The AutPlay ®

Therapy Handbook

The AutPlay® Therapy Handbook provides a thorough explanation and un-

derstanding of AutPlay® Therapy (an integrative family play therapy frame-
work) and details how to effectively implement AutPlay® Therapy for
addressing the mental health needs of autistic and neurodivergent children
and their families.
This handbook guides the mental health therapist working with children
and adolescents through their natural language of play. Opening with an
extensive review of the neurodiversity paradigm and ableism, the chapters
cover AutPlay® Therapy protocol, phases of therapy, assessment strategies,
and common need areas along with understanding neurodiversity affirming
processes. Additional chapters highlight the therapeutic powers of play, in-
tegrative play therapy approaches, understanding co-occurring conditions,
working with high support needs, and using AutPlay® Therapy to address
regulation, sensory, social/emotional, and other mental health concerns that
neurodivergent children may be experiencing.
The handbook serves as a thorough guide for play therapists, child thera-
pists, and family therapists who work with neurodivergent children and their
families.
Dr. Robert Jason Grant is a licensed professional counselor, national board
certified counselor, and registered play therapist-supervisor based in Mis-
souri, USA.
The AutPlay ®
Therapy Handbook
Integrative Family Play
Therapy with Neurodivergent
Children

By Robert Jason Grant

Designed cover image: Getty Image
First published 2023
by Routledge
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© 2023 Robert Jason Grant
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has been asserted in accordance with sections 77 and 78 of the Copyright,
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Library of Congress Cataloging-in-Publication
­ ­​­­ ​­ Data
Names: Grant, Robert Jason, 1971– author.
Title: The Autplay® therapy handbook: integrative family play therapy with
neurodivergent children / by Robert Jason Grant.
Description: First edition. | New York, NY: Routledge, 2023. |
Includes bibliographical references and index.
Identifiers: LCCN 2022027819 (print) | LCCN 2022027820 (ebook) |
ISBN 9781032075495 (hbk) | ISBN 9781032075488 (pbk) |
ISBN 9781003207610 (ebk)
Subjects: LCSH: Play therapy. | Developmentally disabled
children—Treatment. | Play assessment (Child psychology)
Classification: LCC RJ505.P6 G733 2023 (print) | LCC RJ505.P6 (ebook) |
DDC 618.92/891653—dc23/eng/20220802
LC record available at https://lccn.loc.gov/2022027819
LC ebook record available at https://lccn.loc.gov/2022027820
ISBN: ­978-1-032-07549-5
­​­­ ­​­­ ­​­­ ​­ (hbk)­
ISBN: ­978-1-032-07548-8
­​­­ ­​­­ ­​­­ ​­ (pbk)­
ISBN: ­978-1-003-20761-0
­​­­ ­​­­ ­​­­ ​­ (ebk)­
DOI: 10.4324/9781003207610
­
Typeset in Goudy
by codeMantra
 Contents

Foreword vii
Acknowledgements xi
Introduction 1

1 Neurodiversity, Ableism, and Being Neurodiversity Affirming 5

2 The Neurodivergent Child 31
3 Neurodivergent Mental Health Needs 66
4 Neurodivergent Play 91
5 Play Therapy and the Therapeutic Powers of Play 109
6 An Integrative Play Therapy Approach 127
®
7 The AutPlay Therapy Process 147
8 The AutPlay® Therapist 175
9 Phases of AutPlay® Therapy and Therapy Goals 190
10 Parent and Family Involvement 211
®
11 The AutPlay Therapy Follow Me Approach (FMA) 234
12 The AutPlay® Therapy Follow Me Approach (FMA)
with Parents 254
13 The AutPlay® Therapy Follow Me Approach (FMA)
Case Examples 271
14 Social Navigation Interventions 303
vi Co n t e n t s

15 Emotion Identification and Expression Interventions 328

16 Connection (Relationship Development) Interventions 357
17 Anxiety Reduction, Sensory Integration, and Regulation
Interventions 383

Conclusion 407
Common Terms Related to Neurodivergence 409
Index 447
 Foreword

The AutPlay® Therapy Handbook:

Integrative Family Play Therapy with Neurodivergent Children

Connection

Dr. Robert Jason Grant and I met through the play therapy community. We
were both invited to a week-long, international meeting for play therapists.
I was immediately drawn to Dr. Grant and his vast knowledge regarding the
neurodivergent population. Having worked in therapeutic settings since
1991, I had provided services to a number of clients who were neurodiver-
gent by the time I met Dr. Grant. The topic of neurodiversity in general,
along with specific considerations, identification, understanding, and ther-
apy was not a prominent part of my graduate school training. Meeting Dr.
Grant and learning from him allowed me to greatly expand my repertoire be-
yond the piecemeal education and research I had pursued to date. I attended
his trainings, read his books, and became a Certified AutPlay Therapy Pro-
vider. Along the way, it was my pleasure to know him better. We have since
collaborated on a number of projects such as the AutPlay Expansion Pack for
the Virtual Sandtray App©, multiple presentations, and publications such as
Play Therapy Theory and Perspectives: A Collection of Thoughts in the Field and
Implementing Play Therapy with Groups: Contemporary Issues in Practice (both
­
of these texts were co-edited with Clair Mellenthin). Dr. Grant’s contribu-
tion to my knowledge and scope of practice has been invaluable. I am certain
it will be the same for you.
viii Fo r e w o r d

Challenging the Traditional Neurodivergence View

In March 2020, Drs. JÂcqûelyn Fede and Amy Laurent challenged people
to Level Up! their knowledge base regarding neurodivergence. This team of
professionals includes both neurodivergent and neurotypical members, with
a philosophy which includes beliefs that “through education, accessible re-
sources, practical strategies and a commitment to consistently incorporating
the experiences and perspectives of autistic people, we can support the leve-
ling up of society when it comes to autism and neurodiversity” (Fede & Lau-
rent, 2020, para 46). A key aim of this article is to challenge the traditional
view of “deficit and disorder” regarding neurodiversity (para 6).
Fede and Laurent proposed that simple awareness is not enough, particularly
regarding autism. We must be aware and strive toward advocacy, with ac-
ceptance, appreciation, and empowerment along the path (Fede & Laurent,
2020). It is a process of recognizing where you are currently, looking inward
and performing a self-evaluation of biases and belief systems, and then taking
the next steps toward greater understanding, learning, and active involve-
ment. These are some of the critical components of increasing everyone’s
understanding of the realities of neurodiversity and autism (Fede & Laurent,
2020).

The AutPlay® Therapy Handbook

The AutPlay® Therapy Handbook encompasses the philosophies of Autism

Level Up. Building upon a quickly growing set of Dr. Grant’s authored re-
sources, the addition of the AutPlay® Therapy Handbook presents neurodi-
vergence as an inclusion of differences which are “normal, natural variations
in the human genome.” The shift in conceptualization from pathology to
normalcy is very powerful and sets the stage for many ways to work with
individuals in mental health settings utilizing the approaches, goals, and in-
terventions outlined in this book.
Grounded in the acknowledgement of each individual as unique and en-
compassing a multitude of ideologies, Dr. Grant has provided the reader with
a critical foundation. This foundation springs into 18 additional chapters,
each geared toward understanding and working with neurodivergent clients
and their families. Neurodiversity, Grant explains, is not a belief, a political
position, paradigm, perspective, or approach – “it is a fact”; it is a “the vari-
ance of human neurotypes.”
 Fo r e w o r d ix

Of particular interest to me is Chapter 10. Important works by Dr. Eliana

Gil (1994, 2015) and Dr. Kay Trotter (2013) are referenced for further un-
derstanding of family play therapy. Grant describes a “synergetic effect” re-
garding the complementary relationship between play therapy and family
therapy when integrated. This is a powerful statement; inviting the reader
to learn more about the integration, synergy, and impact that utilizing the
tenets of AutPlay® Therapy will have on the family therapy process. This
chapter of the AutPlay® Therapy Handbook informs us about important
concepts such as “parents might find play challenging, parents should fol-
low their child’s lead, parents need to play within their child’s zone of
proximal development…” and so much more. These are skills and con-
ceptualizations that will be powerful with both the neurodivergent and
neurotypical populations!

Importance of Understanding the Realities

Returning to the importance of the above challenge posed by Fede and Lau-
rent, and the importance of increasing our understanding of the realities
of neurodiversity and autism, we can see that Dr. Grant works to guide the
reader toward achieving this goal. Chapters 1–4 are defining key founda-
tional concepts regarding neurodiversity and setting the stage for the rest of
the book. Chapters 5–9 introduce and discuss the key components of play
therapy, an integrative approach, and AutPlay Therapy. Chapters 10–17,
Conclusion present a number of interventions and examples to fill the
play therapist’s toolbox and illustrate the concepts. Easy to follow and use
handouts, inventories, and forms are provided for smooth integration of the
concepts.
This text is certain to contribute valuable foundations, understandings, con-
cepts, interventions, and more to your professional development and offer-
ings. We can all work toward the challenge to Level Up! and the AutPlay®
Therapy Handbook provides a number of concepts and tools to rise to the
challenge. Here we go!
Jessica Stone, Ph.D., ­RPT-S
​­
Affiliate, East Carolina University Neurocognition Science Lab
Certified AutPlay Therapy Provider
Author, Digital Play Therapy
x Fo r e w o r d

References

Fede, J. & Laurent, A. (2020). So, you want to Autism Level UP!? Game on! https://
neuroclastic.com/so-you-want-to-autism-level-up-game-on/
­­ ­​­­ ­​­­ ­​­­ ­​­­ ­​­­ ­​­­ ­​­­ ​­
Gil, E. (1994). Play in family therapy. Guilford Press.
Gil, E. (2015). Play in family therapy (2nd ed.). Guilford Press.
Trotter, K. (2013). Family play therapy. In N. R. Bowers (Ed.). Play therapy with
families. Jason Aronson.
 Acknowledgements

This book has been a great labor of love for me that has span almost a year
and half of consistent focus and writing. I want to thank my family for their
support and all those who kept me motivated. I also want to thank Routledge
publishing for believing is this Handbook concept and committing to this
­high-volume
​­ book.
I want to acknowledge so many wonderful people who contributed to this
book. I want to thank each of you who shared a case example and shared
your own personal lived experience stories. Jennifer Gerlach, Boontarika
Sripom, Rebekah Brown, Spencer Beard, Sarah Moran, Patricia Lomando,
Elaine Hutchinson, Jen Taylor, Lily Wake, Daysi B. Onstad, Canace Yee,
and Jaya Ramesh – you all made this handbook much more dynamic, and I
appreciate your efforts and support.
Thank you to the play therapy and neurodivergent communities. I have
learned so much and continue to learn much from you. So many influencers,
leaders, advocates, and authors have inspired my own journey and helped me
understand and grow. Lastly, thank you to Dr. Jessica Stone for writing the
foreword to this book and thank you to Dr. Linda Homeyer, Jackie Flynn,
and Lisa Dion who took the time to write reviews for this book.
My hope is that the result of this project helps provide awareness, accept-
ance, much better affirming processes to the mental health care of neurodi-
vergent children.
Robert Jason Grant
 Introduction

Introduction

Macy was 9 years old when I first met her. She was sitting with her mother in
my office. It was their first session to see me, her mother was bringing her to
therapy to help with regulation needs. Macy was autistic and gifted. She was
being home schooled due to regulation struggles in the mainstream school.
Macy would regularly crawl under desks and refuse to come out. Her mother
described her regulation struggles to be frequent and lasted for long periods
of time. Macy struggled with becoming dysregulated in most events she nav-
igated including in her own home. She currently stayed mostly at home, did
not participate in any activities outside the home, and rarely left the house
to complete errands with her mother.
Sitting in my office in this first session it was clear Macy felt uncomfortable.
I could see her anxiety and a child who was likely “one more thing” away
from a dysregulated meltdown. Luckily this was not my first experience with
a child such as Macy. I knew the process would be vital and that process must
be supportive, affirming, and focused on building relationship with Macy
that nurtured safety and familiarity. I also knew the therapeutic key to help-
ing Macy existed in the transformative process I had seen over and over
again from child to child – the child’s own natural language of play.
The AutPlay Therapy framework was on full display in my time working
with Macy. There was a central focus on building relationship, identifying
and valuing her play preference of movement play which greatly helped reg-
ulate her system, assessing her strengths, discovering her talents with humor,
and providing her space to shine in her strength at each play therapy session.
It was also important to include her mother in the therapy process and the
three of us working together as partners to help Macy improve her regulation
needs, value her identity as a neurodivergent child, improve her self-worth,

DOI: 10.4324/9781003207610-1
2 Introduction

and amplifying Macy’s voice in the therapeutic process – empowerment in

her own growth.
A neurodiversity affirming foundation and play therapy framework provided
the platform for Macy to process and grow at her pace and achieve her ther-
apy goals. The child I met, who could hardly leave her home and was crawl-
ing under tables in a state of dysregulation started attending a private school,
created a self-advocacy program for students in the private school, began to
develop her strength with humor and starting entering comedy competitions,
began leaving the house without consideration for all types of activities, and
at last check-in, was performing in a main role in her second community
theater musical. We could call my experience with Macy the current me.
The me who can easily define the neurodiversity paradigm and being neuro-
diversity affirming. The me who understands the therapeutic powers of play
and how affirming integrative play therapy can be a wonderful mental health
approach for neurodivergent children. The me who understands my own
lived experience and is fully engaged in advocacy and the neurodiversity
movement. But this hasn’t always been me.
What is neurodivergence? What is play therapy? How do the two intertwine
in a rhythmic fashion where the neurodivergent child finds their therapeutic
outlet that is not only affirming but provides the natural means to address
a whole host of needs. At the same time, how does play therapy find its
child, the opportunity to shine in what it does best – bringing its therapeutic
powers to a historically discarded population working in an empowering and
healing radiance. My neurodivergent and play therapy journeys have inter-
twined on many levels and ultimately combined to form what is known as
AutPlay Therapy. The road to this handbook has been a progression which
began several decades ago with my own childhood.
I knew I was different as a child. I was bright and fairly perceptive. I could
see that I navigated things differently from most of the other children. I
was aware that things seemed to bother me, or I would have struggles where
other children seemed non-affected. The only diagnosis I received (which
was somewhat haphazard) was social anxiety. It would not be until I was an
adult that I would understand my sensory processing challenges and my own
neurodivergence. It did not take me long to figure out that many environ-
ments were dysregulating for me. The social challenges, the sensory issues,
the lack of understanding my own system and the confusion and awkward-
ness that many environments held for me began to create high levels of
anxiety. A great deal of my childhood (mostly anything outside of my home)
is a reflection of survival. I would plan, plot, strategize, and lie to get myself
 Introduction 3

through various social situations as smoothly and less dysregulating as pos-

sible. I made up illnesses, faked being sick, and would even go to the doctor
with one of my “sicknesses” to avoid going to school – which was a night-
mare for my neurodivergent self. I would pretend to go to school but instead
hide in empty homes in my neighborhood all day until I got caught. I would
also pretend to be sick at school and spend hours sitting in the nurse’s office.
Lying, seeing a doctor for no reason, and hanging out in empty homes all day
were a relief compared to the bombardment my system would take trying to
get through a day of school.
Eventually I stopped attending public school. My parents realized the anx-
iety levels and that it had become impossible for me to attend. They found
an alternative education setting for me which worked fairly well and enabled
me to complete my high school education. For the most part, my parents did
not understand what was happening with me nor did they provide much sup-
port. An affirming presence was a complete absence in my childhood. The
concept of being neurodivergent was not known and I doubt anyone had
even heard of sensory processing challenges. We lived in a rural environment
and my childhood was at a time when different was viewed as problematic.
I think my parents likely did the best they could for me with the knowledge
they possessed.
Many environments were a struggle, but I was able to regularly avoid most
of them and spent a great deal of time at home. I spent a lot of time alone
and I liked it that way – alone was peaceful. By the time I graduated, I had a
bit better sense of myself. Meeting a couple of affirming individuals late into
my teen years helped me begin to understand a stronger self-worth instead
of viewing my differences as negative. This led to the motivation to go to
college. My adult life proved to be far more productive than my childhood.
It was full-speed ahead in discovery and growth. I finally learned about my
sensory processing differences, began to understand and appreciate my neu-
rodivergence, and begin to heal from the devaluing messages and struggles
of my childhood.
By the time I became a play therapy therapist, things navigated much more
successfully for me. My process of growth took a certain protectory. First, I
began to understand myself and my sensory system. I stopped judging and
taking in negative cognitions about being different. I learned to appreciate
myself and the way I navigated. Second, once I understood myself better, I
was able to learn strategies, techniques, tips, etc. for things that helped me
navigate specific situations better. I also began to understand how to advo-
cate for myself. Lastly, I realized my control. As an adult I was able to greatly
4 Introduction

control how I lived. I could enter or avoid environments mostly based on my

choice. I realized as this time the great divide between my neurodivergent
adult self and my neurodivergent child self. As a child I had little to no con-
trol, as an adult I have control and that control gives me options to better
navigate a greater society that still falls short in appreciating and supporting
neurodivergent individuals.
I was a neurodivergent child and I am a neurodivergent adult. Neurodiver-
gence isn’t something that goes away. My issues and struggles have never been
about being neurodivergent. I say to clients and parents often that the reality
is a neurodivergent person will be a neurodivergent person throughout their
life. How they feel and what they believe about their neurodivergence will
have a massive impact on their overall mental health. I have reflected many
times that I would have loved having an affirming play therapist in my life as
a child. It would have uplifted me and helped me gain a healthy perspective.
I know it would have provided me a greater peace within the storm.
This is my goal in creating AutPlay Therapy and writing this book – that
play therapists across communities can be that safe, affirming space for neu-
rodivergent children. As you navigate through this handbook, I hope you
will clearly understand what is neurodivergence, what is play therapy, and
how the therapeutic powers of play in the atmosphere of an affirming play
therapist can be a powerfully supportive and growth producing experience
for the neurodivergent child.
 1
Neurodiversity, Ableism, and
Being Neurodiversity Affirming

Neurodiversity

What is diversity? Queensborough College (­­2021) defines the concept of

diversity as encompassing acceptance and respect. It means understanding
that each individual is unique and recognizing our individual differences.
These can be along the dimensions of race, ethnicity, gender, sexual orienta-
tion, ­­socio-​­​­​­economic status, age, physical abilities, religious beliefs, political
beliefs, or other ideologies. Diversity is a reality created by individuals and
groups from a broad spectrum of demographic and philosophical differences.
It is extremely important to support and protect diversity because by valuing
individuals and groups free from prejudice and by fostering a climate where
equity and mutual respect are intrinsic, we will create a ­­success-​­​­​­oriented,
cooperative, and caring community that draws intellectual strength and pro-
duces innovative solutions from the synergy of its people.
Popular definitions of diversity include the state of being diverse; variety,
the practice or quality of including or involving people from a range of dif-
ferent social and ethnic backgrounds and of different genders, sexual orien-
tations, etc., the quality or state of having many different forms, types, ideas,
etc., and an instance of being composed of differing elements or qualities:
an instance of being diverse. Much has been written about diversity, and
much diversity information can be discovered in a quick resource search. A
slightly further exploration will produce a wide variety of offering on specific
diversity needs within specific populations such as race or sexual orientation.
But what about neurodiversity? What about the ­population – ​­​­​­neurodiverse?
Neurodiversity and more specifically, the diversity needs of neurodivergent
individuals, can be conceptualized within the greater diversity awareness
paradigm. Indeed, an understanding of racism, discrimination, prejudice,
bigotry, etc. provides for a greater understating of what neurodiversity means

DOI: 10.4324/9781003207610-2
6 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g

and how neurodivergent people and their allies are leading efforts in the
neurodiversity movement to help improve acceptance and inclusion in soci-
eties that have historically lacked neurodivergent affirming constructs.
The term “­­neurodiversity” appears to have first been seen publicly in 1998
when journalist Harvey Blume published an article in the Atlantic. He stated
that “­­Neurodiversity may be every bit as crucial for the human race as bio-
diversity is for life in general. Who can say what form of wiring will prove
best at any given moment?” Judy Singer, an Australian sociologist, is widely
credited with coining the term “­­neurodiversity.” It is reported that Singer
and Blume corresponded about the topic and Singer wrote about neurodi-
versity in her thesis in 1998. It was in 1999 that she furthered her work in
neurodiversity while writing a chapter “­­Why Can’t You be Normal for Once
in Your Life?” based on her thesis which was published in the UK. Since its
origins, the term has grown immensely with additional understanding and
research support.
Walker (­­2021) stated that neurodiversity is the diversity of human minds,
the infinite variation in neurocognitive functioning within our species. Neu-
rodiversity is a biological fact. It’s not a perspective, an approach, a belief,
a political position, or a paradigm. There exists a great deal of scientific ev-
idence that shows clearly that there’s considerable variation among human
brains. Neurodiversity can be thought of as the variance of human neurotype.
Robinson (­­2013) proposed that neurodiversity is the idea that neurological
differences like autism and ­­attention-​­​­​­deficit hyperactive disorder (­­ADHD)
are the result of normal, natural variation in the human genome. Science
suggests that conditions like autism have a stable prevalence in human so-
ciety as far back as we can measure. There is awareness that autism, ADHD,
sensory differences, and other conditions emerge through a combination of
genetic predisposition and environmental interaction; they are not the result
of disease or injury. This represents a new and fundamentally different way of
looking at conditions that were traditionally pathologized. For neurodiver-
gent individuals, talk of “­­cure” feels like an attack on their very being. They
detest those words for the same reason other groups detest talk of “­­curing
gayness” or “­­passing for white,” and they perceive the accommodation of
neurological differences as a similarly charged civil rights issue. If their di-
versity is part of their makeup, they believe it’s their right to be accepted and
supported “­­as is.” They should not be made into something e­ lse – ​­​­​­especially
against their ­will – ​­​­​­to fit some imagined societal ideal.
Silberman (­­2015) shared that one way to understand neurodiversity is to
think in terms of human operating systems instead of diagnostic labels such
 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g 7

as dyslexia and ADHD. The brain is, above all, a marvelous adaptive organ-
ism, adept at maximizing its chance of success even in the face of limitations.
Just because a computer is not running windows, does not mean it’s broken.
Not all features of a neurodivergent operating system are bugs. Different is
just different, it does not have to be pathologized.
The term “­­neurodiversity” has descriptive appeal as it reflects both the dif-
ficulties that neurodiverse people face as well as the positive dimensions
of their lives. Neurodiversity is not an attempt to disregard the suffering
undergone by neurodivergent people or to romanticize what many still
consider significant needs. Rather, neurodiversity seeks to acknowledge
the richness and complexity of human nature and of the human brain
(­­Armstrong, 2010).
As we understand neurodiversity to represent the diversity of neurotype that
exists in humans, we can begin to value this diversity in children. Realiz-
ing that children do not have to all funnel into a ­­one-​­​­​­way, narrow look.
Providing real experiences that support diverse neurotypes, begins to show
awareness of neurodiversity in application. Armstrong (­­2010) put forth that:
Neurodiversity provides a more balanced perspective. Instead of regard-
ing traditionally pathologized populations as disabled or disordered, the
emphasis in neurodiversity is placed on differences. Dyslexics often have
minds that visualize clearly in three dimensions. People with ADHD
have a different, more diffused, attention style. Autistic individuals re-
late better to objects than people. This is not, as some people might sus-
pect, merely a new form of political correctness. Instead, research from
brain science and evolutionary psychology, as well as from anthropology,
sociology, and the humanities, demonstrates that these differences are
real and deserve serious consideration.
(­­p­­­­p. ­­5–​­​­​­6)

A true understanding of neurodiversity requires an understanding of sev-

eral terms related to neurodiversity. Walker (­­2021) defined the following
constructs related to neurodiversity. Neurotypical – ​­​­​­often abbreviated as NT,
means having a style of neurocognitive functioning that falls within the
dominant societal standards of “­­normal.”
Neurodivergent – ​­​­​­sometimes abbreviated as ND, means having a mind that
functions in ways which diverge significantly from the dominant societal
standards of “­­normal.” Autism, ADHD, sensory differences, and learning dis-
orders are examples of innate forms of neurodivergence.
The neurodiversity movement – ​­​­​­a social justice movement that seeks civil
rights, equality, respect, and full societal inclusion for the neurodivergent.
8 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g

The neurodiversity paradigm – ​­​­​­a specific perspective on ­neurodiversity – ​­​­​­a per-

spective or approach that boils down to these fundamental principles:

1 Neurodiversity is a natural and valuable form of human diversity.

2 The idea that there is one “­­normal” or “­­healthy” type of brain or mind,
or one “­­right” style of neurocognitive functioning, is a culturally con-
structed fiction, no more valid (­­and no more conducive to a healthy
society or to the overall ­­well-​­​­​­being of humanity) than the idea that there
is one “­­normal” or “­­right” ethnicity, gender, or culture.
3 The social dynamics that manifest in regard to neurodiversity are sim-
ilar to the social dynamics that manifest in regard to other forms of
human diversity (­­e.g., diversity of ethnicity, gender, or culture). These
dynamics include the dynamics of social power inequalities, and also
the dynamics by which diversity, when embraced, acts as a source of
creative potential.
(­­p­­­­p. 34–​­​­​­46)

Ableism

Understanding neurodiversity, the neurodivergent child, and being neuro-

diversity affirming must include a thorough awareness of ableism. The term
“­­ableism” is often defined as discrimination and social prejudice against
people with disabilities or who are perceived to have disabilities. Ableism
characterizes persons as defined by their disabilities and as inferior to the
­­non-​­​­​­disabled. On this basis, people are assigned or denied certain perceived
abilities, skills, or character orientations. Ableism can take the form of ideas
and assumptions, stereotypes, attitudes and practices, physical barriers in the
environment, or larger scale oppression. It is oftentimes unintentional, and
most people are completely unaware of the impact of their words or actions
(­­Urban Dictionary, 2021).
Pulrang (­­2020) stated that there seem to be two main schools of ableist belief.
One is that disabled people are unfortunate but innocent victims of circum-
stance who should be loved, cared for, and shielded from harm. The other
is that disabled people are naturally inferior, disagreeable, and at the same
time beneficiaries of unfair and unjustified generosity and social protection.
Neither belief is true, and both beliefs are limiting and poison relationships
between disabled and ­­non-​­​­​­disabled people, and sometimes between disabled
people themselves. He identified three points for evaluation of possessing
personal ableism:
 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g 9

1 Feeling instinctively uncomfortable around disabled people, or anyone

who seems “­­strange” in ways that might be connected to a disability of
some kind. This manifests in hundreds of ways, and can include:

• Being nervous, clumsy, and awkward around people in wheelchairs.

• Being viscerally disgusted by people whose bodies appear to be very
different or “­­deformed.”
• Avoiding talking to disabled people in order to avoid some kind of
feared embarrassment.

2 Holding stereotypical views about disabled people in general, or about

certain ­­sub-​­​­​­groups of disabled people. For example:

• Assuming that disabled people’s personalities fit into just a few main
categories, like sad and pitiful, cheerful and innocent, or bitter and
complaining.
• Associating specific stereotypes with particular conditions. For ex-
ample, that people with Down syndrome are happy, friendly, and na-
ive, mentally ill people are unpredictable and dangerous, or autistic
people are cold, tactless, and unknowable.
• Placing different disabilities in a hierarchy of “­­severity” or relative
value. A prime example of this is the widely held belief, even among
disabled people, that physical disability isn’t so bad because at least
there’s “­­nothing wrong with your mind.”

3 Resenting disabled people for advantages or privileges you think they have
as a group. This is one of the main flip sides of condescension and sentimen-
tality toward disabled people. It’s driven by a combination of petty everyday
resentments and false, dark, and ­­quasi-​­​­​­political convictions, such as:

• Disabled people get good parking spaces, discounts, and all kinds of
other little unearned favors.
• Unlike other “­­minorities,” everyone likes and supports disabled peo-
ple. They aren’t oppressed, they are coddled.
• Disabled people don’t have to work and get government benefits for
life.
(­­para. 8)

Scuro (­­2018) described ableism as a harmful bias, which is often trivialized

but can be very damaging. The embeddedness in cultural conditioning and
10 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g

­Table 1.1 What Can Ableism Look Like?

Lack of compliance with disability rights laws like the ADA

Segregating students with disabilities into separate schools
Punishing a disability
Segregating adults and children with disabilities in institutions
Failing to incorporate accessibility into building design plans
Buildings without braille on signs, elevator buttons, etc.
Talking to, interacting with, and treating a person with a disability like
they have no cognitive ability.
Framing disability as either tragic or inspirational in news stories, movies,
and other popular forms of media
The assumption that people with disabilities want or need to be ‘­­fixed’
Using disability as a punchline, or mocking people with disabilities
Refusing to provide reasonable accommodations
Talking to a person with a disability like they are a child, talking about
them instead of directly to them, or speaking for them
Questioning if someone is ‘­­actually’ disabled, or ‘­­how much’ they are
disabled

societal system is widespread and somewhat menacing. Often ableist con-

structs are put forth (­­without awareness) by ­­well-​­​­​­intended and even estab-
lished, respected, individuals and institutions. Consider the accepted (­­­­well-​­​­​
­conditioned) ableist language that permeates society. That is, they are, you
are retarded. That’s crazy. The short bus, special needs, idiot, the blind lead-
ing the blind, and even symbols such as the autism puzzle piece designed to
imply that there is something “­­missing” with this child, and we have to figure
it out. ­Table 1.1 further highlights what ableism can look like.
The writings of play therapist Lyles (­­2022) illustrate the realness of ableism
and its processes, especially by those who experience it.
­Ableism – Keeping
​­​­​­ the world most convenient for people whose bodies
and minds operate like yours, fueled by the fear that your own body and
mind will inevitably change in ways you like to pretend isn’t real.

Ableist ­Microaggressions – ​­​­​­Subtly insulting words and actions regardless

of intention, that let those with culturally sanctioned “­­strengths” feel
superior while chipping away at the dignity of those not possessing or
demonstrating ­­so-​­​­​­called normative abilities.

Inspiration ­Porn – ​­​­​­Borrowing from the ­­pain-​­​­​­laced survivalism of a weary

soul (­­pain to which you may have even contributed) by just scraping off
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the top layer of feel good while ignoring the intense lived experience of
distress informing that “­­inspirational” strength.

Ableism and ableist practices can manifest (­­and often do) in any system or
setting including mental health care and play therapy. Reeve (­­2000) identi-
fied ableism in counseling practice where counselors employ a predominantly
medical model of disability that risks discounting alternative relational un-
derstandings. In counseling/­­therapy, disability is constructed in relation to
the normal. Disability is always understood as a problematic deviation from
the normal, as an imperfection when judged against what is considered nor-
mative. There is a risk of needing to “­­fix” or “­­cure” something that is actu-
ally a part of or who the person identifies as. This can manifest through the
therapist attitude, approach, and microaggressions such as treatment goals.

Medical Model of Disability

Many organizations, groups, and agencies have historically viewed neuro-

divergence through a medical model heavily influenced by the American
Psychiatric Association’s Diagnostic and Statistical Manual (­­DSM). This
manual has served as the guide in the United States (­­and other countries)
for providing a formal diagnosis of autism, ADHD, learning disorders, etc.
Typically, the process of a formal psychological evaluation diagnosis uses the
protocol outlined in the DSM and thus works out of a medical model, which
views neurodivergence as problematic, highlighting deficits and struggles
and the need to cure or correct deficits. The medical model looks at neuro-
divergence as something that should not be happening regarding “­­normal”
development and must be addressed to help the child become more neu-
rotypical. Under the medical model, diagnosis is given so impairments or
differences can be “­­fixed/­­cured” or changed by medical and other treatments,
even when the impairment or difference does not cause pain or illness. The
medical model looks at what is “­­wrong” with the person, instead of strengths
or what that person needs and does not consider the concept of neurodiver-
sity or neurodivergent as identity.
It is essential to understand that the current mental health system supports
a ­­neurodivergent-​­​­​­related diagnosis typically being given through a psycho-
logical evaluation conducted by a trained psychologist, which would be a
medical diagnosis. This diagnosis would be based on the DSM and thus be
influenced in the medical model view. Schools may also implement testing
to diagnose for autism and other ­­neurodivergent-​­​­​­related diagnosis, which
would be an educational diagnosis. Psychiatrists, neurologists, and medical
12 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g

doctors can provide a medical diagnosis. The psychological evaluation pro-

cess typically includes several assessment/­­evaluation inventories, can take
anywhere from three hours to two days to complete, and is based on the
DSM criteria and process.
Many services, programs, and therapies that may be helpful for a neurodiver-
gent child require a formal diagnosis. The AutPlay therapist will need to help
children and parents understand how the medical model works and ensure
that families do not receive this information as the totality of their under-
standing of the diagnosis or neurodivergence. Therapists will need to provide
additional reading, resources, and have conversations to help families be
aware of neurodiversity and a ­­non-​­​­​­pathologizing view of neurodivergence.
Although we could highlight and deconstruct multiple neurodivergent DSM
diagnoses, for conceptualization purposes we will focus on autism. The follow-
ing will present a synopsis of the American Psychiatric Association’s DSM 5th
Edition (­­2013) criteria for receiving an autism spectrum disorder diagnosis fol-
lowed by information providing a ­­non-​­​­​­pathologizing, affirming view of autism.

A Persistent deficits in social communication and social interaction across

multiple contexts, as manifested by the following, currently or by history:
1 Deficits in ­­social-​­​­​­emotional reciprocity; for example, abnormal so-
cial approach and failure of normal ­­back-­​­­­​­­​­­­and-​­​­​­forth conversation; re-
duced sharing of interests, emotions, or affect; and failure to initiate
or respond to social interactions.
2 Deficits in nonverbal communicative behaviors used for social inter-
action; for example, poorly integrated verbal and nonverbal commu-
nication; abnormalities in eye contact and body language or deficits
in understanding and use of gestures; and a total lack of facial expres-
sions and nonverbal communication.
3 Deficits in developing, maintaining, and understanding relation-
ships; for example, difficulties adjusting behavior to suit various so-
cial contexts; difficulties in sharing imaginative play or in making
friends; and absence of interest in peers.
B Restricted, repetitive patterns of behavior, interests, or activities, as
manifested by at least two of the following, currently or by history:
1 Stereotyped or repetitive motor movements, use of objects, or
speech.
2 Insistence on sameness, inflexible adherence to routines, or ritual-
ized patterns of verbal or nonverbal behavior.
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3 Highly restricted, fixated interests that are abnormal in intensity or

focus.
4 ­­Hyper-​­​­​­or hyporeactivity to sensory input or unusual interests in sen-
sory aspects of the environment.

There are three levels in the DSM-5:

Level 3: Requiring Very Substantial Support

Severe deficits in verbal and nonverbal social communication skills cause
severe impairments in functioning; very limited initiation of social inter-
actions; minimal response to social overtures from others. Inflexibility
of behavior, extreme difficulty coping with change, or other restricted/
repetitive behaviors markedly interfere with functioning in all spheres.
Level 2: Requiring Substantial Support
Marked deficits in verbal and nonverbal social communication skills; so-
cial impairments apparent even with supports in place; limited initiation
of social interactions; and reduced or abnormal responses to social over-
tures from others. Inflexibility of behavior, difficulty coping with change,
or other restricted/­­repetitive behaviors appear frequently enough to be
obvious to the casual observer and interfere with functioning in a variety
of contexts.
Level 1: Requiring Support
Without supports in place, deficits in social communication cause notice-
able impairments; difficulty initiating social interactions and clear exam-
ples of atypical or unsuccessful responses to social overtures of others;
may appear to have decreased interest in social interactions. Inflexibility
of behavior causes significant interference with functioning in one or
more contexts.
(­­p­­­­p. ­­50–​­​­​­59)

A ­­Non-​­​­​­Pathology Affirming Perspective

The neurodiversity movement, which maintains that autism can be a posi-

tive practical identity, is an attempt to eliminate the harm of pathologizing
autism and neurodivergence. An initiative at the center of the neurodiversity
movement is that neurological diversity is a fact that should not be identified
with psychiatric problems. It is unfair to treat the neurodiversity movement
as a monolith. It should be focused on from a social perspective. Their needs
to be an emphasis on the idea that aspects that make life challenging for
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neurodivergent individuals are not intrinsically linked to individual flaws,

but to a mismatch between the individual and the environment, and a lack
of support (­­Bervoets & Hesn, 2020).
Lowry (­­2021), an autistic psychologist, developed a reframe of DSM autistic
traits from a ­­strengths-​­​­​­based (­­­­Strength-​­​­​­Based Autism Diagnostic Criteria)
rather than a ­­deficits-​­​­​­based perspective. He presents the following ­­strength-​­​­​
­based view of diagnosing autism:

I To meet diagnostic criteria for autism according to DSM-​­​­​­

­­ 5, a child must
have persistent differences in each of three areas of social communica-
tion and interaction (­­see ­­A1–​­​­​­A3 below) plus at least two of four types of
repetitive behaviors (­­see ­­B1–​­​­​­B4 below).
A Different social communication and interaction as evidenced by the
following:
1 Differences in ­communication – ​­​­​­tendency to go off on tangents,
tendency to talk passionately about special interests, and ten-
dency to not engage in small talk.
2 Differences in nonverbal communication, including stimming
while talking, looking at something else while talking, and being
bored with conversations.
3 Due to the above differences in communication, autistic people
tend to be shunned by neurotypicals and, therefore, are condi-
tioned to believe that they are somehow less social.
B Repetitive behavior or interests as evidenced by at least two of the
following:
1 Stimming or engaging in echolalia.
2 Security in routines. Autistic people do not have a sensory filter,
so the world is perceived as a constant state of chaos. Routines
and expectations give comfort to overwhelmed autistic people.
3 Special Interests (­­SPINS). Due to hyperconnected brains, autis-
tic people feel more passionately about what they love, so when
they have a special interest, they tend to fawn over and fixate on
it.
4 ­­Hyper-​­​­​­ or hyporeactivity to stimuli. Again, due to hyperconnec-
tions, they feel emotions more intensely. Sometimes, they feel
emotions less intensely because they tune them out in favor of
other stimuli.
II Autistic people are born with these traits but learn how to mask them.
Sometimes, the traits show up only when they are stressed and let down
their guards.
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III These traits cause other people distress. Note the DSM ONLY indicates
impairment when it affects other people or jobs, but not when it is a
daily issue that the autistic person learns to live with.
IV Autism is not due to intellectual disability.

The Autism Self Advocacy Network (­­ASAN) (­­2021) is an organization op-

erated by and for autistic people. ASAN was created to serve as a national
grassroots disability rights organization for the autistic community. The or-
ganization seeks to advance the principles of the disability rights movement
regarding autism. ASAN defines autism as the following:
Autism is a developmental disability that affects how we experience the
world around us. Autistic people are an important part of the world.
Autism is a normal part of life and makes us who we are.
Autism has always existed. Autistic people are born autistic, and we will
be autistic our whole lives. Autism can be diagnosed by a doctor, but
you can be autistic even if you don’t have a formal diagnosis. Because of
myths about autism, it can be harder for autistic adults, autistic girls, and
autistic people of color to get a diagnosis. But anyone can be autistic,
regardless of race, gender, or age.
Autistic people are in every community, and we always have been. Autis-
tic people are people of color. Autistic people are immigrants. Autistic
people are a part of every religion, every income level, and every age
group. Autistic people are women. Autistic people are queer, and au-
tistic people are trans. Autistic people are often many of these things
at once. The communities we are a part of and the ways we are treated
shape what autism is like for us.
There is no one way to be autistic. Some autistic people can speak, and
some autistic people need to communicate in other ways. Some autis-
tic people also have intellectual disabilities, and some autistic people
don’t. Some people need a lot of help in their ­­day-­​­­­​­­​­­­to-​­​­​­day lives, and
some autistic people only need a little help. All of these people are
autistic, because there is no right or wrong way to be autistic. All of
us experience autism differently, but we all contribute to the world in
meaningful ways
(­­para. ­­1–​­​­​­4)

ASAN (­­2021) further explains that autistic people deserve understanding

and acceptance. Every autistic person experiences autism differently, but
there are some things that many have in common. Autistic individuals think
differently, process senses differently, move differently, communicate differ-
ently, socialize differently, and might need help with daily living
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Within the AutPlay Therapy process, therapists have the ability to imple-
ment an autism screening process from a ­­strength-​­​­​­based perspective. The
AutPlay autism screening process serves as a tool for therapists to observe and
assess a child to identify if there appears to be a need for further evaluation or
referral regarding a possible diagnosis. Autism screenings are not a diagnostic
process; they provide a simpler protocol to screen for the need for further
evaluation. Although there are many options open to a therapist when con-
ducting an autism screening, the following highlights the screening process
in AutPlay Therapy that is designed from a ­­strength-​­​­​­based perspective.

1 The entire process should take two to three hours that can be imple-
mented in one setting or across sessions.
2 Parents are given the AutPlay Autism Checklist Revised (­­located in the
appendix of this book) to complete on their child. Parents can also give
the inventory to other adults who know the child well so multiple indi-
viduals can complete the inventory regarding the child.
3 Therapists can give additional inventories if they are familiar with other
screening tools that are ­­strength-​­​­​­based. All inventories are given to par-
ents or caregivers to complete and return to the therapist for scoring and
review.
4 The therapist will conduct an observation with the child in a playroom.
This observation typically lasts ­­30–​­​­​­45 minutes. The therapist can use the
Child Observation form located in the appendix section of this book.
The therapist then conducts an observation of the parent and child play-
ing together in a playroom. This observation lasts approximately 30 min-
utes. The therapist can use the Parent/­­Child Observation form located
in the appendix section of this book. Observations should have a rela-
tional focus with the therapist staying attuned to the child in observing
their play preferences and interests. The therapist will also observe the
child’s communication, interaction, and basic play style. Any strengths
observed should be noted.
5 Once the AutPlay Autism Checklist Revised and observations have
been completed, the therapist and parent discuss the process and results
to identify if there is a need for further evaluation. If there are any signifi-
cant indicators, the therapist should refer the family for a full psychologi-
cal evaluation. If a referral for a full evaluation is made, the therapist will
want to spend time talking with the parent about affirming ideas related
to autism. The therapist can explain the medical model perspective and
help prepare the family for what they will experience during the evalu-
ation process. This might be an appropriate time to provide the family
with additional affirming information about autism. One such resource
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would be the Autism Self Advocacy Network’s parent guide “­­Start Here:
A Guide for Parents of Autistic Kids.” This guide is affirming and covers
many topics such as what is autism, what parents should do next, where
parents can learn more, what good services look like, and topics such as
­­self-​­​­​­advocacy, communication, and presuming competence.

Although autism was highlighted as a specific example of the medal model

perspective versus a ­­non-​­​­​­pathologizing and affirming perceptive, the same
process can apply to any area of neurodivergence. All neurodivergence will
be pathologized in the medical model perspective. Likewise, all neurodiver-
gence can be viewed through an affirming lens, looking at the whole child.
This certainly includes recognizing issues or needs but it does not stop there,
it also looks at strengths, identity, and a healthy understanding and view of
self. Consider the discourse offered by Dr. Nick Walker (­­2021)
At the root of the pathology paradigm is the assumption that there is
one “­­right” style of human neurocognitive functioning. Variations in
neurocognitive functioning that diverge substantially from socially con-
structed standards of “­­normal”– ​­​­​­including the variations that constitute
­autism – ​­​­​­are framed within this paradigm as medical pathologies, as defi-
cits, damage, or “­­disorders.”

Through the lens of the neurodiversity paradigm, the pathology para-

digm’s medicalized framing of autism and various other constellations of
neurological, cognitive, and behavioral characteristics as “­­disorders” or
“­­conditions” can be seen for what it is: a social construction rooted in
cultural norms and social power inequalities, rather than a “­­scientifically
objective” description of reality.

The choice to frame the minds, bodies, and lives of autistic people (­­or
any other neurological minority group) in terms of pathology does not
represent an inevitable and objective scientific conclusion but is merely
a cultural value judgment. Similar pathologizing frameworks have been
used time and again to lend an aura of scientific legitimacy to all manner
of other bigotry, and to the oppression of women, indigenous peoples,
people of color, and queer people, among others.
(­­p­­­­p. ­­18–​­​­​­20)

Social Model of Disability

In contrast to the medical model is the social model of disability. It was not
designed to be a perfect theory of disability but an explanation of disabled
people’s experience in society and, equally importantly, a tool for creating
18 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g

social change. What is powerful and liberating about the social model is that
it does reflect disabled people’s real life experience and puts forward a radical
and practical approach to ending disabled people’s exclusion and oppression
that does not require disabled people to change who they are in order to be
deemed to be entitled to the same rights and opportunities as non-​­​­​­
­­ disabled
people (­­Inclusion London, 2021).
The social model of disability maintains that disability is caused by the way
society is organized. It identifies systemic barriers, negative attitudes, and ex-
clusion by society (­­purposely or inadvertently) that mean society is the main
contributory factor in disabling people. A social model perspective does not
deny the reality of impairment nor its impact on the individual. However,
it does challenge the physical, attitudinal, communication, and social en-
vironment to accommodate impairment as an expected incident of human
diversity. The social model seeks to change society in order to accommodate
people living with impairment; it does not seek to change persons with im-
pairment to accommodate society (­­People with Disability Australia, 2021).
Goering (­­2015) stated that the social model of disability focuses attention
on the attitudinal obstacles faced by people with non-​­​­​­
­­ standard bodies. Other
people’s expectations about quality of life and ability to work for a person
with a disability not only affect the ways in which physical structures and
institutional norms are made and sustained (­­based on presumptions about
inability to perform), but also can create additional disability by making it
harder for such individuals to feel good about themselves. The social model
reminds us to be careful about what we presume to be irremediable through
social change and to question the ways in which we currently understand
disability. Challenging standard definitions of disability and impairment will
require listening carefully to the experiences of people living with those im-
pairments and thinking creatively about possibilities for inclusion, accom-
modation, and accessibility.
Inclusion London (­­2021) stated that barriers “­­disable” individuals by cre-
ating exclusion, discrimination, and disadvantage for people with impair-
ments. The social model, in highlighting the barriers, often simultaneously
can identify solutions. There are three types of barriers common within the
social model of disability.

1 Attitudinal ­barriers – ​­​­​­These are social and cultural attitudes and assump-
tions about people who are neurodiverse or have a disability that ex-
plain, justify, and perpetuate prejudice, discrimination, and exclusion in
society; for example, assumptions that people with certain impairments
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can’t work, can’t be independent, can’t have sex, shouldn’t have chil-
dren, need protecting, are “­­­­child-​­​­​­like”, are “ dangerous”, should not be
seen because they are upsetting, are unpredictable, etc.
2 Physical ­barriers – ​­​­​­These are barriers linked to the physical and built en-
vironment and cover a huge range of barriers that prevent equal access,
such as stairs/ steps, narrow corridors and doorways, curbs, inaccessible
toilets, inaccessible housing, poor lighting, poor seating, broken eleva-
tors, or poorly managed streets and public spaces.
3 Information/­­Communication ­Barriers – ​­​­​­These are barriers linked to in-
formation and communication, such as lack of Sign Language interpret-
ers for Deaf people, lack of provision of hearing induction loops, lack
of information in different accessible formats such as Easy Read, plain
English, and large font, lack of sensory accommodations, and lack of
understanding there are more ways to communicate than verbally.
(­­para. 15–​­​­​­17)

Consider this simple but clear example of the social model of disability: the
case of Adam, an autistic teen who was attending a public high school. As
a freshman in high school, Adam was testing at a 3rd grade level in math
(­­which he had been testing at since 3rd grade). Adam’s mother sought tu-
toring services outside of the school to help Adam increase his math skills.
Upon participation with special tutors, it was discovered that if Adam could
use a calculator to complete his math work, he scored at a 9th grade level in
­math – ​­​­​­five grade levels higher than he was scoring in public school testing
processes. It was further discovered that some of Adam’s school teachers had
recognized that Adam could do more advanced math when he used a calcu-
lator versus ­­pencil-­​­­­​­­​­­­and-​­​­​­paper equation operations, but they felt he needed
to learn how to do math the way they were teaching it and did/­­would not
allow him to use a calculator. Adam continued to struggle until his parents
removed him from the public school he was attending and placed him in a
private school that was more accommodating of Adam’s specific learning
styles, which included being able to use a calculator to perform math equa-
tions. Due to being behind in grade levels, Adam spent an extra semester in
high school but graduated on grade level in all his subjects (­­including math).
In summary, Adam did not have a math disorder. He could comprehend and
perform math equations at grade level when allowed to use a calculator. It
was his environment (­­societal perspective that using a calculator was inva-
lid) that was disabling him from advancing in math ability.
It is important to note the neurodiverse advocates (­­those that highlight
the social model of disability) do not say that disabled people don’t have
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problems, needs, or struggles, that is invalidation. That is not what the so-
cial model of disability communicates. The central idea of the social model
is that needs and differences (­­no matter how difficult or distressing) do not
make neurodivergent individuals any less worthy of access to society than
others.
Neurodivergence is not a disorder, but neurodivergent individuals may have
needs such as executive dysfunction, regulation struggles, trauma responses,
and extreme sensory differences. There is no treatment or cure for neuro-
divergence, but a neurodivergent individual may need accommodations or
therapies. The social model promotes a society where neurodivergent needs
(­­any needs) are accommodated and where disabled people are able to enjoy
full access to society.

Being Neurodiversity Affirming

Neurodiversity affirming is an action. It is a set of multiple processes that col-

late from a neurodiversity informed understanding. The neurodiversity af-
firming play therapist has a thorough understanding of neurodiversity which
includes the neurodiversity movement and paradigm, ableism, the medical
and social models of disability, and the history of ­­non-​­​­​­affirming/­­ableist ther-
apy approaches initiated with neurodivergent children. It is this knowledge
that translates into (­­guides) affirming awareness and approaches in therapy
practice.
When working with neurodivergent children, it is critical for therapists to
assess and conceptualize each individual child in order to fully understand
the child’s strengths and needs. Although there may be some commonali-
ties, each neurodivergent child will present their uniqueness. Therapists are
encouraged to develop a process to help them build a relationship with the
child, get to know the individual child, more accurately identify the child’s
strengths and needs, and understand any particulars a child might be expe-
riencing related to being neurodivergent. In AutPlay Therapy, this process
(­­outlined in later chapters) can be accomplished through ­­parent-​­​­​­completed
inventories, background information from the child’s parents, therapist play
observations, and simply talking, spending time, being attuned, and building
relationship with the child.
Any type of therapy, support, care, or education process with a neurodi-
vergent child or teen should be grounded in valuing the child’s identity.
Therapists will want to conceptualize how their interactions with the child
 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g 21

promote value and acceptance and avoid ableist concepts. Lambert (­­2018)
stated that ­­non-​­​­​­autistic disability advocates often neglect to apply the social
model when they talk about autism and proposed five suggestions for valuing
autistic individuals. Although specifically talking about autistic individuals,
these principles apply across neurodivergent representation:

1 Nothing About Us, Without Us: A popular adage with disability

­advocates – ​­​­​­and it’s still relevant. You can’t talk about autism if you’re
ignoring autistic people and what they have to say. All those people ad-
vocating for a cure. Most of them aren’t autistic.
2 You Don’t Know Me: Much of the information out there about autism
isn’t accurate to the real experiences of autistic people. It’s nice to hear
that you’re interested in autistic issues, but don’t assume you know more
about autism than an autistic person does. In fact, it’s sometimes best to
assume that you don’t know anything about autism at all.
3 Educate Yourself: So maybe you don’t know anything about autism. It’s
time to l­earn – from​­​­​­ autistics. Read what autistic activists write about
their ­experiences – ​­​­​­not only the voices that are easy to find, but also
those that are often quieter. Autistic women, autistic people of color,
queer and trans autistic people, and poor autistic people all have stories
to tell.
4 This Space Is Our Space: Your disability-​­​­​­
­­ centered social circles, articles,
and theories aren’t always accessible to autistic people. If you don’t make
any efforts to make ­­easy-​­​­​­read materials, ­­sensory-​­​­​­friendly environments,
or spaces where people can communicate in the ways that are most com-
fortable for them, you aren’t including autistic people.
5 Who Are You Speaking To?: Many autistic advocates prefer ­­identity-​­​­​­first
language (“­­autistic person” instead of “­­person with autism”). An autistic
person’s disability is part of them, and they don’t want to dance around
it. And ­please – don’t ​­​­​­ call them high functioning or low functioning. If
you don’t respect their language, you don’t respect them.
(­­para. 6–​­​­​­10)

Grant (­­2021) proposes a guideline for being neurodivergent informed that

includes several philosophical points neurotypical individuals can imple-
ment to provide value and affirming practices for neurodivergent children:

1 Do not assume neurodivergent children have limitations. Some are

gifted, some have strengths in a variety of areas. Some do not need any
therapies. A neurodivergent child is not in therapy because they are
neurodivergent.
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2 Ask the child about themselves, allow their voice in the therapy process,
and listen to what they say.
3 Remember that processing speed, communication, and other executive
skills might be different from your own and differences are valued as
okay.
4 Remember social interactions may look differently and the neurodi-
vergent child may have preferences that differ from the typical society
standard. This is not negative; it is different but not a lesser way of doing
things.
5 Do not rely on verbal or nonverbal messages or body language to com-
municate with neurodivergent children. The child may have a variety of
ways of communicating. Remember that play is the natural language of
all children, and all children play. Commit to learning about the neuro-
divergent child’s play preferences and interests.
6 Respect the child’s right to decide how they want or do not want to talk
about themselves and how they want their neurodivergence referenced.
7 Provide space for neurodivergent children to share what they are think-
ing and feeling; do not assume based on a diagnosis or how you would
think or feel.
8 Be willing to use visual supports (­­schedules, pictures), technology, and any
other communication/­­learning accommodations that best fit the child.
9 Do not judge behavior that is different from your own. Consistently
check your interaction, approach, and process for ableist constructs.
10 Look for the strengths the neurodivergent child possesses and try to build
upon those strengths.
11 See the world from the child’s viewpoint. How are they experiencing
what is happening?
12 Do not try to force the child to be like, look like, and act like you.
Respect and learn about the neurodiversity paradigm.
(­­­p. 31)

A Focus on Strengths

How disability is conceptualized will often depends on who is viewing it.

Those working from the outside (­­let’s say neurotypical individuals) may view
disability as an impairment, deficit, or problem. Those with the disability
(­­let’s say neurodivergent individuals) will likely view the social factors they
encounter as the real impairment or problem. This view that neurodiver-
gence is the disability and thus the problem, completely eliminates the truth
or even the consideration of the strengths a neurodivergent child possesses.
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A key component of being neurodiversity affirming is taking a strength-​­​­​

­­
­based approach when implementing therapy. Focusing on the strengths a
child possesses, building upon their strengths, and using them to address
therapy needs can be an effective and neurodiversity affirming approach for
helping neurodivergent children. Stoerkel (­­2021) proposed that a ­­strength-​­​­​
­based approach is successful because the client is the agent of change by pro-
viding the right environment for controlling change. This approach is highly
dependent on the thought process and emotional and information process-
ing of the individual. It allows for open communication and thought process
for individuals to identify value and assemble their strengths and capacities
in the course of change. A strength-​­​­​­
­­ based approach allows for habitable con-
ditions for a child to see themselves at their best, to see the value they bring,
by just being themselves.
Pattoni (­­2012) described a ­­strength-​­​­​­based practice as a collaborative pro-
cess between the person supported by services and those supporting them
(­­the therapist and the child), allowing them to work together to determine
an outcome that draws on the child’s strengths and assets. In therapeutic
settings, it focuses principally on the quality of the relationship that devel-
ops between the therapist and the child, as well as the already developed
resources the child brings to the process. Working in a collaborative way
promotes the opportunity for children to be participants in creating sup-
port rather than being directed by the therapist. ­­Strength-​­​­​­based approaches
concentrate on the inherent strengths of children, families, groups, and
organizations, deploying personal strengths to aid growth and healing. In
essence, to focus on health and ­­well-​­​­​­being is to embrace an ­­asset-​­​­​­based
approach where the goal is to promote the positive. ­­Strength-​­​­​­based ap-
proaches value the capacity, skills, knowledge, connections, and potential
in children.
Rapp, Saleebey, and Sullivan (­­2008) suggested six standards for determining
a ­­strength-​­​­​­based approach. If in agreement, therapists can use the following
list when considering the method they will use when practicing the strength-​­​­​
­­
­based approach:

1 Goal orientation: It is crucial and vital for the person to set goals.
2 Strengths assessment: The person finds and assesses their strengths and
inherent resources.
3 Resources from the environment: Connect resources in the person’s en-
vironment that can be useful or enable the person to create links to these
resources. The resources could be individuals, associations, institutions,
or groups.
24 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g

4 Different methods are used first for different situations: Clients will de-
termine goals first and then strengths that can be used. In strength-​­​­​­
­­ based
case management, individuals determine their strengths by first using an
assessment.
5 The relationship is ­­hope-​­​­​­inducing: By finding strengths and linking to
connections (­­with other people, communities, or culture), the client
finds hope.
6 Meaningful choice: Each person is an expert on their strengths, re-
sources, and hopes. It is the practitioner’s duty to improve upon choices
the person makes and encourage making informed decisions.
(­­p­­­­p. 81–​­​­​­82)

Bronfenbrenner (­­1994) defines childhood as a beautiful time where children

are learning how to do things, and what they like. When using the ­­strength-​­​­​
­based approach in early childhood practice you would implement the same
aspects you would for an adult. This would include paying attention to what
the child likes and offer a variety of ways for the child to learn, grow, and
heal. A great way for children to develop their strengths is to live expres-
sively. Children can express themselves in all sorts of ways (­­their play prefer-
ences and interests), and this can lend well to understanding what someone
truly enjoys and is good at.
A ­­strength-​­​­​­based approach not only examines the child but also the child’s
environment. For example, it looks at how systems are set up, especially
where power can be out of balance between a system or service and the child
it is supposed to serve. In addition, strength-​­​­​­
­­ based approaches identify any
constraints that might be holding back a child’s growth. These constraints
can be when the child must deal with social, personal, and/­­or cultural issues
in environments that cannot be balanced fairly (­­Stoerkel, 2021).
Taylor (­­2019) describes a ­­strength-​­​­​­based approach as the therapist is no
longer the expert, the child is. The therapist approaches the child with cu-
riosity and interests in terms of how the child perceives the problems or
needs and solutions. The therapist no longer views the child through a cer-
tain therapeutic philosophy, that, in turn, shifts and perhaps distorts how
the child is viewed. Rather, the therapist works with the child, ready to be
informed by the child regarding how the child views their needs. For neu-
rodivergent children, it means not viewing the child as a diagnosis and the
diagnosis is the need.
­­Solution-​­​­​­focused play therapy highlights the process of implementing a
­­strength-​­​­​­based approach when working with neurodivergent children. In
 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g 25

­­
solution-​­​­​­
focused therapy, the focus on strengths counters the negative focus
that others often have on weaknesses, deficits, and disabilities. Focusing on
strengths increases the child’s feelings of self-​­​­​­
­­ efficacy and hope in the face of
personal challenges. Strengths focus also increases the child’s attention to
resources that may be employed to compensate for challenges (­­Taylor, 2019).
­­Solution-​­​­​­focused play therapy has been shown to be relevant for working
with children and adjustments can be easily made from child to child ac-
cording to the child’s developmental level (­­Nims, 2007). The play involved
in ­­solution-​­​­​­focused play therapy can involve a variety of type and respects
the child’s play preferences such as art, sandtray, puppets, gamming, toys,
movement, etc.
Focusing on strengths and implementing a ­­strength-​­​­​­based approach does not
mean ignoring challenges or needs the child might have or suggesting that
struggles are strengths. Therapists working from a strength approach will
need to work with the child in ­collaboration – ​­​­​­helping them to implement
their strengths to successfully address their challenges or needs. In this way,
children become ­­co-​­​­​­change agents (­­partners) in their therapy goals. Con-
sider the following in the practical application of looking at and utilizing
strengths:

• What does the child do well (­­dresses themself, is kind to others, plays
independently)?
• What has the child accomplished (­­beat several video games, learned
how to use a tablet, built an original LEGO creation)?
• How can you assess strengths (­­inventories, observations, play tech-
niques, asking the child)?
• What can you observe about strengths the child has (­­plays reciprocally
and alone, follows rules, helps clean the playroom)?

These considerations begin to inform the therapist about the child’s strengths
and conceptualizing how the strengths can be used to address therapy needs.
It also helps the child recognize they are much more than their therapy
needs. Consider the following play therapy interventions designed to help
the child and therapist recognize the child’s strengths.

Look at My Strengths

Therapy Needs: Strengths and ­­self-​­​­​­worth

Level: Child and adolescent
26 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g

Materials: Construction paper (­­various colors), tape, scissors, and a pen

Modality: Individual, group, and family
Instructions:

1 The therapist collects construction paper, scissors, tape, and a pen or

pencil to use in this intervention. The therapist explains to the child
they are going to use the construction paper to help learn about the
child’s strengths.
2 The therapist instructs the child to think about things they are good at,
things they do well, things they can achieve, etc. Some children may
have a difficult time with this, especially if their ­­self-​­​­​­worth is low. The
therapist may use language like “­­What do you like to do?” “­­What do you
like to play with?” “­­How would you spend your day if you could do what-
ever you wanted?” Children may be able to better answer these types
of questions and typically they will communicate answers that indicate
their strengths.
3 The therapist instructs the child to cut out different shapes from the con-
struction paper. The child can cut out as many shapes as they want and
in any color they want. Each shape will have one of the child’s strengths
written on it.
4 Once the child has cut out the shapes, the child (­­and therapist if needed)
will write a strength the child has identified on each ­­cut-​­​­​­out shape.
5 The child will then put a piece of tape on the back of each shape and
tape them to their chest, stomach, and/­­or arms.
6 Once the shapes have been taped onto the child, the therapist and the
child will look in a mirror and read each shape and discuss each strength
further if necessary. The therapist will help point out all the strengths
the child identified and the importance of having and knowing one’s
strengths.
7 The therapist or the child’s parent can take a picture of the child with
their strengths and have it at home to reference.
8 The therapist can contribute strengths if they know of strengths the
child possesses. The therapist can cut out shapes and share them with
the child. This intervention helps the child recognize they do have
strengths. Many neurodivergent children spend much of their time hear-
ing about what they do wrong from adults in the various environments
they navigate. It is important that children understand and recognize the
strengths they possess. This play intervention also helps the therapist
recognize some of the child’s strengths and the therapist can begin to
conceptualize how to use those strengths to help address therapy needs.
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LEGO Build (­­Strengths)

Therapy Needs: Strengths and ­­self-​­​­​­worth

Level: Child and adolescent
Materials: LEGO bricks
Modality: Individual, group, and family
Instructions:

1 The therapist explains that they are going to build some things using
LEGO bricks.
2 The therapist displays several bricks to use in the intervention.
3 The therapist states that the child is going to build something with the
bricks that describes or represents a strength they have. The therapist
may need to explain the concept of a strength. It might be helpful to
phrase it as something you are good at or something you do well.
4 The child can build anything they want in any way they want. The only
guide is that must represent a strength.
5 The therapist should also do a strength build.
6 Once the therapist and child have both completed their builds, they can
take turns sharing what they built and what strength it describes.
7 If the child wants, they can complete another build describing another
strength.

Strengths Plate

Therapy Needs: Strengths and ­­self-​­​­​­worth

Level: Child and adolescent
Materials: Paper plate and a pen
Modality: Individual, group, and family
Instructions:

1 The therapist explains to the child that they are going to do an activity
talking about the child’s strengths (­­things they do well).
2 The therapist gets a paper plate and draws a line down the middle (­­one
half for the child and one half for the therapist).
3 The therapist writes their name at the top of the plate on their side and
the child writes their name on the top of the plate on their side.
28 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g

4 On the ­­far-​­​­​­left side of the paper plate the therapist and child will write
all the strengths they can think of that a person might have. The ther-
apist will want to make sure that several different types of strengths get
listed, especially some they know the child has.
5 Once the list of strengths is complete, the child and therapist will take
turns putting a check mark under their name that corresponds with any
of the strengths listed that they believe is a strength they possess.
6 Once both the therapist and child have finished their checks, they look
at the plate, share, and compare what they put checkmarks beside.
7 The therapist can talk about how everyone has different strengths. The
therapist can also talk about how the child has strengths the therapist
does not have and vice versa. Everybody has strengths and it is impor-
tant to focus on your strengths.
8 The child can keep the paper plate strengths to remind them of the
strengths they possess.

Nims (­­2007) describes the solution focused ­­strength-​­​­​­based play interven-

tion Wows and Hows, which uses statements that begin with the words wow
and how. They are designed to affirm children’s positive conclusions about
their lives in spite of what has happened to ­them – ​­​­​­the “­­wow” – ​­​­​­and asking
them how they knew their behavior was the right thing to do under these
­circumstances – ​­​­​­the “­­how.” This helps them to discover their own capabil-
ities and feel encouraged to use these skills in the future. Examples of this
technique are “­­Wow, you were able to control your anger that time and stay
calm. I wonder how you knew to do that?” “­­Wow, you did your homework
that day. I wonder how you did that? There have been so many times you
didn’t do your homework. What was different that time?”
Mottron (­­2017) concluded that child therapies should allow the child to
achieve an abstract level of happiness, personal accomplishment, access to
cultural material, and social integration, an essential human right, regard-
less of the way in which this is achieved and the form that it takes. An
acceptance of autistic and neurodivergent humanity begins by changing tar-
gets, methods, and efficiency variables of the processes offered to autistic
and neurodivergent children, in favor of ­­strength-​­​­​­informed and affirming
approaches.
Essentially, the basic concept of valuing a child is not complicated. The play
therapist may simply reflect on how they would want to be treated by a pro-
fessional they might be seeing. Would they want to be heard, be listened to,
have a say in what happens to them, be able to freely share and ask questions,
make decisions concerning what happens to them, etc.? In most cases, adults
 N e u r o d i v e r s i t y, A b l e i s m , a n d B e i n g N e u r o d i v e r s i t y A f f i r m i n g 29

would answer yes to all the above questions and desire this type of value. We
should do no less for the children and adolescents we work with and serve.
Being affirming empowers, and empowerment can achieve and heal as this
becomes the meaningful pursuit in our work with neurodivergent children
and their families.

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 2
The Neurodivergent Child

Who Is a Neurodivergent Child?

Neurodiversity or being neurodiverse refers to all humans. We are all neu-

rodiverse (­different neurotypes) and thus neurodiversity exits. Underneath
the “­umbrella” of neurodiversity, there currently exits two primary categories
of ­people – ​­neurodivergent and ­neurotypical – ​­to understand the definition
of one is to understand the definition of the other. Children may be neu-
rotypical or they may be neurodivergent, but all children are neurodiverse.
Basically, even in the neurotypical category there is still neurodiversity as no
two neurotypical brains are exactly alike.
Neurodivergent refers to an individual who has a less typical (­societal con-
sidered “­normal”) cognitive variation such as autism, ADHD, dyslexia,
dyspraxia, dyscalculia, sensory differences, Obsessive Compulsive Disorder
(­OCD), Tourette’s Syndrome, etc. Although not exhaustive, ­Table 2.1 dis-
plays the range of who is neurodivergent. “­Neurodivergence” is the term for
people whose brains function differently in one or more ways than is consid-
ered standard or typical. Neurodivergence refers to any structured, consistent
way that brains work differently for a group of people than they do for the
majority of others.
It is estimated that over 1.2 billion people identify as neurodivergent.
“­Neuro” refers to neurology, or the study of nerves and the nervous system,
which includes the brain. “­Divergent” recognizes that these cognitive pro-
files diverge from what is considered to be a “­typical” cognitive profile. In a
binary framework, those who aren’t neurodivergent are neurotypical. Neuro-
divergence can also be referred to as neurotypes, differences, and variances,
highlighting that while some brains are unlike what is considered more the
norm, all are natural.

DOI: 10.4324/9781003207610-3
32 The Neurodivergent Child

­Table 2.1 Who Is the Neurodivergent Child?

Examples by Diagnosis
Autistic Highly sensitive Sensory processing disorder
person (­HSP) (­differences)
Dyslexia Dyspraxia Dyscalculia
Tourette’s syndrome Developmental Intellectual developmental
disabilities disorder (­IDD)
Obsessive compulsive Gifted/­twice Attention deficit hyperactive
disorder (­OCD) exceptional disorder (­ADHD)

“­Neurotypical” describes individuals who display a ­society-​­defined typical

intellectual and cognitive development. Human beings are social animals
that band together for survival. As we have formed societies, we have also
formed ways of teaching our new generations skills like reading, math, and
the overt and subtle forms of interaction with one another. These individuals
acquire physical, verbal, intellectual, and social processes proceeding at a
specific pace and meeting standardly accepted milestones for development.
Neurotypical people may also display commonly expected physical behaviors
such as being able to easily modulate their volume when speaking based on
the situation, and they don’t find it distressing to maintain eye contact. Indi-
viduals who are described as neurotypical can generally meet the societally
expected presentation of navigating social situations, producing communi-
cation, establishing social connections like friendships, and can function in
distracting or stimulating settings without becoming overloaded by stimuli
(­Weathington, 2020). Systems and environments have operated and con-
tinue to operate with a conditioned belief and thus performance that the
neurotypical “­look” is the look that everyone needs to strive for and sets the
standard of accomplishment. The neurodivergent child is then often seen as
missing the mark and needing help to become more like the standard.
It would be impossible to write a couple of paragraphs or create a list or table
that solidly identify the neurodivergent child. Likely it has become clear that
being neurodivergent can and does have many looks or presentations. There
may be some similarities across neurodivergence but there are many differ-
ences. Many of the neurodivergent children I have worked with present with
some level of rejection, being misunderstood, feeling confused, anxious, feel-
ing devalued, having poor ­self-​­worth, and being regularly disabled by society
 The Neurodivergent Child 33

and systems. It an attempt to bring some perspective in working with neuro-

divergent children in general, the following five dichotomous constructs are
reviewed regarding the neurodivergent child experience.
Inclusion vs Seclusion – ​­Inclusion is defined as the practice or policy of pro-
viding equal access to opportunities and resources for people who might
otherwise be excluded or marginalized, such as those who have physical or
mental disabilities. Seclusion is defined as the state of being private and away
from other people. Unfortunately, many neurodivergent children experience
seclusion in many of the systems and environments they navigate. I have
witnessed many examples of children begin secluded in an educational set-
ting, being asked not to return to a church, being secluded to a “­special”
extracurricular activity set up for “­special” kids. The rejection and message
of “­not being good enough” is an easy internalization when inclusion is not
respected, and the message being delivered to the child is they do not belong
with everyone else.
Acceptance vs Ableism – ​­Am I okay being myself? Am I okay just being who
I am? The message of acceptance of self and feeling accepted by others is
a powerful healing and change agent. Acceptance means the child values
themselves (­­self-​­acceptance) and feels accepted by others instead of feeling
like they are less than and not as good as others. Ableism is the discrimina-
tion of and social prejudice against people with disabilities based on the be-
lief that typical abilities are superior. Ableism in application is the opposite
of acceptance. Many instances of ableism are likely not intentional, but the
message received by the neurodivergent child is one of not being accepted.
Many neurodivergent children struggle with believing they are accepted and
okay as people. Often this is due to many messages communicated to the
child that the child, as they are, is not accepted and needs to change to
gain acceptance. Gabor Mate, a Hungarian Canadian physician is credited
with the statement “­when authenticity threatens attachment… the attach-
ment will trump the authenticity.” A powerful and accurate statement that
so many neurodivergent children understand too well. The desire for accept-
ance will painfully create an internalized hate of self and empty striving to
please others who are perceived to grant acceptance.
Value vs Devaluing – ​­Value has been described as seeing, feeling, knowing,
and understanding the beauty and worth of every human being and to give
love with the power of our soul, subconscious, conscience, and conscious-
ness. How many neurodivergent children feel valued sitting in a classroom
at their school, within their family, participating in society? Many neurodi-
vergent children enter play therapy in a state of not only feeling devalued
34 The Neurodivergent Child

but having had real experience that devalue them. The understanding and
active practice of valuing often becomes a primary therapy goal in the family
play therapy process in AutPlay.
Identity freedom vs Masking – Identity
​­ is defined as the fact of being who
or what a person or thing is. Identity freedom is the uninhibited or un-
restricted path to explore, embrace, and celebrate one’s identity. Masking
involves hiding aspects of yourself or pretending to be like someone else,
pretending to be someone you are not. Masking in neurodivergence is not
manipulative, it is implemented out of a survival response, an inability to
feel that being yourself is acceptable. Masking is the antagonist to identity
freedom, yet many neurodivergent adults share about their experiences with
masking and the harmful effects it created on their mental health and view
of self. Masking is such a common issue with neurodivergent individuals
that it has become almost synonymous with being neurodivergent. Unfor-
tunately, ­non-​­affirming systems and societies continue to send a strong mes-
sage to neurodivergent children that identity freedom is not supported or
encouraged.
Empowerment vs Trauma – Being ​­ empowered means to make (­someone)
stronger and more confident, especially in controlling their life and claim-
ing their rights. Many neurodivergent children will surely travel one of
two roads. They will embrace and feel empowered by their neurodiver-
gence, or they will experience a shame, rejection spiral that ends in a
trauma response. The therapeutic goal becomes developing and increas-
ing empowerment and ideally avoiding a trauma response. Unfortunately,
many children find their way to therapy with a trauma response already
established. At this point, the therapeutic approach shifts to addressing
the trauma issues while trying to empower the child. A guiding truth to re-
member is that a neurodivergent individual will be a neurodivergent indi-
vidual the totality of their life. How they feel about and what they believe
about their neurodivergence will have a massive impact on their overall
mental health.
Anastasia Phelps is an ­18-­​­­year-​­old spoken word autistic artist. Among her
many activities, she dedicates herself to advocating for others through public
speaking, writing, and expressive arts. In an excerpt from her writing My
Life with Autism, she shares her perspective and experiences about being an
autistic child.
Unhealthy comparison has always been an issue of mine. The best exam-
ple I can think of was when I was in the second grade. I often went out
into the playground and sat with my notebook and markers; scribbling
 The Neurodivergent Child 35

away while the other kids played. My hand only broke its rhythm when
my eyes strayed, with much longing, over to my joyfully playing peers.

