can you describe the types of issues you have worked on with neurodivergent children?
How might the play therapy you offer benefit my autistic/neurodivergent child?
What would a typical play therapy session look like and how would you involve the parent and/or family members?
What are some possible mental health needs and typical therapy goals when working with neurodivergent children?
How would you conceptualize neurodiversity and describe a neurodiversity affirming approach?

Each neurodivergent child will be different and thus have individualized experiences, needs, and goals for therapy, however, there are some standards that parents should hear from a potential play therapist that would indicate the play therapist is a good fit for the child and family. The play therapist should be able to tell parents what training they have had to be a play therapist (possibly even produce training certificates) and what type of play therapy they offer (explain the specific play therapy approach or method). They should also be able to communicate in general how the play therapy they implement would be helpful for neurodivergent children (provide some examples). The play therapist should be able to explain to the parent what their training and experience has been in working with autistic and neurodivergent children. They should be able to outline a neurodiversity affirming process and explain what this looks like in therapy. Lastly, the play therapist should be able to define how the parent and/or other family members are involved in the process. Many of these responses might be in general until the therapist has a chance to know the child. If the therapist struggles to produce many of these responses, it might be an indicator they would not be a good fit for the child and family.

Undoubtedly, play provides a natural and engaging element for children and play therapy approaches and interventions provide the therapeutic benefit that children need to heal and grow. The implementation of play therapy is not only gaining in research support, but also presents a logical approach to addressing the mental health needs of autistic and neurodivergent children. Overall, therapeutic play can be engaging, healing, affirming, valuing, and enjoyable process for child clients and their families.

References
Association for Play Therapy (2020). What is play therapy? www.a4pt.org.
Banerjee, M., & Ray, S. G. (2013). Development of play therapy module for children with autism. Journal of the Indian Academy of Applied Psychology. 39, pp. 245-253.
Booth, P. B., & Jernberg, A. M. (2010). Theraplay. Jossey-Bass.
Grant, R. J. (2017). AutPlay therapy for children and adolescents on the autism spectrum: A behavioral play-based approach. Routledge.
Hillman, H. (2018). Child-centered play therapy as an intervention for children with autism: A literature review. International Journal of Play Therapy, Vol 27(4), pp. 198-204.
Howard, A. R. H., 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, Vol 27(1), pp. 56-68.
Salter, K., Beamish, W., & Davies, M. (2016). The effects of child centered play therapy (CCPT) on the social and emotional growth of young children with autism. International Journal of Play Therapy, 25, pp. 78-90.
Schaefer, C. E. & Drewes, A. A. (2014). The therapeutic powers of play: 20 core agents of change. Wiley and Sons.
VanFleet, R. (2012). Communication and connection: Filial Therapy with families of children with ASD. In L. Gallo-Lopez, & L. C. Rubin (Eds), Play-based interventions for children and adolescents with autism spectrum disorders (pp. 193-208). Routledge.