Therapy and Children with Autism.
As Autism is a spectrum disorder, individual children have different degrees of strengths and challenges. Some of the difficulties Kidz Time In has helped children with Autism with include: repetitive behaviours and over investment in persuasive interest areas, anxiety, fears, frustrations and emotional regulation, communication skills, and peer and social interaction, including reciprocal play and building friendships. Therapy can also support children with Autism to move through developmental stages increasing their life skills and becoming more autonomous.
Some examples of this progress include:
• Moving from functional to symbolic play reflecting cognitive development and development of play skills needed for peer interaction and relationship building.
• Developing an awareness of emotions (including empathy) and socially acceptable responses (Emotional Regulation).
• Learning how to initiate and join in play.
• Being emotionally and cognitively equipped to attempt functional skills i.e. dressing, home jobs and school preparation.
What Therapy Mode and Why.
At Kidz On Track we use a number of evidence based modes of therapy to support children with Autism and their families. Some of the methods we use to support change include T.E.A.C.C.H. and Applied Behaviour Analysis (ABA), specifically Pivotal Response Treatment (PRT). Each individual child is assessed to identify the best approach for them and their family. Many children respond well to Non Directive Play Therapy (NDPT) also called Child Centered Play Therapy (CCPT). NDPT targets four areas that have been identified to be pivotal in supporting broader development in social and emotional domains. These are joint attention, imitation response, theory of mind and symbolic and functional play skills. The link between these areas and functions in daily life is briefly described:
Joint Attention
Joint attention is the sharing of a common focus. Skills involved in joint attention have been found to be connected to language formation and social development, and linked to the development of social competency. Within the NDPT session joint attention is explored as the child shares his or her interest areas with the therapist (or parent). This creates a safe platform which the child gradually broadens allowing the child to engage in a wider range of activities and increased interactions. These skills are then broadened to other people and environments.
For example, “Joe” aged 7 years and diagnosed with Autism was totally focused on Minecraft. He struggled to interact with peers at school and reported bullying. Following therapy, parental and school support, he could engage in and talk about two different activities, reported a new friend and stated that the bullying had ceased.
Imitation Response
Imitation has been found to be important in developing reciprocal social skills, including social responses and verbal communication. NDPT interventions help develop imitation skills through the therapist modelling behaviours that occur naturally in social interaction. More complex social interactions are modelled in role plays, portraying different personas and emotions. Because the interactions are child led, children tend to be responsive to this form of social learning.
‘Sarah’ aged 6 and diagnosed with Autism struggled to engage in peer games, not understanding reciprocal turn taking despite social skills training. As Sarah relaxed in NDPT sessions she played out her desire to interact with peers and the difficulties she was having. This led to role plays in the safe therapeutic environment to allow Sarah to practise her skills. With some scaffolding Sarah was then ready to practise these skills in real environments. As she finished therapy Sarah’s parents and teachers reported several incidents where she had been able to engage in peer games. Sarah herself reported back on some new friends.
Theory of Mind
Theory of mind is understanding that other people have thoughts and beliefs that are separate and sometimes different from one’s own. This is seen as central to social deficits in Autism, particularly to the development of perspective and empathy. NDPT helps the child to strengthen these theory of mind concepts, i.e. progress to understand the concept of an alternate perspective and to develop empathy as they work through developmental stages with the support and modelling of an accepting therapist.
“Sam” aged 7 and diagnosed with Autism fell out frequently with his peers when they did not always allow him to play the role of his favourite ninja. Sam interpreted this as his peers “not liking me” and “being mean”. In therapy Sam played out his frustrations and his desire to play with his peers. Through role plays Sam explored the concept of empathy and began to relate to other people’s feelings. Over time Sam began to display empathy in other environments and came to terms with “sharing” the lead role while playing.
Symbolic and Functional Play Skills
Play is recognised to have a cognitive organization function. That is, through play children develop their executive function, the abilities that regulate and control other behaviour, supporting them to be ready to learn and operate within educational settings. This includes functions such as working memory, self-regulation, “self-talk” as well as developing the ability to focus, organise, plan, strategize, initiate and prioritize. Within the NDPT framework this important developmental stage is supported with children being provided with the space to integrate these constructs at their own pace. The therapist will be aware of the developmental stage of play your child is operating at and be able to provide scaffolding to support their progress.
Children with Autism and Emotional Regulation
One of the ways that children let adults know that they are struggling is through their behaviour. When behaviour is continually developmentally inappropriate children are communicating a level of distress and an inability to regulate themselves. NDPT supports children (including those with Autism) to improve or develop their emotional regulation skills. One way it does this is by building a child’s self-esteem. Like adults, children are more likely to be able to absorb frustrations when they feel good about themselves and supported in their environments. Within the NDPT environment the therapist’s interactions, including acceptance of the child and validation of their concerns supports improved self-esteem and emotional regulation. Commonly parents report that children are calmer, have less frequent and less severe reactions to triggering events and are more able to respond to social learning cues around them.
“Ben” aged 4 and diagnosed with Autism was continually hitting peers and family. During therapy Ben worked through his feelings of fear and lack of control. He was then ready to work on social interactions. Over time the incidents of physical aggression decreased in frequency and severity, as Ben became more competent in expressing his emotions verbally. 
Children with Autism and Anxiety
As a generalisation, most children on the Autism spectrum have some level of anxiety that interferes with their ability to interact with others, to learn and to be responsive to the environment around them. NDPT supports children to lower their levels of anxiety through positive attachment interactions with the therapist and /or parents, and building self-esteem. With lower levels of anxiety, children then have the energy and concentration levels to be receptive to environment cues, to understand and take in information. As they develop perspective and have increased understanding of social interactions they are less likely to feel socially persecuted and to enjoy peer interactions.
“Jake”, 6 years diagnosed with Autism was having trouble separating from mum to go to school. His high levels of anxiety also made it difficult for him to concentrate to follow directions and participate at school. In therapy Jake played out his fears and over time became much more self-confident. Jake progressed to being able to separate from mum without becoming distressed and actively engaging in school life. If you are interested in reading this a link to the research is provided Here