Over the past 18 years, I felt like an inadequate weirdo who was always
striving too far, only to never get anywhere. On top of that, my med-
ications always seemed to complicate my emotions and play with my
perception, which really didn’t help me much.
Over the years, I had developed such harsh views of myself. Not only
that… I have also become so attached to the thoughts and opinions
of others. It is a very unhealthy addiction for m
­ e – about
​­ as harmful
to my mind as excessive amounts of drugs or alcohol might be to any
individual.
I do not possess telepathic abilities… I cannot tell what you see in me.
I can only take a guess. So, I like it when people talk to me like I am
another human being like anyone else. I like it when they give me a
chance instead of writing me off as a weirdo.
Just like anyone else, I want acceptance, and I want to be listened to.

Kayla Smith describes some of her thoughts as experiences as a young autistic

person in the book Sincerely, Your Autistic Child by Ballou, daVanport, and
Onaiwu (­2021).
Once I knew about my diagnosis, I didn’t mind telling people that I am
autistic. But all people would do is say, “­Okay,” or “­I don’t know any-
thing about autism at all.” I started getting bullied more, quite a bit, and
I kind of started to hate myself for being different. I remember asking
myself “­Why me?” and wishing I didn’t have it. I became ashamed of
myself. Then I remembered what my mom said when I was ten years old:
“­Don’t let autism define you.” So, as a teenager, I got hard on myself and
tried to be perfect at everything. I developed a mentality that I could
“­beat” autism and that I was an autism warrior (­it wasn’t until later I
found out that is offensive and filled with internalized ableism).
I tried to fight it. I spent most of my life trying to “­prove” to people that
I didn’t let autism “­define me” and that I could do the same things as
everybody else. I struggled with my identity and how I saw myself in the
world. For years, I tried to be somebody that I was not, and I was not
happy. I felt like I was living a lie every day of my life. Sadly, in my teen-
age years, I was so unhappy that I thought about committing suicide,
but I never had the guts to do it, so I did not try to commit suicide even
though deep inside I wanted to.
Now, I regret all those years I did not accept who I am. I want to tell
the younger generation, “­You were born right the first time, and don’t
be ashamed of it.”
(­­p. 97)
36 The Neurodivergent Child

Autistic author Naoki Higashida in his book The Reason I Jump (­2013) writes
about being asked if he would like to be “­normal.” The following response
from his book highlights the stigmatization and ableist views that so often
impede the autistic individual’s advancement through their life journey.

Question: Would you like to be “­normal?”

Response: What would we do if there was some way that we could be

“­normal”? Well, I bet the people around u­ s – ​­our parents and t­ eachers – ​
­would be ecstatic with joy and say, “­Hallelujah! We’ll change them back
to normal right now!” And for ages and ages I badly wanted to be nor-
mal, too. Living with special needs is so depressing and so relentless; I
used to think it would be the best thing if I could just live my life like a
normal person by now, even if somebody developed a medicine to cure
autism, I might well choose to stay as I am. Why have I come around to
thinking this way?

To give the short version, I’ve learned that every human being, with or
without, needs to strive to do their best, and by striving for happiness
you will arrive at happiness. For us, you see, having autism is ­normal—​
­see we can’t know for sure what your ”normal” is even like. But so long
as we can learn to love ourselves, I’m not sure how much it matters
whether we’re normal or autistic.
(­­p. 45)

Life as a neurodivergent person does not have a singular look, feel, or expe-
rience. Just as the spectrum manifests many different looks of autism, so life
as a neurodivergent person can look many ways. Autistic author Dr. Stephen
Shore has famously coined “­If you have met one child with autism, then
you have met one child with autism.” The following is a summary of several
constructs that have challenged many of the neurodivergent children I have
worked with over the past two decades. These are important for therapists
to consider in their work with neurodivergent children and their families.
A systemic issue: Ableist practices and ­non-​­affirming processes regarding
neurodivergent children is a systemic issue. The myriad of ways that a neu-
rodivergent child can be negatively affected weave throughout home life,
extended family, school environment, community, extracurricular activities,
policies, and laws. When working with neurodivergent children, it is critical
to remember how encompassing daily life can become. Everywhere the child
goes, whether it be school, interacting with their family, or participating in
a community ­event—​­they are likely to encounter environments that are not
supportive, not affirming, and do not understand their neurodivergence.
 The Neurodivergent Child 37

School challenge: From the very beginnings of daycare and preschool and
throughout college completion, neurodivergent individuals face an uphill
battle in most educational settings. The school setting can present some
of the greatest challenges to a neurodivergent child. The social and com-
munication demands, rigid learning expectations, processing requirements,
and sensory experiences present in every school day can create great dysreg-
ulation for neurodivergent children. Many schools find themselves in in-
adequate positions or are unwilling to provide resources and support that
neurodivergent children need to be their most successful. Therapists can be
beneficial in helping to educate school personnel about neurodivergence and
providing suggestions for services and resources to facilitate a more successful
learning experience.
Neurodivergence in the family: A ­neurodivergence-​­related diagnosis influences
the whole family. The immediate and extended family can be either a great
support or create problems for the neurodivergent child. Many of my neu-
rodivergent clients have reported some of their biggest challenges have re-
sulted from judgmental and unaware family members. Parents can help their
family by informing extended family about their neurodivergent child and
highlighting strengths and affirming approaches.
Therapies and interventions: The intensity and duration of therapy and inter-
ventions that a neurodivergent person participates in will vary, but it is likely
that most individuals will participate in some form of therapy or interven-
tion sometime during their lifetime. Some individuals may enter and exit
therapies and interventions as needed and some may never be involved in
therapy. Therapies and interventions may cover a variety of needs depend-
ing on the individual. Unfortunately, therapies can create overload for the
neurodivergent child (­especially if participating in several at once). Further,
some therapies have been harmful for neurodivergent children and have
created a trauma response due to the focus being on changing the child to
be more neurotypical. Listening to adult neurodivergent voices is critical in
evaluating and navigating affirming therapy practices.
­Self-​­acceptance: Neurodivergent individuals may be in a continuous pro-
cess of understanding themselves, their diagnosis, how it impacts the world
around them, and how the world around them can create support or barriers.
Gaining ­self-​­awareness of these issues will be critical for the neurodivergent
individual to live their most healthy and content life. Children around the
late elementary and ­pre-​­teen years can begin to learn more about their diag-
nosis and their identity. As they grow and mature, they should master ­self-​
­advocacy skills and become the best expert on themselves. Therapists can be
38 The Neurodivergent Child

instrumental in introducing neurodivergence to children and assisting them

in the ­self-​­awareness journey.
Educating others: Neurodivergent individuals may find much of their time spent
educating others about their neurodivergence. Although education and aware-
ness initiatives continue to increase, there still exists much inaccurate infor-
mation, ignorance, and stereotypes regarding neurodivergence. Unfortunately,
some neurodivergent individuals have found it easier to not disclose to oth-
ers they are neurodivergent because of the mislabeling and stigmatization that
can occur. Inevitably, neurodivergent people will find themselves in situations
where it will be necessary to educate those around them. Resources found in the
appendix of this book are a good place to begin to help children learn about neu-
rodivergence, which will increase their ability to better educate others. There
are also many neurodivergent adults who are writing, teaching, presenting, and
sharing information that can be helpful in educating others. Resources by actual
neurodivergent adults can be found in the appendix section of this book.

Listening to Neurodivergent Voices

The Neurodivergent ­Child – ​­by Jennifer Gerlach

I was a weird kid. In preschool I hid from the sounds of the washroom dryer
and chose to pace while eating my lunch. My teacher flagged me as someone
who could be autistic, however, the school psychologist felt my diagnosis was
not autism but ADHD. My language skills were good. I grew up in the early
1990s as a ­hyper-​­verbal female. I received a prescription for ADHD medica-
tion before beginning Kindergarten.
Then, I was a weird kid on ADHD medication. I remember my grandmother
pulling up the words and telling me what they meant. “­Attention, because
you don’t pay attention well” “­Definite (­deficit), because we are definitely
sure you have it (­I later learned it stands for deficit but I guess my grand-
mother thought I would not have known what that meant)” “­Hyperactivity,
you have literally tried to climb the walls” and “­Disorder” something that
could be used to describe my life then and now in multiple ways. I appre-
ciated that description, it helped me be kinder to myself. I did not like the
medication though. It made me sad and muted me. It felt as though for me
to be acceptable I had to be quiet and sort of drugged for everyone’s benefit.
I desperately wanted to be what I considered to be a “­good” kid. As I got older,
I remember copying down the class rules as soon as I got them. Somehow
 The Neurodivergent Child 39

my name seemed permanently etched on the blackboard. My most com-

mon offenses were “­talking” and “­not following instructions.” My ­third-​­grade
teacher wrote on my report card “­Jennifer seems to lack common sense.” I
would say that is also a decent description of me today.
I had small twitches since I could remember, but in fifth grade they got worse.
I also began to make sounds. One of those sounds seemed a lot like laughing
and another like a bark. I tried to use humor saying things like “­I’m a dog”
to explain something I did not understand and scared me. It didn’t work. I
seemed to get into some kind of trouble most days but luckily never any big
trouble. I had no friends and sensed that I did not fully fit in with my some-
what rural, conservative cultured school and town.
Playing trumpet in band proved to be an exception from my problems. For
some reason when I really concentrated on playing music my twitches and
sounds would quiet. One year, I found my name marked on a solo and to my
surprise there was no notes written for me. I learned about improvisation. You
make it up y­ ourself – on
​­ the s­ pot – it
​­ does not have to be the same every time.
I loved that. A freedom from rules which I seemed to fail so often at following.
Around this time my mind started to get ­stuck – ​­especially on themes of
death and cancer. My uncle had gotten lymphoma and died. I watched my
mother grieve and I felt powerless. I worried constantly about losing people
and took to rituals to try to prevent these bad things from happening. Many
of these rituals were religious. I believed myself to be a bad person who God
would punish severely if I did not punish myself first. I did not know other
people had these kinds of thoughts and kept them to themselves. I became
increasingly quiet, spending my time worrying and thinking by myself.
It seemed like it was my mouth that always got me in trouble, and I worried
about the many sins that involved w ­ ords – bragging,
​­ gossiping, etc. In middle
school, I shut down. I went from a ­hyper-​­verbal female to a kid who didn’t
talk much at all. The school intervened. I went through testing, meetings
with psychiatrists, neurologists, social workers, and counselors. I participated
in social skills groups, intensive outpatient sessions, and hospitalizations. My
diagnosis changed to “­Asperger’s Syndrome.” Then “­Obsessive Compulsive
Disorder,” then “­psychosis,” “­Major Depressive Disorder,” “­Bipolar Disor-
der,” “­Oppositional Defiant Disorder,” and then “­Pervasive Developmental
Disorder.” One practitioner told my parents I would be the youngest person
they had met who almost certainly had schizophrenia, but they had never
diagnosed schizophrenia under the age of 18. At some point, I also learned I
have Tourette’s Syndrome, which of all the labels I was given, I found most
helpful. Nonetheless, I began to dislike diagnosis.
40 The Neurodivergent Child

I also began to hate the assumptions that came with them. I remember once
attending a psychiatrist appointment where my parent complained about my
inconsiderate behaviors. A psychiatrist told her in front of me “­Jennifer has
Asperger’s Syndrome, which means that she cannot put herself in other peo-
ple’s shoes or have real empathy.” That hurt. I wondered if she had empathy
for how hearing that felt to a 1­ 3-­​­­year-​­old desperately trying to “­be good,”
who feared she was so “­bad” that even God would not love her and who
worried intensely about how she affected others and all the negative things
others had to say about her.
Isolation followed. I became aware that I freaked people out. On school
nights, my worries made my physically sick. I cried myself to sleep and cried
first thing each morning. I went days without talking in fear of saying the
“­wrong” things. I read volumes on rules of etiquette, and wrote lists of rules
for myself, trying to be “­better.” Eventually, I stopped going to school.
I missed 30 days of school and begged my parents to homeschool me. My
family did not have the resources for that. Luckily, I had an IEP. Instead
of no school, I would go to a therapeutic school. Initially, being sent to a
therapeutic school felt to me like being finally exiled from the small town I
grew up in (­the school was 45 minutes away in another state). Accurate or
not, I felt at the time (­and to some extent I still do) that this was how the
school district kept us ‘­weird’ kids from contaminating what was known to
be a “­good” school district in a town where differences were not tolerated.
Looking back, I can see that I had never really been accepted there. I missed
out on dances, band concerts, knowing my ­neighbors – ​­things I thought were
important parts of growing up. Still, sending me to this new school made a
major difference for me. It is something in which I will be forever grateful.
For once, I did not feel weird compared to everyone else. Everyone there
had something going on. Rather than placing me in slower paced classes
because of special education, I was upgraded from middle school to high
school a year early. The ­project-​­based learning gave me space to channel my
special interests. The therapists and teachers showed me extreme patience
as I worked toward navigating school again. I remember on one occasion a
therapist sitting with me in the lobby as I was panicking and asking repeat-
edly to go home. They actually gave me the choice to go home, and I found
this empowering. After they walked around the halls with me and we talked,
I didn’t want to leave. I felt I could do things again.
Sophomore year I was given another ­opportunity – ​­to be a mentor to a
younger student. I learned a love for connecting and I wanted to help others
to feel comfortable being themselves, the way the school had done this for me.
 The Neurodivergent Child 41

Receiving quality psychotherapy to assist with my obsessions/­compulsions

and ­self-​­worth also helped ­immensely – especially
​­ group therapy where my
fears were met with kindness and support from other teens. Taking a philos-
ophy class and reading on my own an ethics text that I borrowed from the
library gave me a new perspective. Utilitarianism, Kantian ethics, religious
perspectives of all kinds. I stopped seeing both ethics and myself in black and
white. It is okay to come across as awkward sometimes AND I can live by my
values. I began to consider a career in the helping professions.
Each year I would meet in an IEP meeting with my public school district, and
I would advocate to return to my mainstream school. After two years in the
special therapeutic school, I believed I could succeed in a mainstream class.
My grades were almost all As. I had not gotten in trouble since coming to the
new school and by sophomore year attendance was hardly an issue. Although
I would advocate, each year I was turned down. The end of my junior year I
was offered to return to the mainstream public school my senior year in what
would be an entirely ­self-​­contained classroom. I advocated as best I could for
myself that I felt I would do well in all mainstream c­ lasses – ​­expressing a goal
to go to college and graduate school and not feeling that this would give me
a chance to get the classes I would need to do that.
My voice was overshadowed by that of a school psychologist who I only met
in these IEP meetings. He met my IEP before he met me. “­Autism.” “­Serious
Emotional Disturbance.” Those words were on the first page of my IEP. He
shared a story about having another “­special needs” student in calculus and
it being a nightmare. He did not think I would be able to do mainstream
classes. I wondered if he knew that I was not that student, or that he did
not know me at all. I did not have time to prove myself to him and began
to accept this was not going to be possible. I graduated from the therapeutic
school.
I began the next year in a mainstream university! A few years later, I found
myself in graduate school and a few years after that opened my own practice
as a psychotherapist. I still carry a list of diagnoses although I do not like to
think of myself in those categories. I prefer the term “­neurodivergent.” I con-
sider myself a neurodivergent person in mental health recovery.
My office has a swing for clients who prefer to move while we talk, we discuss
social connection rather than social skills, and I work from a neurodiversity
affirming perspective. I consider my clients the experts on their own situa-
tions and have yet to meet one who I would say lacked empathy or could
not put self in another’s shoes. Often, I find it is the adults around the youth
I work with who struggle most with relating to the child’s perspective. This
42 The Neurodivergent Child

makes sense because when two people are running on a different neurologi-
cal setup, those two people will see things differently. A neurodivergent per-
son is at an advantage in ways in that they are likely to have more experience
syncing their own experience to understand another’s. This is a concept I
now know as the “­double empathy paradox.”
I have found curiosity to be key in relating to people in general and espe-
cially other neurodivergent people. I see diagnosis as an imperfect tool and
stay away from ­diagnosis-​­based assumptions. I have come to see traditional
social skills training as a sort of “­neurotypical communication 101” rather
than skills that neurodivergent people lack and need. I am looking forward
to the day when neurotypical students are offered “­neurodivergent commu-
nication 101” in the form of instruction on inclusion, acceptance, and cele-
bration of differences. The people I wish most to take such a course are the
adults who interface with neurodivergent youth.
Improvisation also remains a key piece of my practice. In communication,
rarely is there a ‘­right’ or ‘­wrong’ – it’s
​­ about context, openness, and willing-
ness to adapt. This is something I integrate into my personal life each day and
which I also seek to share with anyone willing to learn. I also integrate into
my work e­ vidence-​­based ­practices – most ​­ often Acceptance Commitment
Therapy and ­Radically-​­Open DBT. I have found both of these approaches to
help provide the neurodiversity affirming process I am striving to implement.

The Neurodivergent C
­ hild – ​­by Boontarika Sripom

I recently participated on a panel at San Diego ­Comic-​­Con Special Edition

with some colleagues in education and mental health. It’s been a dream to
speak, share, and build community with fellow geeks and divergent thinkers,
and I finally did it! I spoke on representation in pop culture, archetypes, and
heroism through the lens of comic books. I felt like I was speaking for my
younger self; the little girl who sat alone between the buildings in elemen-
tary school, afraid of something, many things, other people. I spoke for the
“­lonely” girl who walked around on the blacktop by herself. I spoke for the
girl who didn’t speak English and desperately wanted to understand a con-
fusing world.
Before the panel, I called my mom to wish her happy birthday, and to share
my joy of having this dream come true. She cried on the phone, and I clearly
remember her words. “­I thought you were going to be a doctor. You were so
good at biology. If your grandpa was still alive, he would at least be proud
 The Neurodivergent Child 43

of your cousins in medicine.” I listened to the worry through her words.

Although I understood from an immigrant parent’s perspective the worry for
the financial success of a child, I also felt the pain, disappointment, and lack
of support from her words.
My mother’s comments took me back to a time when I was a “­promising”
child. Learning was my play. Books were my toys. Puzzles and word problems
were my friends. I had potential that manifested into perpetual disappoint-
ment to my elders. I was born premature with my twin brother. At 28 weeks,
we were small enough to fit in the palms of someone’s hands. I was in NICU
for six weeks and my parents visited me every day. In preschool my brother
and I were separated because we spoke to each other in Thai. The school
wanted us to learn English, so we were not allowed to play together. My mom
once told me that I have “­always been independent” and played alone.
Whenever we went to school, I did not engage with peers or adults. I went
straight to building toys called Octons to visually stim with. The colors and
translucent plastic calmed me while giving me something to build. Thinking
about the colors of the toys now fills me with warmth, a feeling like I had
a companion during times of isolation. I was seen as a sick and weak child.
The doctors emphasized the hardships premature babies and children faced,
so my parents were bound by fear and duty to help their sick child.
Hoping I would gain weight, my family forced me to sit at the dining table
for countless hours from the ages of 3 to 6. I watched my siblings play as I
sat. I used to hide food in the sofa cushions, throw food under the table, and
hide in the bathroom until everyone went to bed. I spent so many hours in
the bathroom just being alone. In kindergarten and first grade, my parents
threatened me with the police or coming to my school to make sure I ate.
They told me I was always being watched. As an adult, my aunts and parents
still ask me, “­Why did you do that? Why didn’t you eat?” My ­6-­​­­year-​­old self
remembers thinking, “­I’m not hungry. Why are they doing this to me?”
I experienced three near drownings as a child (­likely due to my lungs being
weaker as a preemie) and remember thinking, “­No one will protect me. I’m
alone.” The themes of not being seen, heard, or having bodily autonomy
would permeate my childhood and into my adulthood and interpersonal re-
lationships. In second grade I hid between the buildings during recess and
lunch. My twin brother visited me and asked why I was there, and I didn’t
have an answer. I couldn’t speak or understand English very well and I felt
afraid. It felt safer to be in small spaces. Occasionally, some kind children
would pull me out from between the buildings to walk around the playground.
Despite the kindness of others, I still isolated myself and was often alone.
44 The Neurodivergent Child

I tried once to make a friend by kicking a boy at the lunch tables. He picked
me up, slammed me against the table, then walked away. I stopped trying to
make friends or initiate conversations at school for several years after that. I
preferred playing in the dirt and looking at flowers alone.
My ­fifth-​­grade report card had a comment from Mrs. Short, “­Boontarika is a
kind and lonely girl.” I keep this report card nearby as a reminder of where
I have come from and all the personal work I’ve done. I was kind to others
because I remember what it felt like to receive kindness and the unkindness
of others. My siblings had playdates and visited friends’ homes, but it was not
something I wanted or thought about. I rarely had birthday parties. The only
times I wanted one was at 6 and 17 years old. I was an observer and followed
along my siblings’ outings. When my parents asked about friends, I did not
answer successfully. I wanted to talk about the ocean’s depth and the sky’s
vastness, vocabulary words I learned, plants, and my confusion with why
people hurt one another. Why did we have world hunger? Where did these
rocks come from? These conversations were often met with silence or ridi-
cule by siblings, so I talked to myself, my stuffed animals, and my sketchbook.
I enjoyed puzzles and learning trivia. I wrote math problems in the air and
erased them when written incorrectly. Whenever possible, I stayed home
and watched Batman movies on repeat. Batman and Batman Returns were
my escape and comfort. I wished so badly to be a hero and fight for others.
I wished for miracles that life could be different, even though I wasn’t sure
what it could be. When alone, I ritually organized items in groupings of ten.
I’d take books or clothes out of shelves and reorganize them again and again.
I also seemed to be blunt with how disorganized or dirty someone’s home was.
My dad laughed when sharing how I’d tell people, “­Your house is so dirty,” as
a ­4-­​­­year-​­old. I even started organizing or cleaning other people’s things if it
bothered me enough. It was quirky and endearing to do this as a child.
Another quirky and endearing trait to have as a child is to be clumsy. I
tripped often, dropped electronics down the stairs, and many times fell
down while standing still. I broke my nose, sprained knees and ankles from
tripping over things that I knew were there. A few noteworthy times include
being in high school at a family friend’s home, I missed six steps and fell
on my knee. I slipped down a mountain because I walked wrong (­my dad
thought I broke my neck that time). As I walked my bike up a hill, I paused
to rest and very slowly fell onto a cactus. My sister loves reenacting that
scene for people who need illustrations of how clumsy I am. I had and have
bruises on my body from hitting the corners of the wall, and hitting my head
with cabinet doors.
 The Neurodivergent Child 45

When it came to peer relationships and maintaining friendships, I had a few

dear friends who taught me crucial life skills like conflict resolution and iden-
tifying unhealthy behaviors. While this was a gift, I had a skewed perspective
of what I offered as a friend. I did not have enough guidance or experience
with different types of friendships as a teen. I thought I provided value if I
could help people answer their homework questions. I stayed up late waiting
for the phone to ring so I could teach people how to solve biology questions
the night before assignments were due. I stayed up until 1 or 2 am doing this.
I thought it was a way to socialize with others. Looking back, I realize how
­one-​­sided and sad it looked from the outside. After observing cliques and
peer behaviors, I thought I wanted to belong. The only way I thought I could
contribute was to offer knowledge. Since information was always a friend to
me, I thought it was something others would also see as a form of friendship.
While my social/­emotional needs were not met, my family greatly provided
for physical and financial needs, and I am grateful. It is an honor to be my
parents’ child. There have been times when I asked myself should I carry the
emotional pain of unnurtured social/­emotional needs in silence to honor
my family, or speak up and dishonor them? I chose to carry my pain alone. I
accepted isolation for not eating. I accepted isolation and being silenced for
speaking my native tongue. I accepted being alone and not trusting others
after many near drownings. I accepted a message that this world is an unsafe
place after falling often. Many messages compounded to create an even more
isolated young person who grew up to be an adult who continues to isolate.
Does the experience of constantly being “­othered” and seen as the perpetual
foreigner add another layer of never truly belonging, never deserving to be
seen? I think about being a “­Model Minority” student who excelled academi-
cally, yet one teacher saw a lonely girl who walked by herself on the blacktop.
I think about how grades do not always reflect the whole child, yet many
institutions go for numbers and “­hard data” to confirm the curriculum works.
I was a meek Asian girl who earned good grades. That fits the stereotype, so
there was no need to explore. I think I was overlooked because I could func-
tion in a way that pleased those who wanted to see certain results, because
this archaic education system still aims to create cogs in a machine. If I didn’t
challenge the system, it was equated to the system having no flaws. It means
something on a personal level when you fail the children you’re supposed to
protect, teach, and uplift, and sometimes we don’t see what’s right before us.
Having the gift of time and applied knowledge now offers me the opportunity
to share in a way that does not retraumatize, rather, validates and empowers.
There can be healing from intergenerational systemic challenges. Part of
46 The Neurodivergent Child

intergenerational healing can come from cultivated perspective and compas-

sion. My parents have never said they loved me. It’s a very Westernized way
of communicating. In Collectivist families, we ask, “­Have you eaten?” We
offer a warm meal, seconds, and cut of fruit for you. I know that my parents
loved me. They tried very hard in the ways they understood to show love to
a child they did not fully understand; a sick child who was not growing.
A main theme I see in many of my childhood snippets is isolation. I want
to note that although I was alone often, I do not remember feeling lonely.
I think people on the outside may feel pity or discomfort when they hear
a child did not have strong bonds or friendships with peers. I had Batman
with me the entire time and I had words and definitions to comfort me
and felt very connected to the world around me through ideas. I was never
truly alone. There are skills that I needed to develop like understanding
healthy relationship dynamics and strengthening my proprioception. I am
curious how I would have answered the questions, “­Do you want friends?
What do you think friends do for one another?” I believe my younger self
would have loved meeting other children who read comic books (­especially
Batman) and played video games. My younger self would also have appreci-
ated having an Occupational Therapist and/­or other professionals to speak
with. Someone who validated the messages or skills knowledge that hon-
ored a different definition of interpersonal connection, validated different
journeys, and helped to connect with likeminded people. Just as we seek
heroism and possibility through the myths we resonate with, we can very
much instill ourselves with hope and mirroring of humanity when we see
the struggles and triumphs of those who live similar life paths. It is like a
kindred walking alongside you, and sometimes it takes a series of others
stories to hit home.
I want to emphasize the shame that manifests when writing about my child-
hood experiences. As a child, I often did not question things as they hap-
pened. There was a perceived strength in not questioning things, and to
stand out was to cause conflict. When I try to share my story with others,
these early struggle experiences are often dismissed because I can present my-
self as very gregarious and social. I learned to mask in high school. I still mask
and I do it very well. I also sometimes receive the backhanded compliment
of, “­You have empathy, so you’re not Autistic.”
I have not always felt I had permission to belong to the neurodivergent com-
munity because I have rarely experienced myself spoken to in this way. So,
this is a bridge that will hopefully connect others to realms of healing and
having truths witnessed. It’s a rippling effect that can create community and
 The Neurodivergent Child 47

waves of change. The following are affirming messages that I hope bring em-
powerment and comfort to others.

– ​­You are welcome here. Come at your own pace, on your own time.
– ​­The world can be a safe place, and we can learn to find and create these
places together.
– ​­The way you choose to spend time is valid. Parallel play can be a way to
spend quality time with someone.
– ​­Your body is yours. You have the power to speak for what it needs and
wants.
– ​­Books, words, and your geekdoms can be your best friends. Even if other
people do not understand ­fully – ​­you do not have to change to please
them, they can try to explore your world with you.
– ​­There is no need to provide answers or things for others to accept you. You
are worthy as you are.
– ​­Coming from an immigrant family means you have a foundation of perse-
verance and accomplished dreams. You are part of a legacy and can now
redefine what it means to live a good life. You get to define it how you
want, and it’s okay for this to change over time.

The Neurodivergent C
­ hild – ​­by Spencer Beard

There was a time in my life where I would never shut up. I was a kid, and
I used to talk all the time to people I knew well. I loved talking about my
thoughts and the things that really kept my interest. I thought a lot about
people and animals and whatever came across my mind in the moment.
Reflecting back, there were two reasons why I enjoyed talking so much.
One is that I felt like I had to advocate for myself since I felt so different
from everyone else. Ever since I can remember having legible thoughts and
could study other people, I noted that I was different in various ways. What
those ways were, I couldn’t exactly tell. They were obvious in the sense
that everyone, aside from me, seemed comfortable about each other and
themselves. Everyone, even in the middle of arguments, in the middle of
fights, in the middle of emotional outbursts, seemed to understand each
other beyond a conscious level, but I could not. I could understand that
they talk to each other using sounds and words, but it was like their move-
ment of their bodies, their face could reveal something about themselves to
others. I didn’t understand what body language was, and I had a hard time
understanding faces.
48 The Neurodivergent Child

It was much later in life that I realized that the second reason I enjoyed
talking so much was because, at the time, I didn’t know that I was an autistic
child. The issue wasn’t being autistic but that I had to advocate for myself
with those needs in mind, and I didn’t know that when I was diagnosed. To
advocate for themselves, autistic people need to embrace their autism as a
unique part of themselves, and they shouldn’t believe themselves to be a bio-
logical mistake, which is something that I did not fully understand as a child.
When I was 13 years old, I was diagnosed with Asperger’s Syndrome. It was
all a very bizarre ordeal as I remember that I was taken out of town to see a
doctor. I wasn’t told what it was for; all I was told was that I needed to get
checked for “­something important.” At the time, I wondered if I was going
to receive the news that I was going to die; I had ten months to live. Instead,
I was told in medical terms that I was never actually normal. However, it’s
not the diagnosis itself that really changed me. As I said, I always knew
that there was something off with everyone and that I was left out for some
reason. What really changed me was what I was told to do with this infor-
mation. Simply put, I was told to never mention it. I was told that I should
never mention the trip and especially never mention the diagnosis. I was
told by my parents that if I did talk to anyone about it, I would never be able
to hold down a job or a place of my own, and it would be doubtful that I
could start a family of my own.
Usually, when a movie or a show has a character discover something about
themselves, even when it’s something of a secret, they feel enlightened or
empowered to do whatever they would like. That was absolutely not the
case for me. Over time, I was increasingly confused and horrified. For all I
understood, all the stuff that I felt that was off with the world wasn’t because
there was something wrong with the world. It was wrong with me, and I
was inherently wrong. I always wanted to be “­normal.” I wanted to be like
everyone else and I didn’t want to think that I was wrong. But, according to
the professional who diagnosed me, that wasn’t the case. I am medically and
essentially abnormal, a twisted caricature of the everyday human being.
I truly hated myself, and I hated myself more and more. For every fault that
I saw, the more I blamed my Asperger’s. Since the Asperger’s was a part of
me that I couldn’t get rid of, I saw myself in all of my failures. Without go-
ing into too much detail about my social failures, I had very few friends and
even fewer people I could confide my most inner thoughts to. Even the good
moments I had were infested with doubts. Was the guy laughing with me or
actually laughing at me? Was the lady that I was trying to hit on talking to
me out of some pity or courtesy? Did everyone know me just as “­that weird
 The Neurodivergent Child 49

guy who makes weird faces and movements?” I was haunted by the very real
fears that may have not existed in the first place because I knew that I was
always terrible at hiding my autism and hiding is what I wanted.
As I was never talking about my autism to people, I never had conversations
on how to talk to people as an autistic person, and I never was told what to
expect from neurotypical people as an autistic person. It wasn’t until late in
my life that my family would even acknowledge my autism beyond the initial
diagnosis. I wasn’t told about how my condition would affect me with my
romantic relationships. I don’t know if it was because my parents assumed I
would get it on my own or if it was because I was, in some way, a lost cause. I
never thought they didn’t love me, but I always wondered if they ever wished
they had a more “­normal” first born son.
The doubts about the positives in my life extended beyond awkward inter-
actions at school but I was somewhat comforted by being surrounded by a
familiar social environment and, despite all the issues I mentioned, a rather
loving home. Then, I graduated from high school and went to a college in a
different town. Not only was I starting anew, but I also had to start creating
a future for myself. One of the vital things I learned about college over the
years was the importance of the social connections a person makes in col-
lege. Out of everything in my life, it was the opportunity that I wasted the
most. I was afraid of the world around me, and I was too afraid to approach
anyone. Every opportunity to socialize with peers was deliberately avoided.
I was afraid to open myself to conversation as I was embarrassed that I had
barely any social life in high school. I much preferred the predictability of
video games and online discussions where I never had to be honest about
myself and never exposed myself to anything truly new. Of course, as time
went on, I became even more afraid to talk to people as I was embarrassed
over my lack of a college social life.
It was in my junior year of college that I truly considered suicide. It had some-
what surfaced in the past, but it was at this point in college that I realized
that I was about three days away from finishing myself off. I called my parents
and told them that I was going to hurt myself, and I needed counseling. As
I called them and talked to their voicemail, I was distressed and horrified.
However, what I didn’t expect was that it was also relieving to finally get my
thoughts out in the open, to be authentic and not bottling them up anymore.
It was relieving, it was the first time in forever that I felt like I could just drift
off to sleep. Usually I would need sleeping medication, but this time, I found
myself growing more and more tired, and I went to bed expecting to contem-
plate all of my thoughts more in the morning. However, I was awakened by
50 The Neurodivergent Child

my resident hall assistant who informed me that my parents were trying to

contact me. They were worried sick after hearing that message with such a
dark tone that they were ready to drive up to my college to see if I was okay
despite it being late at night.
In a way, this proved my fear about socializing. I literally called my parents
asking for psychiatry help or I might hurt myself (­anyone would be worried
about a message like that), and as I talked to them about my issues, all I could
think about was that even my attempts at help were confronted with social
failure. Nevertheless, my dad asked me if I wanted a counselor who focuses
on autistic people, and I told him that would be for the best. It’s strange
thinking about that question now. I didn’t realize it at the time, but that was
the first time in almost a decade that either of my parents acknowledged me
as an autistic person. This would become the turning point for me and the
beginning of the true journey of healthy exploration of being autistic.
Obviously, I never did kill myself. There are many people that I thank for
moving me off that course. I thank my parents for listening. I thank my
counselor for helping me with my needs. But ultimately, if I have to thank
someone more than anyone else and place the full responsibility on for
changing the course of my ­life – ​­I would have to thank myself. If I hadn’t
opened myself up for the possibility of help, I do believe I would be dead now.
Something that I wish I had known and believed in my youth was that for
autistic people to advocate for themselves, they shouldn’t see themselves as
biological mistakes, and they need to embrace their autism as a unique part
of themselves. It’s ironic in a way. When I was younger, I could never shut up.
It was because I was told my autism was bad that I shut myself down. I was
told that I should never talk about me being an autistic ­person – this
​­ was the
great fallacy. Now I fully understand that the only way that I got the help I
did, obtained the growth I needed, and found the happiness I have now was
because I advocated for my needs as an autistic person.

The Neurodivergent C
­ hild – ​­by Rebekah Brown

Even from the time that I was little, I knew there was something different
about me. I gave it many names as I grew up: bad, shy, nervous. Nothing ever
explained all the quirks until I was diagnosed with autism spectrum disorder
(­Asperger’s at that time) at the age of 15. I am currently 33 years old, and
I live in a small town in the western tip of North Carolina. I am relatively
independent but do still need support in some areas. I do live with my mom.
I own a car and have a part time job in the box office of a performing arts
 The Neurodivergent Child 51

center (­live theater and concerts, not a movie cinema), and I have an exten-
sive garage workshop where I make and sell art pieces made out of eggshell,
wood, stone, and metal. In public, I am often able to mask the fact that I am
autistic.
As an infant, my mom worried that I rarely made eye contact, even when
nursing. I had a harder time with noises and smells than my siblings. As a
young child the effectiveness of disciplinary methods correlated to my diver-
gence; the confinement of “­­time-​­out” was significantly more painful than a
spanking due to my disregard for pain. I was initially diagnosed at the age of
7 with ADHD and sensory integration problems by a developmental pedia-
trician. However, these diagnoses did not explain several of my other traits,
including my knack for taking things literally.
My mom tells a story about when I was around 6 years old when my older sis-
ter had a high fever, and she made the comment, “­Her forehead is so hot you
could cook an egg on it.” Hearing this, I immediately started walking to the
kitchen to get an egg to attempt said cooking. As a 7 or 8 year old, I was at a
store with my dad one time and picked out a Sprite bottle (­back when they
had rewards under the cap). As we checked out, I took the cap off, and read
“­Please try again.” I immediately walked back to the soda case to get another
bottle to “­try again,” before my dad, chuckling to himself, told me you had to
wait to “­try again” until you wanted to buy another bottle.
ADHD also did not explain my aversion to change and need for a rigid rou-
tine. My mom said when I was little, I often viewed the world with dis-
passionate clinical interest like a little scientist. When I was in elementary
school, we had a lady visit us from India for a few days. I grew up in a very
small town in Western NC and the diversity at that time was minimal. As I
watched the visitor getting out of the car and greeting people, I saw that she
had clothing I’d never seen before, a red dot on her forehead, and was a skin
color I had never seen up close. In my mind the routine was broken, and I
turned around and went inside and proceeded to hide behind a small tram-
poline behind the couch. Soon the adults realized I was gone, and everyone
started looking for me. Even knowing people were looking for me I stayed
hidden. This new person was different from what I’d ever seen, the clothes
were strange, and in a risk versus reward analysis it was not worth it to expose
myself.
As I reached my middle and high school years, I had an increasingly difficult
time with social interactions and a positive s­elf-​­perception. I remember in
high school sitting holding the phone, crying and terrified, because I wanted
to call a friend to have lunch but didn’t know how to say the right things.
52 The Neurodivergent Child

When I wrote in journals I often wrote about stressful experiences (­getting in

trouble, discipline, consequences) and often included the phrase “­I am bad,
I must be just bad.”
I constantly misunderstood social interactions, and as a result, they became
confirmation of how I thought about myself. I didn’t know how to control
my temper, and meltdowns included several hours afterwards of crying. I felt
shame, guilt, and despair for my lack of ability to control myself. I sometimes
felt that I must be stupid as well, and even the environment of homeschool-
ing was at times difficult due to sensory overload. Once in a Sunday school
class, I kept asking the teacher to repeat herself because I was having a hard
time distinguishing her words due to ambient noises in the room. After the
third time, she looked at me and said in front of everyone, “­Rebekah, how
can you look so smart and act so dumb.” Immediately I felt ashamed and
“­dumb” and decided then that I would never ask for clarification again if it
gave the appearance of being dumb. I believe this event eventually led to me
having a hard time in college classes with asking for clarification or help on a
subject, for fear of appearing dumb. As an adult, I now realize that I was hav-
ing a hard time distinguishing that Sunday School teacher’s words because I
wasn’t just hearing her voice. I was hearing my dress rustle, the lights buzzing,
the little wood chairs creaking, my classmates giggling or whispering, people
walking by outside the closed door, the sound of shoes scuffing under the
table, and the list goes on. I never went back to that Sunday school class.
Social interaction and internal monolog did not begin to improve until I was
formally diagnosed with Asperger’s. Initially, there was a sense of sadness,
and I didn’t want my siblings to know about the diagnosis. However, there
was also a sense of relief. I was not “­bad,” and there was a real reason that I
had such a difficult time with social situations and emotional regulation. My
mom quickly found resources and we started to work on my areas of difficulty.
My ability to make and have friends improved, as well as my understanding
of sensory overload and how to dissipate overstimulation.
I did have a fantastic support growing up with my mom. After my diagnosis
at 15, my mom immediately found resources for addressing my needs. We
would sit and literally practice all the parts of a conversation, the “­rules” for
different scenarios. She taught me how to be more comfortable with initial
greetings and meeting people. She also explicitly taught me that when first
talking to someone you have met you can ask them about their work, hob-
bies, and family, and that once you bring one of these topics up, the other
person will likely start talking while you can think of other relevant things to
say. I needed training on how my peers interacted with each other naturally
 The Neurodivergent Child 53

and with ease. When do you say “­Hello, how are you” versus “­Hey girl, what-
cha up to?” How long does a conversation have to run for small talk? How
do you lead up to saying goodbye? Do you constantly face the person, half
the time, a quarter? These were things that helped decrease my anxieties and
gave me some sense of social pleasure.
Being neurodivergent has had its ups and downs. Some of the hard things for
me were relating to peers, need for “­recharge” time (­which my counterparts
didn’t seem to find necessary), overwhelmed senses, and a general feeling of
being “­different.” However, since the diagnosis, I have been able to change
the way I think about and value myself. I wish I could have understood my
neurodivergence earlier. However, I am content with having found out at 15,
and I know of several friends that didn’t find out until well into adult years.
Having been able to participate in neurodiversity affirming therapies would
have been great as well. Things like how to deal with overstimulation of my
sensory system, how to head off a dysregulation meltdown, social navigation,
anger management, instilling a positive view of my personhood, and how
my brain worked (­as opposed to the many times I thought that I was simply
“­bad” or “­dumb”).
In many ways, my neurodivergence has felt like a superpower instead of a dis-
order. I feel a great deal of contentment in my adult life. I am happily work-
ing at my part time job at a theater, where neurodiversity is quite common,
and celebrated. I have a service dog, Faramond, who is specifically trained to
help me with anxiety attacks and meltdowns. I have an awesome workshop
that I have worked to add tools to for many years, and making things seems
to scratch an itch in my brain that nothing else has. I play several local
sports, including street hockey (­goalie) as well as ­slow-​­pitch softball (­I played
­fast-​­pitch in college for two years). I enjoy participating in local theater pro-
ductions, and I believe that starting theater in my 20s was a crucial part of
me learning to be truly comfortable in public settings. I understand figures
of speech and metaphors far better and am quick to make pun jokes with my
friends. Making people laugh is something near and dear to my heart (­look at
that figure of speech I used correctly). I am still learning and processing, but
I am feeling quite comfortable in my neurodivergent self.

The Neurodivergent C
­ hild – ​­by Sarah Moran

I was diagnosed with ADHD, combined type, when I was 22. I often re-
flect on my experiences as an undiagnosed neurodivergent child with the
knowledge I have now and identify with many of the struggles my clients
54 The Neurodivergent Child

(­particularly ­middle-​­school girls with ADHD) present with. I was an emo-

tional child. I remember getting “­worked up” about small things and it took
a long time to calm down. I found pleasure in being outdoors, making art,
and experimenting with cooking and baking. I needed to be ­hands-​­on, with
sensory input, to really dive deep into something that was fulfilling. Cooking
forced me to live in the moment and be present with myself, which is why I
think I was so good at this skill from a young age. In hindsight, I was failing
academically and at the same time I was mastering lemon bars and creme
­brulee – it
​­ turns out the world doesn’t value the later successes when you’re
a fourth grader.
I have memories of spending hours in the Museum of Natural History, with
my face pressed up against one window, absorbing all the details in hyperfo-
cus. I would make sure the people around me were also seeing all the small
things I saw, and I remember my mom moving on to the next thing, with me
pulling her back, “­Look at this! Did you see that!” Now I can hyperfixate on
a 1, 000 piece puzzle and lose track of time and space, often completing it in
one to two sittings.
I skipped preschool and went right into kindergarten when I was 4 years
old. I am told this was because I could already read independently. I didn’t
really mind being the youngest in my class in those early years, or more likely
I didn’t notice. A norm for my family was to be enrolled in small private
schools throughout childhood. While I see this as a benefit in a lot of ways,
school is still the place where my undiagnosed ADHD received the most
negative feedback. I have distinct memories of 3rd and 4th grade where my
age difference started to have a social impact. I know I was gullible, and I
know now it’s because I couldn’t read social cues like sarcasm. I remember
trusting peers with secrets, only to have them shared with the class time and
time again. I didn’t understand what was happening, and I didn’t see this
repetition as a pattern or part of a bigger social construct. I also lied often.
I started to really struggle academically in 3rd grade, but my teacher was
patient and kind with me. Then came 4th grade. I had an older teacher who
wasn’t patient and really wasn’t kind. I don’t have many memories of her
or the class that year. I repeated the 4th grade. I remember my parents pro-
viding me with the choice to do so at my same school and watch my friends
move up, or to switch schools. I chose to change schools, and I appreciated
being offered that choice. From all accounts, it sounds like when my family
went to tour my new school, all were pleased by the emphasis on art and
music, the less rigid class structure, the ability to have snacks while in class,
and everyone sitting at group tables or on the floor, rather than at individual
 The Neurodivergent Child 55

desks. Everyone agreed “­This is the place for Sarah” and 4th grade round two
was much better. I felt supported by my teacher and enjoyed being with peers
who were now closer to my age and started to do better socially. I remember
reading more for enjoyment around that time and hating math a little bit
less. I stayed at that new school from 4th grade through 12th, so those peers
became my family.
By 5th grade I wasn’t turning in my homework because I wasn’t doing my
homework, at least not to completion. One assignment that I hated in 5th
grade was memorizing poems. You could pick any poem of a certain number
of lines, and if you memorized a poem that was twice the required length,
that got you off the hook for a week. I tried that once, but I ended up missing
a few lines, and I felt humiliated. I learned that if I did it wrong, I would be
publicly shamed, and if I didn’t do it then the worst thing that would happen
was that I had to go sit in front of the principal. So, I stopped memorizing
poems, and I stopped doing homework. I would walk into my 5th grade class-
room every day and be asked “­Did you do your homework?” And I would say
“­Nope” and spin on my heel to walk myself to the principal’s office.
The first time I attended a school meeting with my parents was in 5th grade.
My teacher called me “­passive aggressive,” and the school psychologist ad-
dressed the homework issue as being “­disobedient and disrespectful to the
school.” If labels were given out at the time, I am certain I wouldn’t have
been recognized as unorganized and scattered ADHD, I would have been
seen as an oppositional and defiant child. My mother remembers thinking
around that time, “­I don’t understand how she is wired.”
There was a study skills class along the way, where we talked about organizing
our binders and sucking on a mint to help us study. I remember thinking, yes,
I can do this! And getting excited about organizing, but the follow through
was lacking when I was left to my own devices. This has stayed common over
time. I have multiple journals and planners, that all started with good inten-
tion… and then one or two days off routine leads to an end in utilizing that
tool. I started doing my homework at the kitchen table while my siblings
watched TV and I played music in the background. If not in this process,
I would become easily distracted by things happening around me (­namely,
whatever my three younger siblings, dog, or cat was up to). The combination
of sounds confused and annoyed my parents, but I think they saw it worked
best to get me to focus on the task at hand, so they allowed it.
One paradox of having ADHD is being distracted by noise but also needing
noise to focus. As an adult (­as I write this paper) I need soft, yet familiar
lyrics blaring in my ears via headphones. This is the only way I can block
56 The Neurodivergent Child

out everything around me and give myself the best chance of focusing on
the correct task. It is easy for me to jump from task to task, and then become
frustrated by my lack of progress on the initial assignment. Hence, why my
emails are often answered, my schedule is organized, and my paperwork piles
up into an overwhelming mountain.
I remember m ­ iddle-​­school history class, where we had an open book test and
I failed it. My history teacher yelled at me, making me feel awful for failing
because I could look at my book. All I thought about during that test was that
I couldn’t remember exactly where I had read the fact I was looking for, so I
frantically flipped back and forth between pages and ran out of time before
my essay was complete. I remember feeling like something was wrong with
me. My first encounter with therapy was in 8th grade, which was prompted
by my parents’ divorce. Like so many children, my ADHD was hidden under
a layer of trauma. My actions were explained as a result of my unsteady home
life, rather than because of my own brain’s doing. This reframe didn’t stop me
from feeling like everyone around me was swimming with life vests on and I
was trying not to drown with a rock tied to my ankle.
The second time I attended a school meeting with my parents was at the
end of 8th grade. The dean of academics told us my private school contract
was being threatened due to my grades. He told me that I wasn’t going to
pass physics, which was a 9th grade requirement. I cried in that meeting and
was told I was being “­dramatic.” Turns out 9th grade physics wasn’t so bad. I
had a wonderful teacher. After a failed test, he asked me to meet with him. I
remember anxiously biting all my nails in anticipation. I remember this in-
teraction like it was yesterday. This little old man, my physics teacher, put his
hand on my shoulder and said, “­Sarah, do you want to be a physicist?” No.
“­Sarah, do you want to be a scientist?” No. “­Ok then. We don’t have to mas-
ter physics. We just have to pass this class.” That was the first time since 4th
grade (­part two) that I felt a teacher really saw me. He really understood that
I was trying my hardest and I was on the brink of failing because the topic
didn’t interest me. I was seen, and then I excelled. I not only passed physics,
but I aced it. I qualified for honors biology. I had never once qualified for an
honors level course; I was so excited. I got to be in class with my friends, who
were almost exclusively good students.
It should be noted that my high school was a college preparatory school,
meaning it is more challenging than a typical high school curriculum. I was
surrounded by intelligent and driven peers, who had aspirations to become
doctors, dentists, surgeons, lawyers, and the like. I did not know this at the
time, I was just going through the motions and moving up in grade levels
 The Neurodivergent Child 57

with all my friends. I had a wonderful group of smart and driven friends in
high school. They were academically competitive and didn’t study, and I
was academically challenged and didn’t study. We were acting in the same
way, but with different outcomes. I remember studying hard for a test, and
everyone around me saying they didn’t study at all and feeling that internal
blame and shame. But I had mastered the art of masking by then, a term I
only learned after my diagnosis. I was socially savvy enough to fit in, even if
my grades were collectively unacceptable to all of my peers.
I participated in several extracurricular activities throughout high school, in-
cluding drama, volleyball, and photography. I poured myself into volleyball.
I played competitively three out of four seasons in the year. I sought novelty
and I wanted to improve this skill, because at my school, you were either
academically gifted and/­or athletically gifted. I was not either, but I knew I
wasn’t the former, so I tried to be the latter. When you’re tall and clumsy,
and easily distracted, and bad at school, you do what you can to fly under
the radar. I felt that if I could just be good at one thing, that would take the
pressure off my back. I jumped through the hoops of requirements to play a
musical instrument, jumping from one thing to the next without demon-
strating any passion for instrument playing. I kept taking drama classes and
never landed big speaking parts. I didn’t have the self confidence in my body
or my brain.
All three of my siblings are musical and artistic. I could feel that they had
found their interests and completely submerged into them, while I was al-
ways trying something new and trying my best to blend in and present as
average. My mom worried that if I did not find my interest, as my siblings did,
I would become aimless and lean into drugs and alcohol. Which is a valid
fear, as statistics show that undiagnosed ADHD girls are at a higher risk for
partaking in ­high-​­risk activities. I was primarily shielded from this by being
at a highly competitive school. I dated the class valedictorian, and he wasn’t
drinking, so neither was I. I was surrounded by squares, and I was socially
masking as one.
There were some highs but a lot of lows. It was 10th grade history and we
were allowed to bring a notecard to our exam. While other people wrote bul-
let points and dates to spark their memory, I spent hours the night before flip-
ping through my textbook and writing a tiny essay on an index card so that I
could copy it word for word in my exam. Passed it. It was 10th grade in hon-
ors biology class and we were doing the experiment with an egg in vinegar.
I remember looking at it with fascination as it became rubbery in its beaker
on the front counter. I remember wanting to touch it, and then picking up
58 The Neurodivergent Child

the first item in my view, which happened to be a p­ encil – ​­I popped it. It
happened so fast. I was yelled at for acting on my impulse. I felt humiliated.
Turns out I wasn’t cut out for honors biology at a college preparatory school.
I went in on a high and came crashing down. I can see now, where my s­ elf-​
­esteem was taking a hit. I didn’t qualify for honors chemistry; I think I barely
passed through to land in regular chemistry. The dean of academics, the one
who had told me that I wouldn’t pass physics, said to me in passing at the
start of 11th grade, “­It looks like you’re back where you belong.”
By the start of 11th grade my eyes were on the prize of graduating from high
school. I did everything I could to jump through the hoops in front of me. I
started cheating in most of my classes. Granted, I was cheating for Cs, not
for As. All I had to do was pass my classes. I was in survival mode. By 12th
grade, I had signed up for the bare minimum requirements and all electives.
What a classic ADHD move.
Shortly after I learned how to drive, I started noticing that I was forgetful,
disorganized, and getting lost easily (­a prime example of executive function-
ing skills). I blamed this on a poor sense of direction at first, but the more it
happened, the more shame I felt because I thought I was just bad at driving.
There was that time I was driving my Volvo back from youth group with my
high school boyfriend in the car, and I turned around because I was sure I
missed my intersection. My boyfriend kept telling me I hadn’t, and I drove
an extra 15 minutes just to discover I was backtracking and I had gone the
right way the first time. There was a time that I took the wrong exit ramp
on the way home from my grandma’s house, with my brother in the car. We
were on the northbound highway, instead of south. We didn’t notice my
error until we came across a sign for a town we recognized. We searched and
searched my car but could not find my cell phone (­because I had forgotten it
at my grandma’s). We found just enough change in the car to use a payphone
to frantically call our mom to express our distress and write down detailed
instructions to come home.
I remember taking the train with a friend, who pointed out that I was very
anxious about missing my stop. She was concerned about my observable
level of panic, standing up two stops ahead. In hindsight I can see that I was
just desperately avoiding messing up a step in my plan because it would be a
whole planning organizing time consuming mess to reroute myself. Instead,
I was ­hyper-​­prepared to get off at the right stop. I wish I could have had a
name for that then, the executive functioning challenges. Executive func-
tioning challenges really troubled me when I was a new driver. High school
driving for me came in the era of Mapquest, and I remember needing to
 The Neurodivergent Child 59

print off the instructions in both directions of my ­destination – ​­one for the
way to the aquarium, and one for the way home. I could not organize my
thoughts to read the instructions backwards to make the same paperwork
twice. While driving home from familiar places, I often needed play by play
instructions from my mom on the phone. My mother reports that when she
explained this to her therapist at the time, that therapist stated, “­It sounds
like she has ADHD.”
That was not the first time ADHD came up as a possibility, but no action was
taken. My mom has reported suspicions that something was off over time.
The primary reason there was no action toward diagnosis was due to lack
of support. No support from my father, who told my mom she was making
excuses for my behavior. No support from my grandparents, who were wor-
ried about me being labeled. The pressure to attend college right after high
school was high in my world. I went to culinary school, because I couldn’t
fathom the idea of putting myself through more academics. College was the
mento in my already shaken up bottle of soda; I burst. I left home heartbro-
ken and reluctant to attend college. I fell into the trap of being an undiag-
nosed ADHD brain, removed from my routine and structure, and left to my
own devices with no coping skills to manage. I acted on every impulse and
harmed myself and my relationships by my actions. I was forgetful, I blamed
my roommates for stealing things I had lost or misplaced. I drank too much,
and I got caught stealing. Ultimately, I dropped out, and impulsively took an
international nanny job.
I would say I took the long way around, eventually finding my way back to
school. When I started college the second time, I loved it. I was motivated
to stay there. I realized I needed to figure out why the amount of studying
I was doing did not equal the grades I expected. Something was wrong, but
instead of shutting down like I had in the past, my more mature brain was
determined to figure out why. I was tested by a psychologist in my home-
town. She diagnosed me with ADHD and prescribed me medication. Even
my mom, who had the insight that I was wired differently, didn’t know how
to approach this new information. It was confirming, but we didn’t know
what to do next.
When I went back to college, now medicated, I noticed my grades started to
reflect the work I was putting in. I could sit and study or write in the library
for hours on end without needing a break. I could retain what I read, without
having to reread. I was less forgetful, less emotionally reactive, less impulsive,
and was more mindful of my routines and my need for them. It turns out I
got in trouble a lot less when my impulses had a pause button. I have learned
60 The Neurodivergent Child

about ADHD on my own and in my career with the clients I see. So many
children and teens feel trapped in a world where they are expected to exceed
expectations, but they struggle to stay afloat like I once did. I validate their
experiences by sharing some of my stories to support their own acceptance
that there is a reason they are acting the way they are.
It is important for ADHD brains to feel seen and heard because no one really
sees what they can do. In general, most adults are focused only on what they
can’t do. It is exhausting. I strive to help ADHD brains find ways to work
with their brains, rather than against them, and I encourage all the explora-
tion of novel experiences. I strive to remember and share, something I was
once ­told – ADHD
​­ brains are glittery brains, a very apt metaphor in describ-
ing disorganization, creativity, the need for novelty, and trying new things.

The Neurodivergent C
­ hild – ​­by Patricia Lomando

As a child in elementary school, I don’t remember hearing anything about

ADHD or autism. Looking back, I don’t think diagnoses were as sought out
as they are today. While I was evaluated for gifted placement in school, I
didn’t receive a diagnosis for ADHD until I was around 20 years old. None-
theless, school was almost a caricature of ADHD experiences. As early as
second grade, I recall sitting at my desk and a large three walled cardboard
box being brought down over my head. I still remember the surprise of my
teacher lowering it in front of me, the way it covered the front and the sides
of my desk, so that it was boxed in like a cubicle. There were little rectangle
cutouts on the sides of the box she called “­windows.” I remember hearing
something like, “­maybe now I can focus, if I have nothing to look at.” It was
confusing. I recall looking around and I was the only one with this contrap-
tion. ­No-​­one had ever spoken to me about attention. I wasn’t receiving poor
grades, but I would stare off into the distance and struggled to get started or
finished with work.
I was a visual learner that had passing grades and was demonstrating the
need for advanced levels. I recall in elementary school, my family being told
that my reading level surpassed the 6th grade books they had in classrooms
so I could be by myself or join a group. I don’t recall that I warranted much
attention, but there were situations. At one point, two teachers were sharing
my large classroom and I needed to shift between them for different classes,
I lived in a state of perpetual anxiety over this switching. Looking back, I
realize I couldn’t keep track of when I needed to shift classes, even though
 The Neurodivergent Child 61

it had been explained. I had no sense of time or sequence and would get
lost in whatever work I was doing, oblivious to class changes. I could also
become hyper focused on when the classes would change and too distracted
by that preoccupation to get any work done. It felt hopeless and I couldn’t
understand why I was the only one who seemed to panic and mess up. I recall
that being a fairly common confusion and frustration; why couldn’t I do what
others seemed to have no struggle with?
Homework was an a­ ll-​­night process. I was asked to sit at the dining table to
complete my work because I was told I would do better where I was visible
and had space. In reality, I would sit and adults and/­or animals would walk
around, and I was drawn to their movement. All of the sounds that were
made as people would get food/­drinks, talk to each other, do anything at
all, focused my attention. I wouldn’t get up, but I would work until after
midnight. I recall my father’s pacing and frustration, saying I was getting too
much homework, but I “­knew” it shouldn’t be taking me that long. That at-
tention to sounds and smells never wavered. I remain just as focused on facial
expressions, body language, and the changes of intonation when someone
speaks. Pauses, the way people change their breathing, and differences in
patterns with the way someone moves are all things that catch my focus and
I believe are part of what help me to “­see” clients as a clinician today. In a
crowded room, in traffic, or on a deadline however, those same qualities can
become overwhelming.
Although socially I had friends, I often felt awkward and isolated. In class, I
was impulsive or quiet. I recall feeling incapable of answering questions for
teachers because they insisted I raise my hand first, and I couldn’t handle
the combination of the anxiety between raising my hand and answering a
question in the spotlight unless I blurted it out to get past those feelings. I
stopped contributing unless I was so excited about the topic that the impul-
sive desire to speak overruled any concern for rules. It was precisely those
many rules, both formal and informal, that made me feel uncomfortable in
social settings.
Whether at school or in public, I did not enjoy crowds. It was too much to
process, too many social rules and expectations that seemed to be “­common
sense,” but to me felt restrictive. I “­felt” people as though they were each
screaming through a bullhorn, and I was so sensitive to sound, touch, and
smells. I remember barely making it through one day of Brownies (­the young
version of girl scouts). I didn’t feel comfortable speaking with strangers
and wouldn’t complete activities because there were too many people in-
volved, keeping me from focusing in on any one task. I despised new social
62 The Neurodivergent Child

environments that came with new social structures and assumptions. I still
laugh when I recall a day that a teacher told my mother I had never arrived at
“­aftercare,” because I’d slipped underneath a desk (­pretending it was my per-
sonal cave) to get away from all the students and noise. That may have been
my last day at aftercare! As an adolescent, I befriended others who struggled
to “­fit” social norms, often as a kind of ringleader, but I was the one to gener-
ally be found outside by myself (­with books or pets) at any social gathering.
The support I received back then was mostly to “­just do this or just do that.”
I hated phrases about “­common sense.” Everything was considered to be so
easy for me and any struggle was considered oppositional. Neither box fit me.
I became ­self-​­conscious early on about how others would communicate and
view “­my process” for things. I didn’t like being told how to do things, because
it felt like that spotlight shining on everything I couldn’t get right. The more
spotlight that was focused on me, the more of a mess I felt like. I walked
around with the heaviest book bag of my classmates because I carried ALL
books, folders, and papers around with me in a spectacular disaster. By the
time I thought of unpacking, it was time to leave. I was repeatedly told I would
“­break my back,” but I was also compensating. I always had everything with
me I needed, and packing and unpacking were additional steps that threw
off my rhythm. These were the little strategies I used to make things easier
for myself. I would be completely overwhelmed by trying to clean a room for
instance, but sequenced steps worked for me (­e.g., I recall a book I was given
which broke cleaning down into categorized boxes and I still use that “­format”
today). I would read anything I was given as a child. I realize now that a lot of
strategies I used to adapt were in areas of executive functioning.
Observing without the expectation of performance also helped. I was a per-
fectionist. Any new experience resulted in dysregulation. I didn’t want to try
new experiences I wasn’t able to figure out. I preferred to watch how things
were done. If I could observe from the outside until I understood how some-
thing was handled, I had a better chance of creating a rhythm for how to
do it in my head. I would say I didn’t want to do things even if I did, in the
hopes I would be able to watch until I felt comfortable to join in. Sometimes,
“­­grown-​­ups” would say if I wasn’t going to join, I couldn’t watch. I’m sure
the attempt was motivation, but it didn’t work that way. It was when I knew
what was going to happen, what would be expected of me, and what actions
ended in success that I felt safe enough to join activities.
I believe it is so important for awareness and understanding that some people
struggle with holding back and aren’t interrupting or blurting to be rude,
but because it’s the only way the flow comes out. I think a recognition from
 The Neurodivergent Child 63

teachers and adults that children try to adapt in their own ways, and that
not everything is attempted disrespect could have been helpful for me. I was
alright with working on interruptions, but to this day when people ask me to
raise my hand, I just let the others respond. Allowing me to observe first and
jumping in when ready versus assuming that would enabling or rewarding in-
appropriate behaviors would have been affirming. Even respecting whatever
is easiest for everyone to participate in activities could have made a huge
difference in feelings of ­self-​­worth, acceptance, and the ability to participate
equally, not only for me as a child, but for all kinds of learners.
For the most part accommodations were not coming from the “­­grown-​­ups”
around me. I do remember the way an art teacher and a creative writing
teacher embodied affirming experiences. They were the coolest! They both
heard my words; they didn’t criticize my need to move and even allowed me
to have “­hall passes” to accommodate my struggles with “­waiting” for others
to complete their work. Interestingly, I remember both of them asking me to
write or draw about my hallway experiences and those were the teachers that
showed me acceptance, interest, and the freedom to be.
As an adolescent, it felt that everywhere the message was that emotions
caused discomfort for others. I remember being asked to “­calm down,” be-
cause my hands would flap, my eyes would get wide, and I would get excited
about ideas. I was “­supposed to” fake it and say everything was fine, regardless
of how I felt. I had spent years being most accepted when I was quiet and
invisible. Being quiet and invisible meant w ­ ell-​­behaved, but I was more than
that. As a teenager, it had been too much time being told to suck it up, calm
down, and to present as more appropriate. I pursued poets who railed against
repression of emotion. I gravitated toward peers who felt similarly, who ech-
oed and heightened my own voice of societal rebellion. I embodied rebel
musicians, superheroes, all that highlighted alienation as strength. I railed
against the concept of mental health disorders and internalized the belief
that society wanted to quiet the masses. Institutionalization seemed the only
avenue for intense or depressed teens when I was young. Therapy wasn’t re-
ally spoken about as an option. I was convinced if I went into therapy, they’d
never let me escape. I wouldn’t pass a sanity test, not because I wasn’t sane,
but because I wouldn’t be able to fit their mold under a spotlight, and I didn’t
even know what that mold looked like.
As I have raised my own autistic son, I have heard other “­professionals” in-
structing children to look at them, what to say, how to stand, etc. I’ve listened
to professionals tell me that they needed to hold children down, allow them to
scream, etc. all while asking for my understanding. As I watched the actions
64 The Neurodivergent Child

“­corrections,” and attempted to explain to these individuals that I couldn’t

maintain eye contact, that I blurt, that I did all of the same things as a child,
that these weren’t things that required c­ orrection – ​­I began to recall those
old feelings and realize how much autistic children have become spotlighted.
I firmly believe that neurodivergent individuals of all flavors are the cathartic
expression of community and should be cherished for their vibrant light in
the same way others have said that theatric performances were the cathartic
expression of an audience. These are the clients who I cherish today, those
who feel so much, think so much, those who believe they are wrong, when
the lens of right and wrong comes from the societal attempt to stifle that
spirit under the guise of civilization.
I didn’t have a diagnosis during my childhood, and I think that changed
the way I experienced receiving one. I am me. I pretty much already knew I
was “­neurodivergent” by the time the ADHD diagnosis came along, but my
childhood was one of being that kid who was invisible and “­left of center.”
That identity is a part of me, and I embrace it. ADHDers are often seen as
“­lazy, lacking motivation, and not demonstrating effort,” and I grew up in the
midst of those stereotypes. It led me to understand that we lived in a society
that could be intolerant, repressive, and judgmental. It also forged a pas-
sionate desire to be the opposite of those elements and to support those who
were on the other end of it as well. I can be quirky, messy, loud, impulsive,
organized, passionate, creative, and bright. I have time blindness and strug-
gle to meet commitments unless I turn them into carefully orchestrated plans
that don’t come at me when I’m overwhelmed. I do not multitask, and I do
not always act in ways considered appropriate and expected. I am authentic,
compassionate, and encourage coloring outside the lines.
At times, I feel as though I’m a computer with zero connection to what I’ve
been raised to believe I “­should be feeling.” As a child reading about Alex-
ithymia (­a condition of struggling with feeling emotions), I thought I had
found myself. To understand things, I need facts and ­percentages – ​­emotions
distract me. Humor has always been a challenge because it doesn’t make
sense and I am fairly obsessed with understanding the origin of idioms and
words in general. At other times, my energy can and has activated a room
full of reluctant rescuers to pull and save eight dogs at once from a county
shelter, a day I will never forget. That same energy can cause a room to treat
me like a ticking time bomb that has to be brought down or can have me
sitting on my hands, picking fingers, kicking, or doodling if feeling forced
to keep it all inside. That energy or adrenaline isn’t good or bad. So much
of how it’s received is related to how others understand it…and so much of
 The Neurodivergent Child 65

handling it is being aware of it, and how it’s channeled so that it doesn’t eat
me up inside. Research, art, journaling, projects, movement, sounds, flap-
ping, ­playing – ​­there are so many ways that neurodivergent individuals like
myself are able to channel and regulate that energy when it’s not obstructed
or judged. That channeling is a need, whether it’s ADHD, autism, depres-
sion, anxiety, etc. Working with other neurodivergent individuals has once
again brought me face to face with society and families who, though well
intentioned, encourage “­masking” and the adaptation to the masses. But that
is not where joy, purpose and ­self-​­fulfillment are found.
As the autistic community has continued to strengthen its voice (­and along
with it that of all neurodivergent populations), I have realized that by be-
lieving society was incapable of change because they were “­the norm,” that
the majority didn’t have the capacity for depth, tolerance, understanding,
etc., I let them off the hook. The majority is accountable. There are concrete
changes that can be made to the way we parent, educate, and offer therapeu-
tic support that allow for neurodivergent connection, appreciation, support,
collaborative skill building, acceptance, and ­self-​­worth.
If those changes are made for the neurodivergent community, they support
everyone, because neurodivergent supports are those of flexibility, tolerance,
and authentic acceptance. They are supports that help with executive func-
tioning strategies, regulation, and being emotionally overwhelmed; strate-
gies that help with restlessness, distraction, and anxiety. They support those
at every developmental stage as well as those experiencing trauma, grief,
anxiety, and depression. They support introverts who struggle with advocacy
and fear as well as extroverts who have difficulty containing their excite-
ment. These supports can be provided in the classroom, at home, and in the
public arena. I have heard people say that they don’t have the resources,
finances, and specializations to work with neurodivergent populations. The
truth is that as we support neurodivergent populations, we support everyone,
including those who have yet to be diagnosed.

References

Ballou, E. P., daVanport, S., & Onaiwu, M. G. (­2021). Sincerely, your autistic child:
What people on the autism spectrum with their parents knew about growing up, accept-
ance, and identity. Beacon Press Books.
Higashida, N. (­2013). The reason I jump. Random House.
Weathington, L. (­2020). Neurotypical vs. neurodivergent: What’s the difference?
Daivergent. https://­daivergent.com/­blog/­­neurotypical-­​­­vs-​­neurodivergent
 3
Neurodivergent Mental Health
Needs

History of Addressing Mental Health Needs of

Neurodivergent Children

Understanding the mental health history of autistic and neurodivergent chil-

dren requires an understanding of the constructs of stigmatization and the
movement toward being neurodiversity affirming and informed. Stigma is de-
fined as the unwanted shadow of a person, produced when society disdains
certain human differences. Stigmatized people are often seen as incompetent,
blamed for their suffering, and socially marginalized in ways that we might now
consider “­ableist.” Stigma comes from deep structural conditions, such as capi-
talism, ideologies of individualism and personal responsibility, and the compli-
cated legacies of racism and colonialism. Our dynamic conceptions of mental
illness ride on the waves of broader historical cultural changes (­Grinker, 2020).
Grinker (­2020) contended that although psychiatric disorders and devel-
opmental disabilities have become increasingly normalized over the past
several decades, this is a stunning reversal of a shameful and stigmatized his-
tory that most autistic and neurodivergent individuals faced for a very long
time. In 1944, for example, one of the most celebrated ­twentieth-​­century
psychologists, Erik Erickson, sent his infant son Neil, born with Down syn-
drome, to a residential institution and told everyone, including his other
children, that the baby had died at birth (­Friedman, 1999). In the 1960s and
1970s, autistic children were often diagnosed with childhood schizophrenia
or intellectual developmental disorder (­mental retardation at the time), and
schools and employers offered few opportunities. With no evidence to back
up their accusations, clinicians commonly blamed autism on supposedly un-
loving “­refrigerator mothers” (­Bettelheim, 1972) and conceived of autism
in the framework of psychotic disorders. In these historical contexts, few
parents wanted to disclose that they had an autistic child (­Grinker, 2020).

DOI: 10.4324/9781003207610-4
 Neurodivergent Mental Health Needs 67

The historical struggles with mental health and neurodivergence can be best
reviewed with a closer look at autism. Arguable, two individuals are respon-
sible for recognizing and perpetuating what would become known as autism.
First, Leo Kanner, following his seminal child psychiatry text in 1935, intro-
duced the world to the condition known as autism. Kanner was an Austrian
psychiatrist who wrote a paper describing the behavior he had observed in 11
children. Secondly, the work of Hans Asperger who was writing in parallel
with Kanner and wrote about the characteristics of children in similar ways.
Asperger was a German pediatrician who observed the behavior of four boys
who he argued were showing challenges in forming friendships, displayed
a general lack of empathy toward others, had clumsy movements, and had
difficulties with communication (­which he identified as autism). Although
much has been learned and changed since their initial efforts, Kanner and
Asperger laid a foundation for what would come under the medical model
describing these children (­O’Reilly, Lester, & Kiyimba, 2019).
O’Reilly, Lester, and Kiyimba (­2019) stated that even in the historical pres-
ent, the classification of autism as a mental health condition is controversial
and contested. The ambition to ‘­fix’ a disorder or disability is central to
the medical model and pathologizing practices, and for many autistic and
neurodivergent people, this provides a perspective that they are ‘­broken’ in
some way. Such ideas are ­co-​­constructed by the mental health profession
and taken directly from medical, psychological, neurological, and develop-
mental positions of autism and grounded in the criteria created through
­DSM-​­5. Importantly, neurodivergent individuals and advocates do not use
the same knowledge spheres or frames of reference as some professionals,
and their relationships with services can be stressful and, in some cases,
conflicting.
O’Reilly, Lester, and Kiyimba (­2019) proposed a significant historical event,
the advent of the ­DSM-​­III in 1980 that recognized autism as a distinct con-
ceptual category, almost 40 years after its inception by Kanner. It was this
point in the twentieth century, with the inclusion of autism on the ­DSM-​­III
that the work of Kanner and Asperger were revived by two British profes-
sionals who coined the notion of autistic spectrum disorder, and the triad of
impairments became part of common clinical discourse. This triad consisted
of three core characteristics attributed to autism.

1 Impairments in social interaction

2 Impairments in communication
3 Restrictive repetitive patterns of behavior
68 Neurodivergent Mental Health Needs

This was later reconfigured in the ­twenty-​­first century as a dyad of impair-

ments and reconstructed as autism spectrum disorder, but the notion of the
spectrum has been maintained. Much of what has been recognized and prac-
ticed in mental health care with neurodivergent children is a result of the
labels and conceptualizations for the DSM. Iannelli (­2020) put forth a his-
torical timeline highlighting significant happenings in the course of autism’s
history.

1943: Leo Kanner publishes a paper describing 11 patients who were fo-
cused on or obsessed with objects and had a “­resistance to (­unexpected)
change.” He later named this condition “­infantile autism.”
1944: Austrian pediatrician Hans Asperger publishes a scientific study of
autistic children, a case study describing four children ages ­6–​­11. He no-
tices parents of some of the children have similar personalities or eccen-
tricities and regards this as evidence of a genetic link. He is also credited
with describing a form of autism, later called Asperger’s syndrome.
1952: In the first edition of the American Psychiatric Association’s Diag-
nostic and Statistical Manual of Mental Disorders (­DSM), children with
symptoms of autism are labeled as having childhood schizophrenia.
1965: A group of parents of autistic children have the first meeting of the
National Society of Autistic Children (­now called the Autism Society
of America).
1975: The Education for All Handicapped Children Act is enacted to help
protect the rights and meet the needs of children with disabilities, most
of whom were previously excluded from school.
1980: The third edition of the Diagnostic and Statistical Manual of Mental
Disorders (­­DSM-​­III) includes criteria for a diagnosis of infantile autism
for the first time.
1983: Throughout the 1970s and 1080s the social model of disability was
emerging. In 1983 disabled academic Mike Oliver coined the phrase so-
cial model of disability.
1990: Autism is included as a disability category in the Individuals with
Disabilities Education Act (­IDEA), making it easier for autistic children
to get special education services.
1994: Asperger’s Syndrome is added to the DSM, expanding the autism
spectrum to include milder cases in which individuals tend to be more
“­highly functioning.”
1998: Harvey Blume and Judy Singer coined and defined the term
neurodiversity.
2006: Ari Ne’eman establishes the Autistic Self Advocacy Network
(­ASAN).
 Neurodivergent Mental Health Needs 69

2013: The D ­ SM-​­5 combines autism, Asperger’s, and childhood disintegra-

tive disorder into autism spectrum disorder.
2013 to Present: The last couple of decades have seen the emergence of the
neurodiversity paradigm and neurodiversity movement with an increase
in advocacy and activism for the acceptance and affirming identity of
neurodivergent individuals.

In the time since autism was first identified as a “­mental illness,” this di-
agnostic category has undergone remarkable changes. Once considered
exceedingly rare and profoundly debilitating, it is now relatively common;
once highly stigmatized, it is increasingly accepted under the banner of
neurodiversity/­neurodivergent put forth by autistic ­self-​­advocates in the
United States, many of whom identify as part of the American disability
rights movement. Indeed, one reason autistic ­self-​­advocates chose to repre-
sent themselves through the term “­neurodiversity” was to claim ownership
of and redefine the currently powerful b­ rain-​­based model. The claiming of
a new identity ­term – ​­“­neurodivergent” and its counterpart “­neurotypical” –​
­stands as an awakening of awareness and acceptance to disrupt the stigma
long associated with “­­autism-­​­­as-­​­­mental-​­illness.” Assigning this diagnosis as
a positive social value resembles the strategy of LGBTQ+ theorists who sub-
verted and disidentified with normative categories and definitions that have
subjected them all to stigma for many decades (­Grinker, 2020).
A core focus of the neurodiversity movement and paradigm is on the lan-
guage we use around autism and other neurodivergent categories. This
movement rejects pathologized negative concepts such as disorder, deficit,
and ‘­impairment’ and instead reconstitutes autism as a way of being. The
neurodiversity movement therefore directly challenged framing autism in
a medical ­model-​­pathologizing way. The popularity of neurodiversity as
a movement arose mostly online in response to what was argued to be a
marginalization of autistic people. Thus, this movement sought to estab-
lish a culture where autistic and neurodivergent people could have pride in
their neurodivergent identity and provide mutual support in ­self-​­advocacy
(­O’Reilly, Lester, & Kiyimba, 2019).
An underpinning principle of neurodiversity was the foundational idea of a
“­differently wired brain.” This movement has been instrumental in advocating
­strength-​­based discourses for autism and other neurodivergence. For autism,
neurodiversity has two main claims as outlined by Jaarsma and Welin (­2012):

1 That autism is simply a natural variation in humans, and being neurodi-

vergent or neurotypical, reflect different ways of being human.
70 Neurodivergent Mental Health Needs

2 That neurodiversity connects to human rights, political issues, and n

­ on-​
­discrimination of autistic people.

This paradigm and movement therefore became associated with the strug-
gle for civil rights (­known as the neurodiversity movement) for those indi-
viduals traditionally diagnosed with neurodevelopmental conditions and as
such became a counterargument for the deficit (­medical) model to prevent
discrimination and stigmatization. This is important, as society tends to be
organized around neurotypical values and by contrast autism and any neu-
rodivergence is then positioned as a deficit. The history has been a “­rocky”
one at best. It has not been kind or very accurate. Fortunately, the neuro-
diversity movement is progressing forward with a goal of changing ableist
systems to a more accurate, valuing, and equitable view of autism and all
neurodivergence.

Neurodivergent Therapy Approaches

Historically, therapies focused on neurodivergent children were viewed as

treatments, designed to address the disorder, and correct the child so they
could live a healthy life. This was basically a code for implementing what-
ever treatment approach could be thought of that would take away the
child’s neurodivergence and make the child neurotypical. Further, most of
these approaches were not mental ­health-​­based.
Currently there still exists a significant number of purported neurodiver-
gent focused “­treatments” mostly targeting autism. Many of the most rec-
ognized and/­or ­evidence-​­based purported “­treatments” consist of behavioral
methods, social skills training, biomedical, existential, and developmental
approaches, many of which are ­non-​­affirming. Actual autistics and neu-
rodiversity affirming advocates resist the notion of “­treatment” for autism
and neurodivergence. There is no cure for autism or any neurodivergence,
and neurodivergent people do not have a disease. The terms “­therapy” or
“­support” are much preferred and more affirming than the term treatment.
Further, the proposition that a neurodivergent child automatically needs a
certain therapy because they are neurodivergent is an ableist concept and
can be detrimental to the child’s wellbeing. A neurodivergent child or ado-
lescent does not enter a therapy because they are neurodivergent. They enter
a therapy because they have a need that the therapy can help address.
Siri and Lyons (­2010) suggested that since the etiology as well as the mani-
festations of neurodivergence are influenced by a variety of multiple factors,
 Neurodivergent Mental Health Needs 71

a ­one-­​­­size-­​­­fits-​­all approach to interventions is not the most beneficial ap-

proach. No two children will have the same therapy needs or respond to the
same combination of therapies. Each child’s therapy plan needs to be unique,
taking into consideration the child’s specific strengths, needs, culture, and
family dynamics. Many autistic and neurodivergent children will participate
in some type of program, therapy, or intervention. The variety and depth of
the service can look different for each child.
It would be easy to produce a list of over 100 promoted and advertised thera-
pies, or services focused on autistic and neurodivergent children. The variety
of options include biomedical, behavioral, developmental, alternative, and
­difficult-­​­­to-​­categorize interventions. Unfortunately, many options are not
neurodiversity informed or affirming. With the plethora of ­neurodivergent-​
­focused services bombarding parents and considering the vulnerability is-
sues, many parents struggle in wanting to provide beneficial supports for their
child, it becomes essential to critically evaluate promoted services geared
toward neurodivergent children and their families. The following guide can
serve as a beginning protocol for evaluating services.

1 Is the therapy neurodiversity informed and affirming? Prizant (­2015)

stated that autism is not an illness. It’s a different way of being human.
Children with autism are not sick; they are progressing through develop-
mental stages as we all do. To help them, we don’t need to change them
or fix them. We need to work to understand them, and then change
what we do. The best way to help an autistic or neurodivergent child to
change for the better is to change ­ourselves – ​­our attitudes, our behavior,
and the types of support we provide. Therapy services should have a
clearly identified neurodiversity affirming focus. It should go beyond just
a claim of being neurodiversity affirming and be able to show how an
affirming process is implemented with the therapy approach.
2 What does the research say about the promoted service or therapy? Is
there any research support? Does the service incorporate any evidence
for addressing what it promotes? Remember that a therapy approach
may be helpful even if it is not ­evidence-​­based or ­research-​­supported,
but it is important to know what research has been presented on the
approach. Also, remember that historically (­and often still in present
day), research specifically focused on autistic and neurodivergent chil-
dren has been laden with ableist bias and thus may not be applicable
for validating the therapy. For research specific to the neurodivergent
population, it would be important to consider neurodiversity affirming
research.
72 Neurodivergent Mental Health Needs

3 What are the potential risks of participating in the therapy? Are there
any potentially dangerous side effects? Can any harm be done to the child
or family? If a therapy approach contains possible harm or risk to the
child, it should be highly scrutinized before beginning. There are plenty
of therapies designed to help neurodivergent children with their mental
health needs that do not cause harm. Anything that has the potential to
cause any type of emotional or physical harm is a large red flag warning.
4 What is the cost of the therapy? How much money will the family have
to pay out of pocket to receive the therapy? It is important to be aware
that some therapies may exist to take advantage of families. The cost
of the therapy should be within reason for the type of service that is
being provided. A sad reality is that there exists special, new, or unique
“­therapies” advertised to help neurodivergent children that are m ­ oney-​
­making scams. If a “­therapy” is costing a large amount of money and can-
not be validated (­for the cost) from other sources, this should be another
large red flag warning.
5 Does the therapy promise to cure autism or take the autism/­
neurodivergence away? What are the proposed benefits of participating
in the therapy? What are the therapy outcomes? Does the therapy make
any promises? If so, what are the promises? Any therapy that promises
to cure autism/­neurodivergence or promises absolutes in gains should be
avoided. Therapy should also have an evaluation component that can
be explained to families so everyone can see how the therapy works and
how the therapy is helping the child/­family.
6 Does the therapy seem like a good fit for the child and the family con-
sidering financial demands, time demands, and therapy expectations/­
processes? Families should consider if the therapy approach is something
the family can commit their time, finances, and energy to before
beginning.
7 How is the therapy governed or monitored? Families should understand
if there is any oversight for the therapy or the professional providing the
therapy. Families should also understand if they can observe or be a part
of the therapy in which their child is participating. If the therapy has no
accountability and/­or parents are not allowed to observe or participate,
this may be a caution for families regarding the therapy.
8 How is the professional implementing the therapy considered a valid
and reliable person to do so? Professionals or those implementing ther-
apy should be able to communicate to families how they are qualified
to implement the therapy. They should be able to produce education
and/­or training documents that demonstrates they are qualified to be
offering the therapy service.
 Neurodivergent Mental Health Needs 73

9 What do actual autistics/­neurodivergent people say about certain ther-

apies, especially therapies they have participated in as children? Why is
the therapy beneficial for the child? What are the child’s actual needs
that align with the therapy?
10 How did you hear about or learn about the therapy or service? Does it
seem like it has a reliable history? Has anyone else you know participated
in the therapy and what did they think? And lastly, what is your first im-
pression? Does it seem like something that your child would be empow-
ered by, help them feel better about themselves? Often if your instinct is
telling you something does not seem right, it’s important to listen.

What Are the Mental Health Needs of Neurodivergent

Children?

Understanding the mental health needs of neurodivergent children means

understanding the role of mental health with neurodivergent children. In
AutPlay Therapy, the role of mental health (­play therapy) is not to fix, cure,
or heal, a child from their neurodivergence. The AutPlay therapist does not
view the process as a treatment for autism, neurodivergence, etc. The process
is a therapy designed to help the child overcome, manage, process through,
heal from, etc. any mental health issues which may be a current struggle.
It’s an important distinction to make that neurodivergence may be differ-
ent from other psychological disorders such as attachment disorders and
trauma disorders. It’s extremely common for symptoms of neurodivergent
conditions and symptoms of mental illness to overlap. For example, people
with ADHD are often misdiagnosed with depression or anxiety and treated
for those conditions, instead of receiving help for the legitimate diagnosis.
However, it’s also not uncommon for people who have ADHD to expe-
rience depression and anxiety as difficulty with executive functioning in
the brain can trigger those symptoms. Mental health challenges can impact
anyone, but there is research to suggest that neurodivergent people have
high rates of mental illness as a product of not being valued and accepted
in a neurotypical society. The neurodivergent brain is often not naturally
accommodated in many academic institutions and work environments,
leaving many neurodivergent people to constantly “­mask” their needs and
identity ultimately creating unhealthy constructs for the neurodivergent
person (­Tricaso, 2021). The following highlights some common mental
health needs that neurodivergent children experience and may result in
them entering a play therapy process:
74 Neurodivergent Mental Health Needs

Anxiety – Perhaps
​­ one of the more common mental health issues for neu-
rodivergent children is experiencing anxiety struggles. The anxiety levels
of some children can produce debilitating results where daily struggles are
difficult to accomplish. Social anxiety, agoraphobia, and other fears can also
be ­present – creating
​­ challenges for the child and the child’s family. Often
anxiety struggles are misunderstood, and children may be labeled as defiant
or stubborn. The child may not understand their own anxiety issues and may
not be able to communicate their issues to others.
Depression – ​­Neurodivergent children can experience rejection, social iso-
lation, bullying, confusion, and being misunderstood. All of which can lead
to feelings of depression. As most of the environments that neurodivergent
children navigate are not neurodiversity affirming or friendly, many en-
counters can leave the child struggling with feelings of depressions. As with
anxiety, children may not understand their feelings of depression, how to
communicate what is happening with them, and how to process and man-
age depression. Issues such as anxiety, depression, and even trauma, which
are not addressed, can lead to even more serious situations such as suicidal
ideation and attempts.
Trauma – Abuse,
​­ sexual assault, violence, natural disasters, and wartime
combat are all common causes of PTSD in the general population. Among
autistic people, though, less extreme ­experiences – fire ​­ alarms, paperwork,
the loss of a family pet, even a stranger’s offhand c­ omment – can ​­ also be
destabilizing. They can also be traumatized by others’ behavior toward them
(­Gravitz, 2018). Research indicates that autistic children reported a signifi-
cantly higher level of exposure to neighborhood violence, parental divorce,
traumatic loss, poverty, mental illness, and substance abuse in the family.
These situational indicators of stress and trauma experienced by the fam-
ily are called adverse childhood experiences (­ACE) and the probability of
reporting one or more of them was higher in autistic children compared to
­non-​­autistic children (­­Lobregt-​­van Buuren et al., 2021). Autistic and neu-
rodivergent children appear more prone to experiencing trauma and thus
presenting in therapy with unaddressed trauma issues. This may be due to
experiencing a traumatic event or may be ongoing developmental trauma
being experienced as a result of navigating as a neurodivergent child.
Poor ­self-​­worth – ​­Many neurodivergent children find themselves entering a
play therapy process after they have already been experiencing life as a neu-
rodivergent child. Many enter play therapy with low ­self-​­esteem and worth.
Much of this is influenced by the rejection they have had and continue to
experience. As much of society is based on, accommodates, and values a
 Neurodivergent Mental Health Needs 75

more ideal neurotypical presentation, neurodivergent children find them-

selves on the outside, feeling devalued, and being excluded. Many children
receive a constant message of “­You are not right,” “­You need to change,” and
“­There is something wrong with you being you.” These messages, whether
they are direct or more subtle, do a considerable amount of damage to the
child’s ­self-​­worth. Thus, working on building the child’s ­self-​­image and ­self-​
­esteem can become a primary goal in mental health care.
Identity struggles (­­self-​­acceptance, masking, code switching) – ​­“­Masking” is a
popular term in the neurodivergent community that refers to minimizing or
completely hiding symptoms to fit in with societal norms. Many neurodiver-
gent people learn to mask as a survival technique as it is often more accept-
ing to appear neurotypical. Masking can include suppressing symptoms and
needs, mimicking behaviors someone who is neurotypical engages in, having
­go-​­to scripts for social interactions, and anything else that helps them cam-
ouflage within society.
Code switching involves adjusting one’s style of speech, appearance, behav-
ior, and expression in ways that will optimize the comfort of others in ex-
change for fair treatment, quality service, and employment opportunities. It
has been widely understood within the BIPOC community but also applies
to the neurodivergent people. Masking and code switching are two exam-
ples of neurodivergent struggles with s­elf-​­acceptance and feeling like being
themselves will not be acceptable in society. Continually denying self and
“­masking” to feel accepted can create a host of mental health struggles in-
cluding depression, anxiety, anger, etc.
Peer issues (­bullying, rejection, friends) – ​­Research has well documented that
neurodivergent children are highly susceptible to being bullied by peers;
three to four times the rate of neurotypical children (­Hoover, 2015). This
can be compounded by experiencing social (­peer) rejection, feeling isolated,
and struggling to find friendships. The results can be devastating to a positive
sense of self. Often children do not know how to address bullying and peer
rejection and suffer in silence. This can become a critical therapy goal for
many neurodivergent children.
Regulation struggles – Becoming
​­ dysregulated and needing help with regulat-
ing one’s system is a common and highly misunderstood therapy need. Many
neurodivergent children struggle with their system becoming overwhelmed
(­dysregulated) and this often leads to behaviors that can feel out of control
and unsafe. The dysregulation can come from a variety of places (­and of-
ten does). This might include sensory challenges, fears, anxiety, confusion,
feeling unsafe, the unknown or unexpected, biomedical issues, etc. Often it
76 Neurodivergent Mental Health Needs

is a combination of issues that has contributed to the child becoming dys-

regulated. Understanding how to regulate one’s system and the process of
­co-​­regulation can become important therapy goals.
Sensory needs – Autistic
​­ and other neurodivergent children often have c­ o-​
­occurring sensory processing needs/­differences. Sensory needs can manifest
in ways that create dysregulation, pain, and problematic behaviors. Under-
standing and addressing sensory needs becomes a therapy goal when the
child’s sensory differences are creating struggles for the child. Sensory work
may be a part of a larger focus on helping the child regulate their system.
Sensory work may also be done in collaboration with other professionals
such as an occupational therapist training in addressing sensory needs.
Emotion expression – ​­Many of the children I have seen in play therapy ini-
tially lack an awareness and conceptualization of their own emotions. Being
able to label a feeling, understand feelings, why they are happening, how to
identify them, how to express them, and how to manage them as part of an
overall regulation ability can become therapy goals. It is important to note
that neurodivergent children may recognize, express, and communicate feel-
ings in their own unique ways. This work, as all work with neurodivergent
children, requires the ability to understand neurodivergent presentation
without the expectation that a neurodivergent child must express feelings
the way a neurotypical child would or there is something wrong with the
neurodivergent child. Therapists will want to take care to recognize and al-
low for a neurodivergent understanding and expression of emotion that may
be different from what the therapist is used to experiencing.
Social related needs – Social
​­ related needs can be vast and complex. The myr-
iad of issues a child might be facing that involve some type of social situation
or navigation can almost feel endless. It is not unusual for social needs to be
creating other issues such as anxiety, depression, and low s­elf-​­worth. Ther-
apists will want to take care to thoroughly assess and understand the social
needs of the child and ensure that social related goals are not supporting
ableist ideas. Historically, “­social skills” work has been implemented and de-
signed in a way that autistic and neurodivergent children are trained to look
and act neurotypical. This would not be an appropriate or affirming goal.
Social needs are real and can certainly be addressed in play therapy, but any
process that involves trying to change the child’s identity is counterproduc-
tive to improving a child’s mental health.
Parent/­child relationship – ​­When working with children clients, it is not unu-
sual to discover issues related to parent/­child relationship strain. This can be
due to many factors and if left unaddressed can interfere with advancement
 Neurodivergent Mental Health Needs 77

in other therapy goals and can create additional issues. Addressing parent/­
child relationship issues would require the therapist to implement a more
family play therapy approach. This is something supported in AutPlay
Therapy and other play therapy approaches such as Filial Therapy and
Theraplay. Therapists should take care to gain training in family play ther-
apy work and understand the dynamics of working with a family versus the
individual child before attempting to involve the family in the play therapy
process.
Life issues/­transitions – Possibly
​­ one of the most important things about im-
plementing mental health therapy with neurodivergent children is under-
standing the following ­construct – ​­this child is not here because they are
neurodivergent, they are here because they have a mental health n ­ eed – ​­in
conjunction ­with – I​­ need to be aware this is a neurodivergent child and
whatever therapy goals we are working on need to be affirmative and indi-
vidualized to support their neurotype. Neurodivergent children can enter
play therapy with needs same as any child. They may be experiencing a par-
ent’s divorce, grief issues, physical or sexual abuse, attachment issues, or any
life adjustment concern. What may be different, is the process of working
on these needs. The therapist will want to understand the child’s neurotype
and take care to work on therapy goals in ways the child responds to and
understands.
Rosa (­2022) created a list to help those who aren’t autistic themselves (­or
whose autistic traits differ from those of their child) to understand what may
upset an autistic person, and cause distress. There hope is to highlight issues
that may not be obvious to a bystander, and how you (­parent, therapist,
etc.) can help the autistic people in your life thrive, as much as possible.
Although the creators focus their list on the autistic experience, much of
what is communicated could apply to any neurodivergent child and should
help highlight the play therapist’s awareness and relationship in working
with neurodivergent children. Rosa and Autistic Science Person’s full list
(­the Autism Checklist of Doom) can be found in checklist form on the web-
site “­Thinking Person’s Guide to Autism” – ​­thinkingautismguide.com and
includes the following important constructs:

• You treat meltdowns, and their triggers, as though they are tantrums and
voluntary, when they are in reality involuntary, and in many cases can
be avoided.
• You insist that they make eye contact with you or other people, even
though eye contact can be painful or overwhelming for autistic people,
and indeed in many cultures is considered an act of aggression.
78 Neurodivergent Mental Health Needs

• You ask them to name their feelings and get frustrated when they cannot,
without considering that they may have alexithymia (­difficulty perceiv-
ing or describing their own emotions) like so many autistic people do.
• They experience sensory discomforts that seem minor to you but are
overwhelming to them: Clothes tags, tight clothes, dry skin, even indi-
vidual acne blemishes, humming machines, loud sounds, sunlight, tem-
perature, strong scents, ­low-​­key flickering lights.
• You don’t believe in their sensory sensitivities or their perception of
pain, and think they are ways of making excuses or getting out of events.
• You consider their passions to be “­special interests” or disruptive, so they
are not given time to delve into them to a satisfying ­degree – ​­or even
worse, those passions are gatekept to negotiate compliance. They are
only allowed to talk about their special interest to you for a short period
of time, and no effort is made from you to engage in the subject.
• They are overwhelmed by their emotions and can’t express that distress
any other way than a meltdown or shutdown.
• You do not allow them to stim or flap their hands at all because you think
it looks weird, or worry what other people may t­ hink – even
​­ if you know
they are happy.
• They are never given opportunities to succeed, or even to feel good
about themselves. They are only criticized or made to feel deficient.
• They don’t know they’re autistic, and so they think they are a broken
person because they aren’t like other people.
• They know they’re autistic, but everything they hear, see, or read about
autism makes them feel like a burden or an alien.
• You just don’t accept them for who they are, and they are depressed,
anxious, and/­or stressed.
• You know they are autistic, yet you keep expecting them to “­just do
things” like adapt to surprises without distress or interact socially like a
­non-​­autistic person, and are upset with them when they are not able to.

Affirming Therapies

Some common affirming therapies are listed below with a brief description.
Therapists should be cautioned that at present, there is no one profession/­
therapy/­discipline that is completely neurodiversity affirming. Play therapy
in general encapsulates the most neurodiversity affirming principles but still
has some history and current protocols that can be ableist. Other professions
and disciplines have some movement toward becoming more neurodiversity
affirming but are not fully realized. It basically comes down to the individual
 Neurodivergent Mental Health Needs 79

provider within a certain discipline. Each individual therapist/­provider needs

to be reviewed for implementing affirming practices. Some simple questions
to ask the professional could be:

• What is your view on neurodiversity?

• Do you implement neurodiversity affirming practices?
• How are you neurodiversity affirming?
• Can you explain what it means?
• Can you give me examples of how you implement a neurodiversity af-
firming approach?

Play Therapy – ​­The Association for Play Therapy (­2022) defines play ther-
apy as the systematic use of a theoretical model to establish an interper-
sonal 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. There exist several affirming
play therapy theories and approaches such as AutPlay Therapy, which is
designed to address the mental health needs of autistic and neurodiver-
gent children. Certified AutPlay Therapy Providers implement a variety
of play therapy approaches and interventions to address needs such as reg-
ulation struggles, anxiety issues, trauma, and ­self-​­advocacy (­Grant, 2017).
Play therapy approaches such as Child Centered Play Therapy, Ther-
aplay, Gestalt Play Therapy, Filial Therapy, and Synergetic Play Therapy
also present affirming protocols and can be beneficial for neurodivergent
children.
Speech Therapy – ­​­­Speech-​­language pathologists are professionals who are ed-
ucated to assess speech and language development and to treat speech and
language disorders as well as swallowing disorders. These professionals may
implement a variety of interventions to help neurodivergent children im-
prove speech and language needs.
Occupational Therapy – C ​­ ommon occupational therapy interventions include
helping neurodivergent children participate fully in school and social situ-
ations, address sensory struggles, and regain skills after injury. Occupational
therapy services may include comprehensive evaluations of the client’s home
and other environments (­e.g., workplace, school), recommendations for
adaptive equipment and training in its use, and guidance and education for
family members and caregivers. Occupational therapy practitioners have a
holistic perspective, in which the focus is on adapting the environment to fit
the person, and the person is an integral part of the therapy team (­American
Occupational Therapy Association, 2021).
80 Neurodivergent Mental Health Needs

Music Therapy – ​­The American Music Therapy Association (­2021) describes

music therapy as the process in which music is used within a therapeutic
relationship to address physical, emotional, cognitive, and social needs of
individuals. After assessing the strengths and needs of each client, the qual-
ified music therapist provides the indicated therapy including creating, sing-
ing, moving to, and/­or listening to music. Through musical involvement in
the therapeutic context, clients’ abilities are strengthened and transferred
to other areas of their lives. Music therapists work with autistic children to
activate the whole brain and improve communication and interactions with
others.

Neurodiversity Affirming Play Therapist Constructs

Presume Competence – ​­A strength-​­based approach and philosophy that as-

sumes neurodivergent children have abilities to learn, think, grow, and un-
derstand. Presuming competence means you believe that the neurodivergent
child client has current ability and potential to develop their thinking, pro-
cessing, and understanding. Jorgensen (­2022) identified four reasons why
presuming competence is important.

1 People’s expectations matter. When therapists, parents, teachers, etc.

expect children to do well, they do even better than expected.
2 Intelligence Quotient (­I.Q.) and other tests that purport to measure hu-
man capacity are terribly flawed. They usually tell us what children can’t
do rather than what they might do if they had good instruction and
­high-​­quality supports. Basing a child’s whole future on a test score just
seems fraught with potential harm.
3 A growing body of research shows “­unexpected” abilities in people who
had been identified as intellectually disabled until they were provided
with a means to communicate.
4 To presume incompetence could cause irreparable harm to children.
5 If we are wrong about presuming a student’s ability to learn and to com-
municate in ways that are on par with their peers without disabilities,
being wrong about that isn’t as dangerous as the alternative.

Value Relationship as a Core Change Agent – ​­Landreth (­1991) stated that the
relationship, not the utilization of toys, or interpretation of behavior, is the
key to growth. Therefore, the relationship is always focused on the present,
living experience. Axline (­1947) outlined eight principles for therapeutic
relationship with the child:
 Neurodivergent Mental Health Needs 81

1 The therapist must develop a warm, friendly relationship with the child,
in which good rapport is established as soon as possible.
2 The therapist accepts the child exactly as they are.
3 The therapist establishes a feeling of permissiveness in the relationship
so that the child feels free to express their feelings completely.
4 The therapist is alert to recognize the feelings the child is expressing
and reflects those feelings back to them in such a manner that they gain
insight into their behavior.
5 The therapist maintains a deep respect for the child’s ability to solve
their own problems if given an opportunity to do so. The responsibility
to make choices and to institute change is the child’s.
6 The therapist does not attempt to direct the child’s actions or conversa-
tion in any manner. The child leads the way; the therapist follows.
7 The therapist does not attempt to hurry the therapy along. It is a gradual
process and is recognized as such by the therapist.
8 The therapist establishes only those limitations that are necessary to an-
chor the therapy to the world of reality and to make the child aware of
their responsibilities in the relationship.
(­p­­p. 73–​­74)

Value and Allow for Multiple ways of Communication – If

​­ a child is nonverbal
it does not mean they are not communicating, and it does not mean they do
not have anything to say. The play therapist will understand that children
can communicate in many ways that are not verbal and these ways will be re-
spected and valued. Some children may communicate through their play, use
an augmentative and alternative communication device (­AAC), body lan-
guage, etc. Some children may be nonverbal, or they may be n ­ on-​­speaking.
Whatever the child’s communication presentation, the play therapist will
make accommodation for the child and make every effort to allow the child’s
way of communicating to be expressed.
Value and Provide Space for the Child’s Voice – Children
​­ (­both neurotypical and
neurodivergent) are arguably the most marginalized group of people across the
planet. For the most part, children have no rights and are often completely under
the control of their ­caregivers – ​­sometimes this works for their benefit and some-
times it does not. In play therapy, the therapist should strive to provide space and
opportunity for the neurodivergent child’s voice to be heard. The child should be
allowed to express their thoughts, feelings, and opinions about the play therapy
process. In AutPlay Therapy, the child is considered a partner in the process
with the therapist and parent. Many spaces eliminate the neurodivergent child’s
voice. In play therapy there is an active effort to amplify the child’s voice.
82 Neurodivergent Mental Health Needs

Partner with Parent/­Caregiver and the Child – There

​­ are multiple play therapy
approaches that focus on working with the parent and child together (­Filial
Therapy, Theraplay, Child Parent Relationship Therapy). When work-
ing with neurodivergent children it is important to have parent/­caregiver
involvement and work with both the parent and child as partners in the
process. Parents often have needs to address and require information about
neurodiversity affirming processes. In AutPlay Therapy, the parent/­caregiver
plays an active role in learning about their child’s play and learning play
times and techniques to implement at home with their child. Parents are
empowered and gain tools for parenting their child while improving their
relationship with their child.
Use a ­Strength-​­Based Approach – ​­An approach that focuses on identifying
what works for the child instead of focusing on what is “­wrong” with the
child and on their supposed deficits. Instead of insisting the child participate
in therapy one certain way, the therapy is individualized to algin with the
strengths the child possesses. The ­strength-​­based approach is focusing on the
positive attributes of a child, rather than the negative ones. Any play therapy
theory or approach can incorporate a ­strength-​­based approach and should
utilize this method when working with neurodivergent children.
Recognize the Child’s Play Preferences and Interests – ​­Many play therapists
may find they are accustomed to seeing one or two types of play presented
in play therapy sessions. Many neurotypical children display pretend and
symbolic play and this may be what most play therapists are familiar with.
Neurodivergent children will likely present a wide range of different types
of play. Some of the many types of play are presented in ­Chapter 4. The
play therapist will take care to understand the neurodivergent child’s play
preferences and interests. They will work with the child’s play instead of
trying to force the child to play in a certain way or teach the child to play
in a way the therapist believes is the correct or most common way to play. It
is the play therapist’s duty to meet neurodivergent children where they are
in their play ­preferences – ​­not to judge, and not devalue. The therapist may
even see a type of play they cannot categorize, this should still be honored
and validated.
Respect Diverse Neurotypes (­Identity Freedom) – ​­Neurodivergent children are
not an indistinguishable construct. Neurodivergent children are not all go-
ing to look the same, talk the same, present the same, process the same, and
have the same needs. Each child will have a distinct neurotype. Respecting
diverse neurotypes means the child has the freedom to be themselves and all
that comes with presenting who they are in the way they are designed. It is
 Neurodivergent Mental Health Needs 83

the therapist’s role to create this open and accepting atmosphere, meeting
each child where they are without judgment and working with them within
their neurotype.
Advocate for Inclusion – ​­Defined as the state of being included or being made
a part of something, inclusion is about offering the same opportunities to
everyone, while providing support and services to accommodate people’s dif-
ferences. Inclusion benefits all within a setting by minimizing stereotypes
while encouraging learning to occur between neurotypical and neurodiver-
gent children. Inclusion application is not likely to be a part of a typical play
therapy session. More so, it will be part of the play therapist’s advocacy work
for and with the child. Most inclusion efforts seem to focus on educational
settings and extracurricular social settings.
Support Self Advocacy Skills – ​­At its basic, ­self-​­advocacy means learning to
communicate for your needs. The Organization for Autism Research (­2016)
stated that ­self-​­advocacy is having the right to make and express your own
life decisions and choices. ­Self-​­advocacy refers to an individual’s ability to
effectively communicate, convey, negotiate, or assert their own interests, de-
sires, needs, and rights. It involves making informed decisions and taking
responsibility for those decisions. Numerous studies demonstrate a clear link
between teaching children s­ elf-​­advocacy skills and their ability to be happy,
­well-​­functioning adults. The Organization for Autism Research furthered
that ­self-​­advocacy includes these components:

• Encouraging use of language that is inclusive, respectful, and ­person-​­first.

• Knowing what services, modifications, and accommodations you require
and being able to request them.
• Knowing whom to ask and where to go to get assistance and support.
• Understanding and expressing one’s strengths, talents, and interests.
• Being able to create personal goals and follow a path to achieve those
goals.
• Having the ability to make choices.

Respect Body Autonomy – ​­The idea that a person gets to make decisions about
what happens with their body. They have control over their body and get to
make choices about how their body is treated by others. This has two impli-
cations for autistic and neurodivergent children. First, that the therapist does
not physically touch, move, or control the child’ body (­any body part) in
any way without the child and parent’s consent. Child therapists are highly
encouraged to read the Association for Play Therapy (­APT) Paper on Touch.
84 Neurodivergent Mental Health Needs

The document can be found on the APT website (­a4pt.org). Second, that
children have literal and figurative right and say to what happens to them
and with them. Other adults should not be making decisions for them with-
out the child having a voice and providing their wishes, wants, and giving
consent. For example, an adult decides it is okay for a child to be lifted out of
their wheelchair and carried into a building for a new tutoring session. This
is decided by the adult without the child having a say in how they feel about
this experience. Another example would be an ­18-­​­­year-​­old learning that
their parents are going to take guardianship of them without discussing it
with the teen and letting them have a voice in the ­decision-​­making process.
Remember that Play is the Natural language of the Child – It
​­ is well understood
that children learn, process, experience, communicate, and grow through
play. The play therapist fundamentally understands the therapeutic powers
of play and welcomes and encourages the child to engage in play. Landreth
(­1991) described the importance of understanding and valuing the child’s
natural language of play:
Children’s play can be more fully appreciated when recognized as their
natural medium of communication. Children express themselves more
fully and more directly through s­ elf-​­initiated spontaneous play than they
do verbally because they are more comfortable with play. For children
to play out their experiences and feelings is the most natural dynamic
and ­self-​­healing process in which children can engage. Play is the me-
dium of exchange and restricting children to verbal expression automat-
ically places a barrier to the therapeutic relationship….The therapist’s
responsibility is to go to the child’s level and communicate with children
through the medium with which they are comfortable.
(­­p. 10)

Case ­Example – ​­Isaac

Isaac was brought into therapy by his parents. He lived with his biological
father and mother and had two older sisters. Isaac was 10 years old when he
began play therapy. He entered therapy with a diagnosis of autism spectrum
disorder which he received from a psychological evaluation when he was 5
years old. Isaac had not participated in any specific therapies. He attended
public school for kindergarten through 3rd grade. His parents described the
school experience as terrible. They stated that Isaac had high anxiety about
going to school and struggled with the environment.
The school had Isaac on an IEP, but the parents reported that the school did
not help with Isaac’s issues. After third grade, they removed Isaac from public
 Neurodivergent Mental Health Needs 85

school and began home schooling using an online program. After third grade
Isaac seemed to improve with his anxiety and depression but prior to coming
into therapy, they began noticing he was struggling with negative s­elf-​­talk,
communicating he was stupid and bad (­because of his autism), and having
some elevated anxiety levels. They wanted play therapy to help Isaac with
his emotions and improve his ­self-​­esteem.
Isaac’s parents were informed about neurodiversity and neurodiversity affirm-
ing processes. They appeared to be supportive of Isaac as an autistic child and
at home, spoke about this freely and positively. They were concerned that he
seemed to be taking on a negative ­self-​­image and unsure why this was hap-
pening. They reported that Isaac had always seemed to struggle with anxiety,
but it had gotten worse over the last few months and now he would become
very anxious and upset about many things such as going out in public, worry
that one of his parents might get hurt or killed when they were not at home,
tornados, and many other things.
I meet with Isaac following the AutPlay Therapy protocol. The first four to
five sessions focused on building relationship with Isaac, getting to know him
better, understanding his play preferences, and helping him feel familiar and
safe with myself and the play therapy process. Isaac very much enjoyed board
games; this was his primary play preference. Isaac was not interested in any
of the playrooms, technology play or the sandtray ­room – ​­he wanted to play
board games. Isaac’s therapy goals focused on understanding and decreasing
his anxiety issues, learning regulation ability, addressing any identity issues,
and improving his s­elf-​­worth. Isaac’s father and mother would alternate
bringing him to therapy and each participated in the therapy sessions.
Sessions 6 through 10 focused on ­strength-​­based and emotion exploration
play techniques. I would introduce an intervention that helped Isaac better
understand his strengths and things he was good at. Isaac’s parent, Isaac, and
I would all participate in the interventions. I also introduced some expres-
sive interventions designed to help Isaac recognize and talk about his emo-
tions. The ­strength-​­based interventions set the foundation for referencing
Isaacs’s strengths and using his strengths to address his therapy goals. Emo-
tion expression interventions set the foundation for Isaac becoming more
comfortable talking about his anxiety feelings. At the end of each session, I
would reserve the last 15 minutes to play any board game Isaac c­ hose – ​­his
go to board game was Chess.
Sessions ­11–​­25 focused on game selection and play to help address Isaac’s
therapy goals. Isaac agreed that each session he and I would each choose a
board game to play. I would go first, and we would play the game I selected
86 Neurodivergent Mental Health Needs

for about half the session. We would then play the game he selected for
the remainder of the session. I purposely chose games that would help Isaac
express his feelings, recognize his strengths and value, and that he would
enjoy playing. Some of the games I chose included Feelings Fair (­a ther-
apeutic board game with a carnival design which has many concepts that
engage the players in talking about their emotions), Feelings Jenga (­each
time a piece is removed the person identifies and shares about a feeling or
acts out a feeling), Strengths Checkers (­each time someone jumps another
person they must share about something they do well or have accomplished)
and Secret Square (­a cooperative memory game that highlighted one of
Isaac’s ­strengths – his
​­ memorization ability). For Isaac’s turn he would mostly
choose Chess which he was very good at. It provided a natural opportunity
to point out many of his strengths and help him feel good about himself. The
parent attending and I would take turns playing with him. There were a few
times Isaac choice a Pop It Dice Game (­a sensory based popping game). This
seemed to be something he would choose on days when he was needing a bit
more regulation for his system. Isaac and the parent attending, participated
in all the games and the process seemed successful and enjoyable for Isaac.
Sessions ­26–​­30 focused on integrating bibliotherapy into our play therapy
times. I selected two books to read with I­ saac – ​­It’s Okay to be Different by Todd
Parr and Some Brains: A Book Celebrating Neurodiversity by Nelly Thomas.
We begin (­session 26) with It’s Okay to Different and Isaac and I took turns
reading each page. After we had finished the book, we each (­myself, Isaac
and the parent attending) shared what we thought the book meant and how
we could apply it to our life. In session 27, we read the book Some Brains,
implementing the same process as we did with the previous book. Both book
readings and discussions provided meaningful opportunity for Isaac to share
about his own thoughts and feelings and things he has struggling with in how
he has felt about himself. Sessions ­28–​­30 involved us creating our own board
game based on helping kids feel good about being different. Isaac was the
lead in developing the concept, design, format, and how the game would be
played. We all worked together in creating the board game. For materials, we
used a piece of cardboard and sharpies. Once the board game was complete,
we all played the game together several times. Isaac took the board game
home to keep and play with his family.
Session ­31–​­37 focused on maintaining and reinforcing our ­self-​­worth gains
and anxiety reduction. At this point, Isaac was doing much better with both
needs. His anxiety had deceased, and he was talking about and expressing
his feelings in healthy ways. He also reported that he did not feel as anxious
about things any longer. Isaac’s s­ elf-​­worth had improved significantly. He was
 Neurodivergent Mental Health Needs 87

no longer making negative s­elf-​­comments. He was actively acknowledging

his strengths and talking about things he could do well. He was also prepar-
ing to join a community chess club and had been playing online chess with
others for the past four to six weeks. Our session times mostly consisted of
myself, Isaac, and the parent attending each choosing a game to play and
playing together. On session 37, we discussed Isaacs’s improvements with his
therapy goals and graduating him from his therapy time. Everyone agreed
and Isaac’s final session was session 38 which was a celebration of Isaac and
his parents, and the therapy work they had done.

Case ­Example – ​­Liam

Liam was brought to therapy by his biological parents who were going
through a divorcee. Liam was a ­14-­​­­year-​­old male who had a diagnosis of
autism, ADHD, and OCD. His parents were concerned with behaviors Liam
was displaying. They presented that he seemed depressed and anxious and
would often engage in behaviors at school and home that were inappropriate
and destructive. They had never told Liam that he had been diagnosed with
autism and OCD. Liam did know he had an ADHD diagnosis. The parents
seemed to communicate a great deal of stigmatization about autism and as
therapy progressed, I discovered they had actively tried to do things with
Liam and direct his life so he would not “­look” autistic.
Beginning sessions focused on working with Liam individually to better get
to know him, help him feel comfortable and safe in therapy, and to build
relationship. Liam did present as a young teen with depression and anxiety.
He could talk about this and express these emotions. By the end of our intake
and assessment phase, a few things were clear about ­Liam –​­

1 He had very low ­self-​­worth. There were a lot of “­failures” in Liam’s life.
Much of this had to do with Liam being placed in multiple environ-
ments (­having no awareness or support for being autistic) that were not
a good fit for him, and the results were negative. Although Liam did not
know he was autistic, he had a great deal of initialized ableism. He did
not know that different neurotypes existed, but he clearly knew he was
different from the peers he was being exposed to. Common names Liam
would often be called by peer groups included “­retard,” “­dumb fuck,”
“­idiot,” and “­moron.” He was often degraded and not treated well or
equally. Liam believed he was these ­things – ​­he was the odd one out, so
these things must be true. As a result, he was extremely depressed and
experienced a great deal of anxiety.
88 Neurodivergent Mental Health Needs

2 He was not handling his parents’ divorce well. He was being regularly
shuffled back and forth between two homes and there had begun to be
new people in his l­ ife – ​­the parent’s new b­ oy-​­and girlfriends and in some
cases their children. Liam was not managing the changes well and it was
creating a great deal of dysregulation which in turn was creating some
destructive behaviors.

Session ­5–​­10 focused on establishing the therapy goals of improving ­self-​

­worth, decreasing dysregulation, processing through his parent’s divorce, and
working on identity issues (­telling Liam he was autistic). Many of these ther-
apy goals were going to involve working with the parents. It was clear that
there would have to be parent education and a shift in the parent’s attitudes
and beliefs if Liam was going to progress.
Sessions ­11–​­45 were a combination of addressing the therapy g­ oals – ​­working
with Liam in individual therapy, working with Liam’s parents, and working
with all of them in family therapy. The earlier sessions involved meeting
with the parents to provide education and help them understand the im-
portance of telling Liam he was autistic. The parents also needed an under-
standing of neurodiversity, ableism, and addressing their own issues. This
was difficult at times. The parents had to do a lot of work at deconstructing
their own ableist beliefs about autism and work on how to support Liam in
an affirming manner before Liam could be told about his diagnosis. While I
was meeting with the parents, I was also having weekly individual sessions
with Liam and we were addressing recognizing strengths, learning regulation
interventions, and working on Liam’s p­ erspective – helping
​­ him understand
that many of his past experiences were not about him being wrong but about
others not accepting him.
We eventually progressed to a point to tell Liam he was autistic and help
explain neurodivergence to him and how this has shaped his life and expe-
riences. His parents needed a lot of support but did make improvement and
were able to shift their parenting and relationship with Liam to be more
affirming. Liam was not surprised by the autism diagnosis. It seemed he had
already done some research and had some suspicion. His anxiety and depres-
sion decreased, and he and his parents began finding peers and social outlets
that were a better fit for Liam. The final therapy sessions, approximately
­46–​­56 were focused on helping Liam process his parent’s divorce and the
changes/­disruption it had made in his routine and familiarity.
Liam entered therapy with a lot of strengths; it was simply a matter of him
recognizing and valuing them. Looking back in reflection, much of Liam’s
 Neurodivergent Mental Health Needs 89

needs were a product of his environments, how people were responding to

his autism, and his own lack of awareness. Had Liam (­his life) navigated
­differently – ​­known who he was, been sent affirming and valuing messages
about who he was, and “­found his people” socially, – it’s
​­ likely he would have
never come to my office.

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Siri, K., & Lyons, T. (­2010). Cutting edge therapies for autism. Skyhorse Publishing.
Tricaso, K. (­2021). What does it mean to be neurodivergent? Modern Intimacy.
https://­www.modernintimacy.com/­­what-­​­­does-­​­­it-­​­­mean-­​­­to-­​­­be-​­neurodivergent/
 4
Neurodivergent Play

Playing is a fundamental part of childhood, and it supports children in their

physical, cognitive, social, and emotional development. Human develop-
ment and play are extremely diverse and, depending on ­socio-​­cultural norms,
some forms of playing are seen as more beneficial or competent than others.
When differences in play do not align to socially constructed understand-
ing of normalcy, as often happens to autistic and neurodivergent children,
they are generally pathologized and considered faults of the child to be fixed
(­Waltz, 2020).
Approximately 20 years ago I sat in a training that was focused on working
with autistic children. This particular training had a mostly behavioral ap-
proach and was targeting professionals outside of mental health. I had hopes
it would provide me with some additional information I could use in my play
therapy work with autistic and neurodivergent children. About two hours
into the ­one-​­day training, the presenter began talking about play. I don’t
remember all of what was covered but I clearly remember the presenter pro-
claiming that autistic children did not play, they did not know how to play,
and thus play approaches would not work for them. The presenter furthered
that you could not even teach an autistic child how to play. For me theses
proclamations were ­absurd – ​­I had already been working with several autistic
children who played in multiple ways. My takeaway was the clear awareness
that there were people (­professionals) who really believed that autistic chil-
dren did not play and were putting forth this view to many other profession-
als who would walk away believing this was true.
It would be nice to blame this uninformed training/­ presenter on some
b­ ehavior-​­based protocol that was antiquated and out of touch. Unfortunately,
the sentiment that autistic children do not play has been a predominant
historically belief. I recall finding my way to a popular play therapy training
with a highly ­sought-​­out play therapist. The training and the presenter lived

DOI: 10.4324/9781003207610-5
92 Neurodivergent Play

up to the hype and 95% of the training was very beneficial. This training
was not focused on autistic children, it was focused on a particular play ther-
apy approach and the case examples and application were primarily about
neurotypical children. Toward the end of the training, the presenter began
talking about who would not benefit from this play therapy approach and
who it would not work for. I believe the exact presentation heading was
Exceptions for Using This Approach. Listed right at the top of three exceptions
was autistic children. “­Autistic children do not understand play and cannot
do this type of play and we would not work with them.” Ugh! If the behav-
ioral focused training was not bad enough, now my sacred play therapy space
had been tainted.
In another example, that was approximately 15 years ago, I was facilitat-
ing a resource booth at a local resource fair that was focused on services
related to autism and developmental disabilities. My booth was highlight-
ing AutPlay Therapy with information that could be given to parents to
explain AutPlay and how it might be helpful for an autistic or neurodi-
vergent child. At some point in during the fair, a person who oversaw a
local “­Autism Center” approached me with a smile on their face and said
“­Hello.” I said “­Hello” back and then this person said to me “­You know play
therapy does not work for children with autism, they don’t play.” “­Oh” I
said, having been down this road before I knew my response, “­Well, what is
play therapy?” I think this question surprised them and they begin to fumble
a bit and then tell me they had taken a ­one-​­hour training about ten years
ago on Child Centered Play Therapy so they knew it didn’t help autistic
children. I nicely began to accurately define play therapy to them, listing
off multiple play therapy theories and approaches, talking about the inte-
gration of approaches in AutPlay Therapy and sharing multiple examples
of autistic children’s play. Their response at the end of my free educational
lesson was “­I didn’t know that, well I have heard you are doing good things,
I’ll talk to you later.”
These excerpts from history are arguably not the thoughts and approaches
by many today (­especially in the play therapy world), but they highlight
the widely held beliefs not too long ago, across disciplines, that was wrong
about and harmful to autistic children. How many of these s­elf-​­proclaimed
experts who emphatically knew what, how, when, and everything about au-
tistic children were daily implementing “­treatments” that were harmful to
autistic children? Autistic and neurodivergent children play, they have al-
ways ­played – ​­all throughout history. Historically, it has been “­well intended”
adults who have stifled, devalued, and failed to recognize the play of autistic
and neurodivergent children.
 Neurodivergent Play 93

The troubled history begs the question “­Are we better now?” The short an-
swer is yes! Over the last ten years there has been a steady and significant
increase in understanding autistic and neurodivergent play and how that
play can be used to address mental health and other issues. Play therapy
theories and approaches began to understand how the therapeutic powers
of play were beneficial for autistic children. AutPlay Therapy and other play
therapy trainings became more common and play therapists began learn-
ing about the mental health needs of neurodivergent children and how
play therapy could help meet those needs. Over the last ­10–​­15 years, play
therapy research for working with autistic and neurodivergent children has
significantly increased. Not only are play therapists understanding that neu-
rodivergent children play, but they are also affirming the play preferences
of neurodivergent children and utilizing the therapeutic powers of play for
healing and growth.
Outside of the play therapy community, awareness and understanding has
also increased. Other disciplines such as speech therapy and occupation
therapy purposefully use play in their work with autistic and neurodivergent
children. Many professionals seem to be speaking about play as the avenue
for working with and helping autistic children. While the shift in thinking
is promising, there is a caution. Some of the new ways of awareness and
acceptance of play have been contorted into the same historic processes of
controlling the child and not letting the child use their natural language of
play. For a professional to say they are using play but are controlling the play
(­typically from their adult perspective) the child does and using play ma-
nipulativly to coax the child into another protocol is neither understanding
nor affirming the play of autistic and neurodivergent children. Five main
constructs separate play therapy theories and approaches from many who
advertise “­using” play or implementing a “­­play-​­based” approach with neuro-
divergent children. The five main constructs include:

• Play is the natural language of children. It is the way they understand

best to communicate with themselves and others. To suppress their nat-
ural language is equivalent to placing tape over the mouth of an adult
whose primary mode of communication is verbal.
• Play is the change agent, not a manipulative tool to lure the child to
something else that is considered the change agent. Play is not to be used
as a manipulative tool.
• Play preferences and interests are understood, valued, and if possible,
utilized (­focused on) to help address mental health needs and goals.
The child is met where they are, with their way of playing (­without
94 Neurodivergent Play

judgment). The neurodivergent child is not forced to conform their play

to a societal neurotypical view of what play looks like.
• Play is never withheld to get compliance. Play is not held back as a re-
ward to get the child to perform.
• The therapeutic powers of play (­defined further in ­Chapter 5) are under-
stood and utilized in play therapy.

How Do Neurodivergent Children Play?

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). When working with neurodivergent children,
it is important to discover what their language of play looks and sounds like.
The AutPlay Assessment of Play (­in the appendix of this book) is an inven-
tory designed to help therapists gain more information about the neurodi-
vergent child’s play preferences and interests (­their unique language of play).
The AutPlay Assessment of Play is typically completed by a parent/­caregiver
of the child or another adult who knows the child well. It is divided into two
sections. Section one lists several types of play (­with descriptions). There
is a ­1–​­10 scale where the parents can circle the number they believe their
child is currently at in terms of showing or not showing the particular type
of ­play – a​­ 1 means does not show, and a 10 means shows very much. Sec-
tion two provides several ­open-​­ended questions about play. The parent is
instructed to answer the questions as best they can. This is a tool that ther-
apists can use to help learn more about the child and their play preferences.
It is important to note that the neurodivergent child may play in a way or
exhibit a type of play that is not listed on this inventory. The neurodivergent
child can play in any way their system desires and it can be an original type
of play. The child’s play is their play. It does not have to fit a preconceived
category, and it can be uniquely their own style of play.
The therapist must begin with a healthy understanding of the individualiza-
tion and uniqueness of neurodivergent play and value the play preferences
of each child. With this understand in mind, there are some common play
themes and expressions. Some of the more common manifestations of play
include constructive play, functional play, sensory play, exploratory play,
reenactment play, and solitary play, etc. The following highlights several
 Neurodivergent Play 95

types of play with a discussion of the play type regarding neurodivergent

children.
Constructive play – ​­A type of children’s play that resembles the meaning of
the word. It is any play that involves constructing, building, putting together,
and/­or creating something with their hands. This might include playing with
LEGO bricks, building a train track or race car track, playing with blocks or
any building type materials (­Lincoln Logs, etc.), Mr. and Ms. Potato Head,
large cardboard blocks, etc. Neurodivergent children may enjoy solitary play
when doing constructive ­play – ​­preferring to build, create, etc. on their own
without participation from others. For some neurodivergent children, con-
structive play may provide the opportunity for therapists to engage and help
with the construction (­working together to create).
I recall working with twin autistic boys. They very much preferred doing
everything together and rarely displayed solitary play. Both of their play pref-
erence was constructive play. They would enter the playroom and create
elaborate train tracks and racetracks utilizing sandtray miniatures and any-
thing they could find to adorn the environment. They would work in unison
and often without saying one word to each other. Their joint constructive
play was powerful in helping their parents and other adults in their life un-
derstand their creativity, intellect, and abilities, much of which was not be-
ing noticed or even considered prior to them entering play therapy.
Functional play – ​­Means playing with something in the way (­or function) it is
intended to be played with or how it would typically be understood in func-
tionality. This might include setting up a plastic bowling set in the playroom
and then bowling. Another example would be taking a toy piece of bread
and placing it in a toy toaster, then serving the toast on a toy plate. Func-
tional play stays within the perceived accurate function of the toy. Many
autistic and neurodivergent children will participate in functional play, espe-
cially if is it something they have seen, done, or are familiar with in their real
life. Sometimes functional play provides an opportunity for mastery, accom-
plishment, practice, and curiosity with happenings they have experienced in
their ­day-­​­­to-​­day lives. Some functional play provides a natural opportunity
to be involved in the child’s play either by the child’s initiative (­placing the
therapist in a role) or by the therapist joining in an obvious participate role.
Sensory play – ​­Many neurodivergent children engage in sensory play. This
sometimes relates to having sensory differences or needs and sometimes it is
simply the play preference of the child. Sensory play can be regulating, calm-
ing, and enjoyable for the child. The play can vary but typically addresses
a sensory related system (­area) such as playing in the sand tray for a tactile
96 Neurodivergent Play

sensory experience or maneuvering on an exercise ball for a proprioceptive

or vestibular sensory experience. Therapists should think about the different
sensory areas and be mindful to include toys and materials in their playroom
that address each area.
Exploratory play – ​­This type of play is characterized by the child exploring
and investigating in their play. This usually involves the ability to have free
play and within the free play process, the child can explore toys, materials,
the environment as they desire.
Reenactment play – ​­This has sometimes been referred to as scripted play. The
child will play with various toys and materials and reenact a scene from a
favorite movie, TV show, or video game. Typically, the child will reenact the
scene ­repeatedly – ​­possibly multiple times a day. This might be the primary
way the child plays. The child may include others in the play but usually the
“­script” must be adhered to and there is no changing or adjusting from the
original scene.
Solitary play – ​­A child may prefer to be solitary and exclusively or primarily
play by themselves. Solitary play would not involve another person. The
child might be in a room with other children but would typically not no-
tice them. The child would be focused on something they are playing with
and not seek to include or get involved with others. The solitary play could
include any type of toy, material, or game that the child is playing with by
themselves.
Pretend play – A​­ type of symbolic play where children might use a variety of
toys, objects, actions, or ideas to represent something else (­people, animals,
ideas, fantasy) using their imaginations to assign roles to inanimate objects
or people. Any variety of toy or material may be used, and children may do
pretend play with others or solitary. The concept of metaphor is often a com-
ponent of pretend play. This type of play gives the child the opportunity to
create, imagine, and “­go” with their play wherever they want. Pretend play is a
type of play often used and seen in many play therapy theories and approaches.
Dramatic Play – ​­Can be part of or like pretend or symbolic play. Typically, a
child pretends to take on a role of someone else, imitating someone real or
a character. When another person becomes involved in the play, it is called
sociodramatic play. The elements of reality and ­make-​­believe are involved as
children imitate ­real-​­life people like a mother or father, a doctor, a school-
teacher, etc. and situations (­going to the dentist, getting their haircut, a fu-
neral) they have experienced. Pretend play often becomes a part of dramatic
play as children may embellish or change the person, character, or situation.
 Neurodivergent Play 97

Group play – ​­Some children may struggle with groups (­playing with more
than one person) and the complexities that they may bring. Some children
may desire group play but struggle with dynamics of multiple peers, fast
changing processes, and sensory issues. Some may not like group play and
simply prefer o­ ne-­​­­on-​­one or solitary play. In my personal experience, I pre-
ferred ­one-­​­­on-​­one and solitary play. I did understand group play; I was not
waiting for some ­well-​­intended adult to come along and explain group play
to me and then I would love it because I finally understood it. I understood
how it worked and what the processes were, what people were supposed to do
in group ­play – ​­I simply didn’t like it as much as ­one-­​­­on-​­one or solitary play.
Movement play – ​­This type of play is mostly what is sounds like. It is play that
involves movement of some type. The movement play can vary greatly from
running and playing a game of catch, acting out charades, or rolling around
on the floor. Movement play has been shown to be beneficial for a variety
of developmental areas including physical, communication, cognitive, and
social/­emotional. It is also helpful for children with sensory differences and
needs. For the play therapist, this involves consideration of how movement
play can be supported in the playroom. This might mean opening space for
larger movement play and/­or adding items into the playroom that promote
movement. This type of play can be done in solitary or with one or more
people. Many neurodivergent children find movement play interventions
helpful for regulation needs.
Art play – ​­This type of play involves the use of a­ rt-​­related materials. This
might include musical instruments, singing, dancing, drama, drawing, paint-
ing, molding clay, and ­writing – ​­many forms of creation. Some children are
more inclined to ­art-​­related play and prefer this type of play. Art play pro-
vides a vast opportunity for exploration, expression, and commutation. Many
neurodivergent children may find art play regulating. Therapists should be
mindful to include a variety of art related materials in their playroom.
Adult Led play – A
​­ dults often coordinate, facilitate, and lead children through
play times. This is referred to as a­ dult-​­led play. This can be a variety of types
of play, it can include many different toys and materials. The adult may in-
troduce and facilitate playing a board game, playing o­ ne-­​­­on-​­one basketball,
leading a group of children through the game of Simon Says, or in some fash-
ion be the lead out in how the play is done. This can be the type of play that
most adults are comfortable playing with children. It may or may not be a
type of play the child would like to engage with. Many children need the
opportunity of showing their play preference and having the adult join it or
follow them in their play preferences. ­Adult-​­led play interventions and play
98 Neurodivergent Play

times can be beneficial but ­adult-​­led play should not monopolize the child’s
play and the therapist should always be seeking to discover the neurodiver-
gent child’s play preferences.
Educational play – ​­Situations or “­play” times that are typically created by an
adult with the goal to provide some type of education or learning experience
through the play. The play is often seen as an engaging element to gain
greater participation from the child and provide an element of enjoyment
for the child while they learn a specific concept or skill. Educational play is
often ­adult-​­led.

The Integration and Complexities of Neurodivergent Play

Play presents a popular pastime for all humans, though not all humans
play alike (­Spiel & Gerling, 2020). It should be well understood and ex-
pected that neurodivergent children play. Neurodivergent children may
share some commonalities, but they also represent a wide spectrum or pres-
entation of identity. Thus, they will also display a wide range of plays. The
complexities of neurodivergent play are not complex for the neurodiver-
gent ­child – ​­they understand their play preferences and interests and value
(­without judgment) their play. It is often the adult (­usually a neurotypical
adult) that finds the neurodivergent child’s play complex. This is often
coming from a ­pre-​­determined and conditioned view of play. When the
adult encounters neurodivergent play that does not fit the preconceived
notion of play, the adult has a difficult time recognizing and valuing the
neurodivergent child’s play.
Consider the following excerpt from an autistic teen’s transcript notes and
script for their video presentation and keynote address at Autistics Present
Symposium: Essential Youth Voices on October 19, 2019 (­Mydske, 2019).
When I was young doctors and therapists told my mom I needed to play
differently. When I’m told that I play in the wrong way it makes me feel
kind of upset. I liked lining up toys for lots and lots of reasons, but no one
had ever asked me why. The pros of lining up toys is some people like
to have things in order, some people like to look at patterns and they’ve
helped… they helped me see all the parts to rebuild them in different
ways and that is creativity more or less. It also made me feel good to look
at my collection and it never hurt anybody either.

I interact with the world in autistic ways and there is nothing wrong
with that.
 Neurodivergent Play 99

There is no right way to play but the most important thing is that every-
one has fun. Just because you don’t understand the value of doing things
my way, that doesn’t make it wrong. Telling people how they have to
play kind of defeats the purpose of playing in the first place.

Play is not work; it holds a natural, intrinsic value (­Landreth, 1991). Play
performs an important preventative function in the lives of children and
serves as an intervention to assist children in coping with personal chal-
lenges. Research continues to demonstrate that play performs an important
role in the development of the b­ rain – ​­rehearsing behaviors, creating neural
connections, learning to ­problem-​­solve, and developing creativity (­Taylor,
2019). Unfortunately, play is sometimes misunderstood by adults who work
with children. Play can be seen a silly, meaningless, a waste of time, and is
often taken away in place of something “­more important” or withheld as a
reward for some type of compliance.
Regarding play, there seems to be two fundamental questions and possible
issues with adults working with neurodivergent children. (­1) Does the adult
understand the therapeutic powers and importance of play, or do they view
it as frivolous? (­2) If the adult does believe in the therapeutic powers and
importance of play, does the adult believe that autistic and neurodivergent
children play, or do they believe that play, and its therapeutic powers, are
somehow lost on neurodivergent children? In AutPlay Therapy the growth
and healing dynamics of play are well understood and are the forefront of
the therapy work being done. Further, AutPlay protocol unequivocally rec-
ognizes that neurodivergent children play and their play is no less beneficial
and is no less important than any child’s play. F­ igure 4.1 illustrates some
of the possible play preferences that neurodivergent children may exhibit.
They are presented in equal ­importance – ​­one type of play or preference of
play is not more important that another.
There is no optimal way to play, and children cannot fail at play. Yet time
and time again, play is boxed into neat and contained categories, often ex-
cluding neurodivergent children. Think of the times you’ve heard someone
say that autistic children cannot ­role-​­play or be imaginative. It immediately
frames autism as ‘­lacking’ when it comes to playing. The therapeutic powers
of play rejects rigid descriptions of play and acknowledges that it has endless
and unknown possibilities. Essentially, play cannot be fully defined because
it is so vast. Our role as therapists is to become play protagonists. We need
to become curious, rather than dubious, when we see play that we might not
understand. And we need to introduce a p­ lay-​­rich environment for autistic
and neurodivergent children (­Murphy, 2021).
100 Neurodivergent Play

Pretend

Group Functional

Play

Constructive Sensory

Technology

­Figure 4.1 The Spectrum of Play. What Are the Neurodivergent Child’s Play
Preferences?

Murphy (­2021) proposed several tips for working with and implementing
play with autistic and neurodivergent children:

• Be open minded during play and challenge your conventional percep-

tions of what play “­looks” like.
• Don’t shut play down too early just because you don’t immediately un-
derstand where it’s going.
• Allow children control and ownership of their play.
• Use a “­small dose” approach to learning, and don’t be afraid to break
tasks down further to support development.
• Focus on the unique child, what they need and assess how best to support
them. Help them find out who they are and flourish in what they find,
instead of ‘­fixing’ them and looking at their behavior through a neuro-
typical lens.
• Always start with the characteristics of effective learning for an insight
into who the child is as a learner.
• Don’t separate the child from the process of play for the purpose of
intervention.
• Make sure to read signs of engagement, involvement, and ­non-​­consent
when interacting with a child.
 Neurodivergent Play 101

Neurodivergent children will play if they are given the space to do so. They
will play and they will access the value and benefits of play. For adults who
wish to join children in their play and/­or utilize the child’s play for therapeu-
tic ­work – ​­it all starts with relationship! For the therapist, it is the interwo-
ven nature of the natural language (­play) of the child and the development
of the therapeutic relationship that creates the atmosphere for growth and
healing. The way the play therapist understands the integration of these two
constructs and facilitates their existence in a naturalistic rhythm is the key
to laying the foundation for neurodivergent children to address their mental
health needs.
Consider the writing How to Play with an Autistic Child (­Vance, 2020). It
beautifully illustrates the importance of building relationship, attuning to
the child, and respecting and entering their play.

If your autistic child is playing by lining up toys or doing something

repetitive, bring your own toys, assume a reasonable distance, and play
happily and silently. Use sparkly toys, blocks, cars, spinning toys, pots
and pans, kinetic sand, magnets, canned food, stickers, dry pasta, color-
ful dough, etc.

Try something new if it doesn’t work the first time. Make a craft. Spin
something that sparkles. Meditate and quiet your mind. Find content-
ment in not worrying, fixing, controlling. Let it all go and stare into a
shiny pinwheel. Watch the way the light bounces and bends, sending a
spattering of dancing lights over your face and chest. Grab a handful of
raw pasta and let it fall from your fingers and try to feel and visualize how
many have fallen.

Put an individual drop of water on the back of your hand. See if you can
feel each fine, ­barely-​­visible hair bend as it slides off. Don’t think of au-
tism. Don’t think of bills. Don’t think. Experience. Breathe consciously.
Conjure a beautiful or a fiery song in your head.

See if you can make your mind play each note in memory. If you can’t,
listen harder next time. Don’t hear. Listen. Once you have learned to
be still, present, breathing, realize how connected you feel to your child,
and to all things, in that moment.

Your child might be curious to join you. They might give you the most
profound gift of communicating without the baggage and bondage of
words. You will learn nothing. You will unlearn. If your child doesn’t
join, just feel. Feel close. Don’t feel disappointed. Feel love. Relax.

Your child might be so sensitive to your tension, worry, and fear that
they internalize it. Just be. Think like your child. Lie opposite your child
102 Neurodivergent Play

and color in a coloring book. Knit. Blow bubbles in the house. Color on
the walls and laugh at how fun it is. Magic erasers work.

Eat your dinner while sitting on the floor. Use your fingers. Do this more
often, and watch your relationship transform. Play like an autistic and
watch your life improve. Laugh at yourself for playing, not in a perform-
ative way. Belly laugh at the rebellion.

If your child joins, great. If not, great. You have spent quality time to-
gether. You have communicated something profound. You have said: I
enjoy being me while you’re being ­you – ​­together.

Respecting neurodivergent play means challenging assumptions about what

play is and how to measure it. It means reminding ourselves that just because
a child does not play with pink and blue plastic toys doesn’t mean they are
not playing. It means not asking a child to show you their play “­skills” and
devaluing their play preferences. It means understanding their play can look
anyway they like, and our job is to join them in their play without judgment.
Respecting neurodivergent play means the mental health community needs
to apologize for decades of mistakenly insisting that autistic and other neuro-
divergent children do not play and play therapy approaches would not work
for them. It means asking what I can do differently to honor the child’s play
instead of forcing the child to play the way I deem is play.

Case Examples of Play

The following case examples are vignettes that highlight the child’s play
preferences. In each example there were some additional processes and
components that are not covered in the example. The purpose of the exam-
ples is to better illustrate the variety of play preferences of neurodivergent
children.

Len

Len entered AutPlay Therapy as a ­12-­​­­year-​­old male diagnosed with ADHD

and sensory issues. His parents described Len as having a difficult time reg-
ulating and expressing his emotions and challenges socially with peers. Len
presented as a quite ­pre-​­teen and was cooperative and seemingly interested
in being in therapy. He concurred with his parent’s description of himself and
added that he also has challenges dealing with his younger sister. As part of
the AutPlay intake and assessment phase, Len was given a tour of the whole
 Neurodivergent Play 103

clinic and shown all the playrooms, the sandtray room, and the outdoor play
area. Len did not seem interested in much play (­he did not like pretend play
or technology play) and the beginning sessions he mostly wanted to stay in
my office and talk, although his conversional talk was usually minimal. He
had indicated on a play assessment that he liked sports, especially football, so
we explored some outdoor play such as throwing the football back and forth,
but it really didn’t seem to engage Len.
Around session 6, Len asked if he could “­Go to that room that had all the lit-
tle things and sand.” I said “­yes,” and we went to the sandtray room. Len had
never participated in any type of sandtray work, but he was highly interested.
I introduced the sandtray room to him giving him a basic description. I asked
him if he wanted to create a sand tray and he did. I told him he could create
whatever he wanted, or I could give him a theme. He requested a theme, so I
asked him to create a sand tray describing himself and his life. Len created a
tray and shared about himself and his life for about 10 minutes. This was the
most expressive and communicative Len had been since beginning therapy.
After he was finished, I asked him if he wanted to create a tray any way he
wanted. He did, and he created another tray and again thoroughly shared
about his tray.
We continued to do sandtray work with Len each session and occasionally
implemented other forms of expressive techniques. Len responded most pos-
itively to these types of play and interventions. These approaches served
the basis for our work toward his therapy goals. It is important to note a few
things about Len’s example:

• Len discovered a type of play that resonated with him (­something he had
not been doing in his life) and could be used to help Len work on his
therapy goals. I was comfortable with and allowed this process to unfold
for Len to find his play preferences.
• Initially, I tried some different things (­outdoor football play) based on
my understand of Len, but I did not force anything and if something was
not a fit, we moved on.
• Len’s play preferences were not just a discovery of play; they provided an
avenue for him to express himself and address his therapy needs.

Brent

Brent entered AutPlay therapy as a n

­ ine-­​­­year-​­old male diagnosed with au-
tism. His parents were concerned that Brent seemed depressed and had a
104 Neurodivergent Play

great deal of ­anxiety – ​­mostly associated with going to school and interacting
with peers. Brent presented very interested in play therapy but was mini-
mally active. He did not say much but seemed focused and attuned. His play
assessment did not show any specific play preferences. His parents indicated
that he did not do much play at home. Brent had received a tour of the clinic
(­including the playrooms) and he seemed most interested in being in one of
the playrooms that had a specific type of ­toy – ​­Goo Jit Zu figures. These are
characters that are stretchy, squishy, and have different materials inside of
them for different tactile experiences when you play with them. Brent really
liked the Goo Jit Zu figures and wanted to play with them every session. He
would set them up to battle each other and enjoyed simply stretching and
squishing them in his hands.
I quickly noticed that Brent was drawn to sensory play. My office and all
the playrooms are healthily stocked with sensory toys and materials. Brent
would often play with tactile sensory toys manipulating them in his hands.
He also enjoyed play that moved his body. He would balance on the wobble
board and his favorite was hopping on an exercise ball in my office and then
bouncing his body off the ball. He would do this play repeatedly. Through
observation I discovered that Brent sought tactile and proprioceptive sen-
sory input, and this was the type of play he was most drawn toward. I worked
with Brent and his parents to establish a regulation/­sensory playtime at home
that the family could do together. This was successful and greatly helped
reduce Brent’s feeling of anxiety and depressions. Throughout therapy, he
became more regulated and emotionally felt in a positive place. A few things
to note about Brent’s example:

• Brent was given the space and opportunity to discover and show his play
preference. I was keenly aware of Brent and observing his play to better
understand his play interests.
• The discovery of Brent’s sensory play and further his sensory needs were
new to Brent and his parents. This enabled a referral for Brent to ac-
cess sensory based therapy at school which helped with some of Brent’s
school issues.
• Brent’s anxiety and depression (­his overall dysregulation) was greatly im-
proved by utilizing Brent’s play preferences and involving his parents in
creating a regulation play time at home, which not only helped Brent,
but he also enjoyed.
• There were additional issues addressed in this case. There were some
school advocacy issues that needed work and some additional parent ses-
sions, but the focus of the example is on highlighting the play of Brent.
 Neurodivergent Play 105

Ella

Ella entered AutPlay Therapy as a ­ten-­​­­year-​­old female diagnosed with au-

tism and sensory processing disorder. Ella’s parents were concerned about
her becoming dysregulated very easily and this would usually lead to phys-
ical aggression toward others. She was also struggling in school with peers,
sensory issues, and becoming overwhelmed. Ella’s play assessment indicated
that Ella enjoyed expressive activities, and anything related to art and craft
creation. She did not like or participate in pretend, movement, or technol-
ogy play.
The majority of Ella’s sessions focused on expressive art play. Ella would cre-
ate many things and we explored a variety of feelings and thoughts about
herself through the expressive play. Ella would share much of this with her
parents which increased dialogue and understating between Ella and her par-
ents. One key intervention was the creation of a sensory mandala. This is
a technique I created for Ella. It combined the expressive play she enjoyed
with a sensory regulation technique. The idea come from contemplating a
way that Ella could regulate herself when she noticed she was feeling over-
whelmed. She liked creating mandalas and found this process calming. I
gathered several tactile items (­cotton balls, ribbon, pipe cleaners, sandpaper,
buttons, beads, etc.) and several olfactory items (­scented stickers, scented
markers, essential oil spray, etc.) and introduced the idea to Ella for creating
a sensory mandala.
The basic instruction for a sensory mandala is to draw the mandala circle
on a piece of card stock (­this is heavier than regular paper and holds the
material better). The child can then draw or write anything they want in
the mandala, but they also add sensory (­tactile and olfactory) items into the
mandala. They typical glue or tape the items in the mandala. The child takes
time to manipulate, feel, and smell each item to choose the ones they enjoy.
The items along with whatever the child draws/­colors forms the mandala.
­Figure 4.2 provides an example of a sensory mandala. Once they have fin-
ished, they can keep the mandala for refence.
Ella loved the sensory mandala. She began to create several of them in play
sessions and at home. Her parents supported this play by stocking her room
with sensory mandala materials. Over time, Ella began to notice when she
was feeling dysregulated at home and would go into her room without any
prompting from her parents and create a sensory mandala to help her regu-
late. This would take her around 30 minutes and then she would return to
the rest of the family feeling regulated. The sensory mandala play became a
106 Neurodivergent Play

­Figure 4.2 Sensory Mandala Example.

great tool for Ella in helping her address her therapy goals. A few notes about
Ella’s case example:

• Ella is a great example of her play preferences and interests being used
to help address her needs. In the process, she leaned about herself and
discovered sustainable things she could do to help her system regulate.
• I did not try to force her to play in any other way. We went with her
play preferences. Not only was this helpful but it also facilitated health
relationship development.
• I did address some additional things in this case. Similar to Brent’s case,
there were some school advocacy needs and some parent sessions but the
focus of this example is highlighting the preference and effectiveness of
expressive play with some neurodivergent children.
 Neurodivergent Play 107

Danny

Danny entered AutPlay Therapy as an ­eight-­​­­year-​­old male diagnosed with

autism (­with a presentation similar to pathological demand avoidance).
Danny’s parents were concerned that he was experiencing a great deal of
anxiety, often debilitating, resulting in him not being able to leave his home.
Going to school was especially challenging. Danny’s play assessment and
observations clearly displayed that Danny liked pretend play. During his play
observations, he was fully engaged with many toys in the playroom creating
scenes, symbolism, and engaging in pretend play. His parents acknowledged
this was typical of Danny, he spent most of his time in pretend play and pre-
ferred this activity over all others.
Danny’s sessions were very similar to child centered play therapy sessions.
Danny would enter the playroom and immediately begin to engage in pre-
tend play. One of his favorite things was to use several of the puppets and
create an elaborate story about them all competing in a contest. They each
had names and personalities and ways they would interact with each other.
Danny created a running story about the puppet characters competing in a
contest where each week one of them would get limited. There was a great
deal of fantasy play happening and Danny would always include me, put-
ting me in the role of several of the puppet characters. As sessions went on,
I began to see play themes emerging in Danny’s puppet play. There were
consistent themes of the unknown, unpredictable, how things could change
and surprise you and you were not prepared. These were all played out in a
negative ­context – ​­the unpredictable was bad and scary for the puppets. He
also began to play out themes that looked very similar to issues he was having
at school. The characters would struggle (­in their own way) with things he
was struggling with at school. When Danny would have a victory at school,
the puppets would have a victory in their journey.
Danny’s fantasy/­pretend puppet play provided many natural opportunities
to address and express his emotions and concerns. There was depth, elab-
orateness, and healing elements in his pretend play. It was important that
I recognize this and see the expression of his natural language as essential
therapeutic process. A few notes about Danny’s case example:

• It was easy to identify Danny’s play presences as he went right to the

playroom and began engaging in pretend play. It created an easy under-
standing for me (­the therapist) to support Danny through a more nondi-
rective (­child centered play therapy) process.
108 Neurodivergent Play

• Danny expressed himself through his ­characters – ​­his worries, his strug-
gles, his victories. It provided a space of expression and exploration and
well as resolution.
• Danny is a good example of not devaluing the play preference of pretend
play. As sessions went on, Danny began to talk more about himself and
his experiences/­needs. Some solutions he came to on his own through
his play, others we were able to talk about together. The valuing of his
play preference instead of trying to force him into a more directive or
“­talk therapy” process gave him the space to feel safe, heard, and express
himself.

References

Landreth, G. L. (­1991). Play therapy: The art of the relationship. Accelerated Devel-
opment Publishers.
Murphy, K. (­ 2021). Neurodiverse play is the way. https://­ www.famly.co/­ blog/­­
neurodiverse-­​­­play-­​­­is-­​­­the-​­way
Mydske, L. W. (­2019). Respecting autistic ways of playing, interacting & making
friends. https://­neurodiversitylibrary.org/­2019/­10/­20/­­respecting-­​­­autistic-­​­­ways-­​­­of-­​
­­playing-­​­­interacting-­​­­making-​­friends/
Schaefer, C. E. & Drewes, A. A. (­2014). The therapeutic powers of play: 20 core change
agents (­2nd ed.). John Wiley & Sons.
Spiel, K., & Gerling, K. (­2020). The purpose of play: How HCI games research fails
neurodivergent populations. ACM Transactions on Computer Human Interact,
28(­2). https://­doi.org/­10.1145/­3432245
Taylor, E. R. (­2019). ­Solution-​­focused therapy with children and adolescents: Creative
and play based approaches. Routledge.
Vance, T. (­ 2020). How to play with your autistic child. https://­ neuroclastic.
com/­­how-­​­­to-­​­­playwith-­​­­your-­​­­autistic-​­child/
Waltz, M. (­2020). The production of the ‘­normal’ child: Neurodiversity and the
commodification of parenting. In H. Rosqvist, N. Chown, & A. Stenning (­Eds.),
Neurodiversity studies (­p­­p. ­15–​­26). Routledge.
 5
Play Therapy and the Therapeutic
Powers of Play

Play Therapy

Play is a child’s form of improvisational dramatics. Playing is how the child

tries out and learns about their world, and it is therefore essential to their
healthy development. For the child, play is serious, purposeful business
through which they develop mentally, emotionally, physically, and socially.
Play is the child’s form of self-​­​­​­
­­ therapy, through which confusions, anxieties,
frustrations, pain, and conflicts are often processed. Play performs a vital
function for the child. It is far more than just the frivolous, lighthearted,
pleasurable activity that adults usually make of it. Play also serves as a lan-
guage for the ­child – ​­​­​­a symbolism that substitute words. The child uses play
to formulate and assimilate what they experience (­­Oaklander, 2007).
Origins of play therapy can be traced back to the early 1900s. Anna Freud
and Melanie, Klein, and David Levy are often credited with being pioneers
in the field for introducing play in therapy and setting the foundation for fur-
ther development. In the 1940s, Virginia Axline applied the philosophy and
constructs of ­­person-​­​­​­centered therapy in her work in counseling children.
Ray (­­2011) stated that Axline was especially influential on play therapy’s
development as she was the first play therapist to undertake extensive in-
vestigation of her therapy methods through research. Second, she provided
a structure to the theory and delivery of play therapy in her publication Play
Therapy (­­Axline, 1947). Third, she published the book Dibs: In Search of Self
(­­Axline, 1964) detailing the course of play therapy over a year with a child.
Play therapy as a field became more formalized and established by ­­forward-​­​­​
­thinking clinicians in 1982 with Charles Schaefer and Kevin O’Conner
founding the Association for Play Therapy (­­APT) and Garry Landreth, Lou-
ise Guerney, and others envisioning a movement of individuals joined by a
common interest in play as a therapeutic model. In 1983, a small group of

DOI: 10.4324/9781003207610-6
110 Play Therapy and the Therapeutic Powers of Play

people gathered to have the first national play therapy conference in New
York. The gathering included around 50 professionals (­­Gil, 2021).
The play therapy field has always been exciting in its evolution. The Asso-
ciation for Play Therapy (­­APT) (­­2022b) recently developed and published a
list of the seminal theories of play therapy that are valid and reliable methods
for guiding its practice. Those foundational theories include Psychoanalytic,
Behavioral, Humanistic, Adlerian, Developmental, and Jungian, to name
a few. These theories are well articulated and established, and ongoing re-
search and practice efforts are underfoot to target key issues that might ben-
efit from different forms of play therapy, such as ADHD, OCD, anxiety and
depression, anger and dysregulation, gender identity concerns, suicidal ten-
dencies, and other symptomatic behaviors or conditions. In addition, play
therapists have documented methods for providing services to specific target
groups: traumatized children, witnesses of interpersonal violence, children
with sexual behavior problems, children with anxious attachment behaviors,
developmental disabilities, etc. And still other play therapists have devel-
oped and shared expertise on working with infants and toddlers, ­­elementary-​­​­​
­aged, or teen clients, as well as couples and families. And thus, the plethora
of approaches and interventions continue, likely falling into one of the sem-
inal theories, and allowing therapists to customize their techniques to meet
unique needs of the target groups mentioned, and those that will emerge
(­­Gil, 2021).
“­­Play therapy” can best be thought of as an umbrella term, as there are cur-
rently several play therapy theories and approaches that exist. Play therapy
approaches range from being nondirective to directive in terms of the ther-
apist’s involvement in the process with their clients. Some theories and ap-
proaches of play therapy rely heavily on the use of toys and props while other
theories use toys minimally. Most play therapy approaches involve some use
of toys, props, art, music, movement, or games as an avenue to help clients
achieve their therapeutic goals. The Association for Play Therapy (­­2022a)
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.
Currently, the Association for Play Therapy recognizes ten seminal and/­­or
historically significant play therapy theories and approaches. The list in-
cludes Adlerian, ­­Child-​­​­​­Centered, ­­Cognitive-​­​­​­Behavioral, Developmental
(­­Viola Brody), Ecosystemic, Filial, Gestalt, Jungian, ­­Object-​­​­​­Relations, and
Theraplay. Beyond these ten recognized, there exist several established and
 Play Therapy and the Therapeutic Powers of Play 111

emerging play therapy theories, approaches, and modalities such as Sandtray

Therapy, Family Play Therapy, Experiential Play Therapy, Expressive Play
Therapy, Relationship Play Therapy, First Play, AutPlay Therapy, Digital
Play Therapy, TraumaPlay, Solution Focused Play Therapy, Synergetic Play
Therapy, and Animal Assisted Play ­Therapy – ​­​­​­to name a few.
Many play therapists ­­self-​­​­​­identify as an integrative play therapist (­­combining
different therapeutic methods, interventions, and approaches to best fit the
needs of the individual client) or prescriptive play therapist (­­selecting and
implementing a particular play therapy approach that research has indicated
is likely to be the most effective for a specific problem or symptom). The
possibilities of what “­­play therapy” might mean or look like in implementa-
tion are so varied that I often teach parents if someone tells you they do play
therapy, the next question you should ask is “­­What type of play therapy do
you do?” (­­Grant, 2021).
Play therapy is not the same as regular, everyday play. While spontaneous
play is a natural and essential part of the developmental process, play therapy
is a systematic and therapeutic approach. Play therapists have earned a grad-
uate mental health degree and are licensed mental health professionals with
extensive training, supervision, and education in Play Therapy (­­The Associ-
ation for Play Therapy, 2022a). Play therapy incorporates a growing number
of ­­evidence-​­​­​­based practices and techniques and should only be utilized by
specially trained mental health professionals. While some play therapists do
not possess a specialized play therapy credential, a Registered Play Thera-
pist (­­RPT), Registered Play ­­Therapist-​­​­​­Supervisor (­­­­RPT-​­​­​­S), or School ­­Based-​­​­​
­Registered Play Therapist (­­­­SB-​­​­​­RPT) are those professionals who have met
the stringent standards set by APT to become a credentialed Play Therapist.
Play therapy approaches have been successfully implemented for children,
adolescents, adults, families, couples, and groups. Play therapy offers the abil-
ity to communicate ­­inter-​­​­​­processes and emotions without using verbal com-
munication and provides awareness properties to help put words to otherwise
unidentified issues. The freedom from judgment and the ability to create
and explore through play therapy offers safety for clients and facilitates an
almost innate desire that exists in all p­ eople – ​­​­​­the desire to play. Kottman
and ­­Meany-​­​­​­Walen (­­2018) highlighted the variance and complexities within
play therapy:
There are many things to consider when you examine the logistics of
play therapy: stages of play therapy; skills, strategies, and techniques;
toys and play therapy materials; explanation of play therapy for parent
and clients; the first session; what to do in sessions; how to end a session;
112 Play Therapy and the Therapeutic Powers of Play

course of therapy, and termination. The process of play therapy can un-
fold in multiple ways depending on the theoretical approach to play
therapy and a therapist’s personal preferences.
(­­­p. 13)

Kevin J. O’ Conner (­­2000) contended that there is a biological, intraper-

sonal, interpersonal, and sociocultural function of play behavior in the lives
of children and furthered the definition of play therapy: play therapy con-
sists of a cluster of treatment modalities that involve the systematic use of a
theoretical model to establish an interpersonal process wherein trained play
practitioners use the therapeutic powers of play to help clients prevent or re-
solve psychosocial difficulties and achieve optimal growth and development
and the ­­re-​­​­​­establishment of the child’s ability to engage in play behavior as
it is classically defined.
The benefits of children engaging in play include cognitive development
(­­learning, thinking, and planning, etc.), social needs (­­practicing social in-
teraction, roles and routines), language (­­talking to others, turn taking, etc.),
­­problem-​­​­​­solving (­­negotiation, asking for help, solving difficulties, etc.), and
emotional development (­­managing feelings, understanding others, empathy,
etc.). Children with play skills are more likely to be included with their
peers and play is a key learning tool through which children develop social
navigation, flexibility, core learning skills, and language. Play also provides
opportunities for children to practice events, situations, and routines in a
safe place, with no pressure to “­­get it right” (­­Phillips & Beavan, 2010).
Play therapy is a theoretical modality that uses a wide variety of methodologies
to communicate with clients, including adventure therapy, storytelling and
therapeutic metaphors, movement/­­dance/­­music experiences, sandtray activ-
ities, art techniques, and structured play experiences in addition to free, un-
structured play. Interactions in play therapy should always allow for and even
encourage ­­self-​­​­​­expression, creative representation, and imagination. Play ther-
apy is a relationship in which a trained therapist creates a safe space for clients
to explore and express themselves (­­Kottman & ­­Meany-​­​­​­Walen, 2018, ­p. 6).
Hudspeth (­­2021) stated that for play therapists, their play therapy is an-
chored in one or more of the seminal play therapy theories. A play ther-
apist’s theoretical orientation runs like a thread through everything from
conceptualization to assessment to diagnosis to treatment planning to deliv-
ery and through termination. It unifies what they see and do into a tightly
woven bundle. For a play therapist, play is the language and toys are the
words clients use; play is more than a tool and a means to an end (­­Landreth,
2012). It is the developmentally appropriate and naturalistic conduit that
 Play Therapy and the Therapeutic Powers of Play 113

incorporates the therapeutic process and the relationship provided to help

clients evolve positively in their overall growth and development. Kottman
and ­­Meany-​­​­​­Walen (­­2018) expressed that play therapy responds to the devel-
opmental level of the person and the area of the brain impacted by distress-
ing events. Play therapy is different from “­­just playing” because the presence
of an empathic and attuned witness helps clients process their experiences,
feelings, and thoughts.
Play therapy isn’t just a nice idea. To date, there are four peer-​­​­​­ ­­ reviewed pub-
lished ­­meta-​­​­​­analyses on outcome effect of play therapy interventions; one
­­meta-​­​­​­analysis includes a systematic review. Lin and Bratton (­­2015) con-
ducted ­­meta-​­​­​­analysis with 24 ­­child-​­​­​­centered play therapy studies and con-
cluded that play therapy demonstrated a statistically significant effect. Ray
et al. (­­2015) performed a ­­meta-​­​­​­analysis and systematic review of 23 ­­child-​­​­​
­centered play therapy RCTs conducted in schools and concluded that play
therapy demonstrated statistically significant outcomes for children with dis-
ruptive behavior, internalizing, ­­self-​­​­​­efficacy, and academic problems. Bratton
et al. (­­2005) employed ­­meta-​­​­​­analysis with 67 play therapy studies and found
statistically significant effects with medium effect size, concluding that play
therapy was effective with both internalizing and externalizing problems.
LeBlanc and Ritchie (­­2001) used ­­meta-​­​­​­analysis to explore findings of 42
RCTs on play therapy, reporting statistically significant effects with mod-
erate treatment effect size. T ­ able 5.1 highlights the published metanalysis
(­­Ray & McCullough, 2016).
Ray (­­2011) developed a list of functions served by play in play therapy result-
ing from a review of the history and theories of play:

1 Fun: The use of play in play therapy provides the opportunity for fun, ei-
ther for the child or for the therapist and child. Although it is recognized
that play is not always fun for the child, especially in therapy, it can of-
ten be fun. The allowance of fun in a therapeutic environment lowers a
child’s resistance to the therapeutic relationship and offers an experience
that is often missing from the life of a child who is experiencing several
environmental conflicts.
2 Symbolic expression: Play in play therapy allows for the symbolic expres-
sion of thoughts and feelings. As eloquently presented by both Piaget
and Vygotsky, children use symbols for the acquisition of language and
expression of emotion and cognition. The symbolic expression of play
in therapy invites the play therapist into the child’s world. The child is
no longer confined by reality and can pretend, creating scenes for the
expression of emotion or building of coping skills.
114 Play Therapy and the Therapeutic Powers of Play

­Table 5.1 O
 verview of Four ­­Peer-​­​­​­Reviewed Published ­­Meta-​­​­​­Analyses on Outcome
Effect of Play Therapy Interventions

Authors Number Mean Age Effect Favorable Outcomes

of Studies Size
Lin and 24 6.7 years 33a Externalizing and
Bratton internalizing behavior
(­­2015) problems; ­­caregiver-​­​­​­child
relationship stress; ­­self-​­​­​
­efficacy
Ray et al. 23 Range .­­21–​­​­​­.38a Externalizing and
(­­2015) ­­4–​­​­​­13 years internalizing behavior
No Mean problems; ­­self-​­​­​­efficacy;
Reported academic; other
Bratton 67 7.0 years .72a Behavior problems; social
et al. (­­2005) adjustment; ­­self-​­​­​­concept;
anxiety; development;
relationships; other
LeBlanc 42 7.8 years .66a+ Emotional adjustment;
and Ritchie social adjustment;
(­­2001) reaction to traumatic
event; academic;
behavior problems; family
adjustment
Source: Ray and McCullough (­­2015; revised 2016).
a
ES is statistically significant + Studies included ­­parent-​­​­​­involvement.

3 Catharsis: Play in play therapy allows a child to work through those is-
sues of greatest consequence to the child. Nondirected play provides an
environment in which the child chooses direction of effort.
4 Social development: Play not only allows for the expression of the child’s
world, but also promotes communication between child and t­ herapist –​­​­​
­or in the case of group play therapy, between peers. The building and
maintaining a nurturing relationship facilitated through play strength-
ens a child’s social motivation and skills.
5 Mastery: In play therapy, play is used by the child to control their world.
They have the power to be anything and the capability to do anything.
They are not limited by ­­real-​­​­​­world restraints. The child uses play in
 Play Therapy and the Therapeutic Powers of Play 115

play therapy to develop a sense of control and competence over the

environment.
6 Release of energy: Although the use of play to release energy may not
seem like a therapeutic endeavor, children are likely to use play therapy
as a place of free expression for unused or confining energy. Children
who spend the day attempting to “­­keep it together” in structured en-
vironments often need a safe place for energy release, which, once ex-
panded, allows for focused therapeutic work.
(­­p­­­­p. 14–​­​­​­15)

Play Therapy and Neurodivergent Children

Play therapy has not always been considered a viable approach for working
with autistic and neurodivergent children. In fact, using any type of ­­play-​­​­​
­based approach to working with autistic children and/­­or children with de-
velopmental disabilities was considered ineffective and a waste of time. The
leading, misinformed, and often harmful belief that autistic children and
those with intellectual developmental disorder did not play, did not under-
stand play, and play held no therapeutic value for them, permeated many
­­autism-​­​­​­focused “­­treatments” for decades. Ableist thinking and processes
guided many autism-​­​­​­
­­ related therapies as autistic children were often viewed
as the equivalent of an animal that required training.
It was in the 2000s that play therapy began to emerge as a therapy approach
that could be beneficial to autistic children and their families. Play thera-
pists began to see more autistic children and recognized the antiquated ideas
that autistic children did not play were not true. Further, they began hav-
ing experiences of growth and success in helping autistic children address
various mental health needs utilize play therapy. Around the same time,
autistic adults began to speak and write about their experiences as c­ hildren –​­​
­​­noting that they did play and engaged in various types of play and the adults
around them did not understand and often mislabeled their play. Autis-
tic adults began to share about their experiences with rigid and “­­training”
oriented therapies and “­­treatments” that felt abusive and created anxiety,
depression, and low ­­self-​­​­​­worth issues. They began to share about the need
for and importance of more relational and humanistic infused therapy ap-
proaches and the play therapy community began to listen. Research using
play therapy with autistic children can be dated back to 1970, but arguably
the last ­­10–​­​­​­15 years has amassed the greatest amount of research support for
implementing play therapy with autistic and neurodivergent children. The
116 Play Therapy and the Therapeutic Powers of Play

following highlights important points in the history of play therapy and

autism (­­including significant research):

1970: This study is published using group play therapy with 6 children ages
­­8–​­​­​­13. They were hospitalized boys with diagnoses of childhood schizo-
phrenia or infantile autism (­­Pratarotti, 1970).
2005: Robert Jason Grant presented the training titled Using Play Therapy
with Autism which highlighted the beginning of what would become the
AutPlay Therapy framework.
2011: Kevin Hull published Play Therapy and Asperger’s Syndrome: Helping
Children and Adolescents Grow, Connect, and Heal through the Art of Play.
2012: Loretta ­­Gallo-​­​­​­Lopez and Lawrence Rubin published ­­Play-​­​­​­Based Inter-
ventions for Children and Adolescents with Autism Spectrum Disorders.
2013: Robert Jason Grant published AutPlay Therapy: A Play Therapy
Approach for Autism, Neurodevelopmental Disorders, and Developmental
Disabilities.
2014: Therplay was recognized by the U.S. Substance Abuse and Mental
Health Services Administration for inclusion on the National Registry
for ­­Evidence-​­​­​­based Programs and Practices as an effective approach for
autism spectrum disorder.

2022: Robert Jason Grant Published The AutPlay® Therapy

Handbook

Today, we fully understand that play therapy approaches can hold many ben-
efits for autistic children and their families, especially in addressing mental
health needs with which they may be struggling. Play therapy is uniquely de-
signed for and responsive to the individual and developmental needs of each
child and recently, there has been an increase in child therapy literature
emphasizing play as the ideal way to address social and emotional difficul-
ties in children (­­Bratton, Ray, Rhine, & Jones, 2005; Josefi & Ryan, 2004).
Research has shown that autistic children participating in play therapy have
gained improvement in attachment issues, social needs, ­­self-​­​­​­regulation, cop-
ing with changes, emotional response, and autonomy (­­Josefi & Ryan, 2004).
Sherratt and Peter (­­2002) suggested that play interventions and experi-
ences are extremely important to autistic and neurodivergent children. They
stated that simultaneously activating the areas of the brain associated with
emotions and generative thought while explicitly involving children in play
will lead to success. Further, Thornton and Cox (­­2005) conducted individual
 Play Therapy and the Therapeutic Powers of Play 117

play sessions with autistic children specifically to address behavior concerns.

They incorporated techniques which included relationship development,
gaining attention, turn taking, enjoyment, and structure. Their research
found that play interventions did impact on the child’s behavior with a re-
duction in dysregulated behavior following the structured play interventions.
On a theoretical level, the therapeutic foundations provided by play therapy
approaches of unconditional positive regard, empathy and congruence (­­e.g.
therapists’ use of their own feelings therapeutically as they arise within social
interactions) and the method’s more recent emphasis on a developmental
approach to t­ herapy – all
​­​­​­ point to the possibility that this modality can en-
able autistic and neurodivergent children to benefit both emotionally and
socially. The therapeutic condition of unconditional positive regard concen-
trates on accepting children’s current self, along with assuming they possess
an innate drive toward growth and healing. In theory, this allows autistic
children to choose the pace and focus of change themselves, thus enabling
interaction to be instigated by children rather than adults, as well as increas-
ing the children’s autonomy under the very favorable conditions of the play-
room. In addition, play therapy’s emphasis on children and adults’ emotional
responses, and therapists’ skilled use of empathy to enter children’s unique
inner worlds essentially target areas of development in which autistic chil-
dren can benefit (­­Josefi & Ryan, 2004).
Play Therapy can be an appropriate modality in working with neurodiver-
gent children especially when working with children who have challenges in
traditional communication methods (­­Parker & O’Brien, 2011). Play therapy
approaches are gaining more and more valid research as effective therapy ap-
proaches for neurodivergent children and adolescents’ mental health needs.
Play therapy approaches provide the opportunity for the therapist to individ-
ualize therapy and engage the child in a playful and natural way that other
therapies may not offer.
Arguably, some play therapy approaches have more research support for ad-
dressing the mental health needs of autistic and neurodivergent children
than others (­­Child Centered Play Therapy), some are more specifically de-
signed for autistic and neurodivergent children (­­AutPlay Therapy and Ther-
aplay), and some incorporate more ­­evidence-​­​­​­based practices than others
(­­Cognitive Behavioral Play Therapy). The variety of therapeutic response in
what is play therapy provides opportunity to individualize and uniquely ad-
dress 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.
118 Play Therapy and the Therapeutic Powers of Play

Several approaches have shown successful clinical outcomes; most notably

Filial Therapy (­­VanFleet, 2014), 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 expression, communi-
cation, and provide improvement in the parent/­­child relationship (­­Howard
et al., 2018). Banerjee and Ray (­­2013) proposed that some core mental health
issues can be addressed through play therapy such as relationship develop-
ment, and recognition and expression of emotion. Further, they reported
that play therapy can be effective for gains in sensorimotor play, reducing
problem behaviors, and improving ­­self-​­​­​­worth.
As a play therapy approach, AutPlay Therapy is an integration (­­synthesis)
of various play therapy theories and approaches designed to specifically fo-
cus on neurodivergent children. Arguably, many play therapy theories and
approaches have had some effect or influence on the creation of AutPlay
Therapy, but the play therapy approaches that have been the most influen-
tial on AutPlay Therapy include Child Centered Play Therapy, Theraplay,
Filial Therapy, Gestalt Play Therapy, Family Play Therapy, and Cognitive
Behavioral Play Therapy. Although play therapy as a whole is the base for
AutPlay Therapy, the ­­above-​­​­​­mentioned approaches have specific elements
and constructs that have more directly impacted the protocols of AutPlay
Therapy. ­Chapter 6 further describes these play therapy influences as well as
the integrative process in AutPlay Therapy.
It is essential to note that play therapy is an umbrella term and can refer to
many different approaches. While the Association for Play Therapy (­­APT)
(­­2022b) defines ten seminal and historically significant play therapy the-
ories, there exists approximately ten additional play therapy theories and
approaches. When parents are seeking out a play therapist for their autistic
or neurodivergent child or a therapist is looking for a play therapist to make
a referral, there are a few questions they might ask:

1 What type of play therapy do you offer and what are your credentials/­­
training for providing play therapy?
2 What is your experience working with autistic/­­neurodivergent children
and their families?
 Play Therapy and the Therapeutic Powers of Play 119

3 Can you describe the types of issues you have worked on with neurodi-
vergent children?
4 How might the play therapy you offer benefit my autistic/­­neurodivergent
child?
5 What would a typical play therapy session look like and how would you
involve the parent and/­­or family members?
6 What are some possible mental health needs and typical therapy goals
when working with neurodivergent children?
7 How would you conceptualize neurodiversity and describe a neurodiver-
sity affirming approach?

The Therapeutic Power of Play

One unifying feature throughout the myriad of play therapy approaches is

Schaefer and Drews (­­2014), 20 core change agents of the therapeutic powers
of play. These powers refer to the specific change agents in which play initi-
ates, facilitates, or strengthens the therapeutic effect. Play powers act as me-
diators that positively influence the desired change in the client (­­Barron &
Kenny, 1986) and provide the foundational framework for the clinical un-
derstanding and use of play therapy (­­VanFleet & ­­Faa-​­​­​­Thompson, 2017).
Under the umbrella of play therapy, the therapeutic powers of play can be
recognized throughout various theories and approaches. Some powers may
be more evident or primary in some theories versus others but certainly the
therapeutic powers of play serve as a unifying component in the vast world
of play therapy. This book does not capture all the play therapy theories,
approaches, and methods that currently exist, but it does provide a snapshot
of the variety that integrate and influence AutPlay Therapy.
Historically, Schaefer (­­1993) identified 14 therapeutic powers of play based
upon a review of the literature and play therapists’ clinical experiences. Later
the list was expanded and revised to include 20 core therapeutic powers of
play (­­Schaefer & Drewes, 2014). Based on similarity of therapy goals, the
20 powers were classified into the following four categories: facilitates com-
munication, fosters emotional wellness, enhances social relationships, and
increases personal strengths (­­Schaefer & Drewes, 2014). He proposed that
play helps in relationship enhancement, expressive communication, growth
of competence, creative ­­problem-​­​­​­solving, abreaction, ­­role-​­​­​­play, learning
through metaphor, positive emotion, and socialization. Children can learn
social skills, develop relationships, learn how to communicate and express
120 Play Therapy and the Therapeutic Powers of Play

themselves through verbal and nonverbal means, and develop problem-​­​­​

­­
­solving abilities through therapeutic play.
Schaefer and Drewes’ (­­2014) therapeutic factors refer to specific clinical
strategies, and the therapeutic powers of play refer to the specific change
agents in which play initiates, facilitates, or strengthens their therapeutic
effect. The change agents include ­­self-​­​­​­expression, access to the uncon-
scious, direct teaching, indirect teaching, catharsis, abreaction, positive
emotions, counterconditioning fears, stress inoculation, stress management,
therapeutic relationship, attachment, social competence, empathy, creative
­­problem-​­​­​­solving, resiliency, moral development, accelerated psychological
development, ­­self-​­​­​­regulation, and ­­self-​­​­​­esteem.
Through specific consideration and selection of the core change agents, all
children, including autistic and neurodivergent children, can learn regula-
tion ability, develop healthy relationships, learn how to communicate and
express themselves, improve emotional modulation, decrease stress and
anxiety, address trauma issues, improve their awareness of self and positive
­­self-​­​­​­esteem, increase advocacy ability, and develop ­­problem-​­​­​­solving/­­coping
strengths. ­Figure 5.1 displays the therapeutic powers of play.
The therapeutic powers of play are the mechanisms in play that actually
produce the desired change in a client’s dysfunctional thoughts, feelings,
and/­­or behaviors (­­Peabody & Schaefer, 2016). Indeed, the prominence of
these powers are evident in the definition of play therapy by the Association
of Play Therapy. Just as an in-​­​­​­
­­ depth understanding of child development
is foundational to play therapy, training in the therapeutic powers of play
creates an understanding of why and how play creates therapeutic change.
These therapeutic powers of play have been referred to in the literature as the
“­­heart and soul” of play therapy (­­Schaefer & Drewes, 2014, ­p. 4), exempli-
fying their essence in initial play therapy knowledge. With this foundational
knowledge, therapists are better positioned during their comprehensive in-
dividualized assessment of each client to identify the core cognitive, affec-
tive, and interpersonal processes involved in the presenting clinical concern,
and to apply specific powers of play designed to activate the desired change.
Without this strong grounding, a clinician may operate with more of a “­­
hope this works” mentality, rather than a purposeful understanding of how
the therapist can initiate, facilitate, and strengthen play to impact change
(­­Peabody & Schaefer, 2019).
The AutPlay Therapy protocol can potentially incorporate and address any
of the 20 core agents of change of the therapeutic powers of play. AutPlay
 Play Therapy and the Therapeutic Powers of Play 121

Catharsis
Self expression
Abreation

Access to the Positive emotions

unconscious
Counterconditiontiong
fears
Direct teaching
Stress inocculation

Indirect teaching Fosters Stress management

Facilitates
emotional
communication
wellness

Increase
Enhances social
personnel
relationships
Resiliency strengths Attachment
Self-esteem
Empathy
Self-regulation

Creative problem solving Social competence

Moral development

Accelerated psychological development Therapeutic relationship

­Figure 5.1 The Therapeutic Powers of Play: 20 Agents of Change.

utilizes ­­non-​­​­​­directed play and structured play therapy interventions that are
specifically chosen and or created for the individual child. Therapeutic play
processes and play interventions are mindfully chosen with input from both
the parent and the child. Each intervention embodies one or more of the 20
core agents of change depending on the child’s assessed needs. Although any
of the core change agents could be identified and addressed with a neurodi-
vergent child, children typically benefit from a focus on specifically identi-
fied agents of change.
Ultimately, play is the natural language of all children and holds many ben-
efits including therapeutic components. Play is also the agent of change that
propels children forward in healing and growth. Within the therapeutic pow-
ers of play, neurodivergent children have a validating and naturalistic pro-
cess to address needs and work on mental health growth and goals. AutPlay
Therapy protocol is mindfully infused with play core agents of change that
specifically align with the neurodivergence of autistic children and children
with other neurotype needs. ­Table 5.2 shows the most common therapeutic
powers of play in AutPlay Therapy protocol.
122 Play Therapy and the Therapeutic Powers of Play

­Table 5.2 Therapeutic Powers of Play in AutPlay Therapy

Common Core Agents of Change

Direct Positive Therapeutic Stress management Social

teaching emotions relationships competence
Positive peer Stress Empathy Counterconditioning ­­Self-​­​­​­regulation
relationships inoculation fears
Moral Attachment Self esteem Creative problem Resilience
development solving

The therapeutic powers of play are organized into four major categories:
facilitate communication, foster emotional wellness, enhance social rela-
tionships, and increase personal strengths. These four categories are then de-
scribed in more detail through the core agents of change as they are assigned
to each category. A play therapist could recognize that a dynamic within the
play interaction enhanced social relationships. To describe this dynamic fur-
ther, the therapist could choose from the core agents under the therapeutic
power of play As an example, the notes would then explain that the play
therapy session met the goal of enhanced social relationships, and the appro-
priate core agents were enacted through play (­­Stone, 2022). The following
provides some examples of common core agents in AutPlay Therapy when
working with neurodivergent children. Each of the core agents could have
multiple and varying examples. The following is simply providing a better
understanding of the possibilities.

• Positive Peer ­Relationships – ​­​­​­The therapist might select the AutPlay

Intervention Paper Friend, which helps children identify what they would
like in a friendship and who they would like to have as friends. The ther-
apist would introduce the intervention and complete it with the child
focusing on friendships. The therapist would continue to follow up with
the child after the intervention had been completed to ensure the child
was making gains toward their friendship goals.
• Therapeutic ­Relationship – The
​­​­​­ AutPlay process begins with a focus on
building relationship. One of the primary goals of the Intake and Assess-
ment Phase is to develop relationship with the child. Additionally, early
in therapy, the therapist might play the intervention Make My Moves,
designed to help develop trust, connection, and work on relationship
development between the child and therapist or child and parent. The
 Play Therapy and the Therapeutic Powers of Play 123

therapist might also let the child choose an intervention to play or read
the child a social story about being in play therapy.
• Direct ­Teaching – ​­​­​­The therapist could choose any play intervention
with a purposeful therapy goal focus to help the child progress toward
their goals. For example, the therapist could choose the intervention
Backward Moves, designed to help children regulate their system. The
therapist would introduce the intervention, provide the instructions to
the child for how to complete the intervention, and follow through with
assessing to make sure the intervention is a good fit for the child and
helping the child with their regulation needs.
• Positive ­Emotions – ​­​­​­The therapist would be active in reflecting emo-
tions presented by the child and co regulate emotions as needed. Fur-
ther, the therapist could choose the intervention Me and My Feelings,
which is designed to help the child identify positive emotions they
experience. The therapist’s ongoing relationship with the child also
enhances the opportunity for the child to recognize and experience
positive emotions.
• Self ­Esteem – ​­​­​­The therapist is continually attuned to the child’s ­­self-​­​­​
­worth and identity recognition and expression. The therapist can reflect
acceptance and create and open and safe atmosphere in the playroom for
exploring and expressing identity. The therapist could also implement
the intervention Look at My Strengths, which is designed to help children
identify one or more strengths they possess.
• Stress ­Management – ​­​­​­The therapist would be active in co regulating
with the child any ­­stress-​­​­​­related feelings. The therapist could also im-
plement the intervention 10 Cloud Relaxation or some other guided deep
breathing exercise to help the child relax and calm.
• ­­Self-­​­­​­­​­­Regulation – ​­​­​­The therapist can continually be modeling regulation
and ­­co-​­​­​­regulating with the child as needed. The therapist can intro-
duce regulation play interventions that are a good fit for the child and
help the child regulate. The therapist can work with the child to help
them discover regulation ideas that do not involve another person for
implementation.
• Social ­Competence – ​­​­​­The AutPlay process begins with an assessment
(­­the AutPlay Social Navigation Inventory) which helps identify any
­­social-​­​­​­related needs the child might be experiencing. Through the
therapeutic relationship and utilization of directive interventions, the
therapist can help address any social-​­​­​­ ­­ related therapy goals. For ex-
ample, the therapist might implement the intervention Safety Wheel,
which is designed to help children identify safe and unsafe places and
people.
124 Play Therapy and the Therapeutic Powers of Play

Kaduson, Cangelosi, and Schaefer (­­2020) stated that the heart and soul of
play therapy is contained in the therapeutic powers of play. They are the spe-
cific, essential ingredients in play that produce therapeutic change. In appli-
cation, the play therapist focuses on selecting the specific change agents(­­s)
in play that will best resolve the client’s presenting problem. For example,
the “­­direct teaching” power of play would be indicated for a child who has
difficulty making friends because of their anger management struggles. The
“­­stress inoculation” power of play would be a good match for a child with
­­medical-​­​­​­related fears or anxieties. Likewise, the “­­moral development” power
of play would be a logical match for a child with conduct disorder. The idea
is to individually match the power of play with the child who would most
benefit from that particular power of play.
In AutPlay Therapy, the therapeutic powers of play 20 core agents of change
can materialize in a number of different ways. They can also overlap and
be integrated in their implementation with some children. Because of the
variance in the spectrum of presentation with neurodivergent children, it is
likely the AutPlay therapist will experience a variety of the therapeutic pow-
ers of play. Thus, it becomes important for the therapist to have a grounded
knowledge in the therapeutic powers of play. The intersection between the
therapeutic powers of play and the therapist’s understanding of the neurodi-
versity paradigm creates the most beneficial, safe, and healthy environment
for neurodivergent children to address their mental health needs through
play therapy.

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 6
An Integrative Play
Therapy Approach

What Is an Integrative Approach?

An integrative therapy approach can be traced back to the 1930s (­Seymour,

2011). There are many different types of psychotherapy that are integrative,
and the concept of integrative therapy has changed and developed since the
1930s. This chapter is not a complete overview of integrative therapy but a
snapshot for the purposes of further explaining and supporting the AutPlay
Therapy framework. Integrative therapy is defined as an approach to therapy
that involves selecting the techniques from different therapeutic orienta-
tions best suited to a client’s particular problem. By tailoring the therapy to
the individual, integrative therapists hope to produce the most significant
effects (­Cherry, 2021).
Gilbert and Orlans (­2011) furthered that the definition of integration in-
volves the combination of two or more models of psychotherapy into a new
and more effective model. The practice of an integrative therapy approach
includes the considered and intentional use of an ethical relationship,
grounded in a therapeutic alliance, in the service of the goals of the client.
It is not a random eclectic “­little bit of this and a little bit of that” approach.
The following highlights an adaptation of Gilbert and Orlans’ four compo-
nents of integration definition with commentary on their application to the
AutPlay integration process of working with neurodivergent children:

1 A holistic view of the person, a view that sees the person as an integrated
whole: affectively, cognitively, behaviorally, physically, and spiritually.
This includes a focus on the developing self as a central integrating prin-
ciple. The therapist will view each neurodivergent child as a holistic
child worthy of value and respect. Historically autistic and neurodi-
vergent children have been devalued, viewed as less than neurotypical

DOI: 10.4324/9781003207610-7
128 An Integrative Play Therapy Approach

children and not as a whole child. The therapist will strive to make sure
the integration supports the neurodivergent self of the child.
2 The integration of theories and/­or concepts and/­or techniques from dif-
ferent approaches to psychotherapy. There is a purposeful integration
at the level of theory and technique and involves drawing together a
model of integration from different orientations. The therapist must un-
derstand that neurodivergence is a wide spectrum of presentation. While
neurodivergent children share some common experiences, needs, and
manifestations, there is still a great diversity in presentation, strengths,
needs, and intersectionality. To fully meet the mental health needs of
neurodivergent children, a carefully focused and assessed integrative and
prescriptive approach is essential.
3 The integration of the person and professional. The integrative therapist
is faced with personal and professional challenges that need to be worked
through in order for the person to feel comfortable with who they are
in the world. The therapist must be aware of their own self and careful
not to project this onto the client. The therapist must take care to ex-
plore their own ableism and not project their ableist beliefs onto the cli-
ent or into the play approaches they are implementing. Exploring one’s
own ableism is often an ongoing work, as many systems and processes to
which the therapist has been exposed are conditioned with ableism. The
therapist must understand the neurodiversity paradigm and movement
and be prepared to implement a neurodiversity affirming approach with
their neurodivergent clients.
4 The integration of research and practice. The therapist studies current
research and integrates these findings into their framework. Also, the
therapist observes their own practice and feeds these observations back
into their model of practice and into their own research endeavors. Men-
tal health therapists must take note of the historically ableist bias pres-
ent in research focused on autistic and neurodivergent children. Only
recently has neurodiversity affirming research been produced. As re-
search related to neurodivergent children is viewed and conceptualized,
the therapist must have a critical eye for ableist methods and practices.
Many therapies boosting research support and findings do cite research
which produced results, but at the same time, were harmful and abusive
to neurodivergent children. Although the research showed a result, the
abhorrent lack of consideration of the harm the research was causing has
unfortunately been a terrible miss in the mental health community.

Integrative play therapy is a relatively new developing approach to work-

ing with children and adolescents. It offers promise in its flexible use of
 An Integrative Play Therapy Approach 129

integrating play therapy theory and techniques in order to offer clients the
best therapy for their presenting problems. Some examples of integrative
play therapy include Ecosystemic Play Therapy (­O’Connor, 2001), Flexibly
Sequential Play Therapy (­­Goodyear-​­Brown, 2010), and AutPlay Therapy
(­Grant, 2017).
Arguably the most developed thought on integrative play therapy comes
from the Play Therapy Dimensions Model (­Yasenik & Gardner, 2012). The
Play Therapy Dimensions model is an integrative approach that provides
play therapists with a framework from which to conceptualize the play ther-
apy process and evaluate their therapeutic interventions when working with
children. Essentially, it is a process which aids the play therapist in ­decision-​­
making about the best approach and/­or integration of approaches to meet
the child’s therapy goals. Yasenik and Gardner further conceptualized the
dimensions model process:
The Play Therapy Dimensions Model conceptualizes the play therapy
process according to two primary dimensions: Directiveness and Con-
sciousness. These dimensions help define the therapeutic space in a man-
ner that most practitioners will recognize as fundamental to the change
process. The Consciousness dimension reflects the child’s representation
of consciousness in play, and is represented by the child’s play activities
and verbalizations. The second dimension, Directiveness, refers to the
degree of immersion and level of interpretation of the play therapist.
These two dimensions intersect, forming four quadrants. Depending on
the case conceptualization, and the theoretical approach of the thera-
pist, a therapist might choose to focus therapy activities primarily in one
quadrant. Alternatively, there may be a number of indicators that suggest
movement is required amongst the quadrants. Furthermore, movement
may occur within a session, or across sessions, as the therapy process
evolves. As will be discussed, this conceptualization assists therapists in
navigating the complex ­client-­​­­by-­​­­therapist-­​­­by-​­therapy interactions in
order to tailor therapy approaches and optimize effectiveness. This in-
tegrative approach also offers a p­ rocess-​­oriented framework, providing
guidance for tracking important change mechanisms.
(­­p. 33)

AutPlay Therapy’s integrative framework is specifically chosen based on the

conceptualization of best practices in working with autistic and neurodiver-
gent children in mental health care. Four themes describe the importance
of integrative efforts in neurodivergent care. (­1) Integration provides the
avenue to access the best course of ­action – ​­allowing for the perfect inter-
section between the options available and the unique neurodivergent need.
(­2) An integrative approach provides for a greater depth in exploration of the
plethora of opportunities to uniquely speak to and serve the neurodivergent
130 An Integrative Play Therapy Approach

child. It avoids the common pitfall of a one size fits all approach. (­3) Integra-
tion provides the range needed to address the many manifestations across the
spectrum when working with neurodivergent children. The therapist must
notice the individual child and join their world as opposed to demanding
the child fit into a therapy model. (­4) Integration requires the therapist to
gain a depth of knowledge across theories, approaches, and techniques. This
allows for greater opportunity to conceptualize individual therapy for each
neurodivergent child. As VanFleet (­2014) stated, “­the heart and soul of any
form of therapy depends on the theories and assumptions behind it” (­­p. 3).
The following presents an overview of the play therapy integration found in
AutPlay Therapy.

Primary AutPlay Play Therapy Theory Integration

Child Centered Play Therapy

What is considered modern day Child Centered Play Therapy (­CCPT) was
founded by Virginia Axline in the 1940s (­Ray, 2011). It is an approach to
­person-​­centered counseling that effectively blends Rogerian tenets with the
natural way children communicate through play. The three core elements of
­person-​­centered therapy are congruence, unconditional positive regard, and
empathy (­Moss & Hamlet, 2020). CCPT practice is particularly concerned
with providing an environment of safety to facilitate the child’s explora-
tion of self and letting go of rigid behaviors resultant from a threatened s­ elf-​
­concept. CCPT occurs in a playroom supplied with carefully selected toys
and materials (­Ray & Landreth, 2019).
Landreth (­1991) described CCPT as an encompassing philosophy for living
one’s life in relationship with children. It is not a reference of techniques
that are implemented in the playroom. It is a way of being based on a deep
commitment to certain beliefs about children and their innate capacity for
growth. It is a complete therapeutic process and not just the application of a
few ­rapport-​­building techniques. It is based on the belief in the capacity and
resiliency of children. Landreth furthered that the following tenets guide the
CCPT process:

1 Children are not miniature adults, and the therapist does not respond to
them as if they were.
2 Children are people. They are capable of experiencing deep emotional
pain and joy.
 An Integrative Play Therapy Approach 131

3 Children are unique and worthy of respect. The therapist prizes the
uniqueness of each child and respects the person they are.
4 Children are resilient. Children possess a tremendous capacity to over-
come obstacles and circumstances in their lives.
5 Children have an inherent tendency toward growth and maturity. They
possess an inner intuitive wisdom.
6 Children are capable of positive s­ elf-​­direction. They are capable of deal-
ing with their world in creative ways.
7 Children’s natural language is play and this is the medium of ­self-​
­expression with which they are most comfortable.
8 Children have the right to remain silent. The therapist respects a child’s
decision not to talk.
9 Children will take the therapeutic experience to where they need to be. The
therapist does not attempt to determine when or how a child should play.
10 Children’s growth cannot be speeded up. The therapist recognizes this
and is patient with the child’s developmental process.
(­­p. 50)

Ray and Landreth (­2019) noted that refences to traditional therapy goals or
objectives is inconsistent with ­child-​­centered play therapy philosophy. Goals
are evaluative and imply tracking specific, externally established achieve-
ments required of the client. Children should be related to as persons to
be understood as opposed to goals to be checked off or persons to be fixed.
Because a central hypothesis of CCPT philosophy is that the therapist has
an unwavering belief in the child’s capacity for growth and ­self-​­direction,
establishment of therapy goals is somewhat contradictory. However, CCPT
therapists seek to facilitate an environment in which the child can experi-
ence growth, leading toward healthier functioning.
CCPT holds many benefits for addressing mental health needs of neuro-
divergent children. Research has been consistently increasing in showing
support for CCPT to address various mental health needs of autistic children
(­Hillman, 2018; Salter, Beamish, & Davies, 2016; War Balch & Ray, 2015).
The tenets of CCPT and p­ erson-​­centered philosophy align well with the pri-
mary philosophy of the neurodiversity paradigm and neurodiversity affirm-
ing principles. The n ­ on-​­directive approach in CCPT provides opportunity
for the autistic child to explore, express, and be themself. Unfortunately,
in many of the therapies the autistic and neurodivergent child participates,
­child-​­led experiences are taken way and/­or not allowed.
CCPT influence and integration in AutPlay Therapy can be seen in basic
foundational constructs. (­1) Accepting the child, allowing the self of the
132 An Integrative Play Therapy Approach

child to be seen and be valued. (­2) Meeting the child where they are with-
out judgment. (­3) Not controlling the child’s play. Allowing for the child’s
play preferences to be realized and not viewed as wrong or an incorrect way
to play. (­4) A foundational focus on relationship development. (­5) Non-
directive and CCPT protocols of attunement, c­ hild-​­led play, tracking, and
reflecting in the AutPlay Follow Me Approach. (­6) The overall respect for
the child. The awareness that the child is not to be turned into a version
of something the therapist wants to see but allowed to be themselves and
become their best self.

Theraplay

Theraplay has been defined as a playful, engaging, ­ short-​­

term therapy
method that is intimate, physical, personal, focused, and fun. It is modeled
on the natural, healthy p­ arent–​­infant relationship, and therapy actively in-
volves parents. The focus of Theraplay is on the underlying disturbances in
the relationship between the child and their caretakers. The goal of therapy
is to enhance attachment, ­self-​­esteem, trust, and joyful engagement and to
empower parents to continue on their own healthy interaction with their
child (­Jernberg & Booth, 2001).
Theraplay is modeled on the responsive, attuned, c­ o-​­regulating, and playful
patterns of interaction between parents and their babies that lead to secure
attachment and ­life-​­long ­social-​­emotional health. The focus of therapy is the
relationship itself; parents are an essential part of the process so that they can
carry on the newly developed patterns of interaction at home. In sessions,
the therapist initially guides the interaction. Progressively, parents take the
leadership role. Regularly scheduled ­parent-​­only sessions allow for additional
reflection and ­problem-​­solving. Theraplay may be combined or sequenced
with other modalities for complex problems (­Booth & Lindaman, 2019).
Booth and Jernberg (­2010) reported that there are four dimensions that are
used in therapy planning to meet the needs of the child and the parent in
therapy. The four Theraplay dimensions are structure, engagement, nurture,
and challenge. The following is a brief explanation of each dimension:
­ tructure – ​­Parents are trustworthy and predictable, and provide safety,
S
organization, and regulation. As a consequence of the caregiver’s struc-
turing of the child’s environment, the child not only enjoys physical
and emotional security, but they are also able to understand and learn
about their environment and they can develop the capacity to regulate
themselves.
 An Integrative Play Therapy Approach 133

­ ngagement – Parents
E ​­ provide attuned, playful experiences that create
a strong connection, an optimal level of arousal, and shared joy. Engag-
ing activities are especially appropriate for children who are withdrawn,
avoid contact, or are too constrained and rigidly structured. Learning to
be more engaging with their child is essential for parents who are dis-
engaged or preoccupied, who are out of sync with their child, who rely
primarily on questions to engage their child, or who do not know how to
enjoy being with their child.

­ urture – ​­Parents respond empathically to the child’s attachment

N
and regulatory needs by being warm, tender, calming, and comfort-
ing. They provide a safe haven and create feelings of s­ elf-​­worth. Nur-
turing activities reassure the child that their parents are available
when they need them. These activities are important in building the
child’s inner representation that they are lovable and accepted as
they are.

­ hallenge – ​­While providing a secure base, parents encourage the child

C
to strive a bit, to take risks, to explore, to feel confident, and to enjoy
mastery. Challenging activities are used to support and encourage the
child’s sense of competence. These activities are designed for success and
are done in playful partnership with the adult.
(­p­­p. ­21–​­25)

A therapist trained in Theraplay protocol works with the child and parents
in a family play therapy context to help work on improvement and suc-
cess in each of the four dimensions. Therapists typically meet with the child
and parent together to model and implement play interventions designed
to meet therapy goals. The overall goal of therapy is to establish a trusting
emotional relationship between the child and their parents. Booth and Lin-
damen (­2019) proposed that the Theraplay process begins with an assess-
ment, including a detailed intake interview with caregivers, observation of
parent and child interactions via the Marschak Interaction Method (­MIM),
and a collaborative discussion of the MIM experience with parents (­Booth,
Christensen, & Lindaman, 2011). Next, the therapist creates a therapy plan,
employing the dimensions, and has a reflective and practice session with the
parent.
Theraplay represents a significant piece of the play therapy integration in
AutPlay Therapy. Theraplay dimensions help form the relationship develop-
ment (­connection) which is achieved by parent and child in process together
to create engagement and connection through natural, fun, ­play-​­based tech-
niques and playtime in the AutPlay Therapy Follow Me Approach. It is im-
portant to note that Theraplay is an established therapy option that has had
134 An Integrative Play Therapy Approach

a great deal of r­esearch-​­supported success in working with autistic children.

Jernberg and Booth (­2001) proposed that Theraplay is particularly helpful in
working with autistic children because it does not depend on their being able
to respond to language or having any particular language presentation. Fur-
ther, Theraplay concentrates on the precursors to cognition and to representa-
tional thinking, mutual attention, and engagement making it an ideal therapy
approach for children with relationship and communication difficulties.
­ undy-​­Myrow (­2012), stated that what differentiates Theraplay for autistic
B
children from other play therapy approaches is twofold: As the primary play-
room object, the Theraplay therapist uses ­sensorimotor-​­based play to engage
the child and address needs. To empower parents as therapeutic partners, the
Theraplay therapist demonstrates and guides parents to provide the unique
relationship building blocks their child needs for development. These con-
structs are supported and more fully realized in the AutPlay Therapy frame-
work for autistic and all neurodivergent children.
Booth and Jernberg (­2010) stated that Theraplay is ideally suited for autistic
children because Theraplay treatment engages children in a playful, positive
social interaction that focuses on establishing the basis of the capacity to
engage with others and participate in relationships. ­Simeone-​­Russell (­2011)
furthered that the use of group Theraplay has been found to be very effective
in developing engagement, interaction, communication, language, and so-
cial navigation in autistic children. In working with autistic children, typical
goals of Theraplay might include increasing relationship and connection,
adjusting to transitions and changes, helping parents to discover methods to
calm and soothe their child, and stimulating communication.
Theraplay’s influence on AutPlay Therapy is evident through several con-
structs. (­1) The purposeful inclusion of parents/­caretakers in the therapy
process. (­2) The emphasis on the role of the parent as a partner or ­co-​­change
agent along with the therapist. (­3) The therapy protocol of teaching par-
ents how to interact or work with their child through natural/­nurturing and
directive play based interventions. (­4) The emphasis on relationship devel-
opment or connection and addressing therapy needs simultaneously using
parent/­child play experiences as the main catalyst to reach therapy goals.

Filial Therapy

The term “­filial therapy” comes from the Latin filios or filias, technically
meaning sons or daughters. Loosely translated, it means p­ arent–​­child. Filial
 An Integrative Play Therapy Approach 135

Therapy is a theoretically integrative psychoeducational model of therapy

in which parents serve as the primary change agents for their children. In
essence, it is a form of family therapy that uses play therapy methods to
enhance ­parent–​­child relationships and to solve a wide range of child and
family problems (­VanFleet, 2014). In Filial Therapy, the therapist teaches
the parent how to have c­ hild-​­centered play therapy sessions at home. The
parent learns the principles and conducts the play times with their child in
the home setting.
Guerney (­ 1964) stated that the basic model or goals of Filial Ther-
apy include: reducing problem behaviors in the child, enhancing the
­parent–​­child relationship, optimizing child adjustment, increasing child
competence and s­ elf-​­confidence, providing parents with an understanding
of their children’s feelings, motivations, needs, and behavior and how to
respond appropriately with empathy and limit setting, and enhancing par-
enting skills involving empathy, attentiveness, encouragement, and effec-
tive implementation of parental authority via the recommended approach
to limit setting. These goals are attained by including parents in the pro-
cess and empowering them to become change agents in working with their
child. The overall goal of Filial Therapy is to focus on improvement in the
­parent–​­child relationship and subsequently produce improvement in other
areas as well.
Scuka and Guerney (­2019) explained that through Filial Therapy parents
could be empowered to help their own children by teaching them CCPT
skills, most importantly, the skills of following the child’s lead, showing un-
derstanding through empathy, and limit setting. By teaching parents these
skills in Filial Therapy, parents would become the primary agents to achieve
therapeutic goals by helping their children work through emotional chal-
lenges and/­or behavioral issues. In this way, Filial Therapy would simulta-
neously leverage the natural ­parent–​­child bond to further therapeutic goals
while strengthening the attachment between parent and child.
Van Fleet (­2014) stated that Filial Therapy is comprised of several core
values and the therapist must embrace these values and always incorporate
them into their work. These values include honesty, openness, respect, genu-
ineness, empathy, relationship, empowerment, humility, collaboration, play-
fulness and humor, emotional expression, family strength, and balance. Van
Fleet furthered that Filial Therapy comprises eight essential features that are
central to its conduct. These features can be found individually or in smaller
combinations in other interventions, but it is the presence of all eight that
define Filial Therapy.
136 An Integrative Play Therapy Approach

1 The importance of play in child development is highlighted, and play

is seen as the primary avenue for gaining greater understanding of
children.
2 Parents are empowered as the change agents for their own children.
3 The client is the relationship, not the individual.
4 Empathy is essential for growth and change.
5 The entire family is involved whenever possible.
6 A psychoeducational training model is used with parents.
7 Tangible support and continued learning are provided through live su-
pervision of parent’s early play sessions with their children.
8 The process is truly collaborative.
(­p­­p. 10–​­15)

Van Fleet (­1994) stated that the overall aim of Filial Therapy is to elimi-
nate the presenting problems at their source, develop positive interactions
between parents and their children, and increase families’ communica-
tion, coping, and ­problem-​­solving skills so they are better able to handle
future problems independently and successfully. Van Fleet (­2014) fur-
thered that Filial Therapy offers several potential benefits to families of
autistic and neurodivergent children. The Filial process provides autistic
children with safety and choices without pressure and there is not a need
for verbal communication ability, as communication can be done through
play. Perhaps the greatest value is the empowerment of parents, giving
them tools with which to better understand and communicate with their
children.
Filial Therapy provides a significant influence and integration on AutPlay
Therapy. The primary focus of parents as change agents and play as the av-
enue to growth and healing is integrated throughout AutPlay Therapy pro-
tocols. The AutPlay Follow Me Approach in particular highlights several
foundations of Filial Therapy including Filial play skills such as tracking, re-
flecting, letting the child lead, and limit setting. Several constructs highlight
Filial Therapy integration (­1) Methods that incorporate a parent training
approach where the parents are taught play times to do at home with their
child. (­2) Parents are considered change agents for their child and partners
in the process with the therapist. (­3) Relationship connection and parent
empowerment are both central features and considered agents of change. (­4)
At home play session training and implementation is focused on the core
values of openness, respect, genuineness, empathy, relationship, empow-
erment, humility, collaboration, playfulness, emotional expression, family
strength. (­5) The entire family is involved whenever possible.
 An Integrative Play Therapy Approach 137

Family Play Therapy

Family play therapy involves the parents and child together in therapy
sessions. Although there are many methods and approaches to involving
children in family therapy, in family play therapy, play therapy techniques
become a part of the therapeutic family process and are utilized to help en-
gage all members of the family and to help address therapy goals. Gil (­1994)
stated that the therapist can teach parents to observe, decode, and partic-
ipate in their child’s play in such a way that their understanding of their
child’s experience is enhanced, and the possibility for deeper emotional con-
tact with their child becomes available.
Gil (­2015) explained that in family play therapy family members are seen
together as a system to achieve systemic changes. The application of play
therapy and verbal therapy approaches are used. The therapist implements
a variety of play therapy tasks and invites participation in the tasks from all
family members. Play therapy tasks are designed to assess and understand un-
derlying issues and promote positive change within the family system. There
is not one identified client; the whole family is the client. The family play
therapist will likely have several directive play therapy interventions in their
“­tool box” to implement with a family to address specific issues happening
within that family with the purpose of addressing and reaching established
therapy goals. Koehler, Wilson, and Baggerly (­2015) provided an example
of a popular intervention used in family play ­therapy – ​­the Kinetic Family
Drawing.
The Kinetic Family Drawing is a structed projective assessment in which
family members are asked to draw each member of their family, includ-
ing themselves, doing something. The counselor asks each family mem-
ber to describe all the family members in the picture and say what they
are doing. Subsequently, they can tell a story about the picture stating
what happened immediately before and after as well as what they would
like to change if they could. Extreme caution must be used by not overly
interpreting the drawing. The drawing should not be used to determine
abuse or predict behavior. It is only to be used for identifying individuals’
perceptions of their family.
(­­p. 98)

Family play therapy can help individual family members’ shift rigid percep-
tions of each other. When a child who has experienced their parent as stressed
and not engaging is now having a play time where the parent is in a role, inter-
acting with their child in a puppet story, the relationship takes a positive shift.
At this point, the adult is meeting the child in their world and the emotional
138 An Integrative Play Therapy Approach

connection that follows is rewarding to both (­Gil, 2015). Family play therapy
can involve multiple members, one or two parents, all siblings, even relevant
extended family members. It provides the opportunity for systems healing a
growth. Gil (­2015) further described the family play therapy process.
Family play fosters attachment and breathes new life into families as
they discover novel ways to interact and explore alternative solutions to
their problems. Family play therapists are in a unique position to exper-
iment with innovative ways to engage and help more than on[e] gener-
ation simultaneously. Play benefits everyone in the room (­including the
therapist) and can address both intrapsychic and interpersonal problems
throughout the family system. It allows families to recapture the joy they
once had as they laugh and play together, experiencing mutual delight
in pleasure activities. Family play opens windows of opportunity to ob-
serve family interactions on a deeper level than achieved in traditional
talk therapy, due in part to the rich metaphors clinicians can use to
assess each family member’s perceptions of the family’s problems, which
often become more transparent when a family is playing together. The
play itself may suggest solutions that might never have emerged though
verbal discussion.
(­­p. 29)

Grant (­2015) put forth that parents and other family members play an im-
portant role in the emotional, psychological, and social development of autis-
tic and neurodivergent children. The process of including family members in
therapy with their autistic child provides an opportunity for parents to become
empowered in relating to and working with their child beyond which the play
therapist can provide by working with the child in isolation. Family members
are typically present for the majority of the child’s experiences and are the
people in the child’s life that remain constant, while mental health profession-
als are transient. This level of social and familial consistency provides oppor-
tunity for parents to become effective healing agents for their child.
Family play therapy’s integrative elements and influence on AutPlay Ther-
apy involves several constructs. (­1) The understanding that a parent’s inter-
action with their child through play methods can have a deep and purposeful
impact on their child and on the entire family system. (­2) Families can par-
ticipate together in play therapy interventions and in special play times. (­3)
AutPlay Therapy at its foundation is a family play therapy approach. (­4) The
understanding that the family system is arguably the “­front line” of support
and most important system for neurodivergent children. (­5) The family unit
as a whole is often affected by and engaged with the various needs and com-
ponents of autistic and neurodivergent children. (­6) Equipping parents with
education and tools to help their child is a critical and sustainable process.
 An Integrative Play Therapy Approach 139

(­7) Most established therapies working with neurodivergent children recog-

nize the importance of a focus on the whole family and actively incorporate
the parents and/­or other family members in the process.
F­ amily-​­focused relationship development approaches, especially those grounded
in play therapy methods, heavily influence the AutPlay Therapy component
area of connection. They transcend throughout the AutPlay Therapy approach
that emphasizes the importance of parent involvement and the important role
that parents have in the AutPlay Therapy process. Ideally AutPlay Therapy
is implemented as a family play therapy approach. Parents/­caregivers and/­or
other family members are actively involved in the therapy approach, engaging
in and learning play times, directive play therapy interventions, and protocols
to improve relationship connection and address therapy needs.

Gestalt Play Therapy

In the 1970s, Violet Oaklander presented the Gestalt approach to therapy

with children (­Gestalt Play Therapy). The principles of Gestalt Play Therapy
are rooted in neuroscience, philosophy, organismic functioning, field theory,
the arts, and knowledge of human development (­Carroll & Orozco, 2019).
Gestalt Play Therapy can be considered a psychotherapeutic technique that
uses the principles of Gestalt Therapy during play therapy with the child. By
developing a therapeutic relationship and contact, and according to a specific
process, children are given the opportunity to confirm their sense of self ver-
bally and ­non-​­verbally, to express their thoughts and to nurture themselves.
Various forms and techniques of play are used during the different stages. Crea-
tive, projective, expressive, and dramatized play can all be used in Gestalt Play
Therapy such as clay play, fantasies, ­story-​­telling, puppet shows, sand play,
music, body movement, and sensory contact making exercises (­Blom, 2004).
Oaklander (­2007) identified several important elements of the Gestalt ther-
apy process. These are areas to explore, usually ­non-​­sequentially, to ­co-​­create
experiences that support the child’s ability to use their contact functions in
order to strengthen their sense of self and support integration. ­Table 6.1 pre-
sents the elements of therapy and possible modalities.
Blom (­2004) noted that Gestalt Play Therapy is a therapeutic process focused
on building the therapeutic relationship. Important aspects include the es-
tablishment of an ­I–​­thou relationship, a focus on the here and now, the re-
sponsibilities of the child and therapist, a focus on experience and discovery,
handling resistance and setting boundaries. Children are viewed holistically by
140 An Integrative Play Therapy Approach

­Table 6.1 Elements of Therapy and Possible Modalities in Gestalt Play Therapy

Elements of Therapy Possible Modalities

Experiencing the contact functions and the Sensory/­body activities
child’s process of making contact
Strengthening ­self-​­support and the child’s Sand tray, drawings, games
sense of self
Understanding emotions and emotional Books, music, role play, clay
expression
Developing the capacity for an accepting, Puppets, drawings
nurturing relationship with one’s self
Experimenting with new ways to get needs/­ ­Role-​­play, homework
wants addressed
Building appropriate support with parents, Parent consultations
teachers, etc.
Closing the therapeutic experience Family involvement,
acknowledgements
Source: Carroll and Orozco (­2019).

taking the various aspects of their holistic self into account. As part of assessing
children’s unique process during Gestalt Play Therapy, the therapist should
give attention to every child’s unique temperament as it contributes to certain
inborn characteristics and ways in which children will satisfy their needs.
Oaklander (­2007) noted that Gestalt Play Therapy processes hold benefits
for working with autistic children. Autistic children often made their needs
known but in ways that were often being overlooked by adults. The focus
should be to tune into the child, what the child wanted to do, rather than
trying to force the child to do what the adult had planned. Oaklander high-
lighted the following case example involving a teacher (­Saliba) working
with a young autistic boy (­Sean):
One boy, age 5, stood in front of the f­ull-​­length wall mirror, ignoring her
call to work on a puzzle with her. Instead of insisting that he come to her,
she went to him, sat by the mirror without a word, and watched as he
looked at himself and felt parts of his face. She realized that he was ac-
tually seeing himself. Suddenly he noticed that her reflection was in the
mirror as well, and he was so delighted and excited that he settled right
 An Integrative Play Therapy Approach 141

down into her lap. Twenty minutes had gone by, and the teacher had
said not one word, issued not one command. Saliba began naming the
parts of the face, as he continued to point to them, looking in the mirror.
But when he came to the mouth, she did not respond. He looked at her
expectantly through the mirror and shouted, “­mouth!” Saliba describes
that up until the first day when Sean showed an interest in the mirror, she
had panned what each student would do during her hours of contact with
them. She knew exactly what puzzle would be done by which student at
what time, and for how long. She believed that autistic children needed a
lot of structure, and in essence, she was demanding them to perform what,
when, how, where, and to what extent, what she thought the needed all
day long. When she allowed Sean that time in front of the mirror, she was
taking a cue from him, which was, “­Hey, I want to study my reflection,
and I like doing it.” From that time on, she was able to open herself up
enough to see that Sean could make other needs and desires known. As a
matter of fact, she just needed to let herself see and respond to those cues
instead of always imposing her own demands on him.
(­p­­p. ­274–​­275)

Gestalt Play Therapy provides several integrative and influential elements

within AutPlay Therapy philosophy and protocols. (­1) The relationship
established with the child is the central focus in the therapeutic process.
(­2) The child is viewed from a holistic ­perspective – ​­the holistic self of the
child is assessed, valued, and seen. (­3) The recognition that autistic children
can express their needs and the therapist should meet the child where they
are instead of trying to force the child to consider to the therapists demands.
(­4) The sensory experience is a vital and crucial piece of therapy for autistic
and neurodivergent children. (­5) Play therapy approaches and interventions
are supported that focus on sensory integration/­experiences which can in-
clude a wide variety of ­play – ​­tactile movement, art, expressive, etc.

Cognitive Behavioral Play Therapy (­CBPT)

Susan M. Knell (­1993) conceptualized that Cognitive Behavioral Ther-

apy (­CBT) underlies ­Cognitive-​­Behavioral Play Therapy (­CBPT) practice.
CBPT is a therapy approach that incorporates cognitive and behavioral in-
terventions within a play therapy paradigm. Play activities as well as ver-
bal and nonverbal forms of communication are used in resolving problems.
Knell defines six specific properties related to CBPT:

1 CBPT involves the child in treatment via play.

2 CBPT focuses on the child’s thoughts, feelings, fantasies, and
environment.
142 An Integrative Play Therapy Approach

3 CBPT provides a strategy or strategies for developing more adaptive

thoughts and behaviors.
4 CBPT is structured, directive, and ­goal-​­oriented, rather than ­open-​­ended.
5 CBPT incorporates empirically demonstrated techniques.
6 CBPT allows for an empirical examination of therapy.

CBPT is predominantly a structured, directive, and g­ oal-​­oriented therapy mo-

dality that systematically incorporates empirically demonstrated techniques.
It includes cognitive and behavioral interventions within a play paradigm
allowing the child mastery and control over their environment while being
an active participant in change (­Knell, 2011). CBPT focuses on the child’s
thoughts, perceptions, feelings, and environment, while providing a strategy
for the development of more adaptive thoughts and behaviors. Traditional
play therapy materials are used, especially puppets for role playing and gradual
exposure, and books using a bibliotherapy approach. Play is used to teach skills,
alter cognitions, create alternative behaviors, generalize positive functioning
across various environments, and reduce symptoms (­Drewes & Cavett, 2019).
In CBPT, the practitioner can present developmentally appropriate interven-
tions that help the child master CBT methodology. A wide array of cognitive
and behavioral interventions can be incorporated into play therapy to address
a wide array of issues (­Drewes, 2009). CBPT interventions provide an oppor-
tunity for children to understand how their thoughts affect their behaviors and
ways to change thoughts and behaviors. CBPT’s emphasis on doing, rather than
talking, allows children to practice all the new skills they have learned and to
generalize them to their lives outside of the play therapy session. Drewes and
Cavett (­2019) stated that coping skills, such as relaxation, mindfulness medita-
tions, guided imagery, and sensory experiences are taught to reduce physiolog-
ical arousal and affect dysregulation. CBPT utilizes exposure therapy through
systematic desensitization for excessive fear combined with coping skills to de-
crease anxiety. Homework is given at each stage of therapy, so the child will
practice skills in multiple settings, aiming for generalization of behaviors.
Drewes (­2009) proposed that CBPT provides a wonderful opportunity to
help children decrease anxiety (­a common struggle emotion for autistic and
neurodivergent children) and by incorporating play activities as a vehicle
to involvement and exposure it may help a child manage and reduce anx-
iety and experience therapy in a more positive and fun atmosphere. Fur-
ther, CBPT can be beneficial in helping children who experience emotional
dysregulation. Children who experience emotional dysregulation (­as many
autistic and neurodivergent children experience), can have sudden explo-
sions of ­out-­​­­of-​­control behavior, high levels of anxiety, and difficulties with
 An Integrative Play Therapy Approach 143

concentration and focus. Through various cognitive methods paired with

play activities, children with these issues gain a greater mastery of their emo-
tions and thus experience less of the issues created by dysregulation.
The use of play to address needs or alternative behaviors is a common aspect of
CBPT. Educating the child takes place in the CBPT model, such as, a puppet
behaves in such a way that teaches the child to express emotions or gain a new
skill. Through CBPT, children can address their feelings and issues and learn
more adaptive ways of dealing with their feelings. Initially this could involve
nonverbal expression and verbal labeling which is modeled for the child by
the therapist. Later, if the child begins to talk to the therapist, more direct ver-
bal labeling of feelings or addressing of issues can be explored (­Knell, 1993).
Drewes and Cavett (­2019) pretended a case example that highlights some
basic ways in which CBPT can be implemented and how it might look in
working with a child client:
Jasmine (­pseudonym), age 5, witnessed domestic violence and devel-
oped symptoms of defiance, mild aggression, anxiety, and depression.
During the initial stage, affective psychoeducation, using dolls with
feeling faces and a t­hree-​­headed dragon in role play, along with a doll
house, allowed Jasmine to play out scenarios from her family life while
identifying and expressing feelings through her doll characters. Jasmine’s
mother assisted in identifying thoughts and feelings that preceded her
negative behaviors, and helped her use relaxation techniques (­i.e., otter
breathing: breathing in and out with the waves as the “­baby” otter pup-
pet rode the waves on its mother’s tummy). As therapy evolved, Jasmine
used play therapy materials to reenact scenarios and verbalize witnessing
domestic violence. She explored affect and beliefs that she will become
like her parents, either the “­hurter” or “­hurted” in relationships. Dur-
ing the working phase of therapy, ­play-​­based techniques helped Jasmine
learn ­non-​­hurtful ways to express her affect, along with systematic de-
sensitization and exposure techniques to address separation difficulties.
(­para, 12)

CBPT provides integration and influence on AutPlay Therapy in a few ways.

(­1) The approach of having a specific agenda for each session where specific play
therapy techniques are implementing with the child (­and often the parent) is
a component of AutPlay Therapy for some children who respond positively to
directive play. (­2) The goal of helping clients understand a connection between
their thinking, feeling, and reactions is sometimes a therapy goal in AutPlay
Therapy. (­3) Incorporating “­homework assignments” and practice for repeti-
tion to address therapy goals is a highlighted component of AutPlay Therapy.
Parents and child may be taught several play therapy interventions to continue
to play at home between sessions. Also, they may be taught special play times
144 An Integrative Play Therapy Approach

to have at home between sessions. For many parents, a ­therapist-​­led psychoed-

ucation time to further understand advocacy, neurodiversity, and implementing
neurodiversity affirming principles is needed and may be implemented.
This chapter highlights the primary play therapy integration that produces
the AutPlay Therapy framework for using play therapy with autistic and neu-
rodivergent children. Although the play therapy theories highlighted do in-
deed influence AutPlay Therapy to a great extent. It would be a miss to not
acknowledge other play therapy theories and approaches. In some regards,
Adlerian Play Therapy, Developmental Play Therapy, Exosystemic Play
Therapy, and a variety of play therapy methods and interventions have in-
fluenced the framework of AutPlay. ­Table 6.2 highlights some the constructs
in AutPlay Therapy and the play therapy theory integration/­influences.
In the 1940s, Virginia Axline presented several tenets for Child Centered
Play Therapy. Since that time, play therapy as a modality has grown and
expanded with currently there being approximately ­10–​­15 recognized play

­Table 6.2 A
 utPlay Therapy Theoretical Constructs and Play Therapy Theories
Integration

Theoretical Construct Play Therapy Theory Integration

Parent/­family involvement Filial, Theraplay, Family PT
Family play therapy approach (­systems) Filial, Theraplay, Family PT
Emphasis on relationship development CCPT, Gestalt PT
Connection and engagement through play CCPT, Theraplay, Family PT
Parents considered ­co-​­change agents Filial
Limit setting model CCPT, Filial
Structured interventions to address CBPT, Gestalt PT, Family PT
specific needs
Interventions and processes to address Gestalt PT
sensory needs
Toys and materials utilized to encourage CCPT, CBPT, Gestalt PT
expression and address needs
Acceptance of the child a holistic and CCPT, Gestalt PT
respected person
 An Integrative Play Therapy Approach 145

therapy theories and approaches. Research support for many play therapy
theories has grown significantly and continues to grow. Many play therapy
approaches hold methodology that is helpful and affirming for autistic and
neurodivergent children, yet no one theory or approach fully meets the
needs across the spectrum of neurodivergence. This void created the need for
AutPlay ­Therapy – ​­an affirming framework for addressing needs across the
spectrum using an integration of existing play therapy theories, approaches,
and techniques. Essentially becoming a fusion of the best, most helpful,
impactful, and affirming components of play therapy into one framework.
AutPlay represents a celebration of play therapy for a population that has his-
torically been forgotten and denied access to the therapeutic powers of play.

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 7
The AutPlay® Therapy Process

Quickly out of graduate school and into a rural private practice group clinic,
I began my mental health work with children. It did not take long (­one ses-
sion I believe) to realize I had not received what I needed from my graduate
program to adequately work with children. I begin exploring play therapy
and working toward receiving the play therapy credential of Registered Play
Therapist (­RPT). I found in play therapy the healing and ­growth-​­producing
processes that spoke to children and gave them a voice and a therapeutic
process. I discovered how their natural language of play could speak through-
out the array of the therapeutic powers of play.
Shortly into my play therapy career I began to receive referrals for children
with ADHD and sensory differences and then my first referral for an autistic
child who was also diagnosed with intellectual developmental disorder, a
chromosome disorder, and various medical conditions. I was initially drawn
to neurodivergent children (­although I did not understand the term neuro-
divergent at the time). I connected with them and much of what they were
experiencing due to my own neurodivergence. Having sensory processing
disorder, social anxiety disorder, and trauma issues in my childhood gave me
an affinity for working with similar populations. I often reflected on my own
childhood and what it would have meant if I could have found my way to a
play therapist. I do believe the therapeutic powers of play would have been a
great gift to me and changed the trajectory of my childhood.
After I began working with my first autistic child, I began to feel that there
was something missing in the play therapy training I had received. I felt I
needed something more to help address the myriad of needs and presenta-
tions I was seeing across neurodivergent children. I began to investigate ad-
ditional trainings and therapy approaches. In the play therapy and greater
mental health fields there was little available. Most of these children were
not being seeing by mental health professionals and were being referred to

DOI: 10.4324/9781003207610-8
148 The AutPlay® Therapy Process

behavioral programs. I began to explore trainings outside of the mental health

­community – popular
​­ advertised trainings for working with autistic children.
I attended many, and most had a strong behavioral focus and/­or rigid child
training protocol and none viewed play in the way I had learned and valued
as a play therapist. Many of these “­therapies” were adamant that autistic chil-
dren and children with developmental disabilities did not understand play,
did not play, and ­play-​­related therapies would not help them. I disagreed.
These training did provide me with a greater knowledge enhancement and
there were some elements I could take and apply that increased my toolbox,
but in general they were not a fit for me and the work I was trying to do as a
play therapist. I began to conceptualize how the greater field of play therapy
(­the various seminal play therapy theories) collectively held a great deal of
value for autistic and neurodivergent children. It was at this point I began
to think ­integrative – ​­how different methods and approaches in various play
therapy theories could be integrated to form a framework or guide for work-
ing with autistic and neurodivergent children. This was the beginning of
what would become AutPlay Therapy.

AutPlay Therapy Overview

This chapter is designed to present an overview of AutPlay Therapy. Specific

protocols and processes in AutPlay are further explored in other chapters.
AutPlay Therapy has been defined as an integrative family play therapy ap-
proach designed to address the mental health needs of neurodivergent chil-
dren (­autistic, ADHD, learning differences, sensory differences, Tourette
Syndrome, giftedness/­twice exceptional, intellectual developmental disabil-
ity, developmental disabilities, etc.). The foundation of AutPlay Therapy
consists of seminal play therapy theories and approaches integrated into a
neurodiversity affirming framework. As a comprehensive model, AutPlay
Therapy is designed to assist children and adolescents (­across a spectrum of
presentation) and their families with mental health needs.
AutPlay Therapy is a synthesis or true integration of various psychological
and counseling theory including humanistic, developmental, and family
systems methodology. AutPlay Therapy protocol involves assessing and ad-
dressing the developmental issues for children and adolescents, and provides
continuous awareness of developmental levels, needs, strengths, and pro-
gress. Four overarching constructs guide the framework and implementation
of AutPlay Therapy:
 The AutPlay® Therapy Process 149

• Play ­Therapy – ​­Consists of multiple theories and approaches that rec-

ognize the therapeutic powers of play. It is a form of psychotherapy and
can be effective in helping children through emotional and mental is-
sues and has a large research (­­evidence-​­based) support. Play Therapy can
involve nondirective or directive play, various types of play preferences,
and can be implemented with individual children and/­or families.
• The Neurodiversity Paradigm and ­Movement – ​­Neurodiversity defines
the variance of neurotypes that exist across the human race. The neuro-
diversity paradigm illustrates the awareness and acceptance of this truth
and a commitment to view children through this paradigm lens. The
movement is ­action-­​­­oriented – ​­attending to processes, approaches, and
techniques to make sure they are neurodiversity affirming and children
receive an affirming approach during their play therapy experience.
• The Social Model of ­Disability – ​­Proposes that an individual is not dis-
abled by their diagnosis, condition, or state of being, they are disabled
by the attitudes and structures in society and the environments in which
they navigate. There is often an ableist process which prevents or makes
it very challenging for neurodivergent children to achieve and excel.
• Family ­Systems – ​­Often defined as an approach to understand human
functioning that focuses on interactions between people in a family and
between the family and the context(­s) in which that family is embed-
ded. Family (­parent/­child) is a critical, foundational relationship and of-
ten presenting issues or needs involve the whole family in healing and
growth.

AutPlay Therapy incorporates a combination of n ­ on-​­directive processes

and directive play therapy interventions and approaches designed to meet
children where they are and provide mental health support. Nondirective
play therapists are trained to trust that children can direct their own process
rather than the therapist directing their own ideas of what needs to happen
in therapy to address therapy goals and needs. A nondirective approach re-
quires the therapist to enter the emotional world of the child rather than
expecting the child to understand the therapist’s world, which is beyond
their capabilities. Nondirective play therapy is based on respect for the child
and confidence in their ability to direct their own process. It requires that
the therapist maintain unconditional acceptance and positive regard for the
child (­Petruk, 2009).
Directive play therapy is an integrative approach that combines different
theoretical models in a manner that responds to and addresses the needs
of children. Other terms that have been used for this approach include
150 The AutPlay® Therapy Process

structured, prescriptive, focused, and ­non-​­humanistic. Therapists use direc-

tive play therapy to focus attention, stimulate further activity, gain infor-
mation, interpret, specifically address therapy goals, or set limits. Purposeful
activities, such as games or play techniques, are structured by the therapist
to elicit process and responses from the client. The therapist assumes the
responsibility for the guidance and interpretation of the play interactions
(­Leggett & Boswell, 2017).
AutPlay Therapy process can be utilized to address a variety of concerns,
and the need areas that neurodivergent children may present with include
but are not limited to trauma issues, parent/­child relationship struggles,
emotional regulation, social navigation, sensory processing, anxiety reduc-
tion, and life adjustment issues. As needs are conceptualized and addressed
in AutPlay, it is important to remember that when children can learn to
understand and regulate their system, possess awareness of and receive sup-
port for the environments in which they are asked to function, and have
meaningful relationship connection, they are far less likely to have any type
of “­behavioral issues” and more likely to successfully maneuver in their ­day-­​
­­to-​­day environment.
Neurodivergent children and adolescents may have overlapping or inter-
twined needs. Often the internal processing ability, the child’s environ-
ments, and supports (­or lack of supports) are c­ o-​­creating mental health needs
for the child. There tends to be a relationship among need areas in regard to
the child feeling or being “­stuck” and needing help with forward movement
(­if a child has a need such as regulation struggles, they will likely have needs
in the other areas, such as school challenges or anxiety issues. If a child ad-
dresses one need area, they will likely see resolve in the other need areas).
For example, as a child makes gains in understanding their internal system
and regulation, it will have a positive effect on their social navigation needs.
As a child’s social needs improve, it will have a positive effect on their ­self-​
­awareness, identity, and ­self-​­worth.
AutPlay Therapy is often refenced as a play therapy approach. AutPlay pro-
tocol and processes are more like a framework for using play therapy with
neurodivergent children. For conceptualization, the analogy of building a
house is illustrated. The framework guides the larger and foundational pur-
poses. It serves as a guide for implementing play therapy principles through an
understanding of neurodivergence and neurodiversity affirming application
(­the basic framework and foundation of the house). In AutPlay we always
start with a healthy understanding of the foundation (­neurodivergence) and
framework (­play therapy). This is what creates the AutPlay therapist.
 The AutPlay® Therapy Process 151

We then move to individualizing the therapeutic approach based on each unique

neurodivergent child’s strengths and needs (­each individually designed room in
the house). Each individual child is understood as unique on the spectrum of
presentation and the play therapy process will be molded to the specific child.
Considerations should include the child’s play preferences and what seems to be
a best fit for the child and their needs. Based upon the child, some processes may
be more nondirective and some more directive, some may integrate multiple
play therapy methods while some function in primarily one approach. The level
of therapist involvement, the type(­s) of play, the utilization of the playroom,
will have an individualized look. Regardless of the design of each individual
“­room in the house,” the totality of each child’s play process, will always be
governed by the neurodivergence and play therapy foundation and framework.

Partners

A partnership or “­partnering” is often defined as relating to an agreement

between people to work together. The purpose of this relationship is to work
toward shared goals through a division that all parties agree on. The pri-
mary characteristics of partnership include commitment, coordination, trust,
communication, participation; and a conflict resolution (­ disagreement)
technique for joint p­ roblem-​­solving. Partnering with the parent, child, and
whole family (­when possible) is an important feature of the AutPlay Therapy
framework. Both parent and child offer much to the therapeutic process.
They are the experts on themselves and their families. On a pragmatic level,
the “­partnership” can take many forms (­this is further discussed in a later
chapter) but would manifest in some fashion.
Kottman (­ 2003) explained the partnership or collaboration process in
­Adlerian Play Therapy when working with children and parents:
I am extremely reluctant to see a child in play therapy without conjoint
parent consultations because of my belief that the child is socially em-
bedded. I believe that I must understand the child’s lifestyle from the
perspective of the child and from the perspective of other family mem-
bers before I can help the family. To effect ­long-​­lasting change, it is es-
sential for (­a) the child to make shifts in the way he or she sees himself,
others, and the world, and (­b) the members of the family to be willing to
make adjustments in the way they view and respond to the child.
(­­p. 21)

AutPlay Therapy incorporates a parent partnering (­training) component

where parents are trained by the therapist in using various play therapy
152 The AutPlay® Therapy Process

approaches and techniques at home with their child. Parents are viewed as
partners with the therapist and are empowered to become ­co-​­change agents
with the therapist in helping their child address and advance in therapy
goals. AutPlay Therapy’s parent training component teaches parents how
to facilitate AutPlay Follow Me Approach play times and specific play ther-
apy technique play times at home with their child between therapy sessions.
Parents learn about play, procedures, and techniques and are shown how to
implement play times at home to improve the ­parent–​­child relationship and
work toward addressing therapy goals.
Children are also viewed as partners in the process with the therapist and
the parent. As much as possible, the child’s thoughts, feelings, and voice are
included into the therapy process, goals, and plan. Children should have a
say in what they want to achieve and the process to achieve it. Children
should be clearly informed that they can freely share what they think, like,
and don’t like. In AutPlay, children are often asked if they liked a play in-
tervention and if they felt the intervention was helpful to them. The level
of “­partnership” that a child participates in will vary from child to child.
Much of this will depend on the child’s age and their need level or ability to
communicate and interact. It would be expected that an older child and/­or
a child with communication and interaction ability would participate more
fully. Regardless of the child’s age or level, the therapist should make every
possible effort to include the child as a partner (­even in small ways or incre-
ments). Any empowerment possible for the child should be extended.
AutPlay Therapy functions ideally as a family play therapy approach involv-
ing both the child and the parent in the therapeutic process. Using a play
therapy base that is a natural language for the child enables the parent to
be involved with their child in a way that builds healthy relationship and
addresses therapy goals within a fun and connecting process. Further, when
possible and appropriate, AutPlay Therapy involves other relevant family
members including siblings and extended family members in the therapy
process. For consistency purposes the term parent is used, but involvement
of the “­parent” means whoever is in the caregiver role with the child.

Play

Play is rooted in processes that lie deep within the brain (­Kestly, 2014). Play
provides an opportunity for children to see their world for what it is and
what has come their way, and to resolve a new way to survive. It provides a
way of understanding and healing each day. Play has a special place in the
 The AutPlay® Therapy Process 153

lives of children throughout the world. Playing provides an experience and

purpose for joining. Children can connect, share, understand their reason for
connecting, growing, and attachment (­Bowers & Bowers, 2013). Models of
play therapy highlight the power of play as an avenue for children to express,
explore, and address a variety of mental health needs.
Given that play is a significant focus of models of play therapy and AutPlay
Therapy specifically, it is important to examine what can be expected of
play in the therapeutic process with neurodivergent children. What are the
similarities and differences from a neurotypical child? What can a thera-
pist expect a client’s play to look like when beginning the AutPlay Therapy
process?
Historically, autistic children, those with high needs, and children with
developmental disabilities were described as lacking spontaneous, flexible,
imaginative, and social qualities that are common with play. Playing with
toys spontaneously, engaging in pretend and imaginative play, understanding
metaphor in play, and successfully engaging in group play was not likely. At
best, it was stated that autistic children would manipulate objects in a de-
tached fashion rather than play either functionally or symbolically. Research
and writings often described common play challenges that limited an autistic
child or adolescent’s play potential such as Cross’s (­2010) five problems with
autistic play:

1 Repetitious play
2 Continual roaming around the playroom
3 Continual anxiousness about or during play
4 Continual detachment or unfriendliness during play
5 Continual rejection by playmates during play

These ideas are contrary to the view of neurodivergent play in AutPlay

Therapy. The play of neurodivergent children is recognized, valued, and un-
derstood for its therapeutic merit. The historical views of neurodivergent
play were incorrect and laden in ableist views of what play must look like and
must be to be recognized as play.
When an autistic or neurodivergent child enters a play therapy room, it is
possible that they will not engage in play in a tradition or socially deemed
“­correct” way to play. A neurodivergent child might be very hesitant when
first entering play therapy. They may be feeling anxiety or dysregulation and
may take some time to get comfortable or familiar with what is around them
and then eventually begin to in play. Some children may prefer to isolate
154 The AutPlay® Therapy Process

themselves and play with toys or materials paying no attention to the ther-
apist or things around them. Some children may find an object not tradi-
tionally considered a toy and desire to play with the object and ignore what
would be considered the popular toys.
When neurodivergent children are given the opportunity to play freely, they
are likely to pursue preferences, interests, and activities that mean some-
thing to them. Some children may produce and participate in elaborate play
scenarios in symbolic or pretend play. Some children might enjoy scripted
­play – ​­playing out a favorite scene from a move or TV show. Some may prefer
to play repetitively with the child coming back to the same scenarios over
and over again for long periods of time. Often autistic children will enter a
play therapy scenario and begin playing in a way that speaks to them and in
a way they understand. If the therapist is patient and allows the child time to
feel safe and familiar with the therapist and the surroundings, the child will
begin to display their play preferences and interests. The therapist should
avoid jumping to a conclusion that the child does not play. The therapist
may see a hesitancy or what appears to be not understanding what to do, but
this typical anxiousness and/­or discomfort is associated with being around a
new person, a new place, and not understanding the expectations.
Autistic and neurodivergent children may have struggles and needs related to
social play with peers. Unfortunately, many neurodivergent children can be-
come isolated in their play and withdraw from peer play groups. There is often
a great deal of rejection and lack of acceptance from peers. The social model of
disability and ableist ideas can often be present in children just as they are in
adults and systems. After several attempts met with rejection and sometimes
ridicule, many neurodivergent children stop trying to engage in peer and group
play. This can present to others and has been misinterpreted to mean that
autistic and neurodivergent children do not know how and/­or do not want to
play with peers. There is significant evidence to indicate that autistic children
do desire peer relationships and to participate in peer play but are often met
with blocks to success. Besides peer rejection, many neurodivergent children
may have anxiety, sensory differences, or other issues that make it difficult to
initiate and maintain such play. There is plenty of evidence to indicate that
autistic and neurodivergent children do indeed play in a variety of ways and
desire play. A neurodivergent child may play in ­non-​­traditional ways, may play
with things that are not socially accepted as toys, and their play may not look
the way an adult is used to ­seeing – ​­but that does not mean it is not play.
Michael (­an ­eight-­​­­year-​­old autistic child) is a proper example of the varia-
bility of play in autistic and neurodivergent children. He entered AutPlay
 The AutPlay® Therapy Process 155

Therapy with a diagnosis of autism spectrum disorder, intellectual develop-

mental disorder, a genetic disorder, and several compounding medical issues.
Michael’s verbal output consisted of very little speaking, when he did, ap-
proximately 80% of what he said was difficult for other people to understand.
Michael mostly kept to himself and did not interact much with others. Due
to some medical conditions, he had difficulty with large and fine motor skills
and also had a feeding tube. I began working with Michael using the AutPlay
Follow Me Approach (­discussed more fully later in this book), with a more
concentrated focus on nondirective play. Michael wanted to be in the play-
room and spent the first couple of sessions roaming around the playroom not
really participating with any toys or activities in the playroom and very little
engagement with me.
The playroom that Michael had his sessions in also had a storage closet that
was used to store various office supplies. Michael discovered the storage
closet during session three. Inside the storage closet was a variety of clean-
ing supplies including a vacuum cleaner. Michael quickly took notice of the
vacuum cleaner and wanted to vacuum the playroom floor and anything else
he could find to vacuum. This often included vacuuming the puppets, plush
chairs, and various toys. The vacuum cleaner quickly became his toy and
type of play for the next several sessions. Michael would enter the playroom
and go directly to the storage closet and retrieve the vacuum. He was very
excited for the vacuum to be plugged in and begin his vacuum play. Michael
expressed positive emotions while he was vacuum playing, he would smile,
laugh, and generally seem happy. I would track Michael’s play and reflect any
feelings presented. I began to try and get involved in Michael’s vacuum play.
I introduced items to see if he would vacuum them, I asked him if I could
have a turn vacuuming and he handed me the vacuum. We began taking
turns giving each other specific items to vacuum. I introduced some vacuum
sharing games between Michael and myself and his mother. I also introduced
some ­problem-​­solving and coping skill games. Michael’s overall interaction
and connection with myself and his parents began to significantly increase.
Michael’s interest in playing with the office vacuum carried over to his home
setting. I was able to teach Michael’s parents how to use the vacuum to have
relational focused play times at home. This became a positive experience for
Michael and his parents. They expressed this was the first time they had been
able to have play times with Michael. Through Michael’s “­vacuum play”
with myself and his parents at home, Michael began to make significant
strides in his therapy goals. In line with AutPlay protocol, Michael showed
me his play preferences and interests and I followed his lead and used his
play preferences to help address this therapy goals. I did not discredit his
156 The AutPlay® Therapy Process

play preferences because it was a vacuum cleaner and not a traditional toy
from the playroom. This acceptance of him and his play was instrumental in
developing therapeutic relationship with Michael. Eventually, he began to
branch into other types of play which opened more opportunities for address-
ing additional therapy goals.
Each autistic and neurodivergent child will have a different assessment in
terms of their play preferences, strengths, and interests. The therapist may
not know the child’s play preferences until they spend time with the child
and observe their play. It is essential that proper assessment is done to learn
the child’s play preferences, strengths, and interests. It is not fair to assume
that every neurodivergent child will play in the same way. Some children
will play but in ways and with objects that may not seem like or look like tra-
ditional play. Some children will display multiple types of play preferences. It
is the therapist’s job to accept and value play preferences with judgment. The
following present points to remember regarding the neurodivergent child’s’
play in therapy:

• Play is the natural language for all children.

• Play can look different from a neurotypical ­presentation – ​­different is
not wrong.
• Engage with the neurodivergent child in the way they prefer to p­ lay –​
­explore their interests.
• Help parents understand the play preferences of their child and how to
relationally play with their child.
• Play is the agent of change not a manipulative to get the child to do
something.

Play Techniques

AutPlay Therapy does utilize a variety of structured and directive play ther-
apy interventions and techniques to help address therapy goals. Although
this directive and more ­therapist-​­driven element exists, it does not replace
the foundational importance of therapeutic relationship. Relationship de-
velopment is central to the successful implementation of any directive play
intervention. It is the relationship that gives the interventions power and
effectiveness.
The purpose of a therapeutic relationship is to assist the child and family in
therapy to change their life for the better. Such a relationship is essential, as it
is oftentimes the first setting in which the person receiving therapy explores
 The AutPlay® Therapy Process 157

intimate thoughts, beliefs, and emotions regarding the issue(­s) in question.

As such, it is very important that therapists provide a safe, open, and ­non-​
­judgmental atmosphere where the child can be at ease. Trust, acceptance,
and congruence are major components of a good therapeutic relationship.
Therapists are encouraged to show empathy and genuineness. As with any
other social relationship, the therapeutic relationship has boundaries which
help to define acceptable and unacceptable behaviors (­GoodTherapy.org,
2015).
Landreth (­1991) emphasized the central importance on relationship devel-
opment in the play therapy process. He conceptualized the following per-
sonal reflections about the play therapy relationship with children:

• I am not all knowing. Therefore, I shall not even attempt to be.

• I need to be loved. Therefore, I will be open to loving children.
• I want to be more accepting of the child in me. Therefore, I will with
wonder and awe allow children to illuminate my world.
• I know so little about the complex intricacies of childhood. Therefore, I
will allow children to teach me.
• I learn best from and am impacted most by my personal struggles. There-
fore, I will join children in their struggles.
• I sometimes need a refuge. Therefore, I will provide a refuge for children.
• I like it too when I am fully accepted as the person I am. Therefore, I will
strive to experience and appreciate the person of the child.
• I make mistakes. They are a declaration of the way I ­am – ​­human and
fallible. Therefore, I will be tolerant of the humanness of children.
• I react with emotional internalization and expression to my world of re-
ality. Therefore, I will relinquish the grasp I have on reality and will try
to enter the world as experienced by the child.
• It feels good to be an authority, to provide answers. Therefore, I shall
need to work hard to protect children from me.
• I am more fully me when I feel safe. Therefore, I will be consistent in my
interactions with children.
• I am the only person who can live my life. Therefore, I will not attempt
to rule a child’s life.
• I have learned most of what I know from experiencing. Therefore, I will
allow children to experience.
• The hope I experience and the will to live come from within me. There-
fore, I will recognize and affirm the child’s will and selfhood.
• I cannot make children’s hurts and fears and frustrations and disappoint-
ments go away. Therefore, I will soften the blow.
158 The AutPlay® Therapy Process

• I experience fear when I am vulnerable. Therefore, I will with kindness,

gentleness, and tenderness touch the inner world of the vulnerable child.
(­p­­p. ­5–​­6)

Therapeutic relationship development is a core change agent within the

therapeutic powers of play. In AutPlay Therapy there is a mindfulness of
relationship development practices at the beginning of therapy and through-
out the duration. Even when implementing directive play interventions, the
therapist’s focus should be on developing relationship which includes the
following:

• Accept the child and the child’s behavior where they are at.
• Do not place judgment on the child and/­or parent.
• Provide unconditional positive regard to the child and family.
• Recognize the child is a fully functioning person and is more than their
diagnosis or issue.
• Provide empathic responding, reflective responding, and active listing
skills.
• Relationship development is an active process throughout the duration
of therapy.

Autistic and neurodivergent children and children with developmental disa-

bilities often do not track to the established developmental age charts. When
deciding on directive play therapy techniques to help address therapy goals,
it is important to remember that some of a child’s developmental levels may
be different from their chronological age. If a child or adolescent is having
difficulty understanding a technique or has anxiety that is preventing them
from fully engaging, it is important to adapt the technique so that anxiety is
alleviated, engagement is increased, and the child can enjoy the interven-
tion (­Delaney, 2010).
AutPlay Therapy directive play therapy techniques are specifically designed
to meet a child where they are at in terms of their development and play pref-
erences. AutPlay Therapy directive play therapy techniques help increase
relationship development and address therapy needs and goals. AutPlay
Therapy takes into account the various issues that may be present with a
child and is sensitive to introducing directive play interventions in a specific
manner so that neurodivergent children can feel comfortable, participate,
and gain from directive play techniques. Children and adolescents are thor-
oughly assessed at the beginning of therapy to identify their needs and play
 The AutPlay® Therapy Process 159

preferences. This assists the therapist in creating therapy goals and choosing
directive play interventions to specifically address each child’s needs.
It is important to remember that when working with any child, and using
any play technique, the therapist will find they participate at various levels
with a child. This is determined by the therapist when working with a child.
If a child has higher needs and is having trouble with a concept, then the
therapist will likely become more involved and may lead much of the play
technique, taking on more of an instructional and psychoeducational role.
If a child has less needs and easily understands the technique components,
then the therapist will do less directing/­instructing and will let the child cre-
ate and develop in the play intervention on their own. The therapist should
remember that they will, at times, be more instruction/­participator oriented,
but the therapist should always be looking for advancement in a child and
allowing them to do as much as they can on their own.
Therapists should take note that there exist multiple play therapy books that
highlight techniques and interventions. Although many of these books are
not ­autism-​­or ­neurodivergence-​­specific, some of the interventions can still
be used with neurodivergent children and adolescents, especially with some
specific modifications. Some important points to remember about directive
play therapy techniques with autistic and neurodivergent children and ado-
lescents include:

1 It is the relationship with the child and family that makes the play tech-
nique work best. This book could be filled with examples of children
who challenged and struggled with other professionals who lacked a re-
lationship focus and those same children freely participated in working
on all kinds of goals with therapists who promoted relationship develop-
ment with an essential focus throughout therapy.
2 Techniques that are directive or structured, meaning the therapist will be
introducing the technique to implement, should be an active and fluid
process in which the therapist can shift focus and redirect as needed.
3 Fun is more important than form. Children should feel safe, comfortable,
and have fun during play therapy interventions. Keep in mind that some
neurodivergent children may experience a level of anxiety or dysregula-
tion when participating in a play technique. Unfamiliar people, places,
and things can create anxiety. Be mindful of this, stay attuned with the
child and provide ­co-​­regulation during play interventions.
4 A difficult to measure and often undervalued skill is the therapist’s play-
ful instinct and attitude. Because some techniques involve structure and
160 The AutPlay® Therapy Process

may initially lack a great deal of enticement, the therapist’s playful at-
titude is essential for making the child’s experience more engaging and
enjoyable.
5 The therapist should involve the child in decisions about directive tech-
niques, ask the child’s opinion, provide choices, and allow for the child’s
voice.
6 Techniques should have a purposeful focus and direct connection to
therapy needs and goals.
7 The therapist should be comfortable with and flexible in their involve-
ment in directive techniques. They may take on a minimal role or a
more instructional role. The level of role will vary from child to child
depending on how much assistance is needed by the therapist.
8 The therapist should be prepared to participate in the play technique
with the child and/­or family. Often the therapist will be actively par-
ticipating with the child, playing with the child, taking on a role, or
creating and sharing their own representation of the intervention.
9 The therapist should be an attuned observer during the session/­technique
to assess if the technique seems to fit the child well and is appropriate for
helping the child or adolescent address therapy goals. Notice if the child
is struggling and try to assess and reflect how to help the child with what
they may be feeling or struggling with.
10 Techniques should align with and respect the child’s play preferences
and interests. The therapist should not implement a directive technique
based in a type of play in which the child is not interested and does not
respond.
11 Techniques can be implemented in which the therapist is unsure of the
play preferences of the child or when introducing a type of play the child
may have never been exposed to. In these situations, care should be taken
to monitor the child’s response. Ideally the child will respond favorably
and seem to connect with the play and/­or intervention. If the child does
not respond favorably and seems disinterested or does not like the play/­
intervention, the therapist should discontinue the intervention.
12 Techniques should have the ability to be easily simplified or made more
complex. This way, techniques can be adapted for any child or adoles-
cent across ages and regardless of need level.
13 Directive play therapy technique should be introduced and explained by
breaking down instructions to the technique into simple understandable
steps. If the child or adolescent is struggling to understand or complete
an intervention, the therapist may want to try completing one step at a
time before giving the next instruction.
 The AutPlay® Therapy Process 161

14 The therapist may model for the child or adolescent what they want
them to do or create. Some children may have receptive language issues
and/­or prefer a visual representation of what is being asked of them. In
these situations, auditory instructions would not be the primary method
of instruction. The therapist would include visuals or demonstrations.
15 Techniques should be created that can easily be taught to parents and
implemented by parents in the home setting. Parents should not be re-
quired to purchase several toys, props, or materials to implement home
play times and interventions.
16 Techniques will not always flow smoothly when being implemented. The
technique may highlight additional issues that need to be addressed. The
therapist may interject helpful statements, reflections, or questions dur-
ing a technique. Additionally, the therapist may need to help some chil-
dren understand the constructs involved with a particular intervention.
17 Therapists should be flexible when implementing a play technique.
Therapists should be prepared to let go of the structure of the session if
necessary and understand that some children may produce an approxi-
mate of the completed technique, and this is okay.
18 Therapists can use prizes and incentives to help engage a child in partic-
ipating and/­or to create another playful element to the technique. Prizes
and incentives should not be viewed or used as rewards for compliant
behavior. Implementing a prize or incentive should always be discussed
with the child’s parents and the child prior to using them with a play
technique.
19 Provide feedback for the child and family during and after techniques to
encourage them in how they did and what they accomplished, especially
when the child and/­or family member is hesitant.
20 Ask the child questions about the play technique. Ask the child or ado-
lescent if they enjoyed the technique or if they felt it helped them with
their needs or goals. Try to process the technique with the child and
apply the technique to the child’s real life. Remember the child is a part-
ner in the process and their voice should be heard. Take time after the
session to evaluate how the session went and if the technique seems to
have been successful for the child or adolescent.
21 Technique options are many but should always be selected and imple-
mented with the individual child in mind. Inspiration can be found in
many places for play therapy techniques. Therapists should try to im-
plement techniques that will be most beneficial for the individual child
or adolescent and the family. Play therapy techniques should follow the
following equation, understanding the individual child + understanding
162 The AutPlay® Therapy Process

the child’s play preferences + knowing the child’s therapy needs and good
+ understanding the family = ready for play therapy technique selection.

Once a play therapy technique is introduced, the technique is made a part

of the child’s awareness from that point forward. The therapist, parents, and
child may practice the same play technique for several sessions in a row. A
technique may be completed in one session and revisited several sessions
later and completed again if it would be relevant and helpful for therapy
goals or evaluation purposes. Many techniques could serve as coping and
accommodation aids that the child could use throughout their lifetime. It is
preferred that a child and parent use and reference play techniques as often
as appropriate. Parent and child can begin to accumulate a “­toolbox” of ideas
and interventions that they can implement any time they feel it would be
beneficial.

Pragmatics

AutPlay Therapy is most appropriate for children aged 3­ –​­18 across the neu-
rodivergent spectrum.

Session Protocols

Starting a ­session – ​­Sessions should begin with a structing statement such as

“­This is the playroom or space and you can play with anything you want, and
I will be in here with you.”
Ending a ­session – ​­The therapist should let the child know when five min-
utes are left of the session and then again when one minute is left of the
session. The therapist should position themselves where the child can see
them and give them the minutes left. It is also helpful for the therapist to use
a visual such as holding up their hand with five fingers then one finger. Often
in AutPlay Therapy a transition item (­small toy, sticker, balloon) is provided
at the end of the session for the child to take home. This is not a prize or a
reward for participating in the session or exhibiting some type of behavior. If
a transition item is established, it is part of the routine to provide consistency
and is always given regardless of the session components.
Playroom ­cleanup – ​­This depends on the developmental level of the child.
Typically, children help (­partner) with cleanup if it relates to a therapy goal
(­such as working together to complete a task). This can be turned into a
 The AutPlay® Therapy Process 163

playful game. In AutPlay, the process of cleanup is at the discretion of the

therapist based on the induvial child they are working with.

Toys, Games, and Materials

AutPlay Therapy sessions consist of both nondirective play and directive

play therapy techniques which usually involves toys, games, and expressive
materials that have been selected by the therapist and placed in a play ther-
apy room and/­or as part of a directive technique. Purposeful toy selection is
essential as it pertains to toys or materials that will be most representative
of the variance in play preferences of neurodivergent children and used in
completing directive play therapy techniques. Therapists should also con-
sider that some neurodivergent children will want to engage in free play in
the playroom setting, may want space for movement play, may have a play
preference in technology play, and these opportunities should be made avail-
able to the child. Many therapists have successfully combined session times
to include both implementing directive techniques and allowing the child
time to have nondirective play time. Much of this is decided by the therapist
and child/­parent in establishing the therapy needs and goals and the play
preferences of the child.
Toys, art, games, movement, sensory, and expressive materials are often used
in AutPlay Therapy (­a list of suggested toys and materials for AutPlay is pro-
vided in the appendix section). When using toys in AutPlay Therapy, there
are some issues for consideration regarding the autistic and neurodivergent
child. First, many typical or popular toys for children or adolescents may not
be interesting to the neurodivergent child. Do not assume that traditional
toys and mainstream marketed toys will appeal to neurodivergent children.
Second, having too many toys in the playroom or toys displayed in a disor-
ganized manner may feel dysregulating to the child. Playrooms should not
be cluttered, and toys should be easily seen and accessed. Third, it is likely
that a child or adolescent will choose to focus on one or two particular toys
and want to play with them repeatedly from session to session. Fourth, more
­reality-​­based toys such as a doctor’s kit, play phone, and kitchen toys, or sen-
sory based toys such as sensory balls, sand, or fidget toys will likely be more
popular or appealing for many neurodivergent children. Finally, therapists
will want to select toys and materials that align with therapy goals and direc-
tive interventions they will be implementing.
Many autistic and neurodivergent children and adolescents will enjoy and
may find more a­ ppealing – board
​­ games, card games, movement based games,
164 The AutPlay® Therapy Process

technology games, or prop based games. Several AutPlay Therapy interven-

tions do involve a ­game-​­based format. Therapists should pay careful atten-
tion to games that involve certain skill levels or physical ability and make
sure the game matches the child’s level. Expressive materials cover a wide
range of materials from art related such as painting and drawing to sand and
other sensory trays to electronic apps. The main consideration regarding ex-
pressive materials involves being sensitive to the child’s sensory differences.
Many neurodivergent children have sensory differences and may have an
aversion to the feel of sand or clay or may have a strong negative reaction
to the smell of paint or markers. Other neurodivergent children will not
have any problems with these materials and may find them comforting and
relaxing. Therapists should pay special attention to the sensory needs of each
child and adolescent when selecting toys and materials and implementing
play interventions.

Play Therapy Rooms

AutPlay Therapy sessions can be facilitated in a play therapy room, practi-

tioner’s office, school counselor’s office, special education classroom, or al-
most any environment. Since sessions may involve ­pre-​­selected play therapy
techniques, the therapist can collect the materials and toys needed and have
them ready in any office space. The exception to this would be implementing
the AutPlay Therapy Follow Me Approach (­discussed in a later chapter).
This approach does utilize a traditional ­child-​­centered playroom. Typically
play therapy rooms include several toys and materials, so if the therapist
needs to change or adjust an intervention during a session, it will be more
likely that the therapist will have the needed materials or toys close by for
an easy transition.
Some children or adolescents may have a preference in regard to going into
a play therapy room or to staying in the therapist’s office or another space. If
a child or adolescent has a distinct preference, then that preference should
be given priority. If the child does not have a preference, then sessions might
be better facilitated in a play therapy room as the play therapy room does
provide a good environment and opportunity to continually evaluate and as-
sess a child’s play preference and space for the child to utilize play for growth
and advancement. Therapists should note that some autistic and neurodiver-
gent children may find a playroom too distracting, overwhelming, or anxiety
producing. If this is the case, the therapist should facilitate sessions in their
office or a more benign, less stimulating setting.
 The AutPlay® Therapy Process 165

In AutPlay, play therapy rooms are typically used during the intake and as-
sessment phase (­discussed more fully later in this book) of therapy when the
therapist conducts a child observation and a parent and child observation
in a play therapy room. Also, during the intake and assessment phase, chil-
dren should be given a tour of the building, office, playroom(­s) that may
be accessed. The tour helps the child become familiar with the space and
gives the child the awareness that they can choose a playroom or some other
space depending on their preference. After the intake and assessment phase
is complete, therapy sessions can occur in any office setting as long as the
needed toys and materials are present to implement interventions and allow
for play preference expression.
The following are some considerations and guidelines for setting up a play-
room or office space when working with neurodivergent clients:

• Develop a normal routine that the child or adolescent follows as they en-
ter the office and/­or playroom to begin a session. Try to keep things the
same from session to ­session – ​­keep toys and materials in the same place
in the playroom and make sure playrooms are back to their organized
state before bringing the child into the playroom. Most neurodivergent
children will respond more positively to things being predictable.
• Some children and adolescent may have strong sensory integration
issues. Therapists should assess for these needs and adjust their office
and/­or playroom accordingly. This might include being able to adjust
the lighting, attending to noise levels, being flexible in where the child
wants to sit and having a variety of options (­soft chair, hard chair, rug,
exercise ball, etc., and avoiding certain odors like a scented candle or air
fresheners.
• Make sure toys and materials include a healthy variety of sensory and
regulation products. This might include play doh, clay, sand trays, vari-
ous sensory trays, sensory balls, fidget toys, various tactile experiences, a
mini trampoline, a balance board, stepping stones, hula hoops, an exer-
cise ball, etc.
• It is best to begin with a traditional ­child-​­centered play therapy play-
room setup and modify as needed from there. Some considerations for
modification include placing some of the toys and materials out of view
in a cabinet or behind a curtain to help with children becoming over-
whelmed, establish space for full body movement play and interventions,
try to represent the various play preferences a neurodivergent child may
have including technology play. Make sure the space is accommodating
for children with differing abilities such as a wheel chair, certain walking
166 The AutPlay® Therapy Process

aids, augmentative and alternative communication supports, and fine

and large motor issues.

Limit Setting with the AutPlay Follow Me Approach

There may be times when the therapist needs to set a limit on something
that is happening in the session. When this occurs a limit setting model
should be implemented. Limit setting should be kept to a minimum, so the
child and therapist do not get distracted and disrupted by continually setting
limits. When a limit needs to be set either by the therapist in the playroom
or by parents in the home setting, they should be consistent, follow the limit
setting model, and moved on from. Limits should consist of situations that
would be dangerous for the child, for others, or situations where the child
might be destroying property. If one of these situations arises, then the thera-
pist could implement the three R’s AutPlay Therapy limit setting model. The
three R’s limit setting model stands for redirect, replacement, and removal.
­ edirect – ​­If the child begins to or is breaking a limit. The therapist could
R
begin with redirection which means redirecting the child’s focus and energy
away from a problematic situation to something that is allowed. For exam-
ple, away from throwing sand all over the playroom to shooting baskets in
the basketball hoop. The therapist would simply try to redirect the child to
another activity, toy, or object to transition their attention off the limit vio-
lation. There does not need to be any dialogue about a limit being broken or
that the child needs to stop. In this situation, the therapist realizes the limit
is being broken and moves to see if redirecting will suffice.
­ eplacement – ​­If the child begins or is in process of breaking a limit, the
R
therapist could begin with implementing a replacement activity. Redirecting
and replacing are two processes that can be used interchangeably. Replace-
ment means literally replacing what is happening (­something that is likely
meeting a need for the child) with something new or different that is accept-
able (­continues to meet the need for the child). For example, the child is
smashing a toy truck into the floor which is breaking the truck. The therapist
or parent would quickly select another object such as a rubber hammer and
play doh and put it in the child’s free hand showing them how to smash the
play doh while taking the truck away from the child. Replacement can also
be replacing a game that is being played with the child with a different game.
Where redirection is the act of transitioning the child’s attention or trying to
distract the child away, replacement is giving the child a tangible, acceptable
alternative that continues to meet their need. As with redirecting, there
 The AutPlay® Therapy Process 167

does not need to be any dialogue about the limit being broken when using
the replacement strategy.
­ emoval – ​­If a child is beginning to or in the process of breaking a limit,
R
redirecting and replacement should be implemented first. If these processes
do not work, then removal is the final option. The first step in removal is
verbally explaining to the child that they need to discontinue a limit set-
ting behavior, or a toy/­material may be removed from the playroom or the
play session may end. In situations where a toy or material can be removed,
the therapist might say “­Michael in here you cannot cut the dolls’ hair, if
you keep trying to cut the hair, I will take the doll and scissors out of the
playroom.” If the verbal prompt does not stop the behavior, then removal
is implemented. The therapist would remove the doll and scissors from the
playroom and continue with the session. If removal involves the child need-
ing to leave the playroom (­usually due to unsafe behavior), the therapist
could try guiding the child into another location, possibly where the child
can be alone or minimally supervised while the child calms. In an extreme
case, removal might involve ending the session and physically taking the
child out of the clinic. If physical removal is necessary, then a parent should
be the one to physically remove the child. This is done in extreme cases
where the child or others are in danger due to the child’s behavior, and ac-
tion is needed to keep everyone safe.
When limits need to be set, the therapist could also try the Child Centered
Play Therapy Limit Setting Model. Landreth (­2001) outlined the ACT limit
setting model. (­A) Acknowledge the child’s wants/­needs (­C) Communicate
the limit in a ­non-​­punitive way (­T) Target acceptable alternatives. For ex-
ample, (­A) “­Sarah, I know you want to paint on the wall.” (­C) “­but in here
we cannot do that.” (­T) “­You can paint on the easel or on this paper.” The
therapist decides what is a limit to set and limits should be set as little as
possible. If the child did not respond to the limit, the ultimate action the
therapist would take is ending the session time.
Additionally, the therapist could try implementing the Filial Therapy Limit
Setting Model. VanFleet (­2014) described a simple three step approach to
limit setting. (­1) Reflect the child’s desire and state the ­limit – ​­“­You want
to paint on the wall, but in here we can’t do that, you can do almost any-
thing else.” If the child continues to break the limit, the therapist would re-
state the child’s desire and state the limit and add a w
­ arning – ​­“­You want to
paint on the wall, but in here we can’t do that, you can do almost anything
else.” “­If you continue to choose to paint on the wall, you choose to lose the
paints.” If the child continues to break the limit, the therapist would follow
168 The AutPlay® Therapy Process

through on taking the paints away and making the statement “­You chose to
lose the paints.”
Some children will be challenging a limit, maybe on purpose, maybe because
they are dysregulated or uncomfortable, or possibly because they don’t know
that something is a limit. Regardless of the limit setting model chosen, the
therapist should be nonjudgmental when setting limits. Many autistic and
neurodivergent children may not understand that a behavior is inappropri-
ate, or they are experiencing dysregulation and anxiety, and this is creating
the behavior. Some autistic and neurodivergent children may produce a be-
havior that is a limit multiple times because they are still learning about reg-
ulating their system, social understandings, and communication. The limit
setting model implemented should be based on an awareness of the child
and what the therapist believes will work best with the particular child.
This may involve trying different limit setting approaches until a good fit is
discovered.

Basics of the AutPlay Therapy Process

AutPlay Therapy is an integrative family play therapy framework (­approach)

where children and parents/­ caregivers participate as ­ co-​­
change agents/­
partners in the therapeutic play therapy process. It is designed primarily for
mental health professionals, play therapists, and child therapists. It addresses
children and adolescents aged 3­ –​­18 who are autistic, neurodivergent, and/­or
have developmental or physical disabilities. This includes ADHD, learning
disorders, sensory differences, and social anxiety.
AutPlay is designed to help address the mental health needs of autistic and
neurodivergent children and their families through a neurodiversity affirm-
ing therapeutic play process. It serves as a guide for therapists in using an
integration of play therapy theories and approaches and the therapeutic
powers of play to address a variety of possible mental health needs for opti-
mal growth and healing.
AutPlay is a neurodiversity informed approach which strives to value neu-
rodivergence and support ­non-​­ableist ­processes – ​­respecting, valuing, and
appreciating the identity and voice of the child client. AutPlay frame-
work highlights affirming evidence based and research informed practices
to address identified needs and therapy goals. It is a guide for establishing
therapeutic relationship, assessing for individualized therapy needs, and im-
plementation of play therapy approaches and interventions.
 The AutPlay® Therapy Process 169

AutPlay is focused on an understanding of needs related to mental health/­

life issues such as trauma, bullying, depression, anxiety, sensory challenges,
education challenges, parent/­child relationship issues, etc. Also important
are needs such as understanding autism, advocacy needs, social navigation,
regulation goals, family awareness, and mental health needs related to ­co-​
­occurring issues such as developmental disabilities, physical disabilities, and
chronic medical conditions.

Research

According to Parker and O’Brien (­2011), the literature over many years
abounds with case studies where changes are noted as a result of an inter-
vention using play therapy. Various issues addressed with play therapy ap-
proaches include regulation struggles, depression, anxiety issues, child abuse,
trauma issues, family issues, and general life adjustments concerns.
Multiple single case study designs have shown that autistic and neurodiver-
gent children who participate in AutPlayTherapy once a week for six months
show gains in original therapy goals such as emotional regulation ability,
social navigation needs, anxiety reduction, and connection (­relationship
development). Parent rating scales also support an increase in targeted ther-
apy goals for those who have participated in AutPlay Therapy once a week
for six months. Parents also report gains in feeling more knowledgeable and
empowered in their parenting abilities and less stress/­strain regarding their
relationship with their child.
Although single case study designs continue to be done and continue to
show positive results for autistic and neurodivergent children, it is challeng-
ing to produce controlled studies as AutPlay is conceptually a framework and
not a theory with specific tenets. It is an integration of play therapy theories
and guide for how to use play therapy with neurodivergent children. Thus,
therapy sessions do not always look uniform from client to client. It is im-
portant to note that the AutPlay Therapy integration/­framework consists of
theories/­approaches rich in research that have shown positive outcomes in
working with the autistic and neurodivergent population.
A great deal of caution should be taken when discussing research, e­ vidence-​
­based practices and “­treatments” concerning autism and neurodivergence.
The history of research with these populations is laden with ableist practices
that have often been harmful. ­Bottema-​­Beutel et al. (­2021) stated that au-
tism research can easily reflect and perpetuate ableist ideologies (­i.e., beliefs
170 The AutPlay® Therapy Process

and practices that discriminate against people with disabilities), whether or

not researchers intended to have such effects. In the past, autism research
has mostly been conducted by ­non-​­autistic and ­non-​­neurodivergent people.
Researchers have described autism as something bad that should be fixed.
Describing autism in this way has negative effects on how society views and
treats autistic people and may even negatively affect how autistic people
view themselves. Some interpretations of research findings have tacitly or
explicitly questioned the humanity of autistic and neurodivergent people.
Even sources such as The National Professional Development Center
(­NPDC) on autism spectrum disorder and the National Standards Project
(­NSP) must be highly scrutinized. There review of literate is predominately
literature that implemented ableist ideas and practices and viewed autism
as a problem that needed to be treated and cured. E ­ vidence-​­based practices
that focus on strict behavioral training and “­correcting deficits” which are
basically labeled as anything the does not look neurotypical, should be dis-
counted. These practices have been shown to be harmful and degrading to
autistic and neurodivergent children and even create trauma responses.
­Bottema-​­Beutel et al. (­2021) explained that participatory models of autism
research have been developed. A hallmark of these approaches is that au-
tistic people are included in the research process conducted by ­non-​­autistic
investigators, and editorial decisions made by ­non-​­autistic publishers elevate
autistic voices into roles with greater power. This can help break down con-
ventional barriers and lead to research that better matches the preferences
and priorities of the autistic community. Below are seven questions created
by ­Bottema-​­Beutel et al. (­2021) that may help researchers determine if they
have adequately considered the impacts of their language process choices on
autistic communities. If the answer to question one is “­no” or the answers to
questions two through seven are “­yes,” researchers should consider alterna-
tive ways of speaking, writing, and conducting research.

1 Would I use this language if I were in a conversation with an autistic

person?
2 Does my language suggest that autistic people are inherently inferior to
­non-​­autistic people, or assert that they lack something fundamental to
being human?
3 Does my language suggest that autism is something to be fixed, cured,
controlled, or avoided?
4 Does my language unnecessarily medicalize autism when describing edu-
cational supports?
 The AutPlay® Therapy Process 171

5 Does my language suggest to lay people that the goal of my research is

behavioral control and normalization, rather than granting as much au-
tonomy and agency to autistic people as reasonably possible?
6 Am I using particular words or phrases solely because it is a tradition in
my field, even though autistic people have expressed that such language
can be stigmatizing?
7 Does my language unnecessarily “­other” autistic people, by suggesting
that characteristics of autism bear no relationships to characteristics of
­non-​­autistic people?

AutPlay Therapy empowers the therapist by providing a comprehensive

therapy framework that addresses mental health needs autistic children
and adolescents and other neurodivergent children may be experiencing.
Through AutPlay Therapy training, the therapist can feel knowledgeable
in the realm of neurodiversity and neurodivergence and be prepared and
equipped to establish and assist in meeting therapy goals for autistic chil-
dren and adolescents and their families. Further, AutPlay Therapy empowers
therapists to assist parents/­caregivers in feeling confident and knowledgeable
in helping their child.
AutPlay Therapy is a flexible and prescriptive therapy process that focuses
exclusively on the neurodivergent child and adolescent population. AutPlay
Therapy can be done in conjunction with other therapies and may be part
of a collaborative approach to helping children and adolescents address a va-
riety of therapy needs. AutPlay Therapy consists of three phases of therapy:
intake and assessment, directive play intervention, and termination. It also
includes the AutPlay Follow Me Approach, a nondirective infused family
play therapy approach for working with younger children and children with
higher needs. The phases of therapy and Follow Me Approach are further
presented and explained in later chapters.

Case Example “­Leah” by Sarah Moran

Leah began AutPlay Therapy at age 6. She engaged in therapy via telehealth,
due to ­Covid-​­19 restrictions. Leah’s parents sought therapy for her due to
concerns about her inattention, impulsivity, behavioral problems at school,
and difficulties with emotional regulation. Leah lived with her mother and
father and had one younger brother. Leah had no previous encounters with
mental health therapy. Leah possessed strong cognitive ability and thrived
in learning skills for a variety of interests. Leah demonstrated a precocious
172 The AutPlay® Therapy Process

vocabulary and was excelling above grade level academically. Leah demon-
strated an ease in entering new social situations and making friends but
demonstrated difficulty maintaining close friendships. Typically, Leah would
do most of the talking and often interrupted her friends and friends would
respond negatively.
Leah attended online school while at a daycare facility. This school environ-
ment was challenging for Leah. Leah and other ­school-​­aged peers would be
directed to a specific area of the room to engage in their individual online
classes, each child wearing headphones. Leah often struggled to focus on her
­zoom-​­class, because she was surrounded by toys and people to socialize with.
Leah would often get distracted or share an idea with a neighboring peer
while she was supposed to be focused on class. If a daycare teacher redirected
her, Leah would quickly become frustrated and verbally defend herself, of-
ten talking louder and becoming more of a distraction to her peers. Other
times, the redirection would cause Leah to shut down and instead she would
communicate by pretending to be a kitten, meowing at her teachers and
feigning understanding. Leah’s daycare would often call home with reports
of her misbehavior and outbursts. Leah’s parents expressed feeling helpless in
supporting Leah at school.
Leah began AutPlay Therapy by participating via telehealth from her home.
The therapist facilitated a modified version of the Intake and Assessment
Phase through telehealth. A play observation was conducted with Leah and
the therapist observed a play time between Leah and her mother. The parents
also completed AutPlay inventories and returned them to the t­herapist –​
­including the AutPlay Assessment of Play and AutPlay Emotional Regula-
tion Inventory (­child version). Leah presented as excited and talkative. She
was eager to share her toys, thoughts, and ideas. Leah basked in the o­ ne-­​­­on-​
­one attention she received from the therapist during their sessions.
Therapy goals were established to work on increasing Leah’s ability to name
and express her feelings, increasing her emotional regulation ability and im-
pulse control. The Structured Play Intervention Phase began around session
four. Structured play therapy interventions and bibliotherapy were imple-
mented by the therapist to address these therapy goals. Leah participated
in these interventions, and engagement differed depending on Leah’s ­buy-​
­in to the specific play activity. One intervention, What Are They Feeling?
was a favorite of Leah’s. This intervention requires participants to recognize
and identify different emotions, and process why a person might be feeling
that way. This intervention suggests the use of pictures cut from magazines;
however, this was modified on telehealth by using a collection of images
 The AutPlay® Therapy Process 173

the therapist had found and shared with Leah through s­creen-​­share. Leah
demonstrated the ability to recognize a person’s emotions and was eager to
use her imagination to create a backstory about each person and how they
came to be feeling that way. Over time, What Are They Feeling? was repeated
to increase variety in Leah’s emotion vocabulary.
Another intervention called Action Identification was also implemented with
Leah. In this play intervention the child is asked to recognize expected versus
unexpected behavior to do in certain situations. The therapist prepared this
intervention by writing various behaviors/­actions on index cards. The thera-
pist included some general actions, as well as some specific to Leah, such as
“­meowing like a kitty” and “­interrupting someone.” The therapist acted out an
action, and engaged Leah to guess what it was, then name expected and unex-
pected environments or situations to do the behavior. Leah enjoyed this activity
and often requested it, engaging the therapist in taking turns to act out the
behavior. Once Leah understood, for example, that “­meowing like a kitty” was
expected to do at home or while playing with friends, she was able to better con-
trol her impulse to do so at school. This play intervention worked on improving
Leah’s emotion regulation and impulsivity in a ­non-​­shaming, affirming way.
Leah progressed quickly with her therapy goals participating in telehealth.
Her parents reported improvement in her emotional regulation ability, im-
provement in p­ roblem-​­solving strategies when frustrated, and a decrease
in major meltdowns. Leah’s understanding of why she behaved in certain
ways allowed her to have ­buy-​­in to change her actions in certain situations.
Leah’s frequency of therapy quickly reduced, and her therapy goals shifted to
focus on increasing positive ­self-​­concept and coordination of care with an
occupational therapist for ongoing body regulation and sensory processing
challenges. Around session 41, the therapist, Leah, and her mother discussed
graduating therapy and began the Termination Phase. Leah participated in
AutPlay Therapy through telehealth for approximately 11 months, and then
graduated from therapy having completed her therapy goals.

References

­Bottema-​­Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., & Hand, B. N. (­2021).
Avoiding ableist language: Suggestions for autism researchers. Autism in Adult-
hood, 3(­1), ­18–​­29. http://­doi.org/­10.1089/­aut.2020.0014
Bowers, N. R., & Bowers, A. (­2013). Play as a voice for our children. In N. R. Bowers
(­Ed.), Play therapy with families: A collaborative approach to healing (­p­­p. ­1–​­6). Jason
Aronson.
174 The AutPlay® Therapy Process

Cross, A. (­2010). Come and play: Sensory integration strategies for children with play
challenges. Redleaf Press.
Delaney, T. (­2010). 101 games and activities for children with autism, aspergers, and
sensory processing disorders. McGraw Hill.
GoodTherapy.org (­ 2015). Therapeutic relationship. https://­ www.goodtherapy.
org/­blog/­psychpedia/­­definition-­​­­of-­​­­therapeutic-​­relationship
Kestly, T. A. (­2014). The interpersonal neurobiology of play: Brain building interventions
for emotional ­well-​­being. W. W. Norton & Company.
Kottman, T. (­2003). Partners in play: An Adlerian approach to play therapy. American
Counseling Association.
Landreth, G. L. (­1991). Play therapy: The art of the relationship. Accelerated Devel-
opment Publishers.
Landreth, G. L. (­2001). Innovations in play therapy: Issues, process, and special popu-
lations. Routledge.
Leggett, E. S., & Boswell, J. N. (­2017). Directive play therapy. In E. S. Leggett &
J. N. Boswell (­Eds.), Directive play therapy: Theories and techniques (­p­­p. ­1–​­15).
Springer Publishing Company.
Parker, N., & O’Brien, P. (­2011). Play therapy reaching the child with autism. Inter-
national Journal of Special Education, 26, ­80–​­87.
Petruk, L. H. (­2009). An overview of nondirective play therapy. Good Therapy.
https://­www.goodtherapy.org/­blog/­­non-­​­­directive-­​­­play-​­therapy/
VanFleet, R. (­2014). Filial therapy: Strengthening the p­ arent-​­child relationships through
play (­3rd ed.). Professional Resource Press.
 8
The AutPlay® Therapist

The Play Therapist

The AutPlay therapist begins with a fundamental understanding of what it

me means to be a play therapist. Across the planet, organizations like the
Association for Play Therapy and the British Association for Play Therapy
have established characteristics and standards for becoming a play thera-
pist. Kottman and ­Meany-​­Walen (­2018) stated that there are specific per-
sonal qualities that are important in becoming a play therapist and there are
professional trainings and experiences that are essential in preparing people
to become play therapists. Kottman and M ­ eany-​­Walen (­2018), Kottman
(­2011) furthered:
Effective play therapists should like children and treat them with re-
spect and kindness, have a sense of humor, and be willing to laugh at
themselves and with others, be fun loving and playful, be sufficiently
­self-​­confident and not to depend on positive regard from other people to
bolster their ­self-​­worth, be open and honest, be flexible and be able to
deal with ambiguity and uncertainty, be accepting of others perspectives
without feeling vulnerable or judgmental, and be willing to think of play
and metaphor as vehicles for communication with others. They should
also be relaxed and comfortable being with children and have experi-
ence building relationship with them, be capable of firmly and kindly
setting limits and maintaining personal boundaries, be ­self-​­[a]ware and
able to take interpersonal risks, and be open to considering their own
personal issues and the impact of those issues on what transpires in play
therapy sessions and relationships with clients and their families.

In general, it is important for those who practice play therapy or want to

become play therapists to be creative, cognitively flexible, fun, passion-
ate, caring, trustworthy, and responsible. This isn’t a whole lot different
from counselors and or therapists who do other types of therapy. We
think an important consideration for professionals who do play therapy
is a willingness to enter into the creative world of the client and to

DOI: 10.4324/9781003207610-9
176 The AutPlay® Therapist

think symbolically. These qualities are important because your primary

“­tool” in play therapy is ­you – ​­the person who loves to ­play – ​­the person
who loves to listen to stories and have adventures and dance and tell
stories and make up songs and mess around in the sand and do art…It
is essential that you are open to thinking about the play (­or what the
client does), rather than words (­what the client says), as the healing
­channel – the
​­ path for communication and facilitation of movement
and growth.
(­­p. 8)

The British Association for Play Therapy (­2014a) created the essential per-
sonal qualities for a play therapist which demonstrate identified personal
qualities of a play therapy practitioner to promote public protection and
ethical practice. This includes Empathy – ​­to empathize with the emotional
and psychological expressions, experiences and needs of clients and signif-
icant others. Sincerity – commitment
​­ to being sincere and genuine to self
and others. Honesty – ​­to act truthfully and with integrity toward self and
others. Respect – ​­to acknowledge and show acceptance toward other peo-
ple’s understanding, experiences, and abilities. Ethical – ​­to be committed to
ethical practice and able to comply with the ethical code and values defined
by the British Association of Play Therapists. Knowledgeable – to ​­ be able to
apply knowledge, evidence and experience critically. ­Self-​­awareness – ​­to as-
sess, review and consider own competencies, strengths, and weaknesses as a
play therapist. ­Self-​­responsibility – ​­to operate and practice efficiently within
own level of competencies. Congruence – ​­to be authentic and genuine in
conduct with clients and significant others. Compassion – to ​­ be emotionally
warm, caring, and concerned toward others. Critical reflection – ​­to critically
reflect upon the emotional, social, and psychological world of clients, sig-
nificant others, and the self and to integrate reflection into practice. Com-
mitment to professional development – to ​­ continue professional development
as a play therapist in a responsible and effective manner. Commitment to
personal development – ​­to be reflexive, to integrate personal insights into
future practice, to continue personal development in a responsible and ef-
fective manner.
The British Association for Play Therapy (­2014b) furthered that ethical
principles are essential for the play therapist and created the following in-
tended to guide and inspire play therapists toward achieving the highest ide-
als of the profession.

• Play therapists need to be motivated, concerned, and directed toward

good ethical practice.
 The AutPlay® Therapist 177

• Play therapists strive to benefit those with whom they work, acting in
their best interests and always working within their limits of compe-
tence, training, experience, and supervision.
• Play therapists are committed to not harming those with whom they work.
• Play therapists establish relationships of trust with those with whom
they work.
• Play therapists recognize that fairness and justice is an entitlement for
all persons.
• Play therapists respect the dignity and worth of all people and the rights
to privacy, confidentiality, and autonomy.
• Play therapists respect the needs of individuals, including emotional,
psychological, social, financial, educational, health, and familial needs.
• Play therapists apply all of these principles to themselves. This involves a
respect for the play therapist’s own knowledge, needs, and development.

O’Conner (­2000) stated that the play therapist seeks to maximize the child’s
ability to engage in behavior that is fun, intrinsically complete, p­ erson-​
­oriented, variable/­flexible, ­non-​­instrumental, and characterized by a natural
flow. ­High-​­quality play therapy as practiced by a given play therapist repre-
sents an integration of the therapist’s specific theoretical orientation, per-
sonality, and background with the child’s needs in working toward therapy
goals. Play therapists universally recognize that therapy has been success-
fully completed when the child demonstrates an ability to play with joyous
­abandon – ​­this is what makes play therapy unique. The Association for Play
Therapy (­2022) identified the following areas of competencies (­knowledge
and understanding of play therapy, clinical play therapy skills, and profes-
sional engagement in play therapy) as essential to the competent practice of
play therapy, irrespective of theoretical orientation.

The play therapist will:

• Demonstrate knowledge of the history of play therapy.

• Demonstrate understanding of the therapeutic powers of play.
• Demonstrate knowledge of the therapeutic relationship in play therapy.
• Demonstrate knowledge of seminal/­historically significant play therapy
theories and models.
• Apply theories and stages of childhood development in play therapy.
• Identify and apply ethical practices in play therapy.
• Demonstrate an understanding of the play therapy treatment process
(­e.g., treatment goals and plans, documentation, intake/­termination,
and tracking of treatment progress).
178 The AutPlay® Therapist

• Demonstrate knowledge of family and systemic theories in play therapy.

• Demonstrate knowledge of ­ childhood-​­
related problems and mental
health diagnosis/­disorders.
• Demonstrate an understanding of the diverse impacts of childhood
trauma (­e.g., neurobiological, systemic, social) and the implications in
play therapy.
• Demonstrate knowledge of assessment in play therapy.
• Apply and articulate the therapeutic powers of play.
• Demonstrate relationship and r­apport-​­ building skills (­
e.g., empathy,
safety, unconditional positive regard) by utilizing ‘­self’ in relationships
with children, caregivers, stakeholders in play therapy.
• Apply assessments that highlight various aspects of the child and/­or
system and the play therapy process (­ e.g., conceptualization, di-
agnosis, family dynamics, treatment suitability and effectiveness,
termination).
• Articulate and explain the play therapy process.
• Demonstrate basic play therapy skills (­e.g., tracking, reflection of feeling,
limit setting, pacing with the client).
• Identify play dynamics (­e.g., types of play, themes, stages) and incorpo-
rate clinical considerations in treatment.
• Develop play therapy treatment goals and plans congruent with theoret-
ical orientation.
• Demonstrate understanding of own cultural and social identity and its
influence in the play therapy process.
• Exhibit multicultural orientation to diversity, equity, and inclusion
through a culturally and socially diverse playroom and play therapy
process.
• Demonstrate play therapy treatment skills congruent with theoretical
orientation (­e.g., conceptualization, interventions).
• Maintain play therapy credentials and involvement in professional play
therapy organizations.
• Consistently evaluate and adjust play therapy practices to meet state and
discipline ethical guidelines and codes.
• Apply ongoing integration of APT’s guidelines within the Best Practices
and Paper on Touch.
• Recognize and adhere to the limits of professional scope of competence
in play therapy.
• Seek and integrate play ­therapy-​­specific continued education, research,
and literature.
• Seek and integrate play ­therapy-​­specific supervision and consultation.
• Practice ­self-​­care to maintain quality play therapy services.
 The AutPlay® Therapist 179

• Seek and integrate ongoing knowledge regarding cultural and social di-
versity in play therapy.
(­p­­p. ­11–​­12)

Landreth (­1991) described play therapy to be a dynamic approach to coun-

seling with children which allows the play therapist to fully experience the
child’s world as the therapist ventures forth in the process of presenting the
person they are and opening their selves to receive the delicate and subtle
messages communicated by the child. Landreth furthered the following de-
scriptors for defining the play therapist.

• The play therapist is a unique adult in children’s lives, unique because

the therapist responds out of their own humanness to the person of the
child.
• The characteristics of acceptance of the child, respect for the child’s
uniqueness, and sensitivity to the child’s feelings identify the play thera-
pist as a unique kind of adult.
• The play therapist is intentional about creating an atmosphere. Thera-
pists must be aware of what they do and why they do it. This makes ther-
apists unique because they are not stumbling through a relationship with
a child, but rather are being careful about their own words and actions.
• The therapist is working hard at treating an atmosphere conducive to
building a relationship with the child.
• The play therapist is an adult who intently observes, empathically lis-
tens, and encouragingly recognizes not only the child’s play but also the
child’s wants, needs, and feelings.
• The uniqueness of the play therapist is heightened by listening actively
not only to what the child verbalizes but also to the messages conveyed
through the child’s activity.
• The therapist should be ­open-​­minded rather than ­close-​­minded. Open-
ness and sensitivity to the child’s world are basic prerequisites for play
therapists. Children are considered and related to primarily on the basis
of their own merit, who they are rather than who they have been de-
scribed to be.
• Play therapists have a high tolerance for ambiguity which enables them
to enter into the child’s world of experiencing as a follower, allowing the
child to initiate activity, topic, direction, and content with encourage-
ment from the therapist.
• The play therapist acts and/­or responds out of personal courage by admit-
ting mistakes, by being vulnerable at times, and admitting inaccuracies
in personal perceptions. The play therapist is personally secure and thus
180 The AutPlay® Therapist

recognizes and accepts personal limitations without any sense of threat

to their feelings of adequacy.
(­p­­p. ­87–​­93)

Deconstructing Ableist Ideas

When I began (­around 22 years ago) compiling the protocol/­integration for

AutPlay Therapy, I had an understanding of neurodiversity. I had read about
the term and concept from Judy Singer and had my own lived experience as a
neurodivergent person. I also had an awareness and understating of ableism,
most specifically as it pertained to individuals with physical disabilities. As the
tenets of AutPlay were being realized, I believed I was celebrating neurodiver-
sity, not being ableist, and providing a new way of viewing and working with
children. To some degree I was doing all this and while I had learned much,
there was still more to learn. I had deconstructed a great deal of the ableist ed-
ucation I received. I fully believed that autistic and neurodivergent children
were not receiving the therapeutic benefits of play therapy approaches and
was committed to advocating for this change, but unbeknown to me, my work
was not finished, there was still much to unpack, unlearn, and understand.
The beginnings of AutPlay certainly contained affirming ideas and a distinct
difference from the behavioral focused “­therapies” that permeated at the
time, but it was not a fully realized affirming approach that it is today. In the
beginning, there were still elements of the medical model, deficit thinking,
person first language, and uneven views of “­skill” development. Even as a
neurodivergent person, I was not immune to the societal and systems condi-
tioning of ableist thought that still found its way into the AutPlay protocol.
My understanding of the neurodiversity paradigm, movement, and ­anti-​
­ableist processes has grown exponentially since the beginning of AutPlay.
Luckily, I have been able to grow AutPlay as I have grown, fi­ ne-​­tune the
framework to comprehensively highlight a neurodiversity affirming approach
and continually eradicate ableist pieces. The process has been challenging
and rewarding and some of the most important work I have done. Along my
own growth journey, I have discovered a few truths that I try to share with
therapists to help them in their own journey of deconstructing ableism and
­non-​­affirming beliefs and rebuilding a neurodiversity informed and affirming
awareness and practice.

1 Ableism is a powerful conditioning process. To deny its power histori-

cally and in our current society is to set ourselves up to produce ableist
 The AutPlay® Therapist 181

(­and harmful) processes, likely without realizing it. There is always a

benefit to question your own thoughts, especially through an ableist fil-
ter. Why do I think this? Why am I doing this? Where did I get this idea?
Is this really important? Who is this important for? Why do I think it is
important? It’s never wrong to stop, reflect, and question.
2 Neurodivergent individuals can be ableist. No one is immune from con-
ditioning and ableist thoughts and beliefs. As a matter of fact, until re-
cently most individuals in the US would have grown up in a society
where every system was laden in ableist ideas and processes. This is be-
ginning to change but it is far from a healthy place.
3 Ableism exists in levels and/­or degrees of ableist thought. Just because
you are not like “­that professional” who believes that autistic children
need to be cured from their autism, doesn’t mean you don’t have your
own ableist beliefs. Many professionals who work with neurodivergent
children seem to have good intentions with a sincere desire to help chil-
dren. Often these professionals are furthering ableist ideas and lacking
affirming practices and they do not realize what they are doing. This is
why it is so critical to ask, “­Could this be me?” No one should assume
they do not need to work on being better at affirming practices.
4 We must continually commit to listening to, hearing, learning from, and
contemplating the words, insights, and experiences of neurodivergent
individuals. There may currently be nothing better in terms of learning
about ableism and affirming practices than spending time listening to
neurodivergent adults. Commit to reading published works by neurodi-
vergent adults who are ­affirming – ​­watch their YouTube channels, read
their blogs, take their trainings, and follow them on social media.
5 To become ­non-​­ableist and affirming is a mindful, consistent, lifelong pur-
suit to deconstruct societies’ conditioning and create new ­self-​­awareness.
This simply must be understood. Growth is progressive. Maintaining
an attitude of l­ife-​­long learner will help ensure that therapists stay the
course and avoid pitfalls.
6 Ideal change happens on a systemic level but starts with one person
making changes within themselves. I have often contemplated how
basically every system seems to be embedded in ableist and ­non-​
affirming processes. How will anything every improve until these
­
systems change and how can something that seems so massive ever
change? Often these questions can feel overwhelming for us and our
clients. The realization of what is and the work that needs to be done
requires the therapist to engage in meaningful ­self-​­care. Change often
does and can start with one person. One therapist shifting, being bet-
ter, can have an impact.
182 The AutPlay® Therapist

Am I ableist? It is not always easy to tell if you are biased or implementing an

ableist belief. Many people have biases, and many are very well conditioned
in ableist practices and thoughts and don’t realize it. It can be because of the
way they grew up or what they learned from their education, media, and/­or
society. Vormer (­2020) developed a set of questions to ask yourself to help
identify your ableist biases:

• Do you feel that people with differences need to be cured?

• Do you think that all disabled and neurodivergent people have intellec-
tual challenges?
• Do you think that people with disabilities can’t be full members of
society?
• Do you feel pity for people with disabilities and/­or differences?
• Do you think that all disabilities are visible?
• Do you think that all neurodivergent people and those with a disability
rely on other people their whole lives?
• Do you believe that a person’s disability is the most important thing
about them?
(­­p. 32)

The AutPlay therapist should be mindful of ableist influences. They should

be active in exploring and recognizing ableist and n
­ on-​­affirming ideas within
the mental health culture, approaches, techniques, etc. and within them-
selves. They will make a commitment to keep learning about the neurodi-
versity paradigm and movement. They will take care to view all play therapy
techniques and interventions through a neurodiversity affirming filtering
process.

Issues of Diversity and Intersectionality

Intersectionality is widely described as the acknowledgement that everyone

has their own unique experiences of discrimination and oppression, and
we must consider everything and anything that can marginalize ­people –​
­gender, race, class, sexual orientation, physical ability, etc. Mallipeddi and
VanDaalen (­2021) stated that intersectionality means that many different
social influences make up a person’s experiences. Examples of these social
influences are gender and sexism, ethnicity and racism, and disability and
ableism. This topic is important because different autistic and neurodiver-
gent people may have different experiences depending on these other social
 The AutPlay® Therapist 183

factors. The theory of intersectionality calls for an understanding of issues

in terms of multiple intersecting power structures and social positionalities.
In other words, when seeking to understand the experiences of persons with
disabilities, it is important to also seek to understand how they may differ-
entially experience, benefit from, or enact racism, sexism, or heterosexism,
among other forms of power and privilege.
Intersectionality can encompass many different scenarios. Considering neu-
rodivergence, this identity could overlap with one or multiple other minor-
ities and/­or oppressed identities. Mette (­2020) provides a snapshot of one
possible example of intersectionality:
As a m
­ ixed-​­race woman with autism, I have three identities that give me
unique lived experience that a white man with autism would not have.
I experience disadvantage on account of my gender, race, and neurodi-
versity. What is meant by this is that I go through something different
by having a t­ hree-​­part identity. For many marginalized people who have
multiple difficulties, intersectionality is a really useful way to describe
how different parts of you can be discriminated against at one time.
(­para. 1)

O’Conner (­2000) proposed that there are two key issues with diversity in
play therapy. One is the therapist themselves and the other is the role of
culture in modern society and the mental health field in particular.
The persona of the therapist plays an incredibly important but often ne-
glected role in the way they practice psychotherapy. The therapist’s phi-
losophy, values, experiences, cultural background, family background,
and so forth influence every nuance of the therapy. These variables in
turn affect the style and pattern of the therapist’s speech and the way
the therapist dresses and moves in the session, the way they react to
different clients, and the way clients react to them. Even the theoretical
orientation that the therapist adopts and the techniques they choose
to implement are not without their determinants in the persona of the
therapist. It is critical that therapists recognize themselves in their work
and not hide behind rationalizations that hold that what they do in a
given case is the one best intervention. Otherwise, the therapist risks
becoming blind to the client’s needs. And therapy may not only cease to
be effective, but it may also even become iatrogenic.
(­­p. 59)

O’Conner (­2000) explained that the play therapist must understand that
in many cases the child’s difficulties are best characterized as conflicts be-
tween the child and any one of a number of other systems in which the child
is embedded (­the social model of disability). The play therapist’s role is to
184 The AutPlay® Therapist

work with the child and family to develop strategies for meeting as many of
the child’s needs as possible within the different environments in which the
child is embedded. This places the therapist in much more of an advocacy
role (­a component of AutPlay Therapy) than is typical of some play ther-
apy theories and approaches. The play therapist must consider their own
and their client’s similarities and differences in neurodiversity (­neurotype),
ethnic and culture background, race, class, language, gender identity, reli-
gion, sexual orientation, family experience, age, and nationality. O’Conner
(­2000), furthered that there are specific guidelines for practicing therapy in
general and play therapy in particular in a culturally competent manner:

1 Awareness/­Sensitivity/­­Empathy – ​­Practicing culturally competent play

therapy requires developing awareness of one’s own and other’s cultures
to facilitate the ability of the therapist to empathize with the client.
The therapist should respect historical, psychological, sociological, and
political dimensions of a particular diversity group, culture, race, and/­or
ethnic group and be certain the child and family feel the therapist ac-
cepts their belief system and diversity experience. The therapist should
display an appreciation for strengths of different cultures. The therapist
should be forthcoming and acknowledge to the client an awareness of
differences between themselves and the client and ask the client in a
supportive way if they have any concerns.
2 Dynamic ­sizing – The​­ ability to understand and evaluate the meaning
of culture for a specific client and the ability to assess the impact that a
history of discrimination may have on the therapy process. The therapist
should not generalize about all clients that belong to a particular group
and focus on understanding the particular individual with whom the
therapist is working. The therapist should be aware that many factors
contribute to a person’s orientation and values and recognize that social,
economic, and political discrimination and prejudice are real problems
for minority and diversity groups.
3 ­Knowledge – Two​­ types of knowledge make it more likely that the ther-
apist will be successful with clients from diverse backgrounds. One is the
knowledge about how to modify the therapeutic process to suit a given
cultural group. The other is knowledge of the culture itself and the way
it is manifested in the system(­s) in which the client is embedded.
(­p­­p. 80–​­82)

AutPlay Therapists must be prepared for diversity and intersectionality in

play therapy. A neurodivergent child may be of a different race, gender, sex-
ual orientation, etc., from the therapist. It will not be only a neurodivergent
 The AutPlay® Therapist 185

child that will come into the playroom. Consider a white American neu-
rotypical male therapist. A new referral the therapist receives is a BIPOC,
female, autistic child or a LGBTQIA+ Chinese child with a developmental
disability. The combinations (­intersectionality) can consist of many experi-
ences. AutPlay Therapy training (­framework protocols) and/­or neurodiver-
sity affirming training will likely not be sufficient to address all the diversity
needs that can present in the playroom. The AutPlay therapist will need to
take care to be trained, informed, aware, and ready to be a healing, helpful
support to their clients regardless of diversity.

Understandings of the AutPlay Therapist

Understandings are fundamental. They are not “­nice ideas.” The AutPlay
therapist realizes that each understanding presented is an active and hap-
pening component of therapy, and it is the therapist’s responsibility to en-
sure they encompass and reflect each understanding. The understandings are
presented as follows:

• The development of the therapeutic relationship is the grounding fo-

cus throughout therapy. This process begins with first contact with the
child and family and continues until termination of therapy services.
The AutPlay therapist makes a distinct effort to understand relationship
development principles and to apply those principles. They also take
care to evaluate that effective relationship development is occurring in
the therapist/­client experience.
• The foundation and framework of AutPlay Therapy consists of an inte-
gration of seminal play therapy theories and approaches. Without play
therapy there is no AutPlay Therapy. The AutPlay therapist values,
supports, and understands the therapeutic powers of play, that play is
the change agent, and play is the natural language of neurodivergent
children. The AutPlay therapist supports play therapy as a viable option
for addressing the mental health needs of autistic and neurodivergent
children.
• The foundation and framework of AutPlay Therapy also consists of
neurodiversity affirming and informed constructs and practices. The
AutPlay therapist will have a working knowledge and understanding of
the neurodiversity paradigm and movement as well as how to implement
neurodiversity affirming constructs in play therapy work. The therapist
will be able to conceptualize how play therapy theories and approaches
can be implemented in an affirming way. The therapist will also ensure
186 The AutPlay® Therapist

that play therapy techniques have been evaluated to ensure ­non-​­ableist

messages and protocols before implementing with children and families.
• The children deserve the right to have their play preferences and inter-
ests recognized and valued. The AutPlay therapist will strive to ensure
that the child’s play preferences and interests are realized and utilized
in play therapy approaches and techniques. Therapy goals will, if at all
possible, be addressed through the child’s play preferences and interests.
The therapist should implement AutPlay processes that observe and as-
sess for play preferences and assist parents in understanding and valuing
their child’s play preferences.
• The parent and child are considered partners (­­co-​­change agents) in the
play therapy process. The AutPlay Therapist will make every effort to in-
clude the parents and child in therapy goals and planning. The therapist
will value and listen to the parents and understand that parents possess a
knowledgeable input about their child and family and parents and family
are a critical and foundational relationship for the child. The therapist
will also listen to and value the child as a partner in the play therapy pro-
cess. The therapist will provide space and opportunity to empower the
child to express ­themselves – ​­their wants and needs related to therapy.
The therapist will realize that the child is an expert on themselves, and
their voice is critical in accomplishing the best therapy outcomes.
• Each child is an individual and developmentally will have unique
strengths, presentations, and needs. Therapy goals and planning should
reflect the individual child and not be a standard protocol based on a
diagnosis. The AutPlay therapist will implement processes to gain an
understanding of the individual child, how they navigate, think, pro-
cess, play, and experience their world. Significant time will be spent (­as
much as necessary) to conceptualize the individual self and identity of
the child. This individual awareness will shape the direction of therapy
and therapy goals.
• A systems approach, including family members and other individuals ac-
tively in the child’s life, is important. Family systems theory looks at the
mutual influences of family members on each other. It moves away from
an identified patient (­usually the child) model to a way of understanding
the problem or issue in the context of the whole family. The therapist
will understand that the family unit is the foundation for c­ hildren – it ​­
has the greatest impact on the child’s development. The family is the
main environment for a ­child – ​­little else has the same influence as the
family environment. What the parents do greatly affects the child and
what children do greatly affects parents. As the AutPlay therapist works
with each family, they will consider and assess: What is the definition
 The AutPlay® Therapist 187

of this family, how does the family play, does the family not play, how
does play contribute to the family’s relationships, and how does/­can the
family heal through play?
• Children and families should be engaged and accepted where they are at,
and diligence is ensured to provide empathy and support. The AutPlay
therapist will provide unconditional positive regard, defined as showing
complete support and acceptance of a person no matter what that person
says or does. The AutPlay therapist accepts and supports the client, no
matter what they say or do, placing no conditions on this acceptance. The
application for providing unconditional positive regard includes having
respect for the parent and child, being n
­ on-​­judgmental and impartial, val-
uing the parents and child and accepting them as a unique individuals and
families, being accepting of the parent and child, and their views, opin-
ions, and beliefs, providing a nurturing and caring support for the parent
and child, and being conscious of their needs and being compassionate
about, and understanding the parent’s and child’s struggles and needs.
• The therapy should have an assessed and identified purpose ensuring
that therapy goals maintain healthy expectations and are clearly iden-
tified and ­explained – ​­the reasons for participation in play therapy. As
much as possible, the parent and child will participate in creating and
adjusting therapy goals and in implementing the process toward achiev-
ing therapy goals.
• The therapy should involve formal and/­or informal periodic evaluation
to monitor for progress toward therapy goals. The evaluation process
should include the therapist, parent, and child. Each should have an
active voice in assessing how therapy is progressing. This can be done
through a consultation/­meeting discussing the therapy process or can be
done through providing formal inventories that assess for progress and
or growth.
• The therapist will stay current with research regarding neurodiversity,
neurodivergent individuals (­autistic, ADHD, sensory differences, learn-
ing differences, Tourette’s syndrome, developmental disabilities, etc.),
and play therapy. The AutPlay therapist will take care to recognize and
avoid research that includes ableist processes. The therapist will also
clearly understand their role and scope of practice when working with
neurodivergent children. The therapist will not falsely advertise or claim
to address needs in which they are not qualified to do. The therapist will
not attempt to establish therapy goals that are outside their scope of
practice and will ensure to make referrals as needed.
• The therapist brings their unique culture, values, and beliefs to their
play therapy work. Therapists may have also been impacted by racism,
188 The AutPlay® Therapist

classism, sexism, ableism, homophobia, xenophobia, or other systems of

oppression. Each child and family client may also bring these experiences
into therapy. AutPlay therapists intend to practice ethically and from a
­diversity-​­informed space. ­Diversity-​­informed is defined as a dynamic sys-
tem of beliefs and values that strives for the highest levels of diversity,
inclusion, and equity. ­Diversity-​­informed practices recognize the historic
and contemporary systems of oppression that shape interactions between
individuals, organizations, and systems of care. D ­ iversity-​­informed prac-
tices also seek the highest possible standard of equity, inclusivity, and
justice in all spheres of practice: therapy, teaching and training, research
and writing, advocacy, and direct service (­Irving Harris Foundation,
2018).

Fundamentally, the AutPlay therapist will strive to follow the legal, ethical,
and best practices of their given license and profession. Beyond the basics
of professionalism, the AutPlay therapist will understand the therapeutic
powers of play, play therapy theories, and work within the construct of play
as the change agent in mental health care. Specially, the AutPlay therapist
will be neurodiversity informed and ­affirming – ​­committed to ­non-​­ableist
practices and doing no harm to neurodivergent children. Realistically, the
AutPlay therapist has no distinction from what should be expected from any
play therapist working with autistic and neurodivergent children and their
families. The commitment to providing best practices and the most valuing
and affirming therapy should be something all professionals are continually
striving toward.

References

Association for Play Therapy. (­2022). Credentialing standards for the registered play
therapist (­p­­p. ­11–​­12). https://­cdn.ymaws.com/­www.a4pt.org/­resource/­resmgr/­
credentials/­rpt_standards.pdf
British Association for Play Therapy. (­2014a). Play therapy core competencies.
https://­www.bapt.info/­­play-​­therapy/­­play-­​­­therapy-­​­­core-​­competences/
British Association for Play Therapy. (­ 2014b). Ethical basis for good prac-
tices in play therapy. https://­www.bapt.info/­­play-​­therapy/­­ethical-­​­­basis-­​­­good-
­​­­practice-­​­­play-​­therapy/
Irving Harris Foundation. (­2018). ­Diversity-​­informed tenets for work with infants, chil-
dren and families. https://­diversityinformedtenets.org/
Kottman, T. (­2011). Play therapy: Basics and beyond (­2nd ed.). American Counseling
Association.
 The AutPlay® Therapist 189

Kottman, T., & ­Meany-​­Walen, K. K. (­2018). Doing play therapy: From building the
relationship to facilitating change. Guildford Press.
Landreth, G. L. (­1991). Play therapy: The art of the relationship. Accelerated Devel-
opment Publishers.
Mallipeddi, N. V., & VanDaalen, R. A. (­ 2021). Intersectionality within crit-
ical autism studies: A narrative review. Autism in Adulthood. http://­doi.
org/­10.1089/­aut.2021.0014
Mette. (­2020). I’m an autistic, mixed race w ­ oman – let’s
​­ discuss intersectionality.
Learning Disability Today. https://­www.learningdisabilitytoday.co.uk/­­im-­​­­an-
­​­­autistic-­​­­mixed-­​­­race-­​­­woman-­​­­lets-­​­­discuss-​­intersectionality
O’Conner, K. J. (­2000). The play therapy primer. John Wiley and Sons.
Vormer, C. R. (­2020). Connecting with the autism spectrum: How to talk, how to listen,
and why you shouldn’t call it high functioning. Rockridge Press.
 9
Phases of AutPlay® Therapy and
Therapy Goals

Therapy Phases in AutPlay Therapy

Ultimately AutPlay Therapy is a framework or guide for the therapist to

implement play therapy with neurodivergent children. The phases of ther-
apy exist to help provide a level of structure for the therapist to follow. The
phases can be considered as flexible phases where the therapist has room to
adjust and navigate as needed to best address the mental health concerns of
the child and their family. The phases of therapy begin with the Intake and
Assessment Phase which typically lasts four sessions. The second phase is
the Structured Play Intervention Phase, which continues until therapy goals
have been completed. The third and final phase is the termination phase
which typically last two to three sessions. T
­ able 9.1 displays the typical pro-
gression through the phases of therapy.

Intake and Assessment Phase

The intake and assessment phase of AutPlay Therapy is all about the be-
ginning of meeting, being with, learning about, and building relationship
with the child and family. This phase of therapy typically lasts three to five
sessions, with the most common being four sessions. The Intake and Assess-
ment Phase begins with first contact. Once the therapist has established

­Table 9.1 The Three Phases of AutPlay Therapy

Phases of Therapy
Intake and assessment Structured intervention Termination phase
phase phase

DOI: 10.4324/9781003207610-10
 Phases of AutPlay® Therapy and Therapy Goals 191

an initial session, the therapist should send the family a social story about
going to see a play therapist. The parents are instructed to read the social
story to the child a few times a day the week before the first appointment.
The social story should include information about what the child can expect
and pictures of the therapist and the office and playroom. If a social story is
not appropriate, the therapist could send an email that welcomed the child
and family and included pictures of the therapist and the clinic. The parents
could share the email with the child. The following presents an example
social story:
A play therapist is someone who plays with kids and tries to help

them with their problems.

My mom or dad or both may take me to see a play therapist.

The play therapist usually has an office.

Sometimes my parents may see the play therapist with me.

Sometimes I may see the play therapist by myself.

There are toys to play with and other things to do at the

play therapist’s office.

I can play with the toys, games, and art materials.

The play therapist may talk to me.

I can talk to the play therapist and that’s okay.

I don’t have to talk to the play therapist and that’s okay.

I can go to the play therapist’s office and not feel nervous.

I can go to the play therapist’s office and have fun.

I can go to the play therapist’s office and feel better.

The first session is a general intake session with the parents. Typically, chil-
dren are not involved in this session. The therapist meets with the parents to
complete all necessary paperwork and to acquire information on presenting
issues and child/­family background. The therapist should begin establishing
relationship with the parents. As parents share their concerns and present-
ing issues, the therapist should listen and provide empathic response. The
therapist will answer any parent questions and explain the therapy process,
192 Phases of AutPlay® Therapy and Therapy Goals

including how AutPlay Therapy works. The therapist provides the parents
with the AutPlay Emotional Regulation Inventory (­child or adolescent), the
AutPlay Social Navigation Inventory, the AutPlay Connection Inventory
(­child or adolescent), and the AutPlay Assessment of Play Inventory (­all
inventories are in the appendix section) to take home, complete, and bring
back in the second session. The therapist may give parents additional inven-
tories to complete if it is deemed necessary. A helpful additional inventory
might include a sensory inventory or checklist such as Biel’s (­2014) Home
Screening Tool and School Screening Tool.
Session two involves both the child and parent(­s) with the therapist con-
ducting a family play observation. The observation can include both parents
with the child or one parent with the child. The therapist will observe the
child and parent together in a play therapy room. If possible, the therapist
will observe via monitor or t­wo-​­way mirror. If this type of process is not
available, then the therapist should stay in one corner of the play therapy
room and try just to observe. The parent should be told in session one that
they will be participating in a play observation with their child in session
two. The therapist should be sensitive to any anxiety this might create for
the parent. The general instruction to the parents is “­I’m going to observe
you and your child playing together for about 2­ 5–​­30 minutes. There are re-
ally no guidelines or rules, just keeping everyone safe. Try to play just as you
normally would at home.” Koehler, Wilson, and Baggerly (­2015) stated that
family play therapy approaches typically begin with some type of family play
assessment or observation. They identified three reasons why this type of
process is beneficial:

1 Observations of family play interactions enhance and enrich the infor-

mation gathered throughout the traditional data collection process of
clinical interviews and ­self-​­report measures.
2 Family ­ play-​­
based assessment is developmentally appropriate for
children.
3 ­Play-​­based family assessment facilitates rapport between a family and the
therapist, which increases the family’s trust, comfort, and motivation to
participate.

The child/­parent observation should last approximately 30 minutes. The

remaining time should be used for the therapist to join in with the child
and parent in their play. During the child/­parent observation, the thera-
pist should use and complete the AutPlay Child/­Parent Observation Form
(­in the appendix section). This form is designed to help the therapist note
 Phases of AutPlay® Therapy and Therapy Goals 193

anything of interest during the child/­parent observation. The observation

is conducted to help the therapist better understand and build relation-
ship with the child and parent. Observing the family playing together can
provide valuable insight for conceptualizing therapy goals. Some areas to
consider when conducting the observation include general child and par-
ent interaction, how the child and parent play together, parent initiations
toward the child, the child’s initiations toward the parent, communication
styles, and how limits are addressed. The therapist should make notes that
will be shared with the parent and child in session four. Typically, session
two will end with the therapist taking the child on a tour of the clinic or
facility including any playrooms or office spaces they may use during therapy
sessions.
Session three involves the therapist working with the child. The therapist
will meet with the child to continue to develop therapeutic relationship and
help the child feel familiar and comfortable with therapy. The therapist will
informally observe the child in a play session. Typically, this is done in a play
therapy room or some type of play space setup. A play therapy room provides
a wonderful opportunity to allow the child to express and display their play
preferences and interests, their communication style, and to facilitate rela-
tionship development between the therapist and child. The therapist will
use and complete the AutPlay Child Observation Form (­in the appendix)
to better understand and conceptualize the child. The therapist and child
will typically participate in the observation play time for the entire session,
approximately 45 minutes. The therapist should focus on relationship and
­rapport-​­building as well as completing the areas on the Child Observation
Form. Observation areas include communication style, play preferences, re-
lational interaction, executive functioning, sensory issues, and frustration
tolerance.
The therapist should introduce the play session (­observation) like any other
session with a structuring s­ tatement – “​­ ­This is the playroom, and you can play
with anything you want in here and I will be in here with you.” The therapist
should begin the observation in nondirective play therapy mode. The child
should lead the play and the therapist should follow, staying attuned to the
child. The therapist can periodically make tracking and reflective emotion
statements and set a limit if needed. Some example tracking statements in-
clude “­You filled the whole bucket up with sand,” “­You colored the picture
just the way you wanted,” and “­You were finished with the dollhouse and
now you are playing with the puppets.” Some example reflective statements
(­done when the child displays or communicates emotion) include “­That’s
frustrating you that the lid won’t come off,” “­Bouncing that ball makes you
194 Phases of AutPlay® Therapy and Therapy Goals

feel happy,” “­You don’t like that,” “­That makes you mad,” “­That feels good
to you.”
If the child invites the therapist into their play (­gives the therapist a role),
the therapist should join the child but stay in the role the child gives the
therapist. The therapist should not change the play or try to direct. Approx-
imatively halfway through the session, the therapist should naturally in-
troduce some directive elements into the observation. This might include
occasionally asking the child a question (­something simple and play related).
It could also include seeing if the child would respond to playing a game or
activity the therapist introduced. The totality of the observation play time
is designed to help the therapist build relationship and better know and un-
derstand the child.
Parents should have completed and returned all inventories given to them
from the therapist by session three. Between sessions three and four, the
therapist should review the parent completed inventories and the observa-
tion forms. The therapist should note any questions they may have for the
parent to ask in session four. The therapist should also begin to formulate
possible therapy goals and a therapy plan to share with the parents and
child.
Session four begins with the therapist meeting with the parent(­s) and child
(­if appropriate) to review the inventories, observations, and ask any addi-
tional questions. Often, parents like to hear some feedback from the thera-
pist about the observations and the inventories. There may be some natural
comments or questions the therapist wants to give the parents. If there is not,
the therapist should still try to provide some feedback to the parents, ideally
something positive or encouraging that the therapist noted during the obser-
vations. This is a time of discussion with the parents. Session four is designed
to establish therapy goals and a therapy plan. The therapist should talk with
the parents and child about possible therapy goals to address. The therapist
will want feedback from the parents and child if they feel the goals are in line
with the child and family’s needs. There may be multiple identified therapy
needs and goals. In this case, there will need to be a prioritization process.
Typically, around two therapy goals can be chosen to address. The other
therapy needs and goals can be addressed systematically as goals are accom-
plished. The therapist, parent, and child can work together to decide what
therapy needs are the priority to begin with.
Involving the child in session four should be done if at all possible and
appropriate. The child’s voice is important, and the therapist wants to hear
from the child as much as possible. The child is considered a partner in the
 Phases of AutPlay® Therapy and Therapy Goals 195

therapy process from the beginning to the end of therapy. In some cases,
the child may be too young or in a developmental state where they may not
participate in session four or they may have a limited amount to contribute.
The therapist needs to be mindful of the partnering/­participation level of
the child and if the child will attend session four or not. Even if the child
is in a developmental position or age which decreases their participation
in partnering, the therapist should look for every option throughout the
therapy for the child to express decisions and contribute to their thoughts
and feelings.
Once the therapy goals have been established, the therapist should explain
the AutPlay Therapy process. The therapist will explain what happens next
as therapy enters the Structured Intervention Phase. Ideally the child and
parent will participate in sessions together during the Structured Interven-
tion Phase. It should be established with the parents how the child and
parent sessions will be facilitated. This can happen in several ways and is
usually decided by what works best logistically for the therapist and family.
The most common way is for the child and parent to attend weekly sessions
and participate together. Another option would be one week meeting with
the parents and the next week meeting with the child. If it is possible to
meet twice in one week, then one time can be with the child and the other
with the parent. Another possible combination is meeting each week with
both parent and child by dividing the session time. The first half of the
session is the therapist and child together and then the parent is brought in
for the second half of the session. If the parent cannot be present with the
child in person during their session time, the parent could join the session
via a video conferencing platform. The level of parent involvement and the
application of involvement will depend somewhat on the therapist’s discre-
tion. Considering the child, family, needs, and therapy goals, the therapist
should determine what would work best for addressing therapy needs. This
might mean more or less parent involvement or parent involvement that
looks a specific way.
Step Guide for the Intake and Assessment Phase:

Session One

1 Therapist meets with the parents only to conduct a general intake process
which includes completing intake paperwork and any legal documents.
2 Therapist gives parents AutPlay inventories to compete and return in
session two.
196 Phases of AutPlay® Therapy and Therapy Goals

3 Therapist collects background information on the child and family and

all relevant documents including any previous psychological evalua-
tions, sensory evaluations, and IEP documents.
4 Parents provide presenting issues and reasons for seeking therapy.
5 Therapist explains AutPlay Therapy and provides information on neu-
rodiversity affirming practices.
6 Therapist explains that session two will be a child/­parent observation
play time.

Session Two

1 Therapist collects the AutPlay inventories from the parents.

2 Therapist facilitates a child/­parent play observation in a playroom set-
ting. Therapist should observe through monitor equipment or station
themselves in one corner of the playroom. Therapist should utilize the
AutPlay Child/­Parent Observation form when conducting the observa-
tion. This observation should last approximately ­25–​­30 minutes.
3 Therapist joins the child and parent in their play time after the observa-
tion time is over.
4 Therapist takes the child on a tour of the facility including all play-
room(­s) and office spaces that may be used.

Session Three

1 Therapist focuses on relationship development and helping the child

become familiar and comfortable with the facility and the therapist.
2 Therapist facilitates a child/­parent play observation in a playroom set-
ting. The parents should observe via monitor or in a corner of the play-
room. The therapist should utilize the AutPlay Child Observation form
when conducting the observation. This observation should last approxi-
mately 45 minutes.
3 Therapist should explain that session four will be a meeting with the child
and parent to discuss therapy needs and goals and answer any questions.

Session Four

1 Therapist meets with the child and parents. The therapist should discuss
the observations and AutPlay inventories with the family and answer
 Phases of AutPlay® Therapy and Therapy Goals 197

any questions they may have. The therapist works with the child and
parent to establish priority therapy goals and discuss moving forward
with the therapy process.
2 Therapist uses any reaming session time to meet with the child in a play-
room and continues to develop relationship and rapport.
3 Therapist prepares therapy goals and a therapy plan which may include
selecting structured play therapy interventions to complete with the
child and parent before session five.

Structured Play Intervention Phase

The Intake and Assessment Phase is an important time to begin developing

therapeutic relationship with the child and parent. It is also an important
time to get to know the neurodivergent child and their parent and begin to
individualize the play therapy process for the child. The Intake and Assess-
ment phase sets the stage and helps establish what will happen during the
Structured Play Intervention Phase. Once the Intake and Assessment phase
has been completed, the next session begins the Structured Play Intervention
phase. This phase typically begins around session five, continues until the
therapy goals have been completed, and includes both the child and parent.
The Structed Play Intervention Phase is where play therapy approaches and/­or
interventions began to be implemented to address the established therapy
goals. Much of the direction in this phase is determined by information gath-
ered in the Intake and Assessment Phase. The therapist may move forward
with a more nondirective approach, may begin implementing structured play
interventions to address specific needs, or may do some type of combination.
This will depend heavily on the individual ­child – ​­their needs, their play pref-
erences, the totality of their self, and how much or little parent participation
is happening. The therapist will want to conceptualize this plan and be open
to adjustments, changes, and feedback from the child and parent. Typically,
the Structured Play Therapy Phase will involve a level of structure from the
therapist. This may include what types of play therapy approaches or methods
to implement, the facilitation play therapy interventions, or an individual-
ized integration designed for the child. The following should be considered
when creating the structure of the Structed Play Therapy Phase:

• Who is this child? What do I understand about them? What do I under-

stand about their neurodivergence? Based on what I understand would
a less structed, or more structured play therapy process be appropriate?
198 Phases of AutPlay® Therapy and Therapy Goals

• What are the child’s therapy needs? What seems to be the best level of
structure to address their therapy needs?
• Will I have parent participation? What level of parent participation will
I have? What type of play approach or level of structure would be best
based on the level of parent involvement?
• If I am going to implement structured play therapy interventions, what
interventions would best address the therapy needs and goals? Have I
filtered the play therapy interventions to make sure they are affirming
and ­non-​­ableist?
• Will the structure involve an integration of nondirective and directive
approaches? If so, what will this look like in each session?
• Will there be a focus on home play times or interventions? If so, how will
I teach, support, help implement home play times? What seems like the
best fit for the family and to address therapy needs?
• How does the child and parent feel about the plan for the Structured
Intervention Phase? Have I shared it with them and gotten their feed-
back and opinion?

The structured Play Intervention Phase can have different “­looks.” Ideally
there is a level of parent involvement and a participation where parents
become ­co-​­change agents, working with their children at home to imple-
ment what they are learning in therapy sessions. As much as possible, par-
ents should be taught how to implement play therapy techniques and/­or play
times at home that mimic what the therapist is doing with the child in ses-
sions. There could be some directive play therapy techniques or approaches
that the therapist does with the child in session that may not, by nature of
the design of the activity, transfer to the home setting. This is fine but should
be the minority of experiences. The majority of the play therapy techniques
and/­or approaches implemented should be able to be taught to the parents
and transferred to the home environment. The following presents a few
examples of the different ways the Structured Play Intervention Phase can
manifest. Each conceptualization would be based on an understanding of the
individual child, their therapy needs, their neurodivergence, and the level of
parent involvement:

• It is evaluated, discussed, and decided that the Structed Play Interven-

tion Phase will consist of directive play therapy interventions to be
introduced each session by the therapist. The child and parent will par-
ticipate in the session together and in the play interventions. The child
and parent will continue to play the interventions together at home be-
tween sessions. The therapist will choose play interventions that align
 Phases of AutPlay® Therapy and Therapy Goals 199

with the child’s play preferences and interests and ensure that the inter-
ventions can be easily taught to parents and implemented at home.
• It is evaluated, discussed, and decided that the Structed Play Interven-
tion Phase will involve the therapist primarily working individually with
the child to address therapy needs. The therapist will meet every 4­ –​­6
sessions with the parent for a parent consultation. The therapist will
implement an integration of nondirective play and directive play inter-
ventions that involve the child’s play preferences and address identified
therapy needs. This will involve the therapist structuring sessions at the
beginning (­the first half of the session) with a directive play interven-
tion designed to address therapy goals. The second half of the session
involves a nondirective play session time designed to continue to address
therapy goals.
• It is evaluated, discussed, and decided that the Structed Play Interven-
tion Phase will consist primarily of a nondirective ­child-​­led play session.
The therapist will structure the beginning of the session with a short
­2–­​­­4-​­minute regulation activity which the child chooses. The remain-
der of the sessions will be ­child-​­led with a more nondirective approach
implemented by the therapist. The child can explore and include the
therapist in their play preferences. The therapist will meet every four to
six sessions with the parent for a parent consultation.
• It is evaluated, discussed, and decided that the Structed Play Interven-
tion Phase involve the child participating in a ­child-​­led nondirective
approach facilitated by the therapist. The therapist will teach the parent
how to have a modified nondirective special play time at home that will
happen once a week between sessions times.

The length of the Structured Play Intervention Phase varies. How much
time is spent during the Structured Play Intervention Phase will depend on
the depth and number of therapy needs and goals of the child, the spectrum
of presentation of the child (­low needs or high needs), the progression of the
child, and the level of parent/­family involvement. Typically, the lower the
needs and the more parent participation, will indicate the Structured Play
Intervention Phase will progress more quickly. It is important to let par-
ents know that there is not a set number of sessions for the Structured Play
Intervention Phase. Neurodivergent children will move through addressing
needs, processing, and conceptualizing at their own pace and this should be
validated. Many case studies and clinical outcomes have shown that neuro-
divergent children have shown a marked improvement in initially identi-
fied therapy needs and goals after participating in AutPlay Therapy after six
months. This does not indicate an end to the Structured Play Intervention
200 Phases of AutPlay® Therapy and Therapy Goals

Phase but rather a guide to showing improvement and progress toward ther-
apy goals.
Therapists should implement an evaluation process which periodically r­e-​
­evaluates to make sure therapy needs and goals are being met and to as-
sess for the need for any changes or additional therapy goals. One approach
would be to have parents complete updated AutPlay inventories from the
first session and compare parent ratings from the initial inventories and the
current ones. As progression is made and therapy goals are being met, it
may be appropriate to lessen the parent involvement and have more session
times with the child. If parents have learned most of the techniques and ap-
proaches and are actively and accurately implementing the techniques and
approaches at home, then session times with the parents may be limited to
a once per month consultation until therapy is terminated. Meeting times
(­consultations of some type) with parents should continue on some level un-
til therapy is terminated. Remember that the combination of parent training
sessions and child sessions can be implemented in a variety of ways. Thera-
pists may discover a unique way that child and parent involvement happens
that works for their particular family. Also, therapists will decide initially
and may adjust as therapy progresses, the level of parent involvement.
An exception to the ­three-​­phase process in AutPlay Therapy involves the
AutPlay Follow Me Approach (­FMA). This approach is defined in later
chapters. The FMA is a nondirective based play approach to working with
children and parents. It is most appropriate for children who have higher
needs and/­or ­co-​­occurring conditions and struggle with attunement, inter-
action, and communication. All children and parents would participate in
the Intake and Assessment Phase. During this phase it if was established that
the FMA would be a more appropriate approach, the child and parent would
begin participating in FMA sessions instead of the Structured Intervention
Phase.

Termination Phase

Kress and Marie (­2019) proposed that when it comes to the actual process
of termination, therapists can take many different approaches with clients.
The interests and developmental level of child and the content of therapy
should all be considered when planning termination activities. Termination
is often an ideal time to incorporate active, engaging, and creative inter-
ventions that encourage children to engage in active learning and reflection
upon the therapy process as a whole. Often, as termination nears, child
 Phases of AutPlay® Therapy and Therapy Goals 201

engagement and enthusiasm in therapy may diminish. By using active and

creative termination interventions, therapists can inject new enthusiasm
into the last few therapy sessions. Children tend to more readily remember
play interventions in which they are interactively involved. Regardless of
the specific intervention used, termination is an ideal time to incorporate
an optimistic, empowering and ­future-​­oriented approach. Therapists can
compassionately empathize with children who are reluctant to terminate
while concurrently encouraging them to see the end of therapy as a new ad-
venture in which they can use the new tools they have learned throughout
their therapy time.
The Termination phase will typically begin with the therapist initiating the
transition. As the therapist becomes aware that therapy goals have been
achieved and maintained, they should have a session with the child and
parent to discuss termination of therapy. The Termination phase usually
consists of three sessions. The first session introduces the idea to the child
and parent to elicit a discussion about the readiness for therapy to end. The
therapist can determine the appropriateness of having the child present or
not for this session. The therapist should review the therapy goals and plan
and point out/­discuss that therapy goals have adequately been accomplished.
The therapist should discuss to make sure there are no other therapy goals
to work on at this time. It is important to note that the initial therapy plan
will likely be updated by the therapist, child, and parent throughout the
Structured Play Intervention phase with new goals being added as others are
accomplished.
Termination phase begins with the therapist, child, and parent reviewing
and agreeing that all therapy goals have been met and there are no new goals
to accomplish. The therapist should then explain that therapy will be end-
ing within the next couple of sessions. The therapist should review with the
child and parent what they have learned and how to maintain the progress
they have made. The therapist can emphasize with the importance of con-
tinuing to facilitate play times, interventions, and activities at home. The
therapist should also emphasize the continued use of any coping and/­or reg-
ulation tools that have been learned. Some children and parents may have
a difficult time with the thought of therapy ending. They may have come to
view the therapist and the therapy time as a type of s­ elf-​­care or steady sup-
port in their life. The therapist will want to be mindful of this and help the
family transition out of therapy. For some families, it might be appropriate
to have a few sessions once a month and gradually end the therapy time. If
needed, the therapist can adjust the termination process to best fit the child
and parent they are working with. The therapist should remain positive and
202 Phases of AutPlay® Therapy and Therapy Goals

encouraging throughout the Termination phase. The language and attitude

should convey celebration for the completion of therapy.
Session two of the Termination phase can be a session with the child alone
or include the parent. This is decided by the therapist and/­or child. The ther-
apist will remind the child that sessions will be ending, and the next session
will be the final session. The therapist will review with the child all they
have accomplished. The therapist will encourage the child to continue using
the techniques they have gained. The therapist and child will plan the basics
of the final session (­graduation party), what they want to do to celebrate.
The therapist can include the parents or give them the information after the
session. Before the session is over, the therapist will complete a closing or
termination intervention with the child. Kress and Marie (­2019) identified
three termination interventions that can be helpful for children:
Aloha lei (­­hello-​­goodbye) activity: Counselors can explain to clients
that the word aloha means both hello and goodbye. Counselors can then
discuss with clients that every end is the start of a new beginning, as is
the case with the end of counseling.

For the activity, paper flowers can be cut out (­clients can select the color
of the materials to enhance autonomy). Clients can write effective cop-
ing skills, memorable counseling experiences, or other notable takea-
ways on the flowers. Next, punch a hole in each flower and thread them
along the string. Family members or caregivers can also be involved in
the process (­with client consent), adding their own flowers to the lei.
The lei can then be given to the client as a parting gift. This inter-
vention involves creativity and metaphor in a way that summarizes the
counseling experience while actively involving the client.

Building blocks: This activity can be tailored to clients of any age. Dur-
ing the final session, counselors can bring a number of building blocks,
LEGO bricks, Jenga blocks, or other toy blocks to session. Clients can
then construct a tower or creation of their choosing. Each block in
the creation can represent a powerful moment in counseling, a coping
skill clients now possess, or another skill clients have learned during
counseling.

As the height of the tower increases, clients may become anxious, es-
pecially as the tower begins to lean. If the tower ultimately falls, the
counselor can explain that, given the clients’ fundamental s­kills—​­the
skills they assigned to each b­ lock—​­the tower can be rebuilt. This inter-
vention helps clients understand that even if they experience the inev-
itable “­falls” of life, they possess the fundamental “­building block” skills
to rebuild. This intervention is a tactile and empowering activity for the
end of counseling.
 Phases of AutPlay® Therapy and Therapy Goals 203

Goodbye letter: There are many variations of a goodbye letter that can
be used as the counseling process comes to a close. Counselors can pro-
vide a letter template with certain blanks to be filled in, or they can
simply provide a blank piece of paper on which clients can write their
own letter. Adding prompts or sentence stems for clients to complete
can add a degree of structure to the letter.

There is flexibility in terms of the letter’s point of view. Goodbye let-

ters can be written from client to counselor, from counselor to client,
or even from the perspective of the process of counseling itself being
personified. Possible writing prompts include “­One thing I remember
from counseling is …” or “­The most memorable moment of coun-
seling was …” Although counselor creativity can yield limitless pos-
sible prompts, it is important that the goodbye letter be narrowed to
focus on the most relevant moments of the counseling process. It is also
important to keep the activity ­strength-​­based (­as is the case with any
termination activity).
(­para. 28)

Session three of the Termination phase is the final session which includes
parents, child, and any other family members that the child would like to
invite. This session is a graduation party (­celebration) for the child. The
emphasis should be positive, fun, and focused on how much the child has
accomplished and thus, has now graduated from therapy. Typically, the
party is held in the therapist’s office, a play therapy room, or any space
that is decorated with party decorations and balloons. A graduation cake
or other dessert is provided, and other components may be included such
as a small graduation gift, card, additional food, etc. The therapist, child,
and parents should plan the party together. Proper goodbyes are given at
the graduation party and child and parents are reminded that they may
contact the therapist at any time if they have questions or need to resume
therapy.

Goals in AutPlay Therapy

In AutPlay Therapy, the therapy needs and goals are specific for each neuro-
divergent child. This is typically conceptualized during the Intak and Assess-
ment Phase of therapy. Any issue or combination of needs could include,
anxiety reduction, addressing depression, sensory issues, trauma issues, iden-
tity issues, parent and child relationship strain, etc. Regardless of the specific
therapy needs addressed, the following presents expected goal outcomes for
children and families who participate in the AutPlay framework.
204 Phases of AutPlay® Therapy and Therapy Goals

Goals for the Child

• Give the child a voice and opportunity to express their thoughts and
feelings.
• Feel empowered in their neurotype. Learn that differences are okay and
not bad, and they are valued as they ­are – ​­without masking.
• Increase ­problem-​­solving, ­decision-​­making, and regulation tools.
• Increase ­self-​­worth and realize and value their neurodivergent identity.
• Eliminate presenting, troublesome needs that are interfering with the
child’s ability feel stable in their quality of life.
• Increase healthy relationship development between the child and parent.
• Learn ­self-​­advocacy skills.

Goals for the Parent(­s)

• Increase their understanding and appreciation of their neurodivergent

child.
• Decrease feelings of frustration with their child.
• Learn about neurodiversity paradigm and movement principles and how
to advocate for their child.
• Increase positive relationship development with their child.
• Learn about their child’s play preferences and how to support their
child’s play.
• Improve family fun time together.
• Strengthen the family unit and improve inter family supports.
• Increase appreciation for each family member and diversity of neurotype
within the family.
• Increase confidence in their ability to parent their neurodivergent child.
• The phases of therapy in AutPlay are designed to help the therapist
put forth the most mindful and beneficial therapy experience for the
neurodivergent child and their family. The phases have an inten-
tional fluidness that can be and should be shifted for each individ-
ual child. The phases present enough structure to guide the therapist
in a direction while encouraging the therapist to pay close attention
to the child in front of them. The neurodivergent experience is not
the neurotypical experience and much of mental health theory and
process has been based on the neurotypical experience. The AutPlay
framework strives to change ­this – ​­to place the therapist in a position
of understanding the neurodivergent experience and reframing the
 Phases of AutPlay® Therapy and Therapy Goals 205

process to see, hear, value, appreciate, and truly help the neurodiver-
gent child.

Case Example

Michael

Michael entered therapy as a s­even-­​­­year-​­old autistic child. He had been

given the diagnosis of autism a few years prior by a neuropsychologist who
completed a psychological evaluation on Michael. He had recently transi-
tioned from being in a private school that focused on working with autistic
children to now being in first grade in a ­public-​­school setting for the first
time. Michael had received an IEP and was participating in special education
classes for the majority of his school time and in a few mainstream classes
with the help of a paraprofessional. At the time Michael and his family
began AutPlay Therapy, he was not participating in any other therapies.
Michael’s parents reported that he made substantial progress in increasing
verbal communication and social navigation during the time he participated
in the private school.
Michael’s parents brought him to therapy due to transition difficulties with
switching from the private school to the ­public-​­school setting. They de-
scribed that he was experiencing social navigation struggles, dysregulation,
and having challenges with some of the other children. Michael’s parents
stated that Michael had begun to make statements such as, “­I am differ-
ent from everyone else,” “­I do not fit in,” and “­No one at my school or in
my family is like me.” Michael’s parents furthered that they wanted help in
learning how to talk with Michael about autism to help him better under-
stand himself and how to navigate issues and situations at school. They also
wanted to see him improve his peer relationships and develop some positive
friendships.
Michael lived with his biological mother and father and 6­ -­​­­year-​­old brother.
Michael’s paternal grandparents were also actively involved in his life and
assisted regularly in caring for Michael and his brother. The family at-
tended activities hosted by their church and participated in a local autism
focused parent support group. Michael participated with his family in vari-
ous ­church-​­related events and activities but otherwise did not participate in
any additional activities outside of going to school. The family was unfamil-
iar with a neurodiversity affirming approach and had not heard of the term
206 Phases of AutPlay® Therapy and Therapy Goals

neurodiversity. The therapist spent time explaining the terms and process
to the parents and providing them with additional information to read at
home. The therapist explained that therapy goals would be established to
address Michael’s needs and therapy would be cognizant of Michael as an
autistic child. It was explained that affirming meant there would not be a
focus on trying to “­cure” or erase Michael’s autism, instead the focus would
be on helping Michael understand and value himself and address any mental
health needs that were creating problems for Michael.
The first three sessions were primarily assessment gathering sessions designed
to gain more specific information about Michael, help Michael and his fam-
ily build rapport with the play therapist, and help Michael feel safe and fa-
miliar in the therapy process. Michael participated in a child observation
session with the play therapist and the play therapist observed Michael and
his parents together in a child/­parent play time. Both observations were con-
ducted in a play therapy room. Michael’s parents also completed three inven-
tories: the AutPlay Social Navigation Inventory, the AutPlay Assessment of
Play Inventory, and the AutPlay Emotional Regulation Inventory (­child ver-
sion). All inventories were provided to the parents to complete in the first
session. The assessments helped identify Michael’s needs, play preferences,
and strengths. Michael’s assessment sessions demonstrated that he was able
to participate in some structed play interventions initiated by the therapist.
Michael seemed most comfortable and interested in more nondirective play
and too advanced instruction or activities seemed to trigger discomfort and
dysregulation resulting in Michael not participating.
After the Intake and Assessment Phase was completed, it was decided that
Michael and both his parents would participate in therapy sessions together.
The sessions would integrate nondirective play with introducing simple
structured play interventions. Therapy goals would focus on helping Michael
increase a positive ­self-​­awareness, improve emotion understanding and ex-
pression, help with social navigation, teach the parents how to have play
times with Michael, and address any advocacy needs related to school is-
sues. Michael, his parents, and younger brother would meet weekly with the
therapist and the whole family, including Michael’s younger brother, (­who
Michael seemed to interact with and respond to positively) would partici-
pate in home play times between therapy sessions. Michael and his family
attended therapy once a week for approximately ten months.
The integrated play sessions began on session five. The play therapist in-
troduced the Draw My Feeling Face intervention to Michael and his family.
This intervention involves the adult making a face to the child and showing
 Phases of AutPlay® Therapy and Therapy Goals 207

a feeling. The child then draws the face on a piece of paper and labels what
they think the feeling is that the adult was demonstrating. The child is then
asked to make a face displaying a feeling, and then the adult draws the face
and labels what feeling they think the child was showing. The play thera-
pist chose this intervention for Michael to help him begin to connect and
engage with others, begin basic learning about emotions, and participate
with the therapist and parents in a fun and playful way. The play therapist
explained the intervention to Michael and his parents and instructed the
parents to watch as Michael and the play therapist completed the interven-
tion. Michael had a difficult time engaging with the therapist. He was able to
begin the intervention but seemed to become anxious about accomplishing
the game. He struggled with identifying the therapist’s feeling face, struggled
with drawing faces, and struggled with making a feeling face himself. It ap-
peared that Michael was concerned or preoccupied with accurately complet-
ing the activity without making mistakes.
After 15 minutes of working with Michael, the play therapist suggested that
Michael and his younger brother try to complete the intervention together.
Even though he was one year younger than Michael, his brother was intel-
lectually gifted and played well with Michael, often functioning more like
an older sibling instead of a younger one. The idea to have Michael and his
brother complete the intervention was beneficial. They were able to com-
plete the intervention several times during the session and seemed to have
a fun time participating together. The structured play therapy intervention
lasted approximately half the session, The reminder of the session was spent
implementing a nondirective play time with Michael and his brother. The
therapist facilitated the play time and the parents observed. It was discussed
with Michael, his parents, and younger brother for Michael and his brother
to play the intervention several times at home before their next session and
for the parents to try and join in and play the intervention themselves with
Michael at least four to five times before their next therapy session.
At the next session, Michael’s parents reported that Michael and his brother
played Draw My Feeling Face several times; they had also played the inter-
vention with Michael, and he responded positively each time. The play ther-
apist played Draw My Feeling Face again with Michael to assess if he would
participate with the therapist. Michael completed several feeling faces with
little to no struggle and displayed a positive playful attitude. This was a sig-
nificant difference from the previous session. The therapist decided to teach
Michael and his brother how to complete the play interventions instead of
teaching them to Michael only. This formula was successful for the entirety
of therapy. The experience of learning something new and feeling challenged
208 Phases of AutPlay® Therapy and Therapy Goals

in new ways was much more comfortable for Michael when he participated
with his brother first and then generalized to his parents and the therapist.
During session six, the play therapist taught Michael and his family two more
play interventions: Together Balloons and Midline Mirror Moves. In Together
Balloons, the family is instructed to pair up and place their hands forward in
front of them while holding another person’s hands. A balloon is thrown in
the air, and the pair has to keep the balloon from hitting the ground while
holding each other’s hands. They must work together to keep the balloon
in the air and they cannot stop holding hands. They continue to play until
the therapist says stop. This play intervention was chosen because Michael
likes balloons. The play intervention was designed to help Michael become
more comfortable interacting with another person, attuning to another per-
son, and facilitate secure attachment between Michael and his other family
members.
In Midline Mirror Moves, the family can play in pairs or as a whole group.
The instructions are that one person goes first as the leader and the rest of
the family follows all the moves the leader makes like they were mirroring
the leader. The leader should make slow moves so all the family can follow
and stay with the leader’s movements. Also, the leader should make several
midline crossing moves (­body moves that activate the whole brain and cross
over the right and left brain). After a few minutes the family can switch roles
and there can be a new leader. They can continue to switch until each per-
son has been the leader. This intervention was chosen to help Michael with
engaging and attuning to others, helping with regulation, and opportunity to
participate in a fun social game.
The play therapist taught both interventions to the family during the ses-
sion. Both of Michael’s parents, his brother, and Michael participated, and
the session was a success. Michael’s participation while teaching the inter-
ventions was somewhat reserved but he remained present and tried to partic-
ipate throughout the session. The family was instructed to try and play both
interventions at home four to five times before the next weekly play session.
The remainder of the session involved Michael and his bother participating
in a nondirective play time with the therapist. The nondirective play times
usually involved a combination of Michael playing on his own and some
playing with his brother. Michael’s play in the nondirective times was typ-
ically some type of constructive play (­building a train track, building with
bricks or LEGOs).
In session seven, the play therapist reviewed with Michael’s parents how the
intervention play times were progressing at home. They reported playing
 Phases of AutPlay® Therapy and Therapy Goals 209

both interventions several times as a family since the last session. They re-
ported that the play times had gone well, and Michael seemed to enjoy them
and appeared less anxious than he normally did when participating in activi-
ties with the family. They reported that family friends, who have a neurotyp-
ical son close to Michael’s age, visited them. They introduced the Together
Balloons game to the friend’s son for him and Michael to play together: the
play time went positively. In the past, when this family visited, Michael
would not engage with the other child. He might do some parallel play but
no other type of play engagement. This time, however, Michael played the
Together Balloons games with him for approximately 20 minutes and then re-
verted back to more solitary play. The family reported that they had not seen
this type of peer play from Michael before, and they were pleased.
After the update was complete, the therapist introduced a new play interven-
tion to the family called The Progressive Balloon Game. There are four play
levels with each becoming progressively difficult. The first level is hitting the
balloon back and forth and keeping it from hitting the ground (­participants
can use any body part, including hands, head, feet, and knees). After about
five minutes, the participants move to level two that involves continuing to
hit the balloon back and forth (­keeping it in the air) with the dominant hand
behind one’s back. After five minutes of level two, the participants move to
level three that is the same goal only with both hands behind the back. After
five minutes, the final level is played which is hitting the balloon with one’s
head only. The family is instructed beforehand that if the balloon hits the
ground, to pick it up, and keep going. This play intervention was chosen for
Michael and his family to help Michael learn to participate p­ ro-​­socially in a
group activity with others, help him with general regulation improvement,
and provide his parents a tool to help Michael practice feeling comfortable
in more social play. Michael and his family played the game together and the
reminder of the session Michael and his brother participated in a nondirec-
tive play time with the therapist. The family agreed to continue to play the
intervention at home before the next session.
The remainder of the play therapy sessions with Michael and his family
progressed in the same formula; checking in with Michael’s parents on in-
terventions during home play times, discussing any questions and/­or con-
cerns Michael’s parents might have, teaching Michael and his family new
play interventions to complete at home, and facilitating nondirective play
times with Michael and his brother. At around the ­tenth-​­month mark of
participating in therapy, Michael’s father was transferred to another state,
and the family relocated. At that point in therapy Michael seemed much
more regulated in general, was engaging with other children in group play
210 Phases of AutPlay® Therapy and Therapy Goals

to a moderate extent and had demonstrated improvement in his social nav-

igation comfort level. He also showed less dysregulation when entering new
social situations. The social and play gains helped improved Michael’s tran-
sition to the ­public-​­school environment. He was participating with more
children and had developed a couple of friends. Further, he seemed to display
less anxiousness about going to school. Michael’s parents reported feeling
a stronger relationship with their child and more empowered to play with
Michael. They also stated they felt they had several tools to help Michael
work on his social navigation, regulating ability, and advocating for Michael.
Overall, Michael’s therapy time appeared to be helpful.
Reflecting on Michael’s therapy, several pieces helped influence a suc-
cessful therapy outcome. First, conducting a thorough assessment process
(­observations and AutPlay inventories) before entering into therapy ena-
bled the play therapist to make informed decisions for a play approach and
intervention selection. It was imperative that the play therapist first un-
derstand Michael and his family before implementing play interventions.
Second, incorporating Michael’s brother in the sessions, proved to be a val-
uable tool. Had the play therapist chosen to work with Michael individually,
it is unlikely the same level of progress would have been obtained. Third,
teaching Michael’s parents about neurodiversity, how to build relationship
with Michael, how to work with him at home between sessions, and how
to advocate, showcased the importance of the family approach in AutPlay.
Michael’s parents also felt empowered and confident in supporting Michael
throughout the day in multiple and diverse situations. Throughout therapy,
Michael’s parents regularly reported being in a public situation with Michael
and referencing something they had been working on in one of their play
interventions. Having tools to use in “­real life” situations in real moments
was valuable to them and provided a practical application piece for Michael.

References

Biel, L. (­2014). Sensory processing challenges: Effective clinical work with kids & teens.
W. W. Norton & Company.
Koehler, C. M., Wilson, B., & Baggerly, J. (­2015). ­Play-​­based family assessment and
treatment planning. In E. J. Green, J. N. Baggerly, & A. C. Myrick (­Eds.), Coun-
seling families (­p­­p. ­91–​­105). Rowman & Littlefield.
Kress, K., & Marie, M. (­2019). Counseling termination and new beginnings. Coun-
seling Today. https://­ct.counseling.org/­2019/­10/­­counseling-­​­­termination-­​­­and-­​­­new-
​­beginnings/
 10
Parent and Family Involvement

Parents, Families, and Play Therapy

Family therapists tend to view the family as a system that is greater than
the sum of its parts and believe that family members mutually influence one
another. They do not see one person as the problem; rather, family ther-
apists view problems as having circular causality, with all family members
(­adults and all children) involved to some degree in creating or maintain-
ing the problem; thus, individual issues are often reframed as family issues
(­Gil, 2015). Several family and child therapists have specifically advocated
for a family play therapy (­the integration of family work and play therapy)
approach and offered innovative family play suggestions (­Ariel, Carel, &
Tyano, 1985; Busby & Lufkin, 1992; ­Combrinck-​­Graham, 1989; Gil, 1994;
Vanfleet, 2014). Play therapy and family therapy complement one another,
and the integration of the two has a synergistic effect in meeting the goals of
each. Play provides an important tool for assessing family systems as well as
for helping to reach the range of possible family therapy goals (­Gil, 2015).
The therapeutic powers of play and benefits of play in family work exist for
all members of the ­family – ​­the adults, not just the children. “­Play provides
an opportunity to experience what has been denied or ignored, in the safe,
benign, fun world of pretend. The play experience lives in the twilight zone
between cognition and emotion, where the defenses are not on alert” (­Ariel,
2005, p­p. ­6–​­7). There are a number of reasons why the involvement of fam-
ily members in a child’s play is important and healthy for both child and
parent. Not only is formal family play therapy valuable but supporting play in
the home setting can be important in neurodivergent children’s s­ elf-​­worth,
social, emotional, regulatory, and cognitive development. As children grow
from young childhood to older children, imagination and creativity through
play continue to be important for learning, exploration, expressing ideas,
and communicating feelings. Thus, the private context of the home can offer

DOI: 10.4324/9781003207610-11
212 P a r e n t a n d Fa m i l y I n v o l v e m e n t

toys, materials, objects, along with family members as play partners, which
allow for continued development and consolidation of various growth ave-
nues throughout the totality of childhood (­Trotter, 2013).
Trotter (­2013) discussed several reasons play is important to a child’s health
and wellbeing and why family play is instrumental for a myriad of family and
individual growth and healing initiatives.
When working with families and children, meaning is embedded in ac-
tion and behavior, and play is a significantly ingenious and creative way
to illuminate meaning through an action that constitutes the child’s pre-
ferred way of communicating. Play is a powerful medium within to work
with families and offers therapist and family members alike a myriad
of wonderful techniques that range from family art therapy to family
puppet interviews to spontaneous and meaning saturated storytelling.
Play has many benefits. It creates feelings of w
­ ell-​­being between players,
helps to release emotions, is a natural way to express the self, facilitates
positive interactions between parent and child, creatively and symboli-
cally deals with concerns, allows processing to take place on a number of
different levels, and allows family members to step outside the confines
of ­well-​­rehearsed and problem saturated narratives. Family play therapy
increases the potential for family members to laugh and have fun to-
gether and engenders creative expression in both problem formulation
and solving.
(­­p. 92)

Freeman and Kasari (­2013) reviewed how parents play with their autistic
child and examined which strategies lead to longer and more connected play
interactions. They summarized the following:

• Parents of autistic children have difficulty playing within their child’s

zone of proximal development (­the space between what a learner can do
without assistance and what a learner can do with adult guidance or in
collaboration with more capable peers).
• Parents of autistic children tend to be more directive during play
(­suggesting and commanding more often), which results in shorter play
interactions.
• Children match their play level to that of their parents.
• Imitating (­recognizing and joining play preferences) an autistic child re-
sults in longer play interactions/­engagement.
(­­p. 159)

Lowry (­2016) furthered Freeman and Kasari’s work stating by helping par-
ents follow their child’s lead, play within their child’s zone of proximal
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 213

development, and imitate their child, therapists can promote positives in

how children interact and communicate with their parents. Furthermore,
and possibly more importantly, parents will discover new ways to connect
and have fun with their child. Lowry identified several key points to keep
in mind when helping parents of autistic children follow their child’s lead as
they play together:

• Parents might find play challenging – ​­children with autism often have
unique or repetitive interests, limited play skills, and/­or lack of social
engagement. As a result, parents sometimes find it difficult to start a play
interaction or to keep it going. This is reflected in Freeman and Kasari’s
(­2013) observation that parents of children with autism had difficulty
playing within their child’s zone of proximal development, and that they
resort to commanding and directing their child in an attempt to get their
child’s attention. Helping parents find ways to engage their child during
play by determining the right types of toys and the right play strategies
can be a great first step in intervention.
• Parents should follow their child’s lead – ​­Freeman and Kasari (­2013)
showed that ­didactic-​­style interactions in which parents attempt to di-
rect and “­teach” their child result in shorter play interactions. This lends
support for the AutPlay Follow Me Approach (­FMA) and n ­ on-​­directive
play therapy such as Filial Therapy, in which parents are taught to fol-
low their child’s lead and focus on relationship development. Teaching
parents nondirective play times and skills can be a particular challenge
when working with parents of autistic children, as there are competing
approaches in autism which advocate a more directive style.
• Parents need to play within their child’s zone of proximal development –​
­parents had difficulty with this in Freeman and Kasari’s (­2013) study.
Therapists should ensure that parents are not responding to their child at
a play level that is too high (­or too low). When parents match their child’s
play level, interactions last longer and joint engagement is promoted. Par-
ents should also respond in ways that are slightly above (­but not too far
above) their child’s play level, so that their child benefits from modeling
within their zone of proximal development. In order for this to happen, we
need to raise parents’ awareness about their child’s current play skill level.
Having parents observe their child and complete the AutPlay Assessment
of Play Inventory can help parents become aware of their child’s play level.
• The power of imitation – ​­the power of imitating is confirmed by Freeman
and Kasari’s (­2013) observation that imitating the children resulted in
longer play interactions. Imitation is also a useful strategy to use dur-
ing direct intervention when faced with a child who has little social
214 P a r e n t a n d Fa m i l y I n v o l v e m e n t

engagement and restrictive play skills. It can be difficult to let go of des-

ignated goals and intervention agenda. But taking a step back and imi-
tating a child in order to establish an interaction can be a valuable first
step in accomplishing other goals.
• Choosing toys that promote play – ​­Freeman and Kasari (­2013) didn’t
examine the impact of different types of toys on parents’ and children’s
abilities to play together. The children in their study were verbal chil-
dren (­average language age ­37–​­38 months) who engaged in some pre-
tend toy play. Parents of children who struggle with toy play or are less
verbal might find play even more challenging than the parents in this
study. For children with less play skills, a good place to start can be with
playing with people. This would be using toys for which the involvement
of another person is necessary, such as bubbles, balloons, or ­wind-​­up toys.
Because a play partner is needed to operate the toy or help the child in
some way, these toys facilitate interaction.
(­para. 10)

Gil (­2015) described the research and results of Sori and Sprenkle’s (­2004)
best practices to train family therapists to work with children. These prac-
tices present a guide for the family play therapist, the AutPlay therapist, and
for those implementing an integration of family therapy and play therapy.

1 Include children in family sessions unless discussing sensitive issues such

as sex.
2 Course content should include developmental issues, theoretical issues,
methods to engage children and adults, both play and family therapy
theories, and family therapy protocols to address child issues.
3 Therapist attributes are important, including being playful, humorous,
and creative, and liking and joining well with children.
4 The therapist should participate in deductive and inductive training
methods, including live supervision and an apprenticeship model.
5 Family play therapy techniques should be understood and may include
puppets, storytelling, drawing, games, and nonverbal art techniques.
(­­p. 35)

AutPlay Therapy and Parents

AutPlay Therapy offers a great deal of flexibility when working with parents/­
caregivers and the parent partnering (­training) component. In AutPlay, we
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 215

identify the parent as being a c­ o-​­change agent or partner in the process.

This means the parent is considered an equal and important member of the
therapy process. The parent’s voice, opinions, and concerns are valued. The
parent is considered the most influential and important relationship in the
child’s life. As such, the therapist will actively pursue the parent’s insight
and expertise on their child and family. VanFlett (­2014) stated about Filial
Therapy (­a primary integration approach in AutPlay Therapy) that
therapists welcome and encourage parent input at every step of the way.
What parents think, feel, and say matters. Whether they are reflecting
on their own play sessions of trying to determine the possible meanings
of their children’s play, parent’s views are elicited and discussed. Thera-
pists consider and use parent’s perceptions, realizing that parents know
the child’s context much better than they, and that parent’s ideas about
the meaning of the play is significant.
(­­p. 16)

The Filial philosophy highlights the AutPlay approach to working with par-
ents. Although the level of involvement from parents may fluctuate, parents
should always be conceptualized as parents in the process.
The term “­parent” is applied loosely. In AutPlay Therapy the therapist works
with the legal caretaker of the child. This may be the biological parent, or it
may be another adult. This may be a foster parent, adoptive parent, grand-
parent, a residential facility case manager, or whoever is primarily involved
with and raising the child. It AutPlay, we are also cognizant of and try to
involve other family members or others who are active in the child’s life.
For example, if there is an older sibling in the family, then at some point,
that sibling might be brought into the parent partnering (­training) time and
taught how to implement play interventions or special play times at home
with the child. This could also be done with a grandparent, aunt, uncle, sib-
ling, or any family member who is actively involved with the child.
Before involving various family members, it will be necessary to discuss with
the parents and assess for appropriateness and benefits of involving other
family members. The other family member will need to be someone who
could be taught the play interventions and/­or play times and would be capa-
ble and appropriate to work with the child. If it appears that the other family
member in question would not work well with the child (­possibly they are
a trigger for the child), then that family member should not be incorpo-
rated into the partnering (­training) process. Some reasons for not involving
a family member might include the person does not know the child very
well or does not spend much time with the child, the person does not agree
216 P a r e n t a n d Fa m i l y I n v o l v e m e n t

with therapy or with neurodiversity affirming constructs, the person seems to

have a negative relationship with the child, or the person seems not capable
of learning the play interventions or special play times. When appropriate
and possible, therapists should try to incorporate other family members as
this will provide additional support for the parents, relieve some of the im-
plementation responsibility from parents, and help the child generalize re-
lationship development working on therapy needs with a variety of people.
AutPlay may involve working with one parent/­caregiver or if there are two
parents involved, then both parents can participate at the same time. Often,
this involves logistic issues of scheduling. Sometimes, only one parent is
capable of attending sessions. When working with separated or divorced
parents, and one of the parents does not support the therapy process, the
therapist should adhere to legal mandates, their licensure best practices, and
ethical guidelines. If both parents want to participate, the therapist should
try to offer two sperate sessions with the ­child – ​­working with each home
independently. As the therapist works with each home, this might involve
working with step parents or significant others. The management of these
constructs should be decided by the therapist determining what seems to be
the best scenario to help achieve therapy goals.
Parents partner in the AutPlay Therapy process in a few possible ways. All
parents are considered partners from session one to termination in being
involved, working with the therapist, contributing ideas, providing feed-
back, and generally being a part of the therapy process in a number of ways.
The parent’s thoughts, feelings, questions, and feedback are important and
wanted. Parents may also participate in sessions with their child and learn
directive play therapy interventions and then continue to implement the
interventions at home between sessions. Whatever play intervention the
therapist is facilitating with the child, the parent is also a participant and
learning the intervention. The parent and child are then instructed to con-
tinue to play the intervention at home. Additionally, parents may participate
by being taught how to have a special play time or a Follow Me Approach
play time at home with their child. The therapist provides instruction to the
parent helping them learn how to have these play times and supports and
monitors for successful home implementation.
For therapists working in a school setting or other setting where access to par-
ents may not be an option, trying to incorporate other professionals who could
also work with the child is an appropriate alternative. Some examples might
include a paraprofessional, another teacher, or an intern. The goal would be to
include one or more people so the child could practice the play intervention
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 217

or play time multiple times between meeting times with the primary thera-
pist. Ideally there would be parent involvement, but if parent involvement is
not possible, then incorporating other professionals to create additional play
times and play intervention implementation would be appropriate.
As needed, it may be appropriate to incorporate into the parent training ses-
sions traditional parenting skills training. The therapist may recognize that
the parent needs parenting help or reframing. The parent may also ask the
therapist for information and support. The therapist should plan to work this
component into the therapy ­time – possibly
​­ scheduling one or two sessions
to address these needs with the parent. Some examples of formalized par-
enting programs might include providing information from Love and Logic,
123 Magic, Nurtured Heart, or any parenting approach that would have el-
ements helpful for the parent. It is important to be aware that many popu-
lar parenting programs are designed for neurotypical children and may have
components that are ableist and/­or not helpful or beneficial for an autistic or
neurodivergent child. The therapist should fully understand both the neu-
rodivergent child, the parent needs, and the parenting approach they are
teaching to apply elements that would be helpful and affirming.
It is likely that the parent training sessions will cover some level of talk-
ing about and addressing behavior (­this may include addressing discipline
approaches). Constructs that could be covered include teaching the child
and parent how to create and set up a weekly visual schedule for their child,
developing routine and consistency, establishing appropriate consequences,
and understanding the meaning of behavior. The AutPlay Situation Behav-
ior Assessment (­located in the appendix) can be completed by the therapist,
parents, or others observing the child’s behavior. This inventory can be help-
ful in identifying what might be causing particular behaviors and what might
be implemented to help decrease the behaviors.
Therapists can also use the AutPlay Unwanted Behaviors Inventory (­located
in the appendix) to help identify what types of behavior issues are happening
at home and at school. This will help therapists identify what the parent
and/­or school officials are referring to when they communicate there are be-
havior issues happening. It also helps illuminate possible reasons the behav-
ior may be occurring. As a general rule, many “­behavior issues” are a result
of the child becoming dysregulated. It becomes important to focus on what
is creating the behavior and/­or what is the behavior communicating and
address the core issue. Some possibilities may be sensory issues, anxiety re-
sponses, trauma, confusion, etc. Therapists should take special care to avoid
labeling the child as defiant, oppositional, disobedient, doing the behavior
218 P a r e n t a n d Fa m i l y I n v o l v e m e n t

on purpose, etc. This is very rarely the case with neurodivergent children.
The therapist may need to help parents, school officials, and others under-
stand this awareness of behavior.

Addressing Parent Hesitation and Resistance

A common issue echoed by AutPlay therapists is what to do when there is a

lack of parent participation. For a variety of reasons, a therapist may encoun-
ter a parent who does not participate in implementing play interventions
and play times at home. Parental lack of participation can manifest for a
variety of reason including parents may be too busy, parents may have good
intentions but live a very stressful life and have difficulty scheduling play
times at home, parents may feel inadequate or not prepared to implement
interventions at home, parents may believe the interventions will not help
or it seems like a waste of time, parents may have never played as a child and
may not play with their child and do not know how, parents may be dealing
with their own neurodivergent needs or other emotional needs and cannot
focus on their child, or a variety of other reasons.
Therapists should try to discover what is creating the lack of parental partic-
ipation and support the parent to resolve the issue(­s). The therapist should
be encouraging (­nonjudgmental) and attempt to work with the parent and
empathize with their situation. If all else fails, and there is a lack of parent
participation that cannot be resolved, therapists should continue to work
with the child and try to make as much gain as possible toward the therapy
goals. Therapists may try to incorporate other professionals to work with
the child such as an intern or try to have multiple sessions each week with
the child. Although the level can vary, parent participation is an important
piece to fully implementing the AutPlay Therapy framework. It should be
noted that there may be situations where there is no parent available to
participate. This could be due to a termination of parental rights, a child
living in residential placement or a child in foster or other type of care. The
baseline is providing care for the child and if there is no parent to participate,
the therapist should still work with the individual child.

Suggestions for Addressing Parent Lack of Participation

1 Provide empathy, encouragement, and support. Treat parents with re-

spect and remember the goal is to have parents as partners and ­co-​­change
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 219

agents in the play therapy process. The therapist’s approach to address-

ing any parent hesitation or lack of participation should be layered in
helpful and emphatic responses.
2 Gently address the lack of participation and try to assess what might be
creating the lack of participation. Listen to parent’s issues and concerns,
brainstorm with the parent, and work with parents to rectify the issue(­s)
that are creating a lack of participation. Help parents explore potential
problems and feel comfortable and safe discussing the issues. Remember
that therapeutic relationship development should be happening with
parents just as the child.
3 Educate parents about autism and neurodivergent children. Provide in-
formation to parents about the benefits (­research supported) of including
parents in the therapy process with their child. Remind parents that they
do not have to be perfect and are not expected to understand how to do
everything, but they are an important and valued part of the therapy
process.
4 Educate about the importance of empowering parents to become change
agents for their child. Make sure parents understand the value in learn-
ing lifelong tools to work with and help their child. Explain to parents
that parent participation helps them learn tools, learn how to advocate
for, and learn how to assist their child in the present and into the future.
5 Discuss with parents that typically the AutPlay Therapy process moves
at a slower pace regarding the accomplishment of therapy goals when
there is a lack of parent participation. This is not done to try and make
the parent feel guilty but to be honest. Clinical outcomes have shown
that therapy goals are achieved, and therapy is progressed through more
quickly when there is active parent participation.
6 Talk with parents about adjusting the level of parent participation. Help
parents understand that whatever level they can commit to is okay and
they should not overcommit. This might be reducing the at home play
times, having parents just participate in sessions with no at home com-
ponent, having periodic parent consultations, or some other established,
workable involvement. It is better to have some level of parent involve-
ment than to have nothing.
7 Consider starting with small parent participation steps. Introduce a
simple level of involvement and then gradually increase parent partici-
pation. Consider providing a level of accountability for parent participa-
tion such as asking the parent to commit to a day and time at home to
implement the play therapy intervention. Once the time is established,
let the parent know you will call them a few minutes after the home play
time is over to see how it went. Consider if you need to become more
220 P a r e n t a n d Fa m i l y I n v o l v e m e n t

directive with some parents, providing more direction for setting up the
home play times and the overall parent participation.
8 Discuss with parents the possibility of other family members participat-
ing in therapy in place of the parent. If the parent is struggling with
active participation, explore the option of another appropriate family
member who could attend sessions and implement play times at home
with the child.

Teaching Parents Directive Play Therapy Interventions

AutPlay Therapy incorporates a parent partnering (­training) component

which teaches parents how to facilitate directive play therapy techniques
at home. Parents learn the procedures and techniques and are shown how
to implement techniques at home to help address therapy needs and goals.
Around session five, the therapist will begin facilitating directive play therapy
interventions with child and parent. This may be done by child and parent
participating together in the same session and playing/­learning the interven-
tion at the same time. It could be done by meeting one week with the parent
and the next week meeting with the child; or this may be done by having two
sessions in one ­week – ​­one with parent and one with the child. How the child
and parent participate while introducing and facilitating a play intervention
should be given careful consideration. There may be topics to discuss or ex-
planations that need to be covered with the parent which would not be ap-
propriate for the child to be present. It may enhance the therapeutic process
by ensuring that the child and parent are together in the play time in a true
family play therapy fashion. The arrangement will depend on several factors
such as scheduling, but there should be some type of parent participation to
adequately train parents in implementing play interventions at home.
Gil (­1994) stated that family play therapy offers special insight into family
dynamics. In assessing a family engaged in play activity, the therapist may
observe how the family organizes and engages around a task, revealing its
communication styles, hierarchy, and boundaries and exposing any coali-
tions. Play exposes who is in charge, whose ideas prevail, whose voices are
being heard, and who might be marginalized. Gil (­2015) proposed the fol-
lowing guidelines for observing the family’s behaviors and interactions dur-
ing family play therapy interventions:

1 The family’s level of cooperation and organization as they approach a

play task.
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 221

2 The ability to reach consensus, and the manner in which this was
achieved.
3 The level of affective and physical contact.
4 The level of enjoyment in participating in the activity.
5 The level of spontaneous insight, such as seeing the play as a metaphor
for their own reality.
6 The collective unconscious, where themes are developed individually
and collectively, allowing families to communicate on an unconscious
level.
(­p­­p. 42–​­43)

As the child and parent engage in play therapy interventions together, both
the process and content can be revealing. Process observations include not-
ing how the family communicates and the nature of their ­interaction – ​­noting
awareness of others, nonverbal and physical interaction. Content refers to
what is talked about and what is communicated or produced through the
play, metaphor, symbolic presentation, and expressive presentation. As the
therapist introduces and teaches a directive play intervention, they should
be observing the process and content and providing constructive feedback.
The therapist should feel comfortable with the child and parent continuing
the play intervention at home between sessions. Any additional feedback
the therapist needs to make should be given before the session ends and the
family goes home to continue the play time.
Home play interventions should mimic what the therapist is doing with the
child and parent in sessions. For example, if the therapist has a session with
the child and parent and implements the ­feeling-​­focused play intervention,
the child and parent participate in session and are taught how to continue
playing the intervention at home. There is an expectation they will com-
plete the play intervention at home between counseling sessions. When an
intervention is taught to child and parent and sent home, it is most helpful
to establish with the child and parent specific instructions regarding com-
pleting the intervention home. An example of a specific instruction might
be asking someone to complete the feelings intervention three times before
the next session, or complete the intervention once a day before the next
session. Working with the child and parent to establish this type of expec-
tation will give the family a better guideline to follow and they will be more
productive in ensuring they complete the intervention at home.
As the Directive Intervention Phase progresses, the therapist will review
how things are going at home and ask the child and parent for an update
on any ­at-​­home play techniques the family has been implementing. The
222 P a r e n t a n d Fa m i l y I n v o l v e m e n t

therapist will also discuss with the child and parent any new play techniques
to begin at home and any adjustments to the home implementation. Dur-
ing the Directive Intervention Phase, it is common for the therapist to en-
gage with the parent concerning their own process in parenting their child.
Often, therapists will listen to and counsel parents regarding their own needs
or questions in parenting a neurodivergent child. In some situations, this
may be done with the child and parent together. In other situations, this
may warrant scheduling a separate session to meet just with the parent. If
this happens with the child and parent together, it should not consume the
entire session. It is important that the child and parent sessions cover the
play interventions that the child and parent are going to be doing at home.
If it seems like the parents would benefit from, or need their own regular
individual or couples counseling, then a referral should be made for such
intervention.
In AutPlay Therapy, the ultimate goal in regard to parent involvement is to
have parents become ­co-​­change agents with the child and therapist. Parents
should be encouraged, supported, and feel empowered to work with their
child in ways that will be productive to established therapy goals. The ther-
apist is training the parents to implement directive play therapy techniques
at home with their child. These techniques are typically chosen by the ther-
apist (­although the child and parent can participate in choosing techniques)
as techniques to use to help add mental health needs and therapy goals. The
therapist will continue to meet with parents and train parents on imple-
menting play techniques at home until the therapy goals have been met. It
may be appropriate, after a certain length of time, to reduce parent involve-
ment to once per month, but parent meetings should continue at some level
until therapy has been terminated.

Checklist for Teaching Parents Directive Play Interventions

1 Explain to parents that they will be participating in play interventions

with their child, and they will be learning the interventions to imple-
ment with their child in the home setting.
2 Explain to parents that the play interventions are chosen to help address
the identified therapy needs and goals.
3 Once the play intervention has been completed, explain to parents that
they will be facilitating the intervention at home with their child before
the next session, establish with the parent how often and when they will
implement the intervention.
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 223

4 Explain to parents that home play interventions may look different than
in session interventions. This is normal and to be expected. Play times
at home may have a more casual and loose application. Make sure they
understand the intervention and check to see if they have any questions.
5 When the child and parent return for their next session, begin by re-
viewing how the home play intervention went. How often did they
implement the intervention? Did things go smoothly? Were there any
problems? What were observed outcomes? Did the child participate and
seem to gain from the intervention? Are there any questions?
6 Get an update from the child and parent on how things have been going
in general.
7 Try to cover any issues or questions that the child or parent may have
about the therapy goals, AutPlay, home behaviors, parenting strategies,
school issues, and the home interventions play times.
8 Teach the child and parent any new play interventions to implement
at home before the next session. Play and complete the intervention in
session and facilitate a discussion of where and how often the family will
complete the play intervention time at home.

Teaching Parents Relational Play Times

The AutPlay Therapy framework incorporates a parent partnering (­training)

component where parents are taught how to have nondirective relational
play times at home with their child. Whether to teach child and parent di-
rective play interventions or a nondirective relational play time will depend
on the child and the therapy needs. The therapist should use assessment and
discretion in deciding what approach would be best. The therapist may also
do an integration of relational play times and directive play interventions.
When teaching parents how to have a nondirective play time with their
child, the parents should first observe the therapist facilitating a nondirec-
tive play session with the child. Once the parent feels confident in imple-
menting a nondirective relational play time, they can begin to have these
play times at home. The therapist will work with the parent to teach them
how to have these play times and will continue to support the parent as they
implement the play times at home. These play times provide opportunity to
improve the parent and child relationship, help the parent develop a better
understanding of their child, increase engagement and connection, and im-
prove communication. A nondirective relational play time would incorpo-
rate the following constructs:
224 P a r e n t a n d Fa m i l y I n v o l v e m e n t

• The play time should be introduced. This can be as simple as saying “­It is
time for our special play time, you can play with anything you want, and
I will be here with you.” The relational play time does not require any
special toys or materials, this can be done with whatever exists at home.
• The child leads the play time, the parent follows the child’s lead and
does not try to direct the play time. This may be a challenge for some
parents as they may be used to directing play with their child and/­or
introducing and facilitating the play.
• The play time is focused on the child’s play preferences and interests.
Whatever the play preference of the child, the parent should honor the
preference and follow the child’s lead in the play. The play interest may
be technology play, constructive play, or playing with objects not con-
sidered ­toys – ​­whatever the play, the parent does not try to change it,
instead the parent stays attuned, accepting, and focused, essentially join-
ing the child’s play world.
• Tracking and reflecting statements can be provided by the parent. A
tracking statement is periodically tracking what the child is doing. It
communicates that the parent is present with the child. An example
would be the parent saying, “­You built that tower with blocks.” or “­You
are done with cars and now you are playing with the puppets.” Reflective
statements reflect back what the child is feeling or expressing. An ex-
ample would be “­You feel proud of your painting,” or “­You are frustrated
with that doll.” Tracking and reflecting statements can be made period-
ically. Parents do not need to feel like they must be making a statement
continuously. It is okay to have silent attunement and observation in the
play time.
• The parent will primarily provide tracking and reflective statements but
may also ask “­can” questions. These types of questions include “­Can you
show me,” “­Can you teach me,” and “­Can you help me understand?” Can
questions provide opportunity to empower the child and for the parent
to learn more about their child. “­Can” questions are appropriate during
relational play times but should be used minimally.
• The parent follows the child’s lead and does not direct but if the child
invites the parent into their play, wants the parent to play with them, or
gives the parent a role in the p­ lay – ​­the parent should participate. The
parent should remember that they are participating in the way the child
wants and dictates. The parent should not use this as an opportunity to
start trying to direct the play.
• The parent should have a positive and curious attitude during relational
play times. The parent should be mindful of the time spent with their
child and both child and parent should find enjoyment in the play time.
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 225

Checklist for Teaching Parents Relational Play Times

1 Introduce the concept to the parents and explain that they will be learn-
ing how to have a relational play time with their child. Explain the
benefits of a relational play time and how this will help address therapy
goals.
2 Give the parents written material that explains the constructs of a rela-
tional play time. Read through the material with the parent and explain
each of the components of a relational play ­time – ​­what the parents
will be doing and what they will not do. The concepts/­skills include in-
troducing the play time, being nondirective (­following and joining the
child’s play preferences), making tracking and reflective statements, ask-
ing “­can” questions, and joining the child’s play when invited.
3 Conduct a relational play time with the child while the parent observes.
End the play time after about 30 minutes and use the rest of the session
time to again go over the basic concepts of the play time with the par-
ents. Answer any questions the parent may have.
4 Conduct a mock relational play time with the parent (­the child does not
attend). The therapist will ­role-​­play being a child and the parent will
practice having the relational play time. This session is an opportunity
for the parent to practice before they begin having the play times with
their child. Typically, there are ­1–​­2 of these mock play sessions. How
may will depend on how quickly the parent understands and implements
the skills and when both the parent and therapist feel they are ready to
start having play times with their child.
5 The therapist will establish with the parent when they will have rela-
tional play times at home, how often, for how long. The therapist will
remind the parent to be flexible and adaptable with home play times,
focus on enjoying being with their child. A typical arrangement might
be one to two times a week for 30 minutes each time.
6 The parent will begin having relational play times at home with their
child.
7 The child and parent will continue to have weekly sessions with the
therapist. The therapist may conduct a relational play time with the
child, may conduct a more formal CCPT process, or may implement
directive play interventions with the child and parent. The therapist
can integrate depending on the therapy goals and what seems to be
the best process for the child. For example, the therapist may teach
the parents to have a relational play time and get this established at
home and then in sessions with the child, facilitate directive play
interventions.
226 P a r e n t a n d Fa m i l y I n v o l v e m e n t

8 Regardless of what the therapist is doing in sessions, at each session the

therapist should check in with the child and parent about the relational
play times and how they are going. The therapist will want to support
the family in successful implementation of the play times and answer any
questions they may have.

Considerations with Home Interventions

The implementation of play times and/­or play interventions at home is a

critical piece of the AutPlay Therapy process. Some special considerations
or issues may occur with home implementation. Being at home can provide a
familiarity and comfort that might not be the same in a clinical office setting.
While this can be positive, it can also present a challenge to implementing
home interventions. Families may not take the interventions as seriously or
value the home play times and interventions. This can result in the play in-
terventions becoming less than or a ­watered-​­down version compared to the
play times and interventions being implemented by the therapist with the
child in a therapy session. This would be something to assess and take note
of during c­ heck-​­in times in sessions when gaining feedback. If this is hap-
pening, parents should be encouraged to try and present the interventions
fully and with a purposeful intention, possibly even adding a more formal
piece such as establishing with the therapist exactly when, how, and where
interventions are going to be done at home that week. The therapist might
even follow up later that week to see how things have been going.
Another possible home consideration would be distractions and disruptions.
The home environment will likely be less controlled than the therapist’s
office. Families may have other children or even other relatives in the home.
There may be a challenge to finding space and time where the parent can
exclusively focus on and implement a play time or intervention with the
child. This is something the therapist would address with the parent and try
to establish the best possible option with the least amount of distractions or
disruptions. Therapists may also discover that parents are implementing the
play times and interventions in an inaccurate version. This could be due to
time restraint issues, not fully understanding the intervention when it was
explained, not remembering the instructions, or a variety of other reasons.
Therapists will want to address this issue and make sure parents are accu-
rately implementing play times and interventions at home.
Occasionally parents may find that they have a more challenging time get-
ting their child to participate with them in the play times and interventions
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 227

at home than is experienced by the therapist working with the family in

the therapist’s office. This would be important feedback to acquire during
­check-​­in sessions and to discuss with the child and parent to discover what
is happening at home. The therapist may want to address with the child
and parent more formally explaining the expectation for participating in
at home play times. The therapist might ask both the child and parent
to start sharing in each session a favorite thing from their at home play
times. The therapist can also try observing the child and parent during
their play ­times – ​­either having them record the attempts at home or have
them complete a play time in the session while the therapist observes. It is
important to try and troubleshoot any at home issues and support the child
and parent in successful implementation of play times and interventions
at home.
Parents may also have difficulty with providing materials at home that are
needed to complete various play interventions. If parents are struggling to
provide the needed materials, the therapist should try to provide interven-
tions that require little or no materials or assist parents with ideas for ac-
quiring the needed materials. Some AutPlay therapists keep tubs of toys and
materials in their offices to lend to parents who are implementing home play
times and interventions. This would be another way to support parents who
are struggling with any materials that are needed.
Therapists may discover that play times and interventions are not be-
ing implemented at home. The therapist will want to discover why this is
happening and focus on helping parents become successful with home im-
plementation. This may require exploring parent hesitation and resistance
mentioned earlier in this chapter. When introducing play times or interven-
tions to parents, therapists should make sure to present the instructions and
expectations in written form (­provide a handout detailing the intervention
or have the parents write down the instructions), verbal form (­explain the
play time or intervention), and practice the implementation of the play time
or intervention with the child and parent. This will help ensure proper im-
plementation and follow through in the home setting.

Checklist Prior to Home Implementation

1 Does the parent feel comfortable with implementing the play time
and/­or intervention at home? Do they need more instruction or practice?
2 How often will the child and parent have a play time and/­or implement
the play intervention?
228 P a r e n t a n d Fa m i l y I n v o l v e m e n t

3 When and where will the child and parent have play times and or imple-
ment the play intervention?
4 How do they play to manage disruptions?
5 Do they understand the importance in staying consistent with home
times?
6 Do they understand that the play times and interventions may look dif-
ferently from in office implementation? This is okay, and any questions
that arise, should be discussed with the therapist.
7 Do they understand the play times and interventions may look differ-
ently due to the therapist not being present? This is also okay and again,
any questions that arises should be discussed with the therapist.

Encouragement and Parent Self Care

I recall being at a large training several years ago. I cannot remember the
venue or much about the trainer, but I do remember something he asked the
audience. He said, “­What do you think is the most important thing a parent
can do for their child?” There were many responses and most all of them
were very nice and seemed appropriate, yet the speaker continually stated,
“­That’s a good thing but it’s not the most important.” Finally, he revealed
that the most important thing a parent can do for their child is take care of
themselves. The sentiment has stayed with me throughout my professional
career and has rung most true in my work with parents of neurodivergent
children.
Parents of autistic and neurodivergent children may find themselves in a life
that requires a high degree of focus and attention with little or no respite or
opportunity for some m ­ uch-​­needed ­self-​­care. Often parents are the lead per-
son in daily care, scheduling and getting to multiple appointments, dealing
with various systems, advocating for their child, and just generally trying it
parent. Some research has suggested that stress and anxiety levels of parents
with an autistic child can equal the levels of someone with PTSD.
A common discussion during parent trainings involves discussing with par-
ents the concept of ­self-​­care. ­Self-​­care is often defined as the ability of in-
dividuals, families, and communities to promote health, prevent disease,
maintain health, and to cope with illness and disability with or without the
support of a healthcare provider. In more practical terms, it can be thought of
as the practice of individuals looking after their own health using the knowl-
edge and information available to them. Some parents may understand the
benefits and necessity of s­ elf-​­care and are already producing regular s­ elf-​­care
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 229

into their lifestyle. Other parents (­unfortunately many) may not understand
what ­self-​­care looks like and how to implement ­self-​­care into their life. The
AutPlay Parent Self Care Inventory (­located in the appendix) can be use-
ful in identifying ­self-​­care beliefs and needs for parents. Therapists should
address parent ­self-​­care at some point and identify if parents currently have
­self-​­care resources and options in place, and if not, process with parents to
establish some ­self-​­care resources and strategies.
For many parents, ­self-​­care must be understood on a micro level. I have
talked with several parents who have explained to me that ­self-​­care is lying
on a beach somewhere with nothing to do. While this may be true, this is
not a realistic ­self-​­care plan for most of the families I work with in Southwest
Missouri or across the United States. Even for those families who could take
a break and go to a beach once or twice a year, healthy sustainable ­self-​­care
must happen more than once or twice a year. Indeed, it needs to happen
weekly, sometimes daily. Therapists will want to help parents conceptualize
how ­self-​­care can be a meaningful and active part of their everyday life.
They may need to understand that simple, small, and even short interval
activities can be ­self-​­care and can have big impact. ­Table 10.1 list provides
several ideas for everyday s­ elf-​­care. The application of any type of s­ elf-​­care
is always individualized. It must be something that the specific person feels
helps them, rejuvenates them, gives them a break, etc. Sometime after the
therapy goals have been established and therapy is well underway, the ther-
apist should find a couple of sessions to meet with the parent(­s) and discuss
­self-​­care.

­Table 10.1 Self Care

Examples of Daily ­Self-​­Care Activities

Read a book Take a walk Meditate Take a bath
Color or paint Draw Relax in nature Pray
Exercise Listen to music Do yoga Deep breathing
­Self-​­talk Garden Cook Go shopping
Watch a movie Journal Take a nap Play a video game
Talk to a friend Get a massage Knit Lift weights
Go for a drive Unplug from media Go to a museum Make a grateful list
230 P a r e n t a n d Fa m i l y I n v o l v e m e n t

Parenting the Neurodivergent Child

Ramesh, J., & Raghav, P. (­2022). Parenting at Intersections of Race and Neuro-
divergence. (­Excerpt shared with permission).
As T started growing, I would notice differences in them that made us do
a double take as some of the things they did and said were unexpected for
a child their age. For instance, I remember them standing in their diaper
at the age of 1.5 in front of the kitchen wall in our old condo discovering
their shadow. They would move in and out of the room, mesmerized by this
curious sidekick that appeared and disappeared. Instead of being afraid or
ignoring it, they were genuinely curious.
Their awe was my awe. This moment sticks with me because it is one of the
first times I noticed that the way they engage with their external and internal
world is distinctive. When they were 2.5 we moved out of the condo and
into a bigger home. I was excited that we had wall space to hang a white-
board on the kitchen wall at their level. I imagined them practicing letters
or doodling on this whiteboard while I made dinner or sat and worked at
the dining table. Instead, they knelt down at the wall and with their chubby
fingers begin to calculate the number of seconds in a year with repetitive
addition. I asked them what they were doing and in a thick honey voice of a
toddler they answered, “­I’m calculating seconds in a year mamma.” I respond
with an “­Oh!”
I took pleasure in their curiosity, and I also begin to feel the rumblings of
what I would later identify as a feeling called overwhelmed; how am I sup-
posed to satiate this child? It would be untruthful if I did not claim the pride
I felt in my child’s abilities. And in that pride in my child’s ability, I would
come to recognize that as a parent I participated in something called humble
bragging.
“­Oh, I can’t tell you how many books we have to keep getting!” someone
in our social circle would say about their child. Or another parent would
complain ­half-​­heartedly “­We could not get her to leave the museum, she
was so enthralled by the spider exhibit.” And then I might add something
to the effect of how T continues to excel in math and what a struggle it is
to find the right school system for us. Underlying all of these “­complaints”
was something else unspoken. Today I understand these conversations to be
about pride in our children that is also rooted in ableist values.
And it is also historically rooted in being products of colonized cultures and
immigrants. For those of us whose ancestors have been colonized, a value we
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 231

have inherited is that our worth is connected to how well we perform and
produce. We as adults were already on a capitalistic treadmill, which values
bodies that produce. A subtle and insidious way we were inculcating our
children on to this way of life was by talking about the ways in which they
could perform.
Then there were the differences in T that would provoke concern. For in-
stance, when they were around children their age, they were not interested
in connecting, in playing with others. While all the other kids were con-
necting (­or at least as much as ­4-­​­­year-​­olds peers connect) my child was on
the side reading, talking to my ­40-­​­­year-​­old friend about bacteria, or playing
out scenes with their stuffed animals. And my worry would kick in right on
cue. Was something wrong with them? What would the other parents say?
My own desire for community and belonging would become a tug of war in-
ternally. Do I stay and talk to the parents, or do I leave and be with my child?
What I was not noticing was the faulty narrative I was setting u­ p – that
​­ their
differences were causing me (­our family) to be more alone in the world. To
even approach it as something that is wrong is rooted in this sense of differ-
ence is bad, difference must be erased. This is ableism at its core.
A shift in my parenting started to take seed when I went back to graduate
school for the second time for counseling psychology. The shift has been a
slow unfolding and it has a spiral quality; at times we are moving towards
liberation and at times we take steps back. Around this time, I also started
critically looking at our own family dynamics and the impact of my own up-
bringing and how that was informing my parenting. My inclination towards
social justice analysis would widen the lens of understanding to include how
larger systems of capitalism, white supremacy, and ableism, have also in-
formed how I was parented and how I was parenting.
More than the graduate program itself, I think it was also the time period
my family was in and that the dynamics we were entangled in were just not
working. The constant fighting with T trying to get them to be something
else, the tension in our marriage, the overlooking of our younger child, ulti-
mately was not sustainable. I got the needed kick in the butt to put a pause
on the family autopilot we were on.
And all of this was helpful to me in that it helped me to see my child more
holistically, it helped me to move away from the ADHD diagnosis as some-
thing to be fixed, it helped me to see beyond just giftedness and it began to
help me to see my own pain, my own longings and how I had swallowed
wholesale the narrow narratives of success.
232 P a r e n t a n d Fa m i l y I n v o l v e m e n t

One day, T and I were on a m ­ om-­​­­and-​­child hike. As we made our slow ascent
through ­old-​­growth forests in the lush Issaquah Alps, I decided I needed to
share my truth and be vulnerable with them and begin the long apology that
was due. Taking a defining breath I begin, “­I want to share something with
you, and I am hoping that it may offer you some explanation for where I am
coming from.” “­Um ok,” they offer tentatively as a 1­ 2-­​­­year-​­old is unsure of
what to expect.
“­I know I have been hard on you about your school and grades, and I have
been thinking a lot about what that is about.” I proceeded to explain my fears
and provide insight into my own upbringing and schooling. “­I love you so
much and want so badly for you not to struggle the way I did that sometimes
I end up pushing and inserting myself in ways I think are actually unhelpful.”
They continue to listen silently, walking beside me, the rhythm of their
breathing letting me know they are present with me. In deep, both in the
conversation and the hike, I proceed with a commitment to both endeavors
to come through the other side. “­I am learning now that my fear and anger
are connected, and they are about something bigger than what I can fix. I
have also been angry with myself for not seeing it sooner. I am so sorry.” They
hear my voice choke at this moment and T leans over and hugs me. T is not
a hugger. At this moment I feel the beginnings of a shift, as my body releases
some of the fight I have been holding on to.
Today, sometimes I will see T sitting and doing something on the computer
and my anxiety will kick in about homework, or how they are using their
time. Sometimes I might say something like “­Should you be doing that?” But
more and more I’m catching myself, learning to trust the self they are, their
process and truth.

References

Ariel, S. (­2005). Family play therapy. In C. Schaefer, J. McCormick, & A. Ohnogi

(­Eds.), International handbook of play therapy: Advances in assessment, theory, re-
search, and practice (­p­­p. ­3–​­22). Jason Aronson.
Ariel, S., Carel, C. A., & Tyano, S. (­1985). Uses of children’s ­make-​­believe play
in family therapy: Theory and clinical examples. Journal of Marital and Family
Therapy, 11(­1), ­47–​­60.
Busby, B. M., & Lufkin, A. C. (­1992). Tigers are something else: Case for family play.
Contemporary Family Issues, 1(­3), ­246–​­255.
­Combrinck-​­Graham, L. (­Ed.). (­1989). Children in family contexts: Perspectives on
treatment. Guilford Press.
 P a r e n t a n d Fa m i l y I n v o l v e m e n t 233

Freeman, S., & Kasari, C. (­2013). ­Parent-​­child interactions in autism: Characteris-

tics of play. Autism, 17(­2), ­147–​­161.
Gil, E. (­1994). Play in family therapy. Guilford Press.
Gil, E. (­2015). Play in family therapy (­2nd ed.). Guilford Press.
Lowry, L. (­2016). Play & Autism: More evidence for following the child’s lead.
The Hanen Centre. https://­www.hanen.org/­MyHanen/­Articles/­Research/­­Play-​­-​­-­​
­­Autism-​­-­​­­More-­​­­evidence-­​­­for-­​­­following-­​­­the-​­chi.aspx
Sori, C. F., & Sprenkle, D. (­2004). Training family therapists to work with children
and families: A modified Delphi study. Journal of Marital and Family Therapy, 30,
­479–​­495.
Trotter, K. (­2013). Family play therapy. In N. R. Bowers (­Ed.). Play therapy with
families. Jason Aronson.
VanFleet, R. (­2014). Filial therapy: Strengthening the p­ arent-​­child relationships through
play (­3rd ed.), Professional Resource Press.
 11
The AutPlay® Therapy Follow Me
Approach (­FMA)

What Is the Follow Me Approach (­FMA)

Directive play therapy approaches and techniques are utilized and impor-
tant to the AutPlay Therapy process. With most directive play therapy tech-
niques; the technique can be adjusted to be more simple or more complex
depending on the child and family. The adjustment from simple to complex
does not affect the quality of the technique in being effective for helping
children and adolescents, it is simply individualizing the therapy process to
the specific child. It is essential that the therapy process aligns with the child
instead of trying to force a child into a therapy process.
For some neurodivergent children and adolescents, directive play approaches
and interventions may not align with their needs, manifestations, and ther-
apy goals. For some children a more structured or directive approach will be
too directive, and the child will not respond well to the therapy process. In
situations where it is more appropriate, beneficial, and needed, the AutPlay
Therapy Follow Me Approach (­FMA) will be implemented. This approach
exemplifies a more nondirective play therapy approach. Often children and
adolescents who have higher support needs or who are younger (­preschool
age) can benefit from participating in the FMA. Children (­of any age) who
may have a difficult time attuning to and participating in directive tech-
niques even when the interventions are simplified would also be good can-
didates for the FMA.
The FMA is a nondirective family play therapy approach which is used with
children who would benefit from a more nondirective play therapy process.
It was created to provide a supportive and healing therapeutic play approach
for children who have higher needs and for a variety of reasons are unable
to participate in structured or directive play interventions. Axline (­1969)
described nondirective play as therapy that starts where the child is and bases

DOI: 10.4324/9781003207610-12
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 235

the process on the present configuration, allowing for change from minute to
minute during the therapeutic contact. It grants the child permission to be
themselves and accept that self completely, without evaluation or pressure
to change. It offers the child the opportunity to learn to know themselves
and to openly chart their own course so they may form a more satisfactory
design for living.
Axline (­1947) furthered that nondirective play therapy can be described
as an opportunity that is offered to the child to experience growth under
the most favorable conditions. Since play is the natural medium for ­self-​
­expression, the child is given the opportunity to play out their accumulated
feelings of tension, frustration, insecurity, aggression, fear, bewilderment, and
confusion. When the child has achieved emotional relaxation, they begin to
realize the power within themselves to be an individual in their own right, to
think for themselves to make their own decisions, to realize selfhood. Axline
explained that as a result of the nondirective therapy experience children
are able to:

• Gain respect for themselves as an individual of value

• Learn to accept themselves
• Grant themselves permission to utilize all of their capacities
• Assume responsibility for themselves
• Gain a respect and acceptance for people as they are
• Gain responsibilities for making their own decisions
• Gain a belief in their capacities
• Understand a positive and constructive way of life
(­­p. 27)

Mittledorf, Hendricks, and Landreth (­2001) discussed the merits of play

therapy (­primarily nondirective play approaches) with autistic children.
They noted essential recognition of autistic children’s play that support the
use of nondirective play processes.

Play is the most natural thing all children do, and autistic children en-
gage in their own s­elf-​­involved play through which they express them-
selves and communicate with their world. Although much of the play of
autistic children is ritualistic, it is, nevertheless, play and is their way of
declaring themselves. Play is the language of children, and when toys or
play media are used, the item can become the words of children convey-
ing vast resources of messages, which cannot be communicated verbally.
Useful toys of play items are not necessarily what would be thought of in
the traditional sense, but rather are any items that children use for play
236 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

or expressive purposes. Children can ascribe their own personal mean-

ings to nondescript items. The therapist may not understand what mean-
ing an item has for a child, but it does potentially possess some meaning
to the child. The therapist’s job is to make contact with autistic children
through the medium chosen by the children and with which they are
most comfortable. Once play is viewed as having meaning, the therapist
is much more likely to sense the inner rhythm of the child since chil-
dren’s play activity expresses the inner rhythm of their emotional life.
(­p­­p. ­257–​­258)

The FMA creates space for the autistic and neurodivergent child to feel ac-
cepted and free to explore and express. The FMA is an integration and exten-
sion of established nondirective play therapy theories and approaches such as
Child Centered Play Therapy, Child Parent Relationship Therapy, and Filial
Therapy. Ray, Sullivan, and Carlson (­2012) described that in nondirective
play therapy approaches, the therapist seeks to understand the child in the
context of their world. The therapist provides full acceptance to the child,
offers unconditional positive regard, and sends a message of respect and safety
to children to enable them to share their world freely. The FMA utilizes es-
tablished nondirective play therapy processes and individualizes the processes
to the specific neurodivergent child being sure to acknowledge the neurodi-
vergent child’s play preferences and interests as well as their unique strengths.
Implementation of the FMA would begin with the Intake and Assessment
Phase, and through observation, inventory assessment, and feedback, it will
become clear to the therapist if a child is a good fit for the FMA. If this
is the case, then the therapist will begin implementing FMA sessions and
teaching parents how to have these types of play sessions at home. Often
FMA sessions become the primary therapeutic approach until termination.
In other instances, FMA sessions continue for a period of time until more
directive interventions can be implemented. The nondirective element of
the FMA approach does have variation. Just like any process in AutPlay, the
exact approach is individualized to the child. The best fit for some children
will be conceptualized with primarily nondirective play sessions, while oth-
ers may have more of an integration of nondirective and some directive play.
This chapter will outline the skills for implementing FMA sessions and help
conceptualize how to individualize the FMA for each neurodivergent child.

Relationship as the Agent of Change

The FMA focuses heavily on relationship development as the agent of

change in the nondirective play process. Axline (­1947) stated during play
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 237

therapy, relationship is established between the therapist and the child that
makes it possible for the child to reveal their real self to the therapist, and
having their self accepted, and thus growing in s­ elf-­​­­confidence – the
​­ child is
more able to extend the frontiers of their personality expressions. K ­ nobloch-​
­Fedders (­2008) defined the qualities of therapeutic relationship as mutual
trust, respect, and caring, general agreement on the goals and tasks of the
therapy, shared ­decision-​­making, mutual engagement in “­the work” of the
therapy, the ability to talk about the “­­here-­​­­and-​­now” aspects of the relation-
ship with each other, the freedom to share any negative emotional responses
with each other, and the ability to correct any problems or difficulties that
may arise in the relationship. ­Knobloch-​­Fedders (­2008) furthered that the
therapist’s ability to communicate empathy and understanding to the pa-
tient is very important. Another essential component is the therapist’s open-
ness, flexibility, and willingness to adapt the therapy to the patient’s needs.
Skilled therapists actively solicit patients’ input about the goals and methods
of therapy, in order to facilitate collaboration.
Kool and Lawver (­2010) described the therapeutic relationship as a key cri-
terion in play t­ herapy-​­effectiveness. As play becomes a creative outlet that
blends imagination and reality, it becomes fun and absorbing; the therapeu-
tic relationship is deepened in play. The child is afforded the freedom to
abreact and displace the unconscious ideas on the play event, allowing them
to be observed by the therapist. The r­ elationship-​­focused play therapist rec-
ognizes that growth is a slow process, not to be pushed, prodded, and hurried
along. This is a time when the child can relax, a place where growth takes
place naturally without being forced (­Landreth, 1991). It is the focus on re-
lationship development with autistic and neurodivergent children which fa-
cilitates children becoming more comfortable and confident which promotes
engagement gains. Landreth (­1991) outlined the following for therapeutic
relationship development in play therapy:

• Establish an atmosphere of safety for the child

• Understand and accept the child’s world
• Encourage the expression of the child’s emotional world
• Produce facilitative responses
• Produce reflective and tracking attention and statements
• Establish limit setting
(­p­­p. ­154–​­155)

Ray, Jeffrey, and Sullivan (­2012) stated that there are six conditions
that must exist for the therapeutic process to work effectively. All six
238 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

conditions are based on the primacy of the relationship between the ther-
apist and child:

1 Two persons are in psychological contact.

2 The first person (­client) is in a state of incongruence.
3 The second person (­therapist) is congruent in the relationship.
4 The therapist experiences unconditional positive regard for the client.
5 The therapist experiences an empathic understanding of the client’s in-
ternal frame of refence and attempts to communicate this experience to
the client.
6 Communication to the client of the therapist’s empathic understanding
and unconditional positive regard is to a minimal degree achieved.
(­­p. 162)

In FMA application, the AutPlay therapist and child participate in a typ-

ical (­CCPT) playroom setup. The child is given no directive instructions
from the therapist. The therapist introduces the play session and follows
the child’s lead, moving with the child around the playroom, focusing on
the child and staying attuned with the child. The therapist transitions as the
child ­transitions – ​­as the child transitions from one toy or activity to another,
the therapist transitions with the child and does not try to bring the child
back to a toy or activity. The therapist provides space for the child to lead but
occasionally attempts to get involved with what the child is d­ oing – ​­trying
to engage with the child in whatever type of play they are expressing. The
therapist is observant in looking for opportunities to connect with the child
through the child’s play and notice any engagements back to the therapist.
Throughout an FMA session, the therapist is periodically implementing re-
flecting and tracking statements and being mindful of the child’s comfort
level. In the FMA, it is important to not only share physical space with
the child, but also share attention, emotion, and understanding with the
child. Initially, autistic and neurodivergent children may find FMA sessions
uncomfortable and the experience of a new place and someone trying to
connect or engage with them intrusive. If a child starts to become agitated or
dysregulated by the therapist’s presence or attempts to get involved with the
child’s play, then the therapist should discontinue attempts to get involved
and simply stay present with the child occasionally providing reflecting and
tracking statements until the child feels safer and more regulated. Although
the FMA consists of some elements that encourage the therapist engaging
with the child, the primary focus is on relationship development through
nondirective play. There are a few integrated directive constructs, but the
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 239

therapist should be aware that the directive constructs are not interfering
with relationship development goals.
The therapist is not only having FMA sessions with their child but is also
teaching the parents how to implement FMA play times at home with their
child. The therapist must be mindful of facilitating relationship develop-
ment with the parents. When parents are taught the FMA, it will be help-
ful for them to watch the therapist conducting the FMA with their child
in sessions. Parents should be observing the FMA sessions the therapist is
having with the child. The therapist will not only be developing relation-
ship with the parents but also teaching the parents about therapeutic rela-
tionship development in the FMA play times. When parents implement the
approach at home, they are instructed to try and schedule a FMA play time
for 25 minutes multiple times a week (­whatever is realistic for the family).
This is an ideal scenario, parents and therapist will need to be flexible with
the length of time and the number of times that the play times can be im-
plemented at home. When deciding how many play times to have and the
length of the play times, consideration should be given to the child’s needs
and ability to participate. The therapist stays active and connected to the
parents (­continually developing relationship) as they are implementing play
times at home. During therapist process times with the parents, the therapist
will review with the parents how the FMA play times are going at home and
address any questions or concerns parents may have. Parent training in the
FMA is discussed further in ­Chapter 12.
As FMA sessions progress, the therapist stays consistent in recognizing ther-
apeutic relationship development as the primary agent of change. As the
child enters the FMA sessions, the child is given no directive instructions
from the therapist. The therapist begins the session with a structuring state-
ment such as “­You can play with anything you want in here and I am going
to be in here with you.” The therapist lets the child lead but periodically
attempts to engage with what the child is doing. The therapist transitions
as the child transitions. The therapist notes when the child participates in
engagement or connection with the therapist. If appropriate for the specific
child and their therapy goals, the therapist may be continuously looking for
opportunities to introduce more directive play therapy techniques. This is a
­testing-​­out time to see if the child is yet capable to engage in some directive
play therapy techniques. If the child responds well, then the therapist could
continue to introduce more directive techniques. If the child does not re-
spond well, the therapist will continue with FMA sessions and keep looking
for opportunities to introduce more directive play therapy techniques.
240 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

Integrating Directive Elements

The FMA focuses primarily on relationship development through nondirec-

tive play therapy processes. There is an integration of two directive elements
that add to the nondirective skills that make up the totality of FMA skills
implemented. Therapists periodically ask the child questions. The questions
are basic questions that should make sense and be relevant in regard to the
child’s play or what is happening in the play session. For example, if the child
is playing with a dog miniature, the therapist might ask the child “­Do you
have a dog?” Another example would be if the child is painting a picture,
the therapist might ask “­What is your favorite color?” The question asking
should not be continuous and should integrate with the other FMA skills.
Questions should not probe for deeper psychological context, be leading or
invasive, or attempt to illicit therapeutic information. Questions are sim-
ple and relevant in the moment. The purpose for the question asking skill
is to help further connection and engagement and begin social navigation
processes. Some children (­those with higher needs and little to no engage-
ment) will likely not answer questions at first. If a child does not respond
to a question, the therapist should move on and try another question at a
later time. Over time, the therapist will notice and note as children begin to
acknowledge the therapist’s ­questions – ​­this is a positive sign of relationship
development and increasing engagement and connection.
Therapists will also periodically attempt to engage with the child in
the child’s play. This should also be done in an integrated fashion along
with the other FMA skills. As the child becomes established in a type of play,
the therapist may try to join the child in their play and see if the child will allow
the therapist to join and if the child will accept the joining through a recip-
rocal play interaction. For example, the child may be filling up a bucket in
the sand tray. The therapist would move over beside the child and the sand
tray and take another shovel and see if they could help fill up the bucket.
The therapist might get their own bucket and place it in the sand tray and
fill up their own bucket doing a type of parallel play. The therapist might also
hold out their hands over the child’s bucket and ask the child if they could
pour sand in the therapist’s hands. There are multiple ways the therapist
could try to engage in the child’s play. The therapist should be respectful to
not lead or change the play, be respectful of the child’s ignoring of the ther-
apist or desire to not have the therapist engage and be mindful of the child’s
limits or discomfort with the therapist’s engagement attempts. It is likely
that some children will not engage back with the therapist, and this is okay.
The therapist should make an attempt and then back off of attempts until a
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 241

later time and try again. It is the therapist’s role to offer and the child’s right
to accept or reject. Engagement and connection should move at the comfort
level of the child.
In some situations (­due to the child’s needs and therapy goals) the therapist
may be looking for gains in moving toward the child being able to participate
in directive play therapy techniques and approaches (­the Structured Play
Intervention Phase). Some children may stay in the FMA until termination
of therapy. For other clients, the FMA may be a beginning approach to lead
to the child to participating in more directive play therapy techniques. It is
important to note that typically if a child is at a need level where the FMA
is going to be implemented, it is likely that the child will need other concur-
rent therapies in addition to AutPlay Therapy. Such therapies might include
occupational therapy and speech therapy. If this is the case, the therapist
should make the appropriate referrals.
For situations where the goal is to eventfully move the child into the Struc-
tured Intervention Phase, there is progression from the FMA to the Struc-
tured Intervention Phase. The therapy starts with the FMA and moves to
connecting games and then to the Structured Intervention Phase. ­Table 11.1
demonstrates the progression. Connecting games are a natural next step or
middle step between the FMA and more directive techniques found in the
Structured Intervention Phase. Connecting games are focused on engage-
ment and reciprocal participation and consist of a set of several short, fun,
engaging games between the therapist and the child. The therapist intro-
duces the connecting game, and each game requires a simple level of instruc-
tion and participation with the therapist.
Connecting games should consist of several games or activities that last ap-
proximately ­15–​­20 minutes. The activities should be short and simple and
have a connection component. Activities will likely begin slowly with little
or no response from the child. Therapists should continue with the games
and look for the child to gradually increase their participation with the ther-
apist. The therapist should have several connecting games to choose from
and introduce to the child, as the child will likely respond more positively to

­Table 11.1 T
 he Progression from FMA to the Structured Intervention PhaseThe
Progression

Intake and assessment phase ➪ FMA phase ➪ Connecting games ➪

Structured intervention phase ➪ Termination phase
242 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

some games versus others (­depending on the child’s play preferences). The
therapist and child may play one activity for 30 seconds and another for five
minutes. This will vary and depend on the child’s interest. In the beginning
of introducing connecting games, it is likely the connecting set time will
not reach ­15–​­20 minutes. The child may start by only participating with
the therapist for one minute. The therapist can work toward building up to
­15–​­20 minutes of connecting games.
Once the therapist identifies that the child is ready to start participating
in more directive engagement with the therapist, the therapist will intro-
duce a connecting game. The therapist should have some indication that
the child is willing, interested, and/­or capable of participating in a simple
game the therapist introduces before the therapist would introduce a con-
necting game. For example, the therapist might introduce to the child to hit
a balloon back and forth and work together to keep the balloon from hitting
the floor. The fi­ rst-​­time balloon toss is introduced, the child hits the balloon
back once and then leaves the activity and plays by themselves. The next
session the therapist tries the balloon hitting game again. This time the child
hits the balloon back three times, by the fourth session, the child is hitting
the balloon back ten times before becoming disinterested. During the fourth
session, after the balloon game, the therapist immediately introduces a sec-
ond connecting game; bubble blowing and popping. The child participates
with the therapist blowing the bubbles and the child popping the bubbles for
approximately five minutes. By the seventh session of introducing connect-
ing games, the child is participating in approximately 15 minutes of connect-
ing games with the therapist.
Connecting games do not have to be designated therapeutic games. The ther-
apist has a wide range of options available when introducing a connecting
game. The primary goal is to have the child participating with the therapist
in a simple game that requires a level of following instruction, attunement,
and acknowledgment. Some examples might include hitting a balloon back
and forth, lotion games, thumb wrestling, playing hand games such as patty
cake, feeding games, throwing, rolling, or kicking a ball back and forth, play-
ing hide and seek, playing chase and catch, mirroring games, bubble blowing
games, Play Doh games, movement games such as duck, duck, goose, and
hand games.
Once the child is regularly participating in 1­ 5–​­20 minutes if connection
games, the therapist can begin to move into the Structured Intervention
Phase and implement more directive interventions that focus on therapy
needs and goals. In this type of scenario, the FMA would be considered
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 243

a beginning approach with the goal of moving into more directive inter-
ventions (­the Structured Intervention Phase). Throughout the FMA, the
therapist could be periodically “­checking out” the possibility of moving into
connecting games and then more directive interventions. Becoming more
directive will likely be a step process with the child responding to the thera-
pist to gradually and at their own comfort level.

Who Should Participate in the Follow Me Approach (­FMA)

Anyone can participate in the FMA. If the therapist feels that this would
be the best point of therapy for the child, they should move forward with
the FMA. Technically, the FMA was designed for working with autistic and
neurodivergent children and children with developmental disabilities that
have higher needs and ­co-​­occurring needs. The basic description of the child
would be a child who has little to no engagement or interaction. This may be
a nonverbal or ­non-​­speaking child, may be a child who does not respond in
any way to others, or a child in which the therapist assesses would likely not
participate in directive play approaches or interventions.
The therapist would begin by assessing for appropriateness and best fit for
implementing the FMA. Typically, this is done in the Intake and Assessment
Phase. Through observations and inventories, the therapist should have an
indication if the FMA is the appropriate avenue of therapy for a particular
client. This would primary be based on the child’s manifestation and pres-
entation and the identified therapy needs and goals. Remember that there
are fluctuating levels in AutPlay. A therapist may decide the FMA is the best
avenue but also feel they could integrate in some basic directed play inter-
ventions. Another therapist may feel their client needs to begin exclusively
in the FMA with a higher focus on nondirective play processes. This depends
on the individualization of therapy for the specific client. Also remember
that the child and parent are partners (­co change agents) in the therapy
process. They will also have a say in formulating what would be the best fit
for moving forward with therapy.
To help conceptualize what types of clients would benefit from the FMA,
the following simple vignettes presents some of the clients that would likely
be good candidates for the FMA. This is not a complete presentation but
assists the therapist in gaining a better understanding. These vignettes do
not reflect judgments about children as many therapists will discover many
strengths and capabilities of children as they begin to develop relationship
244 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

with the child. These vignettes are simply provided to give a very superficial
presentation of what children might be a good fit for the FMA approach.
Remember a basic construct of AutPlay and being neurodiversity affirming
is presuming competence.

• A ­three-­​­­year-​­old autistic child. Due to the child’s young age, the FMA
would be a likely approach.
• A ­seven-­​­­year-​­old neurodivergent child who displays little to no engage-
ment or interaction with others. The child will not respond or acknowl-
edge when addressed and seems to be in their own space not aware of
others.
• A ­six-­​­­year-​­old autistic child with an additional diagnosis of intellectual
developmental disorder, and a chromosome disorder. The child has lim-
ited verbal output and does not respond to others.
• A ­12-­​­­year-​­old child who has down syndrome and intellectual develop-
mental disorder and typically does not acknowledge others.
• A ­seven-­​­­year-​­old autistic child who has verbal and speaking ability and
can interact with others but is strongly against directive instruction and
will not participate in therapist introduced interventions.
• An ­eight-­​­­year-​­old child who has high support needs and multiple diag-
noses and medical issues who uses a wheelchair and cannot implement
fine or large motor skills. The child has little to no verbal output and
seems to be ­non-​­responsive or aware.

A special consideration would be working with extremely limited or ­non-​

r­esponsive clients. This can be a child of any age. Occasionally a client
might have high medical and physical needs that prevent them from being
mobile. They may have to stay in a wheelchair or similar accommodation all
the time. Some clients in this category may be able to be mobile but they do
not speak or seem to have verbal or other identified communication and do
not respond to initiations from others. This could also be a client who has
the majority of things done for them or require someone to help them such as
eating, dressing, bathing, going to the bathroom, etc. These would certainly
be children with high needs and ­co-​­occurring diagnose or issues. This would
not be simply an autistic child or a child with only ADHD.
This is a client who will likely not initiate anything on their own. They
will not engage in nondirective, or directive play on their own. With
these clients, it is still appropriate to start with the FMA as a base, but
the therapist will have to be more directive with the child. The therapist
will likely have to introduce various toys, materials, activities to the child
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 245

and assess for response that indicates a preference or interest. This might
be a traditional toy, a sensory item, art, music, or t­echnology-​­based play.
The therapy session and process may look very differently from work with
other neurodivergent children. There may be much less happening in the
sessions and progress toward therapy goals may seem to move at a much
slower rate. This would be expected and should not be something the ther-
apist is surprised to experience. It may be an adjustment for the therapist
who may not be used to this type of presentation and how to appreciate
the process of sessions and moving toward therapy goals with a child with
very high support needs.
In my work with children with this type of presentation I have often be-
gan with an exploration of introducing various things to see what the child
might be interested in and respond to. I have discovered this to be tech-
nology games on an iPad (­this has often been a positive result), baby dolls,
sensory trays, puppets, and various other things. Once a play preference or
interest was discovered, it facilitated the process of beginning to connect and
engage together through the play interest. The FMA base is helpful in keep-
ing the therapist in a space of building relationship, assuming competence,
and looking for all ways possible to value the child’s voice.

The Follow Me Approach (­FMA) Skills

There are five primary skills in the FMA. These skills represent what the
therapist is doing in each FMA session and ultimately what the therapist
is teaching the parent to do. The nondirective play skill serves as the foun-
dation for the FMA sessions. The other four skills should be implemented
periodically during a session and at the therapist’s discretion.
Nondirective Play Skill – ​­The child leads the play in the session. The child is
allowed to maneuver around the playroom and play with or attend to any-
thing they like. The child is also allowed to switch from toy to toy or types
of play as they like. The child leads the time, and the therapist follows the
child figuratively and literally in the playroom. The therapist stays present
and attuned with the child, paying attention to the child, and observing the
child closely. The therapist does not try to lead the play or direct the child to
participate in a play therapy intervention. The therapist is communicating
presence and awareness and that the FMA session is a safe place for the child
to be themselves and engage in play their way. The therapist is also building
relationship with the child.
246 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

Reflective and Tracking Statements Skill – The

​­ therapist periodically provides
a reflective and/­or tracking statement. These statements communicate to
the child that the therapist is present with them, sees them, and is attuning
to them. These statements further help develop relationship with the child.
Reflective statements in particular help the child identify and express their
emotions. A reflective statement is reflecting to the child any emotion stated
or shown by the child or that the therapist perceives is coming from the
child. An example would be a child struggling to get a cap off a marker. The
child is looking frustrated with their effort. The therapist might say “­That
cap is frustrating you,” or “­You are frustrated that the cap will not come
off.” Another example would be if the child says “­This is my favorite” while
tightly hugging a stuffed animal. The therapist might reflect “­You really like
that one,” or “­That one makes you feel happy.” Additional examples include
“­Blowing the bubbles makes you feel happy” or “­You don’t like it when I
move the cars.” A note of caution. Because neurodivergent children can
experience and express emotion differently from neurotypical presentations,
the therapist will want to be careful about interpreting a feeling they see
from the child. Unless the therapist feels absolutely sure they are interpreting
a feeling correctly, they may want to reflect something more general such as,
“­It looks like something is happening with you,” “­Something is happening,”
“­I’m noticing something,” I’m noticing you and what is going on,” or “­You
can’t get the lid off and you might be feeling something.”
Tracking statements are simply tracking what the child is doing. An example
would be if the child is scooping up sand and putting it into a bucket, the
therapist might say “­You are putting the sand in the bucket,” or “­You are
doing what you want with the sand.” Another example would be if the child
paints a picture and holds it up to show the therapist, the therapist might
say “­You finished the whole painting,” or “­You finished that and now you are
showing me.” Additional examples include “­You are finished with the sand
tray, and now you are playing with the doll,” or “­You are hammering that
really hard.”
Asking Questions Skill – ​­The therapist periodically will ask the child a ques-
tion. The questions are designed to communicate to the child that the
therapist is present, to begin developing social navigation, and to help the
therapist assess for engagement improvement. The questions asked should
be in the moment and related to what is happening in the therapy session.
An example would be the child painting blue on a piece of paper and the
therapist asking, “­Do you like the color blue?” Another example would be
the child is building with blocks and the therapist asks, “­Do you have blocks
at home?” Additional examples include “­Do you have any brothers at home,”
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 247

“­Do you like to play sports,” or “­What color is that?” It is likely that many
questions will not garner a response from the child. Many children may not
even acknowledge they have been asked a question. The therapist is asking
questions to identify when a child begins to answer questions and how well
and often a child answers questions. When a child begins to answer ques-
tions regularly and fully, it is an indication the child is attuning more with
the therapist and is moving toward being able to do connection games or
directive techniques.
Engage with the Child Skill – Throughout
​­ an FMA session, the therapist is
periodically trying to engage with the child in whatever the child is doing
(­the child’s play). Remember that the child leads and chooses whatever the
child wants to play with, and the therapist follows the child and tries to get
involved with what the child is doing. The therapist should make attempts
throughout the session to get involved in the play. How many attempts, in
what ways, and at what time is left to the therapist’s discretion. The ther-
apist does not need to be constantly trying to engage. If the child responds
and engages with the therapist, the therapist should continue with whatever
is being done until the child is no longer interested. If the child begins to
show irritation or dysregulation with the attempts the therapist is making
to engage, then the therapist should stop trying to engage and move away
from the child and simply make some tracking and reflecting statements for
a period of time and then return to trying to engage with the child. Some
examples of engaging with the child include:

• The child starts playing with the play dishes. The therapist sits beside
the child and takes a bowl and puts it on the therapist’s head and says
to the child, “­Look at my silly bowl hat.” The therapist is trying to en-
gage the child by having the child look at the therapist and notice the
bowl on the therapist’s head. The therapist might take a bowl or plate
and put it on the child’s head and say, “­Look at the plate on your head.”
The therapist might ask the child to put a bowl or plate on the therapist’s
head and see if they can begin to engage in this activity back and forth.
• The child starts playing with the sand tray building a sandcastle. The
therapist moves beside the child and starts adding sand to the castle or
asks the child where to put the sand. The therapist might try pushing
sand to the child to use for their castle. The therapist might also try
building their own castle in a separate area in the sand tray.
• The child is shooting a basketball into the basketball hoop. The ther-
apist moves beside the child and helps get the ball and hand it back to
the child after they shoot a basket. The therapist might also try getting
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another basketball and also shooting the ball in the basket. The thera-
pist could try getting the child to take turns shooting the basketball or
allow the therapist to pass the basketball to the child and then the child
shoots it.

Being Mindful of Limits Skill – ​­The therapist should be sensitive to the child’s
comfort, feelings of safety, and regulation level. Some sessions may be mostly
tracking and reflecting statements if the child is displaying discomfort with
the therapist’s attempts to engage. The therapist should not engage or try
to get involved with what the child is doing to the point where the child
becomes fully dysregulated and has a meltdown. An example would be the
child starts to play with rolling some cars around on the floor. The therapist
sits down beside the child and starts rolling some cars with the child. The
child grabs the cars from the therapist and pushes the therapist away. This is
a clear sign the child does not feel comfortable with what the therapist is do-
ing, or the child may be becoming dysregulated. The therapist should move
away from the child and observe the child while periodically making some
tracking and reflecting statements and try to engage with the child again
when the therapist feels it would be appropriate.

Goals for the Child

The therapist will want to always be looking for some advancement or dis-
playing of progress toward therapy needs and goals. Prior to beginning the
FMA, the therapist, along with the parents and child (­if appropriate), should
identify and establish therapy needs and some basic attuning and engage-
ment goals to work toward through the FMA. Some examples might include
recognizing the therapist, responding to questions and/­or asking questions,
reciprocal communication (­this can look many ways and does not have to
be verbal), initiating with the therapist, engaging with the therapist, par-
ticipating in reciprocal play, asking the therapist, etc. The therapist should
take note of instances where the ­pre-​­identified goals occur and seem to hap-
pen more frequently, or the child has achieved the goal with the therapist.
Accomplishment of these goals is another indication that the child is mov-
ing toward being able to participate in more directive techniques and the
Structured Intervention Phase if this is warranted for the child.
Another goal of the FMA is developing empowerment vs ­dis-​­empowerment.
Jeffreys (­2021) described ­dis-​­empowerment as removing one’s own or some-
one else’s power. Usually, it is used to describe a power of ­self-​­care or emotion
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 249

versus some violent s­elf-​­defense action. Neurodivergent children are often

­dis-​­empowered. They are susceptible to others taking their power away in
many shapes and forms. Much of this is driven by unchecked ableist prac-
tices. The FMA attempts to empower neurodivergent children. Empower-
ment encourages confidence, decision making, s­elf-​­advocacy, and ­self-​­care.
In the FMA, neurodivergent children can lead, use their voice, make de-
cision, gain confidence, and feel empowered through the FMA skills. The
therapist should be monitoring for gains in empowerment as children pro-
gress through FMA sessions.
A possible goal might be implementing the FMA as a beginning point for
therapy to help the child progress to where they could participate with the
therapist in more directive play techniques and approaches. This would not
be a goal for every child but if it was, the therapist should periodically initi-
ate and see if the child will participate in a more directive game or activity
with the therapist. As the child begins to progress in this way, the therapist
can begin to advance the games or activities and increase the child’s level of
participation.
There are some standard goals which apply to all children participating in
the FMA. Standard goals for children include:

• Give opportunity for the child’s voice to be heard.

• Increase the child’s ­self-​­worth.
• Increase relationship development between the child and parents and
others in the child’s life.
• Empower the child in ­decision-​­making, identity, and ­self-​­advocacy.
• Help the child express emotions.
• Help the child develop ­problem-​­solving and coping skills.
• Promote positive social and relational dynamics for the child.
• Reduce and/­or eliminate presenting needs/­issues.

Pragmatics of the Follow Me Approach (­FMA) Session Setup

Using a Playroom and Toys/­Materials – ​­A playroom or play space is recom-

mended when implementing the FMA. A playroom with toys and materials
provides the greatest environment for play preferences and interests expres-
sion and utilization for processing and growth. The playroom design is typi-
cally a CCPT playroom setup. Landreth (­1991) stated that the atmosphere
of the playroom is of critical importance because that is what impacts the
child first. Ideally, the therapist would have a large enough space to have a
250 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

variety of toys and materials available for access and space for movement.
The toys and materials selected should reflect a variety of play preferences
and interests with include pretend play, functional play, constructive play,
sensory play, movement play, technology play, and expressive (­art) play. The
variety is important, but the playroom should not be overstocked. If the
room is too full of toys and materials it can become overwhelming. The chil-
dren should be able to easily access the toys and materials and consideration
should be given to children who may have physical needs or accommoda-
tions and those with sensory differences. A recommended toys and materials
list is provided in the appendix.
Starting and Ending a FMA Session – The​­ practitioner begins by introducing
the child to the playroom. The practitioner explains to the child that, “­This
is a playroom, and you can do whatever you like in here, and I will be in
here with you.” No rules or limits are established at this time. The therapist
begins each FMA session with this structuring statement. The therapist gives
a ­five-​­minute verbal and visual warning that the play session is almost over
and again at the o­ ne-​­minute mark. The verbal statement can be “­We have
five minutes left of our play time and then it will be over for today,” and again
at the one minute, “­We have one minute left of our play time today and
then it will be over.” The visual can be as simple as the therapist holding up
their hand with five fingers and then one finger as they are giving the verbal
warnings. When the session is over, the therapist states, “­Our time is up for
today” and leads the child to the take home (­transition) item and then out of
the playroom. In AutPlay, a transition item is used at the end of the session
to transition out of the session. The transition item can be a sticker, small
toy, balloon, a pebble, a LEGO piece, or it can be an ­activity – ​­a game that
is played as the therapist and child leave the playroom and exit the building.
Transition items are used to provide routine to the session and ease the end-
ing of the session and help with progressing on for the child.
Limit Setting – ​­The ­limit-​­setting approach in the FMA is fairly simple. Many
of the children that will be participating in the FMA may not understand
limit setting models that are too verbal or too cognitive and they may need
a more basic redirection. For most l­imit-​­setting needs, the therapist should
simply redirect the child or remove the limit casing toy or material. The
therapist could try implementing the CCPT ACT limit setting model. This
may work for some children, but for others it will likely involve too much
language and cognitive processing. The Act limit setting model was outlined
by Landreth (­2001). (­A) Acknowledge the child’s wants/­needs (­C) Commu-
nicate the limit in a n ­ on-​­punitive way (­T) Target acceptable alternatives.
For example, (­A) “­Sarah, I know you want to paint on the wall.” (­C) “­but in
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 251

here we cannot do that.” (­T) “­You can paint on the easel or on this paper.”
The therapist decides what is a limit to set and limits should be set as little
as possible. If the child did not respond to the limit, the ultimate action the
therapist would take is ending the session time.

Therapists Guide for Implementing the Follow Me Approach

(­FMA)

The Therapist Should

• Follow the ­Child – ​­The child leads, and the therapist follows the child
figuratively and literally. The therapist lets the child move around the
playroom and provides space for the child play with anything in any way
they choose. The therapist moves with the child, sits by the child, and
transitions as the child transitions.
• Make Tracking S ­ tatements – These
​­ are statements that the therapist
makes periodically tracking what the child is doing. For example: “­You
are playing in the sand tray,” or “­You just shot the Nerf gun,” or “­You are
looking around at all the toys in here.”
• Make Reflecting ­Statements – ​­These are statements that the therapist
makes when the therapist notices a child displaying a feeling. For ex-
ample: “­That makes you mad,” or “­You feel sad that there is no more
paint.”
• Ask ­Questions – The
​­ therapist should periodically ask the child ques-
tions. The therapist should try to ask questions that are relevant. For
example: The child picks up a basketball. The therapist might ask, “­Do
you have a basketball at home?”
• Attempt to Engage with the C ­ hild – ​­The therapist should frequently try
to engage the child or play with the child in whatever they are doing. For
example: The child is playing in the sand tray. The practitioner might
try scooping up some sand and pouring it on the child’s hand or scoop-
ing up some sand and putting it in the bucket the child is trying to fill.
Another example: The child is playing with some balls; the practitioner
might pick up a ball and try to roll it or toss it to the child.
• Monitor for ­Dysregulation – ​­The therapist should be sensitive to the
child’s comfort level especially regarding engaging with the child. If the
therapist notices that the child is becoming uncomfortable or dysregu-
lated by the therapist’s attempts to engage, the therapist should discon-
tinue making attempts to engage and move away from the child for a
period of time and then try again.
252 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

• Be Mindful of ­Goals – ​­The therapist is working on relationship devel-

opment and increasing the child’s comfort level being present with the
therapist. The therapist is looking for ways to connect and signs of the
child responding to or connecting with the therapist. This might be
through verbalizations or playing together or in some way acknowledg-
ing the therapist. The therapist should never try to force engaging or
a connection. If the child is showing they are not interested, then the
therapist should do some tracking statements for a while and try engag-
ing again later.
• Introduce Simple Connecting Games (­if part of the therapy plan) – The ​­
therapist should periodically introduce a simple connecting game or ac-
tivity to see if the child will participate with the therapist. This is some-
what of a “­testing out” process to evaluate if the child is making progress
toward participating in more directive interventions.

Autistic and neurodivergent children often find themselves in therapies and

programs designed to dictate and “­instruct the child in what to do and when
to do it. Often children find little to no time in their life to control their
process. The FMA provides children many opportunities that are not often
present in their lives. The nondirective elements of the FMA promote em-
powerment and therapeutic relationship ­development – ​­a key component
for therapy. Relationship development is not only foundational and central
to the successful implementation of the FMA but also with implementing
directive play interventions. It is the relationship that gives the interven-
tions, approaches, and the totality of the therapy experience its power and
effectiveness.

References

Axline, V. (­1947). Play therapy. Houghton Mifflin.

Axline, V. (­1969). Dibs: In search of self. Houghton Mifflin.
Jeffreys, R. (­2021). You were made for this. Empowerment Publishing.
­Knobloch-​­Fedders, L. (­2008). The importance of the relationship with the therapist.
The Family Institute at Northwestern University. https://­www.­family-​­institute.
org/­­behavioral-­​­­health-​­resources/­­importance-­​­­relationship-​­therapist
Kool, R., & Lawver, T. (­2010). Play therapy: Considerations and applications for the
practitioner. Psychiatry (­Edgmont), 7(­10), ­19–​­24.
Landreth, G. L. (­1991). Play therapy: The art of the relationship. Accelerated Devel-
opment Publishers.
Landreth, G. L. (­2001). Innovations in play therapy: Issues, process, and special popu-
lations. Routledge.
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 253

Mittledorf, W., Hendricks, S., & Landreth, G. L. (­2001). Play therapy with autistic
children. In G. L. Landreth (­Ed.), Innovations in play therapy: Issues, process, and
special populations (­p­­p. ­257–​­269). Routledge.
Ray, D. C., Sullivan, J. M., & Carlson, S. E. (­2012). Relational intervention: C ­ hild-​
­centered play therapy with children on the autism spectrum. In L. ­Gallo-​­Lopez &
L. C. Rubin (­Eds.), ­Play-​­based interventions for children and adolescents with autism
spectrum disorders (­p­­p. ­159–​­175). Routledge.
 12
The AutPlay® Therapy Follow Me
Approach (­FMA) with Parents

The Importance of Parents

There must be a fundamental understanding that if you support neurodiver-

gent children then you must support parents and families of neurodivergent
children. Parents play a vital role in the life of any child but perhaps the
relationship between the neurodivergent child and their parent is an extra
significant one. Parents enter into the AutPlay Therapy process as partners
(­­co-​­change agents) but parents often bring with them their own needs and
issues that warrant attention. If these needs are left unaddressed, it can have
a detrimental effect on the child and everyone in the family. Parents of au-
tistic or neurodivergent child can look like and have the same issues as any
family but there are some considerations and possible needs that may be
specific to or at an extra level for these families.

• Financial stressors from services and therapies

• Social isolation
• Lack of respite care
• Sibling struggles
• Extended family members not understanding the child
• Waiting lists for therapies
• Mislabeled and misunderstood
• Worrying about the future after the parents are gone
• Education struggles, being kicked out of school
• 24/­7 parenting attention, hypervigilance on prevention
• Highly scheduled and consistent routine
• Marriage stressors

Booth and Jernberg (­2010) discussed that working with parents is often
multifaceted. As you assist parents in developing healthy relationship, you

DOI: 10.4324/9781003207610-13
T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) w i t h P a r e n t s 255

must be sensitive to their needs. You may need to discuss developmental

issues while helping parents understand the meaning and communication of
their child’s behaviors. You may need to help parents with general parent-
ing ­issues – ​­how to provide appropriate discipline, helping extended family
members who do not understand neurodivergence, addressing school related
problems, etc.
Why are parents and families so important? The family unit is the founda-
tion for children, it has the greatest impact on the child’s development. The
family is the main environment for a child, little else has the same influence
as the family environment. What the parents do greatly affects the child
and what children do greatly affects parents. Often individual therapy may
not be addressing the “­real” issues or not fully addressing the issues. Many
presenting issues may have a root in what is happening in the family or issues
are being exasperated by situations happening in the family.
Parents often need help as well as the child. Parents and anyone in the
family unit may be having struggles that need attention. Siblings and ex-
tended family members matter. Family is not just the child and parent. Sib-
lings often play a large part and so do extended family members that are
actively involved in the child’s life. Family is where the child’s learning and
development is ­modeled – ​­from attachment to social navigation. Each fam-
ily will possess their own unique family culture which carries influence into
adulthood.
Stinnett and DeFrain (­1985) identified six features of strong or healthy fam-
ilies, (­1) ­Commitment – ​­Family members were committed to each other’s
growth as individuals. (­2) ­Appreciation – Family
​­ members told each other
often how much they appreciated them, and were also specific about it.
(­3) ­Communication – ​­Family members communicated frequently with each
other, using good communication skills. (­4) Fun Time T ­ ogether – Family
​­
members spent time together, and some of that time was used for having fun
together. (­5) Spiritual ­Wellness – ​­Strong families in the study felt that spirit-
uality helped them keep a perspective, especially when times were tough.
(­6) Coping ­Ability – ​­When times were tough, strong families would work to
face the problems together. The family coming together in a family play ther-
apy process such as the Follow Me Approach (­FMA), has the opportunity to
address a whole host of possible needs in a sustainable way. The family has
the safe environment of the play sessions to process and explore and create
strong and healthy features for their family.
An effective family play therapy approach strives to heal relationships so
that all family members can engage with each other in a way that encourages
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safe, positive, and creative relating. In family play therapy, play is the vehicle
for change, and it is a vehicle for engagement. It provides a context for both
assessment and intervention and is the crux of therapeutic communication
(­Trotter, 2013). As child and parents enter into the FMA, the process will
provide growth and empowerment for both, and as additional family mem-
bers may become involved, they will grow as well.
Play engages both the adults and children in cognitive and affective pro-
cesses where fantasy and symbology facilitate one’s ability to organize infor-
mation and entertain divergent thinking. It is far preferable to act aggression
out through the play rather than actual fighting. Working through powerful
emotions such as aggression while using a toy or play as a vehicle for ex-
pression, enhances one’s capacity to process and regulate emotions as well
as integrate them with cognitions (­Trotter, 2013). Play benefits everyone
in the family and can address both intrapsychic and interpersonal problems
throughout the family system. It allows families to recapture the joy they
once had as they laugh and play together, experiencing mutual delight in
pleasurable activities (­Gil, 2015).
Gil (­2015) furthered that family play therapy holds a myriad of possibilities.
It can help individual family member’s shift perceptions of each other, break
up old patterns of interaction and introduce healthier alternatives, foster
attachment and breathe new life into families, open windows of opportunity
to observe family interactions on a deeper level than achieved in traditional
talk therapy, and can address the goals of individual children and adults,
promote overall family functioning, and strengthen relationships.
When we consider involving parents and other family members in the FMA,
we value them as partners in the process. If parents are struggling, we want
to provide help for them. This may be in the form of offering counseling
sessions just for the parents or referring them to another professional who
can help. As parents participate in the FMA, it is important that they feel
empowered, competent, and encouraged to work with, play with, and be ­co-​
­change agents in helping their children. It is important that parents can be
in a state of mind where they are celebrating their child and understanding
their child through an affirming parenting lens.
A component of the FMA involves helping parents build health relation-
ships and providing neurodiversity affirming messages to their child. Jeffreys
(­2021) stated that the healthiest parents are the ones who have unlimited
pride in their children who struggle. They don’t hide their children’s limita-
tions. They celebrate them and their success. They have thrown out society’s
scale of success and built their own.
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The Autistic Self Advocacy Network (­2021) created a parent’s guide, Start
Here: A Guide for Parents of Autistic Kids. Their guide provides many af-
firming pieces of information to help parents better understand their child.
Although the guide focuses on autism, much of the information can pertain
to all neurodivergent children. The guide highlights the need for parents to
understand an affirming way to view and parent their child, proving direct
suggestions for parents included the following:
Your kid is still the same kid as they were before they got their autism
diagnosis. All the things you love about them haven’t changed. Your kid
loves you, and they know you love them. Now that you know that they
are autistic, you are going to be able to understand them better. Being
autistic is a part of what makes your child who they are. Autism doesn’t
mean that your child will have a worse life than other children. Their
life may be different than what you had expected. But your child can still
have a great life. Part of building that great life for your child is learning
how to support them as an autistic person… Your child is still the same
child as before they got an autism diagnosis. They still have the same
personality, likes and dislikes. You should still treat your child with the
same love and respect as you did before. At the same time, now that you
know your child is autistic, there are lots of things you can do to support
them. Your support can help your child have an easier time in the world.
(­p­­p. ­3–​­13)

Teaching the Follow Me Approach (­FMA) to Parents

Many parents interact with, teach, and play with their children through a
didactic directive style that they probably learned or experienced as a child.
Certainly, there is a time and place (­even in AutPlay Therapy) for a more
directive type of teaching and playing but it is not the most natural way
for children to learn and communicate. The nondirective attuned parent
participating in an FMA type of play with their children provides the most
successful environment for the child to express their natural language, heal,
grow, and communicate. MacDonald and Stoika (­2007) described this as a
responsive approach which allows the adult to focus on the child’s signature
strengths and the interests the child currently demonstrates successfully, be-
cause the adult responds to what the child does instead of directing or insist-
ing that the child does what the ­grown-​­up has in mind.
Landreth and Bratton (­2020) shared that play is the most natural way chil-
dren communicate. Toys are like words for children and play is their nat-
ural language. Adults talk about their experiences, thoughts, and feelings.
Children use toys to explore their experiences and express what they think
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and how they feel. Landreth and Bratton (­2020) furthered the benefits for
parents and child when participating in nondirective play times:
In special play times, you will build a different kind of relationship with
your child, and your child will discover that they are capable, important,
understood, and accepted as they are. When children experience a play
relationship in which they feel accepted, understood, and cared for, they
play out many of their problems and, in the process, release tensions,
feelings, and burdens. Your child will then feel better about themselves
and will be able to discover their own strengths and assume greater ­self-​
­responsibility as they take charge of play situations. How your child feels
about themselves will make a significant difference in their behavior. In
special play times where you learn to focus on your child rather that your
child’s problem, your child will begin to react differently, because how
your child behaves, how they think, and how they perform in school
are directly related to how they feel about themselves. When your child
feels better about themselves, they will behave in more s­elf-​­enhancing
ways rather than ­self-​­defeating ways.
(­­p. 16)

VanFleet (­2014) proposed that special play times format permits optimal re-
lationship development and attention to the child’s needs. VanFleet (­1994)
stated that when parents conduct nondirective play times with their own
children it creates a safe and accepting environment which create opportu-
nities for the expression of feelings, communication, and resolution of so-
cial, emotional, and behavioral issues. The process also helps shift parent’s
negative attitudes and beliefs about their children, helps parents cooperate
more effectively with each other, reduces parental stress and frustration, and
motivates parents to change some of their own behaviors.
As defined in ­Chapter 11, the FMA is a nondirective family play therapy
approach which is used with children who would benefit from a more nondi-
rective play therapy process. A significant piece of the FMA process involves
teaching parents how to have FMA play times at home with their child.
Parents are taught by the therapist how to facilitate and implement FMA
play times at home with their child between sessions with the therapist. The
therapist will teach parents the core skills for implementing an FMA play
time which include nondirective play, making tracking and reflecting state-
ments, asking questions, and attempting engagement with their child, and
monitoring for the child’s limits. Therapists will also guide parents on how to
implement the FMA play times in the home setting. Parents will decide on
a specific area in their home to have an FMA play ­time – ​­preferably not the
child’s own playroom or bedroom. Parents should also collect some toys and
materials to use during the FMA play time and the toys and materials should
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be boxed up and put away and only used for the FMA play times. Some
autistic and neurodivergent children may be very attached to their toys and
their space and they may not want the parent “­intruding.” Further, the FMA
play times are therapeutic play times, not general play times like the parent
might be already doing with their child. The separate space and toys provide
a cleaner distinction between the two types of play times. There are always
exceptions. Again, in the AutPlay Therapy framework, the process is indi-
vidualized to the specific child. There may be situations where it would work
best to have the FMA play time in the child’s own playroom using their own
­toys – ​­perhaps this is what the child prefers and how they respond best. It
should be noted that general ideas shared in conducting the FMA play times
are a guide, and adjustment and individualization for each child is supported.
Many parents have reported it beneficial to have the FMA play time in a
different part of the home and to collect toys that are only used during the
FMA play time. Parents have shared that this seems to engage their child
more in the play times. Some parents have discovered that the FMA play
time occurs throughout the whole house with the child moving from room
to room and the parent moving with the child. Other parents have shared
that they have their FMA play times outside in their backyard. Any of these
variations are acceptable as long as the parent is able to apply the core skills
of the FMA. The therapist should communicate to parents that the home
implementation can look many ways and there may be a bit of experiment-
ing to discover what works best for the child. A list of recommended toys and
other materials is available in the appendix and can be shared with parents.
Therapists should explain to parents that they do not need to acquire all the
toys on the list. The list is a guide and parents should select just some of the
toys and materials that the parents believe will be the most engaging for their
child. The parents are free to acquire toys and materials that are not on the
recommended list. The priority is collecting items that would be engaging
for the child to play with.

General Session Outline for Teaching and

Implementing the FMA

Sessions 1­ –​­4: Conduct the Intake and Assessment Phase in AutPlay Ther-
apy. This provides opportunity to get to know the child and parents better,
develop relationship, and assess for readiness and appropriateness to partic-
ipate in the FMA. During session four, the therapist would discuss with the
parents about participating in FMA sessions and provide a general overview
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about what to expect. During session four it would also be decided if one or
both parents were going to participate in the FMA play times. This is largely
up to the parents depending on what works best for them. It may be observed
during the Intake and Assessment Phase that the parents seem to not know
how to play with their child or have never played with their child. In this
case, the therapist would take a couple of sessions to work with just the par-
ents ­role-​­playing and teaching to improve their play ability with their child.
This would be important to do before beginning the FMA sessions.
Session 5: Begin the FMA sessions. The therapist conducts an FMA session
with the child and the parent observes the session. The parent can observe
through a monitoring window or be in the playroom sectioned off in one corner.
The parent is given a paper copy of the core skills to read and watch for during
the session. They are also given some paper and something to write with so they
can record any questions that arise. This FMA session takes about 30 minutes
with the child. The rest of the session time is used to go over the skills with the
parent. There may need to be arrangements made for the child to be watched
or have something else to do while the skills are covered with the parent. The
therapist should read through and explain each skill. The therapist should also
point out each skill as the therapist demonstrated them in the session.
Sessions ­6–​­7: The therapist conducts an FMA session with the child for
about 30 minutes. The parents are observing the sessions and learning the
core skills. The therapist is using the reminder of the therapy time to go over
the skills and help the parents learn how to implement an FMA play time
with their child. The therapist should be mindful to respond to any questions
the parents may have.
Sessions ­8–​­9: Once the parent and therapist agree that the parent has the
skills learned and feel confident, the parent can begin conducting the FMA
play times with their child (­in the therapist’s playroom/­office) and the ther-
apist can observe. This usually take two sessions of observing the parents to
make sure they have the basic skill ideas mastered and are ready to start hav-
ing the play times at home. If both parents are participating, they will need to
have separate FMA play times with their child. If this is the case, then each
parent should have two times they are conducting the FMA play time and
being observed by the therapist. This would mean four total sessions instead
of two. The parent will conduct the FMA session for 30 minutes and spend
the rest of the time following up with the therapist. The therapist should pro-
vide positive feedback on what the parent did well and provide any feedback
on any area to work on. The therapist should remain positive and encourag-
ing while providing feedback and address any questions the parent has.
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Session 10: If the therapist’s observations went well and the parent feels
ready, the transition to home play times begin in session ten. In this session
the therapist will meet with the parents to discuss the home implementation
of the FMA play times. This is a time to make sure parents are ready and
everything is set up for successful home play times. ­In-​­home play time imple-
mentation is discussed in more detail later in this chapter.
Sessions ­11-​­termination: At this point, parents should have conducted their
first ­in-​­home FMA play times. The format of sessions 11 through the termi-
nation of therapy look very similar. The therapist begins by getting an update
on the home play times. The therapist should provide parents copies of the In
Home Play Times Summary Sheet (­located in the appendix). The parents would
complete the summary sheet after the play time and bring it with them to the
therapy session. This is an opportunity for the parent to ask any questions
to address any issues that may have come up during the ­in-​­home play times.
Once the update has been covered, the therapist will conduct an FMA play
time with the child and the parent will observe. The parent is expected to
continue to have ­in-​­home play times between session times with the therapist.
If the FMA is the primary approach being implemented with the child and
family, then sessions will continue in this way until therapy goals have been
met and therapy is terminated. The therapist and parent should be discussing
periodically what advancement is happening regarding therapy needs and
goals. This should be an ongoing evaluation to assess that therapy goals are
being met and when therapy has been completed. There is no limit on the
number of sessions prior to termination. This will depend on each child and
the specific therapy needs and goals.
If the FMA is a beginning approach with the goal to move into the Structed
Intervention Phase, then the therapist and parents should be monitoring for
changes and opportunities that move through the progression from the FMA
to connecting games to the Structured Intervention Phase. The therapist,
parent, and child will progress as appropriate and r­ e-​­examine therapy needs
and goals as they move through the progression. Once they are functioning
in the Structured Intervention Phase, they will proceed toward completion of
any identified therapy needs or goals until reaching the Termination Phase.

Teaching the FMA Skills to Parents

The following descriptions can be copied and given to parents to help them
understand the FMA skills. Additionally, therapists can provide parents with
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a copy of the Parent Guide for Implementing the AutPlay Follow Me Approach
(­FMA) located in the appendix.
Nondirective Play Skill – ​­The child leads the play in the session. The child is
allowed to maneuver around the play time and play with or attend to any-
thing they like. The child is also allowed to switch from toy or types of play
as they like. The child leads the time, and the parent follows the child figu-
ratively and literally in the play time. The parent stays present and attuned
with the child, paying attention to the child, and observing the child closely.
The parent does not try to lead the play or direct the child to participate
in play the parent wants to do. The parent is communicating presence and
awareness and that the play time is a safe place for the child to be themselves
and engage in play their way. The parent is also building relationship with
the child.
Reflective and Tracking Statements Skill – The
​­ parent periodically provides a
reflective and/­or tracking statement. These statements communicate to the
child that the parent is present with them, sees them, and is attuning to
them. These statements further help develop relationship with the child.
Reflective statements in particular help the child identify and express their
emotions. A reflective statement is reflecting to the child any emotion stated
or showed by the child or that the parent perceives is coming from the child.
An example would be a child struggling to get a cap off a marker. The child
is looking frustrated with their effort. The parent might say “­That cap is frus-
trating you,” or “­You are frustrated that the cap will not come off.” Another
example would be if the child says “­This is my favorite” while tightly hug-
ging a stuffed animal. The parent might reflect “­You really like that one,” or
“­That one makes you feel happy.” Additional examples include “­Blowing the
bubbles makes you feel happy” or “­You don’t like it when I move the cars.”
A note of caution. Because neurodivergent children can experience and
express emotion differently from neurotypical presentations, the therapist
will want to be careful about interpreting a feeling they see from the child.
Unless the therapist feels absolutely sure they are interpreting a feeling cor-
rectly, they may want to reflect something more general such as, “­It looks like
something is happening with you,” “­Something is happening,” “­I’m noticing
something,” I’m noticing you and what is going on,” or “­You can’t get the lid
off and you might be feeling something.”
Tracking statements are simply tracking what the child is doing. An example
would be if the child is scooping up sand and putting it into a bucket, the
parent might say “­You are putting the sand in the bucket,” or “­You are doing
what you want with the sand.” Another example would be if the child paints
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a picture and holds it up to show the parent, the parent might say “­You fin-
ished the whole painting,” or “­You finished that and now you are showing
me.” Additional examples include “­You are finished with the sand tray, and
now you are playing with the doll,” or “­You are hammering that really hard.”
Asking Questions Skill – The
​­ parent periodically will ask the child a question.
The questions are designed to communicate to the child that the parent is
present, to begin developing social navigation, and to help the parent assess
for engagement improvement. The questions asked should be in the moment
and related to what is happening in the play time. An example would be
the child painting blue on a piece of paper and the parent asking, “­Do you
like the color blue?” Another example would be the child is building with
LEGO bricks and the therapist asks, “­What do you think you will build?”
Additional examples include “­Is that interesting,” “­Do you like to play with
blocks,” or “­What color is that?” It is likely that many questions will not
garner a response from the child. Many children may not even acknowledge
they have been asked a question. The parent is asking questions to identify
when a child begins to answer questions and how well and often a child an-
swers questions. When a child begins to answer questions regularly and fully,
it is an indication the child is attuning more with the parent and is moving
toward being able to do connection games or directive techniques.
Engage with the Child Skill – Throughout
​­ an FMA play time, the parent is pe-
riodically trying to engage with the child in whatever the child is doing (­the
child’s play). Remember that the child leads and chooses whatever the child
wants to play with, and the parent follows the child and tries to get involved
with what the child is doing. The parent should make attempts throughout
the play time. How many attempts, in what ways, and at what time is left to
the parent’s discretion. The parent does not need to be constantly trying to
engage. If the child responds and engages with the parent, the parent should
continue with whatever is being done until the child is no longer interested.
If the child begins to show irritation or dysregulation with the attempts the
parent is making to engage, then the parent should stop trying to engage
and move away from the child and simply make some tracking and reflecting
statements for a period of time and then return to trying to engage with the
child. The following examples of engaging with the child can be shared with
parents:

• The child starts playing with the play dishes. The parent sits beside the
child and takes a bowl and puts it on the parent’s head and says to the
child, “­Look at my silly bowl hat.” The parent is trying to engage the
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child by having the child look at the parent and notice the bowl on the
parent’s head. The parent might take a bowl or plate and put it on the
child’s head and say, “­Look at the plate on your head.” The parent might
ask the child to put a bowl or plate on the parent’s head and see if they
can begin to engage in this activity back and forth.
• The child starts playing with the sandtray building a sandcastle. The
parent moves beside the child and starts adding sand to the castle or asks
the child where to put the sand. The parent might try pushing sand to
the child to use for their castle. The parent might also try building their
own castle in a separate area in the sand tray.
• The child is shooting a basketball into the basketball hoop. The parent
moves beside the child and helps get the ball and hand it back to the
child after they shoot a basket. The parent might also try getting another
basketball and also shooting the ball in the basket. The parent could
try getting the child to take turns shooting the basketball or allow the
parent to pass the basketball to the child and then the child shoots it.

Being Mindful of Limits Skill – ​­The parent should be sensitive to the child’s
comfort, feelings of safety, and regulation level. Some play times may be
mostly tracking and reflecting statements if the child is displaying discomfort
with the parent’s attempts to engage. The parent should not engage or try
to get involved with what the child is doing to the point where the child
becomes fully dysregulated and has a meltdown. An example would be the
child starts to play with rolling some cars around on the floor. The parent sits
down beside the child and starts rolling some cars with the child. The child
grabs the cars from the parent and pushes the parent away. This is a clear
sign the child does not feel comfortable with what the parent is doing, or
the child may be becoming dysregulated. The parent should move away from
the child and observe the child while periodically making some tracking and
reflecting statements and try to engage with the child again when the parent
feels it would be appropriate.
Additional elements that the therapist will want to cover with parents in-
clude how to start and end the play times, what to do when the child invites
you into the play, and how to manage when both parents or additional family
members participate.
Starting and Ending the Play Times – ​­The parent begins by introducing the
child to the play space. The parent explains to the child that, “­This is our
special play space, and you can do whatever you like in here, and I will be
in here with you.” The parent gives a ­five-​­minute verbal and visual warning
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that the play session is almost over and again at the ­one-​­minute mark. The
verbal statement can be “­We have five minutes left of our special play time
and then it will be over for today,” and again at the one minute, “­We have
one minute left of our special play time today and then it will be over.” The
visual can be as simple as the parent holding up their hand with five fingers
and then one finger as they are giving the verbal warnings. When the session
is over, the parent states, “­Our time is up for today.” If the parent is having
difficulty with the child ending the play time, they should repeat the ending
statement and give the child some time to process. If the child refuses to end
the play time, the parent can try implementing a transition item. This would
be a small or simple item the child gets at the end of the session, a treat such
as going to the kitchen with the parent and getting a snack, or a special game
that is played as they transition out of the special play time.
When the Child Invites the Parent into their Play – Children
​­ may more readily
involve their parents in their play. If the child invites the parent into the
play, the parent should accept the invitation and join in the play. The parent
will need to remember that they do not take over the play or start leading the
play. The parent should think of themselves as the actor and the child is the
director. The parent stays in the role the child gives them and changes only
when the child changes it.
Setting Limits – The
​­ limit setting approach in the FMA is fairly simple. Many
of the children that will be participating in the FMA may not understand
limit setting models that are too verbal or too cognitive and they may need
a more basic redirection. For most limit setting needs, the parent should
simply redirect the child or remove the limit causing toy or material. If
the therapist feels it would be helpful, they can teach the parent the Child
Centered Play Therapy ACT limit setting model. This may work for some
children, but for others it will likely involve too much language and cog-
nitive processing. The Act limit setting model was outlined by Landreth
(­2001). (­A) Acknowledge the child’s wants/­needs (­C) Communicate the
limit in a ­non-​­punitive way (­T) Target acceptable alternatives. For exam-
ple, (­A) “­Sarah, I know you want to paint on the wall.” (­C) “­but in here
we cannot do that.” (­T) “­You can paint on the easel or on this paper.” The
parent decides what is a limit to set and limits should be set as little as possi-
ble. If the child did not respond to the limit, the ultimate action the parent
would take is ending the session time. If parents are setting a lot of limits or
struggling with ­limit-​­setting, the therapist should practice with the parent
and/­or observe a parent/­child play time to discover and help with any issues
that may be occurring.
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In Home Follow Me Approach (­FMA) Play Times

Before parents begin to conduct FMA play times at home with their child,
there are some elements that need to be established. The therapist will typi-
cally have a session with the parents around session ten (­before the ­in-​­home
play times begin) to go over the following:

1 When and where will the play times happen? This includes how long
and how often the play times will occur. Parents should be realistic about
how many play times they believe they can do each week. A once a week
play time is fine but if the parent wants to commit to more play times this
is also acceptable. The primary consideration is not o­ ver-​­committing.
The parent will want to try and stay consistent with whatever they plan
to do. Typically, the play time would be 30 minutes. Some children may
not be able to have a play time that lasts that long, and some parents
may find that they go over this time. It is about what works best for the
child. Some parents have discovered that they are most successful with
a morning ­15-​­minute play time and another 1­ 5-​­minute play time in the
evening. The parent should think about what day(­s) and where in the
home the play times will occur. This can be adjusted as special play times
begin to be implemented at home.
2 How will the play space be set up? There are many options available to
the parent and it will likely be established by what works best for the
child. It is often recommended that the parent collect some toys and
materials they believe the child would enjoy and keep those items put
away and bring them out for the FMA special play time. It is also rec-
ommended for the parent to think about a space or room in the home
to have the FMA play times. Inevitably, things can deviate from these
recommendations. Parents sometime find the play time is a roaming
throughout the house play time or an outdoor play time, etc. The space
and materials used are not as important as the parent being able to im-
plement the FMA skills. The skills are versatile so many parents find it
easy to follow the lead of the child with their play preferences and still
be able to implement the skills.
3 Will ­in-​­home play times look the same as in office sessions? The home
setting may bring more challenges than the office setting. The therapist
should explain this to parents and be prepared for parent questions. The
therapist will want to help parents find a way to work through any home
challenges and be successful with their special play times. Typically, the
home play times will not look as structured or flow as smoothly as office
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sessions. This is okay, and the therapist should prepare parents for poten-
tial differences.
4 Do parents have to be perfect? It is important to communicate to par-
ents that they do not have to be 100% effective in their home play
times. It will take some time and practice for parents to feel confident
in understanding how to implement the FMA and get into a comfort-
able rhythm. Parents may miss a planned FMA play time, this is okay,
and they should get back on track as soon as they can. Parents are not
becoming therapists. They do not have to know everything or do things
like the therapist. The therapist should ensure the parent is producing
an acceptable level of FMA skill and provide encouraging feedback to
the parents.
5 Can both parents participate? Both parents can be involved in the FMA
and having play times at home with their child. It is recommended that
each parent has separate play times with their child. Children may be-
come overwhelmed from multiple people trying to engage with them or
even multiple people in the room making tracking statements. Parents
may also talk over each other or get into each other’s way. Parents should
have separate play times; this creates a better experience for the child
and benefits the parents as one parent does not become overwhelmed
with being responsible for trying to implement all the play times.
6 Can other family members participate? Other family members can be
involved in implementing the FMA. It is best if the therapist can meet
with the family member who is going to be involved and having a FMA
play time with the child and make sure that family member understands
how to implement the approach. There are some important benefits to
involving other family members. First, it provides support to the parent.
Parents of neurodivergent children are usually doing a lot and having
other family members be able to support with some of the tasks is ex-
tremely helpful to parents. Second, it helps generalize the child’s con-
necting and relationship skills. The child can benefit from working with
multiple people, not just one person. Before other family members par-
ticipate, the therapist should ensure they are appropriate to work with
the child, understand the FMA skills, and are someone who does not
trigger the child.
7 Can the ­in-​­home play times lead to other things? Many parents discover,
as they begin the FMA special play times, that they start to generalize
new ways of engaging and interacting with their child throughout the
entire day. This generalization is not unusual as parents tend to find a
new way of interacting with and understanding their child and discover
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an improvement in relationship development with their child. Also,

parents often find that other issues or therapy goals begin to dissipate
and correct as the progress through the FMA play times.
8 What happens if the ­in-​­home play times are not going well? Sometimes
parents will share issues or problems happening with the i­n-​­home play
times. If needed, the therapist can ask the parent to record the special
play time and bring in the recording to watch or ask the parent to con-
duct the FMA play time with their child in session while the therapist
observes. The therapist will want to try and discover what is happening
and help the family correct the situation.
9 Are the ­in-​­home play times that same as other play times? The ­in-​­home
FMA play times are therapeutic play times. They are different from regu-
lar play times the parent may be having with their child. The parent can
continue to have their typical play times while they are implementing
the FMA play times. The design of the FMA play times will help the
child understand the difference.
10 What happens when the special play times are over? The FMA play
times are designed to end at some point because they are a therapeutic
process. As the FMA play times are ending, the therapist should help
the parent generalize and transition their FMA play time to other time
spent with the child. The parent should switch to a less formal play time
but continue to have regular play times with their child which should
provide some ­child-​­led processes. As the goals are accomplished and the
special play times are drawing to an end, the children are usually ready
to move from the structure of the FMA special play times to a less formal
play time with their parent.

Goals for Parents

There are some standard goals which apply to parents participating in the
FMA. Goals can be shared with parents and include:

• Strengthen the ­parent–​­child relationship.

• Increase and or develop play times and the level of playfulness and en-
joyment in the ­parent–​­child relationship and help them recognize the
importance of play.
• Help parents understand and value their child’s play preferences.
• Increase parents understanding of neurodivergence and their neurodi-
vergent child.
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• Decrease parent’s feelings of frustration with their children.

• Help parents understand their child’s regulation and communication
system and develop appropriate parenting practices.
• Increase parent’s confidence in their ability to parent and advocate for
their child.
• Increase parent’s feelings of warmth and care toward their children.
• Address presenting therapy needs and goals.

Providing Continuous Support to Parents

The majority of parents are fully capable of learning the FMA skills and im-
plementing the FMA play times with their children at home. Many parents
may lack confidence, feel insecure, or worry they are not doing something
correct. The AutPlay therapist will want to provide consistent support to
parents, encouraging them in their parenting process, and as a c­ o-​­change
agent in working with their children. The AutPlay therapist will also want to
respect the parent as an expert on themselves and their child and value their
voice in the therapy process. Some potential issues that may arise include
parents feeling inadequate to implement the play times at home without
the therapist’s presence, handling issues that come up at home during the
play times, being hesitant to participate in therapy, struggling with their own
fears and questions about parenting their child, and being overwhelmed. At
the end of the FMA process, an empowered, educated, and confident parent
is a great success.

References

Autistic Self Advocacy Network. (­2021). Start here: A guide for parents of autistic kids.
The Autistic Press.
Booth, P. B., & Jernberg, A. M. (­2010). Theraplay. ­Jossey-​­Bass.
Gil, E. (­2015). Play in family therapy (­2nd ed.). Guilford Press.
Jeffreys, R. (­2021). You were made for this. Empowerment Publishing.
Landreth, G. L. (­2001). Innovations in play therapy: Issues, process, and special popu-
lations. Routledge.
Landreth, G. L., & Bratton, S. (­2020). ­Child-​­parent relationship therapy (­CPRT): An
evidence based ­10-​­session filial therapy model (­2nd ed.). Routledge.
Macdonald, J., & Stoika, P. (­2007). Play to talk: A practical guide to help your ­late-​
­talking child join the conversation. Kiddo Publishing.
Stinnett, N., & DeFrain, J. (­1985). Secrets of strong families. Berkley Books.
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Trotter, K. (­2013). Family play therapy. In N. R. Bowers (­Ed.), Play therapy with
families. Jason Aronson.
VanFleet, R. (­1994). Filial therapy: Strengthening the p­ arent-​­child relationships through
play. Professional Resource Press.
VanFleet, R. (­2014). Filial therapy: Strengthening the p­ arent-​­child relationships through
play (­3rd ed.). Professional Resource Press.
 13
The AutPlay® Therapy Follow Me
Approach (­FMA) Case Examples

Case Example “­Mallory” by Robert Jason Grant

Mallory was ­3-​­years old when she first entered the playroom with her bi-
ological mother and father. Mallory had been diagnosed with autism
spectrum disorder six months earlier through testing and evaluation con-
ducted by a psychologist. She was described as having limited verbal output
(­communication), sensory needs, and dysregulation struggles. At the time
Mallory began play therapy, she was participating in speech therapy, occu-
pational therapy, and on a waiting list for intensive ­in-​­home therapy. Mallo-
ry’s parents sought play therapy to improve their relationship with Mallory
and help Mallory improve regulation ability, gain social and play interaction
with peers, and feel comfortable participating in group play with others.
Mallory lived with her biological mother and father. Mallory had one younger
brother and was involved with other family members, specifically her pater-
nal grandparents. Mallory’s parents reported they had positive family and
community support in place and were active in various support groups. Mal-
lory was participating in several therapies throughout each week but was not
involved in any extracurricular or play/­social activities.
The first three play therapy sessions were designed to help Mallory build rap-
port and become more comfortable with me and being in the playroom. Fol-
lowing the AutPlay Therapy Intake and Assessment Phase protocol, the first
three sessions were also used to further assess Mallory’s strengths and therapy
needs. I conducted a child observation session with Mallory and a parent/­
child play observation session with Mallory and both her parents. Mallory’s
parents also completed four inventories: the AutPlay Emotional Regula-
tion Inventory, AutPlay Social Navigation Inventory, AutPlay Connection
Inventory, and AutPlay Assessment of Play Inventory. Mallory was observed
in a playroom. She presented around 75% nonverbal and did not appear to

DOI: 10.4324/9781003207610-14
272 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

have any obvious communication preference. She would periodically speak

words, but they were not comprehensible. She would occasionally say a word
that was understandable, and it seemed to be used in appropriate context and
she would occasionally give an appropriate ­one-​­word response to a question.
Most of the time, Mallory would not respond to my presence in the play-
room; she would not respond to any verbal prompting; and she seemed to
not pay attention to me or my efforts at engagement. Mallory played primary
with one toy (­the dollhouse) repeatedly and performed the same action with
a person miniature entering and exiting the dollhouse door repetitively. At
the end of the assessment period, the AutPlay Follow Me Approach (­FMA)
was identified as the therapy approach. This approach was used due to Mallo-
ry’s age and her lack of interaction and engagement ability. Both Mallory and
her parents would participate in therapy with the goal of teaching the FMA
to Mallory’s parents to implement in the home setting. Goals for therapy
included increasing play interaction between Mallory and her parents, in-
creasing engagement (­relationship development) with another person, and
decreasing regulation struggles. Further, it was discussed that the FMA would
help Mallory gain the presence to be able to participate in more structured
play therapy ­interventions – ​­interventions that would require a greater level
of attunement and engagement than she was currently displaying.
During the fourth session, I provided Mallory’s parents an outline to review
the FMA and described the process to them. At the fifth session, I conducted
an FMA session with Mallory as her parents observed from the corner of the
playroom. The purpose of the session was to further develop relationship
with Mallory and demonstrate a FMA play session to her parents to help
them begin to learn how to conduct play sessions at home. The play session
lasted about 20 minutes. I demonstrated tracking and reflecting skills, letting
Mallory lead the play and following her as she transitioned from toy to toy
and making attempts to try and engage with her in her play preferences.
Mallory seemed to be comfortable with my presence and attempts to engage
her. It is important to note that about 90% of engagement attempts were
not acknowledged by Mallory. She did seem to notice me during play time
with a toy car and answered a question that I asked. This was the only overt
engagement piece that occurred during the play session. At the end of the 20
minutes, I reviewed the play time with Mallory’s parents and answered any
questions they had about what they had observed. They were most curious
about how often to try and engage Mallory and in what ways. I discussed the
engagement attempts that I made and gave examples of other options that
could have been attempted. Mallory’s parents were instructed to review the
written FMA skills they had been given and during our sixth session they
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 273

would observe me demonstrating another FMA play time and have the op-
portunity to ask questions and clarify the process.
During the sixth session, Mallory’s parents observed me conducting a play
session with Mallory that lasted approximately 25 minutes. After the play
session demonstration, I processed the session with Mallory’s parents and
discussed any questions or observations they had. The session time pro-
gressed similarly to session five, except that Mallory seemed more interested
in exploring the playroom and she played with a greater variety of toys. She
also seemed to be making more attempts to communicate with me verbally
although much of what she was saying could not be understand. Mallo-
ry’s parents were again instructed to review the written outline they were
given describing the FMA skills and think about the observation they had
watched. In the next session, they would have the opportunity to practice
the FMA approach.
During session seven, each parent felt comfortable to try facilitating an FMA
play time with Malory. Mom went first and Dad went second and each FMA
play time lasted approximately 15 minutes. Both parents seemed to under-
stand the approach and successfully implemented the skills throughout the
session. Mallory’s parents were instructed to practice the FMA at home with
each other in a ­role-​­playing scenario, and during the next session, the thera-
pist would again observe each of them having a FMA play time with Mallory.
The next session began with Dad having a FMA play time with Mallory
while Mom and I observed from the corner of the playroom. Dad’s session
lasted approximately 15 minutes and then Dad and Mom switched places
with Mom having a 15 minute play time with Mallory and Dad observing.
After Mom’s play time, I processed through the experience with the parents
and discussed some observations giving them mostly positive feedback and
a couple of things to work on for the next play time. Overall, both parents
were efficient and seemed to have a solid grasp on how to have an FMA play
time. Mallory’s parents were very good at playing with her and seemed to
have a natural instinct about children’s play. They were instructed to begin
having FMA special play times at home with Mallory. It was established
that they would try to have a 2­ 0-​­minute play time four times before the next
session. Mom and Dad could have separate play times so each of them would
plan on having two play times before the next session. I also discussed logis-
tical issues of where the play times would be at home, what toys they would
use, and when they would try to have the play times.
During the next session, Dad was unable to attend, so I gathered from Mom
an update on how things went with the play times at home. They had each
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conducted two play times with Mallory and they went well. I then observed
Mom having a FMA play time with Mallory. Their play time lasted approx-
imately 25 minutes. The remainder of the session was used to process the
session with mom and go over details for continuing play times at home. In
this session with mom and Mallory, there was a marked change in Mallory
navigating around the playroom and playing with a greater variety of toys
than previous sessions. She also made several verbal comments to her mom
and invited her mom into play and engaged in some play with her mom. I
encouraged mom to make more reflective statements as there were several
times Mallory displayed emotions. I also encouraged her to continue to look
for opportunities to try and engage Mallory in her play time as this seemed
to be improving each play time. Overall, the play session and home imple-
mentation were a success.
The next session began with a ­check-​­in with both mom and dad on how
the play times had gone at home. Things seemed to be progressing well and
they did not have any questions. After the ­check-​­in, each parent conducted
a play time with Mallory for about ten minutes while the other parent and I
observed. These two play times seemed to be the most positive and produc-
tive to date. Both parents executed the protocol, and Mallory responded well
to her parents. Mallory continued to display more verbal interaction, and her
parents attempted to engage with Mallory in her play several t­ imes – the
​­ ma-
jority of those times Mallory reciprocated back. This reciprocal engagement
was the most I had seen from Mallory to date. Mallory’s parents noticed the
advancements and seemed pleased with how the FMA play times were going.
They were noticing an improvement in Mallory’s reciprocating play with
them, overall engagement, and overall increases in Mallory seeming more
regulated. They expressed that the play times at home had been successful.
Sessions ­10–​­20 continued with Mallory’s parents having four to five FMA
play times at home between sessions and processing the home play times
during weekly session with me. During the weekly session with me. I would
conduct an FMA play time with Mallory while the parents observed. Mal-
lory continued to progress in becoming more engaging during her play times.
Her parents reported each session improvement in engaging with them, ac-
knowledging and attuning to them, some increase in verbal statements, and
that overall, she seemed more regulated. Mallory’s parents also reported they
were now having additional play times with her that felt more natural and
enjoyable. Around session 16, it was discussed to introduce more structured
group games with Mallory. Her parents introduced games to play during their
special play times such as hitting a balloon back and forth or blowing and
popping bubbles. The games were simple connection/­participation games.
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Mallory responded to the introduction of the games well and participated

with her parents. Around session 17, Mallory’s parents began to involve the
grandparents in the FMA play times and teach them how to have the play
times with Mallory.
By session 20, Mallory was having play times once a week with her grandpar-
ents. She was also having play times with her parents and actively engaging
with them in games that they were introducing to her that required her to
attune to them and follow instructions such as “­Ring Around the Rosie”
and “­Duck Duck Goose.” During session 21, original therapy goals were r­ e-​
­evaluated and identified as accomplished. New therapy goals were estab-
lished for Mallory and her family that involved integrating more structured
play interventions. By session 21, Mallory had made great progress toward
relationship development and engagement goals. She was also more verbal
and interactive, seeming more comfortable being around and attending to
others. She had also made improvement in being less dysregulated and was
able to participate in more directive play therapy approaches that focused on
specific interventions where this was not possible for her at the beginning of
therapy.

Case Example “­Alex” by Elaine Hutchinson

Alex was referred for therapy when he was 7.5 years old. He lived at home
with both of his parents and his younger sister. His mother referred him be-
cause she wanted additional support for him to develop his emotional liter-
acy. Prior to the referral, Alex was assessed for autism and ADHD, but his
mother was told he “­Didn’t quite tick enough boxes” to meet the threshold
for either diagnosis. The school’s Education and Health Care Plan (­EHCP)
application was made before therapy started but was not finalized and addi-
tional provisions not provided at the time therapy began. His mother felt the
school was not adequately meeting his needs, which had a significant impact
on his education in relation to peer interactions and his ability to access the
curriculum.
There was a family history of autism on both his mother’s and his father’s side.
Alex’s mother had an older brother and a father with an autism diagnosis,
so she had an ­in-​­depth, personal understanding of neurodivergence. While
wanting to support Alex in his uniqueness, she also felt he needed additional
life and social understandings. According to his mother, Alex was a sensory
seeker. He would easily get emotionally flooded, leading to regular “­massive
meltdowns” that often occurred several times a week at school and home.
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Noise was a key trigger for him, so the noisy classroom and after school care
environments didn’t help him cope well at school. School also appeared to
have trouble supporting him positively when he became dysregulated. The
restrictions due to the ­Covid-​­19 pandemic have had significant implications
for Alex in managing his school environment effectively, and his 1:1 support
had been removed, leaving him without a supportive and familiar key adult.
Alex’s mother and I completed the intake paperwork after an initial tele-
phone conversation. She prepared Alex for coming to see me by using the
video tours on my website to help familiarize him with the setup. We also
had a “­hello” call over Zoom so he could meet me without a mask. We shared
an informal introductory session before starting ­face-­​­­to-​­face therapy so that
Alex had an opportunity to come and meet both me and my therapy dog
(­Orca) and spend some time becoming familiar with my room.
The AutPlay Therapy Intake and Assessment Phase was completed along
with the assessment and inventory paperwork. In completing the initial in-
take assessment, Alex’s mother noted that he struggles with varied play, any
change to his routine, stereotyped and repetitive mannerisms and abnormal
functioning regarding his empathy for others. The initial assessment of play
showed that Alex chooses to play mostly using sociodramatic play with some
rare functional and representational play. Alex’s mother noted that play at
home is primarily sociodramatic. Alex and his sister like to reenact scenarios
from TV programs. However, a large part of Alex’s play is concerned with
directing his sister, organizing the setup, and establishing the ground rules
rather than interacting in play.
The initial social navigation inventory indicated that Alex’s mother felt that
most of Alex’s social navigation involved struggles, with most of her scores
listed as 2 or 3. Those indicated at a 4 or 5 were all l­inguistics-​­based skills.
The initial emotional regulation inventory showed that Alex’s mother felt
that he struggles to verbalize or express emotion and understand emotion
in others. At home, Alex tended to demonstrate “­big emotions” that are
hard to handle, including shouting, hitting, biting, and running away, even
though both parents stated they and his sister correctly model emotions. The
initial connection inventory revealed that relationships were challenging
for Alex, with most connect components getting scored at a 2 or 3. Alex’s
mother stated that he has little awareness of personal space and when he
would hug others, he can hug hard to the point of pain in the other person
and then not release the hug when asked.
In completing the initial unwanted behaviors assessment, Alex’s mother
noted that he has sensory issues around oral behaviors (­licking inappropriate
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 277

things, biting people); an apparently high pain threshold, “­he doesn’t seem
to feel pain often;” both a need for and overstimulation by loud noise and
a need for heavy c­ ontact – ​­bashing into people, leaning hard against them,
and hugging overtly hard. When Alex would become overloaded, flooded,
or experience a meltdown, Alex’s unwanted behaviors included becoming
uncontrollable, throwing, pushing, hitting, and biting. If he feels he is being
disciplined, then his behaviors become even more extreme, with Alex ap-
pearing “­manic” for up to 24 hours after the event. At school, he bashes into
children on the playground, making peer friendships hard and, if triggered,
will run off so adults cannot help address him. Alex’s mother stated he will
not listen to instructions, including those linked to his safety. He can be a
danger to both himself and others. He is regularly threatened with exclusions
at school with little effect.
During the child/­parent play observation, Alex’s mother demonstrated clear
boundaries for her son and a warm, loving, and nurturing approach toward
him. When playing together, she connected with him verbally and physi-
cally, often putting her arm around him if he came and leaned against her or
dropping a kiss on the top of his head. Both these actions made him smile or
say something positive to her in return. As they played, she recalled other
times they have enjoyed playing together. She seemed to facilitate his suc-
cess, would whisper cues to him when he was off task, giggled with him,
noticed him and was curious about his play. She seemed to delight in his
knowledge and competence, and clearly enjoyed sharing dialogue and ques-
tions with him and complemented him appropriately without going over the
top, which again, he seemed to delight in.
At the end of the intake and assessment phase, it was agreed by Alex’s
mother and myself that Alex would begin with a series of sessions that were
nondirective and using the FMA. The therapy goals would include increased
social navigation ­needs-​­reciprocal play. After this, the second phase of more
structured therapy would begin with therapy goals that would consist of Alex
gaining in emotion identification and regulation awareness and his ability to
feel more fulfilled in his connections with others.
A Goodman’s SDQ (­strengths and difficulties questionnaire) was completed
at intake by Alex’s mother, a common UK practice for play therapy and some
NHS mental health screening. The SDQ scores showed Alex had significant
issues with hyperactivity, conduct, and peer relationships, scoring 24 out of
30 possible difficulties and correlating to the AutPlay intake paperwork find-
ings. However, what is interesting is that Alex failed to score for any ­pro-​
­social behaviors on the SDQ but that some were evident and noted on the
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AutPlay intake paperwork and seen during observations. One of the things I
reflected on as a therapist is how I gather information on clients during the
intake phase. Now I ask a lot of AutPlay based questions at intake for all
clients, which benefits my understanding of them.
Alex initially presented in FMA sessions as a controlled but chaotic player.
As is often the case with a child in the early stages of therapy, there was a
great deal of room familiarization in the early sessions as he went through
multiple activities in a short space of time. Throughout therapy, Alex was
delighted when Orca met him at the door at the start of sessions. He spent
a few minutes grounding himself and managing the transition by engaging
with her, either by fussing her, giving her a treat, or throwing her ball. He
would then transition to other play preferences. He did not seek her out in
the main part of therapy sessions but would engage with her if she came to
him.
At the end of each session, part of Alex’s ending ritual was to acknowledge
Orca and wish her a good week. He liked dogs, but he did not have one at
home. Session endings were particularly hard for him, even with plenty of
notice, time remaining warnings, and an ending count down. I had to be
consistent with him about ending every time, but in some sessions, he found
it much harder than others, possibly in reaction to days at school that had
not been so positive.
From his first FMA session Alex was drawn to small world play, using figures
on the table or the floor or create a “­team” for him and for the adult who was
playing with him. Often, he would not designate any team to the adult at
all. Instead, he would instruct both his mother and me about the complexi-
ties of every team member. The briefing would include each character’s role,
strengths, and weaknesses, how they interacted with their team, and their
role in challenging the other team. This detailed briefing would often go on
for the entire session with no genuine desire to play it out, just to clarify and
instruct. Sometimes Alex would give a demonstration between two charac-
ter’s combat so that the adults could see “­how to do it properly,” but there was
no desire for reciprocal play on his part. The play was always ­socio-​­dramatic,
with Alex ­re-​­enacting combat from TV series like Pokémon, Yu Gi Oh, and
Power Rangers, which were his only real viewing interests.
Early on, sometimes the teams would battle it out on the table, the floor, or
in the sand tray. However, regardless of location, the same formulaic ­socio-​
­dramatic play was always used. Occasionally when Alex’s concentration
wavered, he would deviate to enclosure ­schema-​­based play, investigating
lockable houses, jail cells, and treasure chests that I have in my room.
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 279

Over the course of a session, ­80–​­100% of the session time would be team/­
combat based. Whenever the adult made reflections, they would be ignored.
Often the use of his name would bring no response either. If Alex’s attention
was needed, it required physical touch and an “­Alex, please give me your
attention” type comment from either adult to get his attention. Alex would
then break from his imaginary world and commentary, but he would then
briefly make eye contact and acknowledge the adult before going back into
his play.
In session five of the FMA, Alex made an interesting change to his setup.
Everything on both teams had to be precisely matched in terms of relative
size and placement of characters and symbols. This placement and organi-
zation would link to a Pokémon battle setup or using a Yu Gi Oh card deck,
both of which were familiar to Alex. A fascinating development was that
he could break from his setup dialogue to discuss it when I reflected on the
need for symmetry. Another intriguing aspect of this was that once he had
set it up, where it had to be “­perfect,” it was OK for someone else to move
around characters or symbols on their side, and he felt OK with that. If his
team came out of their planned alignment, it made him feel “­yukky” in his
body. Alex’s comment would suggest a sensory ­whole-​­body response to his
need for symmetry and order in that instance, but not necessarily an OCD
based response, as it is the only occurrence of a need for symmetry that his
mother can recall.
Something was definitely going on for him in this session because he lost the
slight sense of personal distance he had retained until that point and was
leaning hard against me as he was explaining the setup and needing to be
up ­super-​­close to talk to me. Later, when Alex’s mother and I reflected on
the session together, we felt there had been a positive shift in Alex’s process
relating to his comfort level. Alex’s mother could also think of no reason
why Alex’s need for symmetry had been triggered in that session, but we
both acknowledged that didn’t mean there hadn’t been something he was
responding to in the session. It is worth noting that symmetry is not essential
at home for him, either before or after that session. It did not emerge again
in therapy sessions, and Alex attended over 20 more sessions.
It was definitely a pivotal moment for Alex in his therapeutic process. For
the subsequent eight sessions, his play and process completely shifted. He
changed to playing board games in most sessions, with some very occasional
painting and puppet work. Again, the setup and the rules were more im-
portant to him, perhaps reflecting his need for control and mastery still,
but just in another skill set. However, he was capable and willing to engage
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in reciprocal play, ­turn-​­taking, engaging, and ­game-​­related conversations.

Alex’s change of activities in sessions could have aligned with changes to
UK lockdown restrictions and rules at school. Perhaps the playroom changes
reflected changes in his wider world, with his need for control reflecting the
uncertainty of the new lockdown restrictions outside of the playroom envi-
ronment he controlled.
Chess became important to Alex at this point, potentially echoing his need
for rules and control in other areas of his life. When we played, he coped ex-
ceptionally well with losing pawns early in the game and other critical pieces
as we played without any hint of frustration or annoyance. Outside of the
playroom, he struggled at this stage with hyperactivity and following rules in
school. However, Alex’s behavior in the playroom did not reflect this.
At session 14, Alex looped back around in his play to the ­team-​­based small
world play. This looped revisiting process showed a more mature approach
to his play that was now far more independent and less reliant on the adult.
Previously the teams had been based exclusively on fantasy figures and nat-
ural symbols. They now occasionally morphed into battle play with soldiers
and tanks, but Alex’s play was still ­fantasy-​­based for most sessions. The need
for two teams has receded with often only one team being set up, sometimes,
but not exclusively, enclosed in the safe confines of an armchair. The chair
was situated next to my fantasy figures, so it could merely be a coincidence
and a handy spot to play, but it is worth noting Alex didn’t previously use it.
Following the change in his process for board games, Alex was much more
likely to respond to reflections. However, he would only respond if he consid-
ered the reflections or comments worth answering. Alex’s selective answer-
ing could be funny as he would pretend to ignore anything that he thought
was not worthy of comment. He would acknowledge me more readily in con-
versation, right from greeting me at the door. He would now share jokes with
me appropriately and laugh at me when I make a joke in return. Orca chasing
her tail had him in fits of laughter, whereas previously, he looked bemused.
Overall, Alex just felt lighter in himself and more assured in the playroom.
Sessions paused for the Easter holiday at session 18. Alex’s mother and
I agreed to use the break as a chance to move into the structured phase
of AutPlay. We spent several sessions before the holiday discussing the
change with Alex and showing him the sort of activities we would be
working on together. Currently sessions are organized with set activities
and games for the first half of the session. Once these are completed, the
remainder of the session is FMA, as he still clearly needs a ­self-​­directed
element to therapy.
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Alex’s mother has reported that he is much calmer at home, with meltdowns
now a rare event in response to a specific trigger rather than a way of com-
municating a need. School is still a source of recurrent outbursts for Alex,
with no real improvements there, mainly because he still is not getting the
support he needs. However, Alex’s mother is feeling more empowered by the
therapy process. She thinks that she has a better understanding of Alex and
his needs. Consequently, she feels able to be more assertive about requiring
Alex’s needs to be met in school and that she can ask for support and equip-
ment from a place of authority and understanding.
It is clear that Alex still has some therapy goals to achieve. It is anticipated
that he will graduate therapy within a year, probably after he has used ses-
sions to support him to settle into a new school year with a new teacher.

Case Example “­Melody” by Jen Taylor

Melody began Autplay Therapy services at age 5, a few weeks after she was
diagnosed with autism spectrum disorder by a local psychiatrist. When Mel-
ody and her mother arrived at the office, the mother was carrying the child
who was actively attempting to escape from the mother’s arms. The mother
reported that Melody was often extremely aggressive toward her, often hit-
ting her or slapping her when she was frustrated. At other times, Melody was
overly clingy and often refused to attend Kindergarten. The mother had to
physically carry the child to the classroom and remain there for 30 minutes
or more because Melody had such a difficult time transitioning from the car
to the classroom. During class, Melody was struggling academically, isolating
herself from other children and often refusing to participate in any activities.
Melody refused to communicate with this therapist during the initial inter-
view. She spoke in a very low whisper during the few instances where she
spoke at all. She would not answer questions directly and often whispered
answers into the mother’s ear instead of answering out loud. Melody would
frequently hide behind the mother’s back or bury her face into the moth-
er’s shoulder or lap. She was not interested in visiting the playroom and
would not go anywhere in the office without holding onto the mother’s leg
or clothing.
Melody’s mother did not have a positive experience with the psychiatrist and
was resistant to any medication recommendations. She felt that Melody was
“­too little” and was worried that medications would result in potential side
effects. She was using homeopathic vitamins but was not noticing a change
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in behaviors and wanted to explore other therapy interventions. During the

completion of the initial AutPlay screening assessments, she was honest and
forthcoming but very anxious about the use of the term “­autism spectrum
disorder” or any variation of those terms. She provided history of her own
childhood where she had similar (­although not as excessive) struggles and
was able to learn how to manage those symptoms as she got older. Through
the intake and assessment process, a history of delayed speech and toilet
training and social/­emotional needs were reported. In play observations,
Melody seemed to have areas of concern in communicating wants/­needs,
parent and child interactions, dysregulation, and shyness/­anxiety in social
settings, lack of awareness of danger, and continued toileting issues, general
anxiety, and difficulty with transitions.
Therapy began using the FMA due to the child’s separation anxiety and re-
fusal to participate in any play therapy without the mother in the room. In
addition, the intensity of behaviors and the mother’s own anxiety about the
child’s diagnosis created a strain in the ­parent–​­child relationship that could
be addressed using this intervention. The next two sessions consisted of the
therapist, mother, and child spending the entire session in the playroom and
allowing the child to choose activities. The therapist gently reflected on the
child’s closeness to the mother at the beginning of the session and allowed
for the child to take as much time as necessary in choosing any play mate-
rials. The focus of the sessions was on building a therapeutic rapport and
reducing conflicts and power struggles with the child.
The next six sessions were spent allowing the mother time to practice the FMA
in the office playroom under the supervision of this therapist. The mother
initially struggled with allowing the child time to choose and frequently of-
fered suggestions or encouraged specific play. Over time and with additional
practice at home, the mother became more competent in accepting the child
as she was and felt more comfortable allowing the child to choose what toys
to play with and in what manner during these practice sessions. During this
time, the therapist noticed that the child enjoyed racing cars across the table.
The therapist and the mother were able to copy these play behaviors and
encourage joint attention and shared play with Melody. Melody liked to push
the cars off the table or watch them crash into each other. The therapist
began introducing emotional regulation by identifying the feelings expressed
during these races and by engaging the child in contests to see who could get
closest to the edge of the table without going over the edge.
During future sessions, the therapist was able to use these cars in the waiting
room to “­race” to the door of the playroom. The child would often crash
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them into the walls and laugh or push them so they went very far past the
entryway. However, throughout this practice, the child became less anxious
about separating from the mother and more capable of entering the play-
room independently. The degree to which the child was able to stop the
car in front of the playroom doorway improved over time and appeared to
be indicative of the ease with which the child was able to separate from the
mother. At home, the mother and child practiced various emotional regu-
lation games including Red Light, Green Light, Simon Says, and playing
a card game known as Slapjack. The child’s ability to name her emotions
improved. In addition, she was able to control impulses better and was be-
coming less aggressive toward the mother.
Despite this success in the therapy setting regarding the separation anxiety
and communication issues, the child was still struggling with transitions out-
side of the therapy session. She refused to walk to her classroom and would
get extremely distressed if there was any change in the routine throughout the
day. During the next session, the therapist worked with the child using the
AutPlay intervention Same Plan, New Plan. In the session, the child deco-
rated two signs made from popsicle sticks, paper, and arts and crafts materials.
One sign had an “­S” indicating “­same plan” and one sign had an “­N” to in-
dicate a new plan or change in expected plans. The child and therapist used
play to rehearse activities using the signs as a way to provide a visual cue to the
other about what was going to happen next. This set of cards remained at the
office and the mother and child made additional sets for home and for the car.
Upon arrival at the office for subsequent visits, the therapist would ensure
that the cars from previous visits were available in the waiting room and hold
the cards “­S” and “­N” when the child arrived. The child would indicate “­S”
if she wanted to race the cars as usual or “­N” if she had a new idea for how to
get to the playroom. She would practice coming up with her own new plans
during the session and would sometimes walk in slow motion, hop, or bear
crawl to the office instead of racing cars. Inside sessions, the therapist would
interrupt the FMA by using the “­N” new plan card to introduce a directive
play intervention addressing emotional regulation or social needs. Melody
was observed to be able to transition from n ­ on-​­directive to directive activi-
ties more readily using this technique. The mother practiced at home as well
and found that it was effective in helping the child transition to and from the
car on school days. The resistance toward entering the classroom had sub-
sided and the child was walking, hopping, or skipping to class on most days.
Melody continued to participate in Autplay Therapy for nearly one year.
She and her mother implemented the play interventions at home during
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structured practice for ­20–​­25 minutes per day. The mother’s own anxiety
about her ability to manage the child’s behaviors was significantly improved.
She reported having more joyful interactions with her daughter and fewer
power struggles. Melody continued to improve over the course of one year
until the family moved out of the area and discontinued therapy.
In working with Melody and her mother, it was important to model ac-
ceptance for the mother’s own anxieties and perceived shortcomings. The
normalization of the mother’s fears and insecurities created a model for the
mother to accept her daughter’s neurodivergent strengths and needs with
less judgment. The use of c­ hild-​­centered play using the FMA allowed the
child to feel less rushed, more competent, and reduced the power struggles in
the relationship. The child became more verbal and emotionally expressive,
and the parent and child had fun together and often laughed and giggled
together. The use of more directive AutPlay interventions were critical in
helping the child outside of the playroom. This specific practice provided the
child with coping skills to manage transitions successfully.

Case Example “­Lottie” by Lily Wake

This case example is set in my private practice, in a small village in the

Southwest of England where I am lucky to have a large fully equipped play
therapy room. Mum initially approached me as she had heard I offered a
model of support and therapy for neurodivergent children. An initial intake
meeting was conducted with Mum, to explain the process of Autplay, and get
some background information.
Session one was an intake meeting with Mum, who shared that Lottie was 3
years old, and at the time was ­pre-​­verbal, and had significant developmental
delays. Lottie was with a foster family for the first ten weeks of her life who
nurtured her through neonatal opioid withdrawal, before being adopted by
a couple who, for the purpose of this case study, I refer to as Mum and Dad.
In addition to Lottie, this year her biological parents had another baby, who
Lottie’s Mum and Dad also adopted. The baby sister was 5 months old at this
stage and was neurotypically developing, responsive, and engaging, although
she was also born with neonatal abstinence ­syndrome – Mum ​­ and Dad have
three children of their own, one has grown up and left home. However a
teenage son and daughter live at home.
Mum shared that Lottie had autistic presentations of repetitive/­indiscriminate
patterns of play and narrow focused interests, little social communication
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 285

ability, and poor emotional regulation, although there was no formal diagnosis
of autism. Lottie attended a specialist communication p­ re-​­school five morn-
ings a week, where they worked in conjunction with a speech and language
therapist (­SLT) to start introducing Lottie to the first stages of the pictorial ex-
change communication system (­PECS), within a total communication envi-
ronment. Mum reported that Lottie was oblivious to the other children unless
irritated by their sounds and the school was also working on social interactions.
One of the most problematic behaviors at home and preschool was seen to be
Lottie’s obsessive throwing of objects. Mum described this behavior as hav-
ing started when she was very young, and it has caused many breakages and
the house to be turned into a ­projectile-​­free space. Which is hard to main-
tain with six people living in a small ­four-​­bedroom British terrace house,
particularly with a new baby in the home. Mum shared the pressure this put
on normal family social experiences, as Lottie cannot discriminate between
acceptable projectiles, and presents this behavior wherever they go.
Another challenge Mum presented was that Lottie has no sense of awareness
of her surroundings or safety. Lottie would run at any given opportunity,
without seeing any hazards. Lottie will hold a hand for short periods of ­time –​
­from house to c­ ar – ​­car to her preschool b­ uilding – ​­but would attempt to
break free beyond that. For her safety, Lottie was restrained in a buggy when
they went out and about, particularly with the new baby as Mum could not
chase Lottie and manage the new baby.
Lottie’s diet was described as being limited, preferring bland unthreatening
familiar foods, not engaging with food out of these food groups. She was
­noise-​­sensitive, particularly to her baby sister, who she did not acknowledge
was there, unless she made a noise. Mum also described a lack of response
from Lottie to her name being called, or any initiated engagement that was
not on her terms.
Noise was often a trigger for dysregulated behavior like throwing things,
shouting, crying, screaming, and rarely, but occasionally hitting. Other trig-
gers were when she was tired, overwhelmed, or in an unfamiliar environ-
ment, when she needed to sit still, change of routine, and if she was excited
or frustrated. The frequency of these sensory and impaired semantic and
pragmatic responses, and subsequent dysregulation, was continuous at dif-
ferent levels throughout the day. Lottie also appears to need very little sleep,
averaging ­5–​­7 hours a night.
The initial three sessions were ­child-​­led, and child and parent/­child ob-
servations were conducted, using Autplay observation forms. Session four
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involved meeting with the parent. Observations, Autplay inventories, and

information received at intake were assessed, and informed my clinical de-
cision to work with Lottie and the family using the FMA. Her age of 3 years
old and her assessed needs in emotional regulation, connection, social safety,
and her inability to participate in any directive play techniques, making the
FMA the most developmentally appropriate place to start. I began working
with Lottie and Mum, implementing sessions on a weekly basis, for 40 min-
utes each.
The first time Lottie came to the playroom, I met her and Mum in the car
park, to show them the way in. Lottie grabbed my hand and walked with me,
with no discrimination or concern that I was a stranger. When we entered
the playroom and I dropped to my knees in front of Lottie and introduced
myself, using spoken word, sign, and gesture to tell her “­Here you can play
with anything, and I will be with you.” She ran around on her tiptoes looked
at everything for a few moments, before heading to the fruit and play food. I
followed, and she picked items up and threw them on the ground. I put my
hands out for her to pass them to me, but she ignored me and continued to
throw them on the ground. Her attention was lost after around two minutes,
and she ran on to explore the doll’s house. I verbally tracked and noticed, as
I moved myself alongside her again “­Now you’re exploring the doll’s house.”
She opened and closed the door, and the front panel, exploring the hinge
motion, I said “­Open, and close,” and we made eye contact for the first brief
moment.
She soon ran on from the doll’s house to the sand symbols which are all dis-
played on shelving. I had to ­limit-​­set very quickly. Directing her hand with
the first symbol in it, naming it, and said “­On the shelf” before she could
throw it, and showed her how to put it back on the shelf. She soon moved
on again. Next, she discovered the drums. I sat alongside her, matching her,
a beat and tone lower than hers, and for the first time I had engagement. She
clearly observed and noticed our musical connection and started giggling
every time I mirrored her beat. This exchange continued for about three
minutes, which was the longest her attention had been held on an activity
so far. As I saw her moving off, I pulled the draw of musical instruments out
into view and reach. She almost fell in the tub headfirst as she eagerly pulled
everything out, one at a time, shook it, explored it, and threw it over the
other side.
Next, Lottie went and threw herself on the sofa with Mum and “­Cuddles
the Koala,” a HUGE m ­ an-​­sized Koala. I sat on the other side of Cuddles,
closed my eyes and pretended to snore. Lottie came to explore my antics,
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engaged, and intrigued she touched my arm. I pretended to wake up and said
and signed “­Ooh, good morning, Lottie,” which made her jump a little and
giggle, while looking at me. I repeated the action and this time she pushed
Mum as if to tell her to go to sleep as well. We both snored and woke up with
a jump and an excited “­Good morning Lottie” when she touched us. She
dissolved into a fit of giggles, delighting in the engagement. It was a lovely,
nondirective piece of engagement work. This was an activity Mum was able
to easily introduce to Dad and older siblings, to start to build all of their
bonds of engagement and connection with Lottie at home.
Lottie established this circuit on that first session, and she would loop around
the playroom engaging with the different objects, in the same order, at least
seven times per session. From this first session, at various points through
the loop, she would acknowledge my presence alongside her, matching her
movement, energy, and pace, and gently, verbally, and through sign tracking
some of her movements and actions. This was in line with FMA integration
of Axline’s (­1958) ­child-​­centered play therapy foundations.
The acknowledgment of my presence increased over the sessions, little by lit-
tle, with Lottie actively engaging with Mum and/­or me, in nearly all aspects
of the loop. Sometimes seeking our engagement, other times delighting in
engagement initiated by us. Lottie started verbalizing on the second session.
I would verbally and through sign label the food as she threw it down, I
would pick it up and name the item again, and she watched my mouth and
repeated, for example: “­Banana, pear, cake,” and many more words. Mum
was thrilled with this development, and reported she was also starting to
label items and objects at home by the third session.
After the initial assessment phase of three weeks, which mum was present
for and observing, we were able to establish some therapy goals. We agreed
I would teach mum the FMA, to empower her to become a ­co-​­change agent
for Lottie’s outcomes. I would spend the first 25 minutes conducting a FMA
session, while Mum observed. The remainder of the session Mum would
practice, and we would process and review the FMA session and answer any
questions Mum had. Mum had taken the principles of the FMA on board
quickly. I observed Mum was able to be alongside Lottie, and maintain the
level of attunement, curiosity, and engagement needed to effectively imple-
ment the approach at home. After four weeks of practice (­session seven) we
had a review without Lottie present to create a plan for implementing the
FMA at home. We discussed when and where the set playtime would take
place, and she decided it would be in Lottie’s bedroom, after the baby was
in bed. This is where the majority of her toys were located and there would
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be the least disruptions. We considered how often would be feasibly practi-

cable to maintain consistency, and Mum felt four nights a week would be
manageable.
By session eight Lottie started to place the sand symbols in my hand volun-
tarily, wait for me to name, and she would repeat, and then take them from
my hand and place them gently back on the shelf, in the correct position,
unprompted. She would then turn to me, clap and cheer, along with me clap-
ping and celebrating “­Yay on the shelf.” Playing musical instruments together
was a particularly engaging and connecting experience. Lottie evolved in
this play as well, and enjoyed the sound of me playing the harmonica, and
Mum playing the guitar, while she ran across the room and back listening to
the different pitches of the harmonica and moving with it. She would take
them away from us, and then give them back and say, “­Thank you,” and run
across the room, and say “­Ready, steady, go,” and we would start to play as she
ran back. The loop had also diversified and evolved over time, with Lottie’s
confidence in exploring the playroom and our relationship now secure.
Lottie discovered the tea set at around session eight and quickly integrated
it into the loop. She enjoyed setting up the plates, cups, and saucers, and
quickly began to match the colors in their sets. In session ten I wondered if
she wanted water in the tea pot and I took the lead in filling it up to offer.
Once she understood the concept of pouring water, she quickly mastered
it with careful, precise filling of the t­eacups – rarely
​­ overflowing them, and
then tipping it back into the tea pot. She did not drink the water, but did
pass me a full cup to drink, watching, smiling, and looking at me until I had
finished it. Mum shared that she bought Lottie a tea set for Christmas, and
she had been making everyone cups of tea daily.
We had now conducted 24 sessions, and Lottie was beginning to develop
a sense of awareness of herself, both as an individual, and in relationships
with others. Lottie regulated her emotions positively in the FMA sessions,
as there were no obvious demands. An emerging theme had been focused
on an observable, intrinsic desire to develop her expressive language. When
we began sessions, Lottie was not verbally communicating at a­ ll – beyond
​­
screaming or crying. Lottie was now labeling dozens of objects throughout
each session, intensely engaged with Mum and I, watching our mouths, wait-
ing in anticipation for us to repeat and confirm.
Her vocabulary had grown, and Lottie was beginning to make concrete con-
nections, generalizing songs learnt at ­pre-​­school and home, and initiating
them in the playroom. For example, at Christmas I had a felt Christmas tree
on the wall with Velcro decorations and a star on top. Lottie took the star
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down and started to say “­twinkle, twinkle.” I started to sing, and she was
so excited, flapping her hands and bouncing up and down, and intensely
looking at me. I reflected to her that she was excited that I knew twinkle,
twinkle little star, mirroring her expressions. She had started to vocalize sing-
ing “­baba black sheep,” “­itsy witsy spider,” “­I’m a little tea pot,” and other
nursery rhymes. She would regularly request them by handing me symbols
(­spider, sheep, tea pot) and saying one word.
Lottie appeared to be better connected, able to process, and generalize infor-
mation received visually through objects and sign, alongside spoken word.
The intensive interaction nature of the sessions allowed me to be a mirror to
Lottie and provided her with the opportunity to rehearse these new skills of
expressive language and connection. We delighted in all achievements, and
Lottie glowed with confidence and joy.
Lottie was developing connection gains at a rapid pace, and I had been able
to start to introduce more directive Autplay techniques such as Perspective
Puppets puppet show, with two puppets. In this intervention puppets are used
to display a story where each puppet has a different thought and/­or feeling
about the same thing. Mum, Lottie, the puppets, and I tried different play
foods, and responding in different ways, each with a different thought or
perspective. I also introduced a balloon into sessions, and into the FMA at
home, passing it to each other, building anticipation and bringing connec-
tion. Sessions were typically fluid with Mum and I always seeking opportu-
nity to engage and make new connection opportunities, and respond to signs
of ­development – keeping
​­ her in her zone of proximal development as much
as we could.
Lottie had a complex matrix of needs and presented with atypical pattern
of receptive and expressive language development, which was often the
cause of frustration and dysregulation. Lottie presented with repetitive con-
crete play, a lack of imagination and flexibility and limited understanding
or awareness of the world around her. Lottie received a diagnosis of autism
in January 2021, at age 4 after a multidisciplinary meeting to review all ev-
idence, including my report with the outcomes from the AutPlay Autism
Checklist Revised. A ­pre-​­school review celebrated Lottie’s progress in all
areas over the last eight months, but most notable in her connection ability,
her tolerance and curiosity of other children, and the beginnings of s­ ide-­​­­by-​
­side play developing.
Lottie, Mum, and I had established a strong therapeutic relationship and
alliance, Lottie was engaging very well with the FMA process, and we were
developing to the next stages, starting to weave more focused Autplay
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structured play techniques into sessions at the clinic and home. We secured
funding to continue sessions for another six months. This allowed Lottie
to continue to grow in the now ­well-​­established therapeutic relationship
within the FMA, continue to make and rehearse gains, and offered Mum
the ongoing support in implementing the FMA at home. Mum was consist-
ently implementing the FMA at home around four nights a week, creating
a 20 minute “­Lottie play time,” after the baby had gone to bed. The other
children were also being taught how to use the FMA with Lottie and were
all starting to notice more connection and interest in relationship from her.
Being a parent is never easy but creating the time and space to have a joy-
ful and connected interaction brings rewards that help heal the pain of the
battle for services and provision for children. Each neurodivergent child or
young person I have worked with in education, or as a play therapist over
the last 12 years has one thing in common. They are a child first and fore-
most, and they want and need connection, social validation, and emotional
fulfilment. The FMA not only helps the child develop these fundamental
elements, but helps to support often frightened, inexperienced parents who
have not had experience with neurodivergence, or are feeling isolated and
out of their depth to engage with their child in a new and more purposeful
and meaningful way.

Case Example “­Steven” by Daysi B. Onstad

Steven, age 3, was referred for receiving Autplay Therapy with this ther-
apist. His biological mother was the adopted daughter of his current fos-
ter grandmother, who had her custody and brought him to see me. Family
history noted her mother smoked and drank alcohol during the pregnancy.
Steven’s mother was diagnosed with bipolar disorder, posttraumatic stress
disorder (­PTSD), reactive attachment disorder, and persistent depressive dis-
order. Steven’s father was diagnosed with autism spectrum disorder, ADHD,
cognitive delays, and other substance abuse disorders. Steven’s grandmother
reported Steven was exposed to domestic violence, and he suffered verbal,
emotional, and physical abuse as a baby and toddler. She also suspected he
was sexually assaulted due to several sexualized behaviors. These included
rubbing his penis when feeling upset, stimulating his private area on the
floor when feeling distressed, and touching other people’s toes when encoun-
tering new stressful situations. Steven’s grandmother indicated she realized
Steven was not reaching his developmental milestones at 8 months old,
so she looked for further testing and additional services in the community.
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 291

By collateral information, Steven’s mother used to give Steven alcohol and

Nyquil to get him to sleep. It was also suspected that sometimes his mother
would give him other types of medications to make him “­sleepy.”
According to Steven’s grandmother, Steven was challenging to handle from
the beginning. Steven would run in circles, throw things around, he strug-
gled with l­ow-​­frustration tolerance, difficulties with mood regulation, and
poor social navigation. Steven was often unresponsive to others at daycare,
especially other children, and he rarely noticed other people. When being
redirected by daycare staff due to inappropriate or unsafe behaviors, he would
punch, scratch, pinch, and s­ elf-​­stimulate to decrease high levels of anxiety.
Steven often grabbed people’s jewelry, eyeglasses, scarves and flung them
across the room. He would often display aggressive behaviors when some-
thing new or someone new was introduced. Steven would also repeatedly
drop small objects in front of his eyes to decrease anxiety. However, once he
was done, he would throw these objects across the room.
Steven was diagnosed by his pediatrician with autism spectrum disorder with
accompanying language impairment and needing substantial support. It was
also suspected Steven met the criteria for ADHD and chronic PTSD. Steven
started receiving occupational, physical, and speech therapy. However, his
progress was little, and it seemed to plateau due to high levels of dysregula-
tion. His grandmother also found extra resources in the community, and he
was enrolled in the Early Childhood Intervention (­ECI) in the town that
provided additional support for Steven and his foster family. Even though his
grandmother was vastly involved in his care, he still showed little progress in
multiple areas and sometimes no progress at all.
Steven was unable to form any words or sounds that made sense. He made no
effort to communicate with others and was often oblivious to others. Steven’s
grandmother communicated with him through sign language and sensory in-
put, such as singing songs or gently rubbing his belly or head. She indicated
it was difficult in the beginning even to get his attention. However, with
time he seemed to respond positively to these forms of communication. His
favorite toys included dinosaurs, cars and trucks, bubbles, and sharks.
Steven’s therapy goals were established to decrease dysregulation (­aggressive
behaviors) toward himself and others, reduce unsafe s­ elf-​­stimulatory behav-
iors in public places, and increase relationship development. Steven’s grand-
mother completed AutPlay assessment inventories and play observations
and agreed to participate in Steven’s healing process. It was discussed and
decided that therapy would involve the FMA with some integrated connec-
tion interventions. In the beginning, Steven was significantly dysregulated,
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displaying aggressive behaviors toward his grandmother and this therapist

(­e.g., biting, scratching, throwing things, breaking toys, slamming doors,
running in circles, yelling, and so forth). After removing multiple toys and
sensory tables in the second session, Steven could only access ten of his fa-
vorite toys. It seemed to help with overstimulation. Since Steven was accus-
tomed to having his grandmother around when engaging with other people,
we decided to have them both in the playroom while the FMA was imple-
mented for four sessions. The FMA concentrated on selected activities that
the therapist planned for the day, allowing Steven to access and chose from
those materials. Bilateral music in the background was also incorporated to
decrease anxiety because his grandmother already had a repertoire of calm-
ing songs that were utilized for regulation. When implementing the FMA,
we utilized his likes and strengths to modify some of the basic FMA activities
due to his lack of verbal language. Some main components were introduced
one at a time to improve ­communication – ​­music and sign language.
Steven participated in the play interventions, but his engagement was lim-
ited. For the most part, he would display high levels of dysregulation as ev-
idenced by ­self-​­stimulatory and aggressive behaviors. Steven’s grandmother
was also learning the play interventions and following AutPlay Therapy pro-
tocol by implementing the play interventions at home.
Steven participated in multiple connection interventions in the first six ses-
sions. Due to high levels of anxiety, the activities proposed were modeled for
the most part. He would engage in them in subsequent sessions from 25 to 35
minutes. Sometimes, his grandmother would help us with the setting of the
activities. Steven loved bubbles, and the Body Bubbles intervention was one
of his favorite activities. In this intervention one person blows bubbles while
the other person has to try and pop them with a specific body part. I began by
blowing bubbles and tying to pop them myself with a specific part of my body.
I tried to call for his attention in two sessions, and he would only observe the
bubbles drop to the floor. He would glimpse with the corner of his eyes, and
at one point, he decided he wanted to be part of it.
Ring Around Me was also one of his favorites. In this intervention the adult
holds the child’s hand as they walk around the adult. The baby shark song
was added to address connection and decrease anxiety at the beginning of
our sessions. When this activity was introduced, Steven had difficulty hold-
ing my hand, so we added a teddy bear that he would bring to the session,
and we both held its hands while Steven would walk around me. Little by
little, Steven was able to get used to holding my hand and walking around
an ABC rug in circles. Later, the Obstacle Course play intervention was
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 293

implemented, which helped Steven and this therapist connect. In this in-
tervention the child puts on a blindfold and the adult leads the child around
the room avoiding obstacles. He seemed, for the most part, present and focus
on collaborating to reach the end goal. The first time his grandmother and
this therapist engaged in this activity and shortly after, Steven was able and
willing to let this therapist touch his shoulders and redirected when needed.
In the beginning, Steven seemed anxious to let this therapist grab his shoul-
der without facing me. However, with the help of a teddy bear and then
grandmother, he fully engaged in the activity. It was a success.
By session seven, Steven started engaging in the Iguana Walk activity, allow-
ing me to “­tickle” (­using his grandmother’s words) his arms. In this interven-
tion the adult uses their hands to press down on the child’s arms (­moving up
and down their arms) like a lizard walking on their arms. In the beginning,
Steven would copy me to use this intervention on a dinosaur stuff animal.
Slowly, he allowed me to use a dinosaur puppet and clamp it onto his hands,
his arms, and later his legs. The Break Out activity was also applied to address
attunement and regulation. In this intervention the adult uses a soft paper
like crepe paper and wraps different parts of the child’s body (­such as hands)
and then the child breaks out. First, the therapist wrapped a dinosaur who
needed to set itself free. After this demonstration, Steven allowed me to
wrap his legs, and he burst out of it. He asked me to wrap his legs and arms as
we did with the dinosaur in a second attempt. He burst out again, letting in
a big smile and a big hug, which completely changed his comfort level with
this therapist.
In subsequent sessions, Steven engaged in additional connection interven-
tions. He was able to participate in the proximity and frequency of positive
touch actively. All these connection activities were also practiced at home
with his grandmother and grandfather. They reported good progress toward
positive touch, attunement, and engagement.
During therapy, Steven’s grandmother became a foster parent of two younger
children, 1 and 2 years old. Steven’s progress was jeopardized due to his grand-
mother’s divided attention to his needs and high anxiety levels due to this
new life transition. Steven needed extra time to engage in new activities, so
we repeated some previous techniques. Slowly, Steven was able to engage in
new activities with less preparation time. Despite all these new challenges,
Steven continued his Autplay therapy sessions very consistently. Steven ex-
celled at socializing with these new foster siblings in his home, and he was
able to regulate, learn new words, and improve the recognition and imple-
mentation of social cues, such as interacting and taking turns. The therapist
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kept working on connection activities: Hands, Hands, Hands helped with

positive touch toward his siblings. In this intervention several ideas are writ-
ten down that two people could do together that involves touching hands.
Soft Touches was also introduced with the help of his grandmother. In this
intervention several soft items such as cotton balls and feathers are selected
and then one person closes their eyes, and the other person touches them
with one of the objects and they must guess what object it was. Steven col-
lected some sensory items to touch his grandmother smoothly and brought
them to the playroom. The younger siblings were also part of this activity in
the following session. Steven showed better interaction with this therapist,
his grandmother, and his siblings during these activities.
Steven showed significant improvement by session 30. His interactions were
assertive in multiple settings with this therapist and other professionals in his
different therapies. He was able to use over 20 words in the correct form. He
started using sign language for longer phrases. He was able to recognize emo-
tions with sign language and visual aids. Due to the ­COVID-​­19 Pandemic,
our sessions moved to a telehealth modality after assessing his readiness. We
completed eight more sessions while reviewing the central core of his ther-
apy goals. At the same time, this therapist would help Steven’s grandmother
implement or modify several home activities with or without Steven’s new
foster siblings. Social navigation interventions were also implemented, re-
viewed, and changed at home involving Steven’s siblings. Most of them were
­role-​­played by this therapist and his grandmother. At the same time, Steven
would witness appropriate social cues for boundaries and touch. Steven suc-
cessfully graduated therapy after meeting his therapy goals.

Case Example “­Jace” by Daysi B. Onstad

Jace and his younger brother were removed from their mother’s care due to
neglect, emotional, and physical abuse and placed with a biological aunt. His
social caseworker referred Jace to see me when he was 7 years old, due to an
increase of ­self-​­harm behaviors. The first three play therapy sessions followed
the AutPlay Therapy protocol for the Intake and Assessment Phase. In this
first phase of therapy, assessment procedures were implemented to gain more
specific information about Jace and designed to help Jace and his aunt build
rapport with me.
During the intake process, Jace’s aunt reported that in the three previous
months, Jace became more challenging to manage after school, and his
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outbursts increased in frequency and intensity with transitions. Lately, his

supervised visitations with his birth mother exacerbated these issues at home
and at school. According to Jace’s aunt, Jace usually felt irritable without an
apparent reason. Jace displayed dysregulated behaviors in situations where
he was not in control or in cases where he was expected to follow implicit
rules that may or may not be to his liking. His biological father was never
involved in his life since birth. During the first interview, Jace reported that
his brother was “­annoying,” and they did not get along. He stated that he
sometimes got along with his aunt and uncle, and he missed his maternal
grandmother, who used to take care of him.
Jace had multiple motor delays for which he was receiving occupational ther-
apy during the school year. Jace indicated he enjoyed watching cartoons but
could not think of anything not going well with him at home or at school.
He recognized he was very competitive and wanted to know things right
away. Overall, Jace struggled with a change in routine, sensory issues, pa-
tience, and frustration tolerance.
By his aunt’s reports, his mother struggled heavily with substance abuse,
and she also had a long history of trauma. Jace witnessed his mother be-
ing physically abused by her partner. He described how his mother would
sleep so deeply and breath so slow after drinking that on multiple occasions,
he would think she was “­dead.” It was reported that Jace would take care
of himself and his brother by cooking and getting help to resuscitate his
mother, who usually was under the influence of illicit drugs or large amounts
of alcohol. Moreover, Jace described his little brother being thrown across
the room multiple times due to “­his whining.” Jace had a long history of fam-
ily psychopathology, including depression, anxiety, PTSD, and ADHD. Jace
also had significant mental health history due to ­self-​­harm tendencies, toi-
leting problems, and aggressive behaviors in previous placements. During a
psychological evaluation, Jace’s scores fell within the low average range with
a FSQI of 83. He also scored very low in social navigation. He was diagnosed
with PTSD and autism spectrum disorder, requiring substantial support and
accompanying language impairment.
Jace was attending first grade in a small public school, where he qualified for
an IEP for reading, social interaction, and communication. His teacher re-
ported Jace enjoyed math but was quickly frustrated when he did not under-
stand it very well. He did not enjoy music class and “­hated” children’s music.
Jace’s aunt added he experienced communication issues, cognitive inflexibil-
ity, and difficulty transitioning. He reportedly experienced social difficulties
with peers due to his inability to play well with others and take turns. Jace
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was also receiving school counseling, but it was mostly unsuccessful. The
school environment was a massive source of anxiety and dysregulation for
Jace. He was often getting in trouble due to poor emotional and mood regu-
lation, low frustration tolerance, aggression, and lack of friends.
Jace would become overly aggressive toward his peers or engage in ­self-​­harm
behaviors when he felt he was misunderstood. For instance, he would punch
himself or others, scratch his face, arms, or legs when feeling extremely upset.
He would also bang his head in the wall and pull his hair out. Jace would scream,
yell, and throw things at peers if they would get close to him. Moreover, Jace
would hide under tables or build a fort around himself when teachers would try
to help him or talk to him. Jace was frequently sent to the principal office to
­de-​­escalate, and his aunt would pick him up. Jace started receiving some special
education services, but his behaviors were still a significant concern.
Overall, Jace’s aunt brought him to receive AutPlay Therapy due to Jace’s in-
ability to connect with them and others, poor regulation, and social concerns.
Jace and his aunt participated in a child observation session while utilizing
multiple toys in the playroom. Jace’s aunt completed four AutPlay Therapy
inventories: the AutPlay Social Navigation Inventory, the AutPlay Emotional
Regulation Inventory (­child version), the AutPlay Connection Inventory
(­child version), and the AutPlay Assessment of Play Inventory. All invento-
ries were provided to identify strengths and needs for Jace in social/­emotional,
regulation, connection with others, and play preferences. Jace’s assessment
sessions indicated that Jace was able to participate at a limited level in direc-
tive play instruction. Advanced instruction or activities beyond his limited
skill ­level-​­triggered discomfort resulting in Jace withdrawing and shutting
down. It was also observed that Jace lacked interactive social engagement and
the ability to engage in reciprocal play. Moreover, Jace seemed to not enjoy
pretend or functional play and did not want to participate in interactive play.
After four sessions, therapy goals were determined to help Jace identify and
label emotions, connect with caregivers, and build positive peer connections.
The play therapist utilized the FMA in order to address engagement ability
and attunement. The FMA was chosen to help Jace feel safe and comfortable
in the play sessions and build relationship with the therapist. It also provided
the opportunity to increase the relationship between Jace and his aunt.
Jace participated in a typical play therapy room with my assistance. At first,
he was timid and would not utilize any toys, objects, board games, etc. Slowly,
Jace was able to ask if he could touch a toy/­object. Gently, this therapist
explained multiple times that he could use and play with anything he may
want or need. Slowly, Jace was able to go around the playroom and started
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 297

playing with some action figures. This play therapist followed Jace’s lead, but
he soon would become overwhelmed and withdraw. Then, he would walk to
another part of the room and engage with a new toy. The therapist would
come around and ask additional questions about his play or the object. Jace
continuously became extraordinarily anxious and would leave the toy he was
playing with. As Jace transitioned from one toy or activity to another, I took
every opportunity to engage but being very mindful of his limits.
In session seven, Jace still found it challenging to initiate play or interaction
with this therapist. Throughout the session, Jace found new toys that he
would ask the name of or its purpose. He would often touch or manipulate
toys he did not realize were there the previous week. The therapist used
tracking and reflecting statements to encourage Jace to engage or explore.
Jace found it challenging to share space, emotion, and attention due to high
anxiety and lack of agency. Jace would make statements such as “­I just want
to play by myself, can I just play with ­it – ​­I don’t want to share, I don’t like
taking turns,” and so forth. Most of the time, Jace would share his uneasiness
about being followed around the playroom. However, within the next couple
of sessions, he would demonstrate parallel play, letting me sit down next to
him or actively participate in his exploration of the playroom.
These sessions lasted around 30 minutes, and the remainder of the sessions
were utilized to process them with Jace’s aunt. She indicated that Jace re-
ported enjoying coming to play with this therapist. Moreover, Jace seemed
to like the variety of the toys and the rhythm of our sessions. On the other
hand, Jace mentioned that he still preferred playing by himself.
In session ten, Jace invited me to play a board game he used to play with his
aunt at home. He was able to explain the rules and show me some “­tricks of
the game.” He mentioned he liked coming to my office, and he would like
to bring some of his toys. The following session, Jace brought a puzzle he was
working on at home. He then allowed this therapist to arrange all the pieces
facing up on the floor to complete the puzzle “­faster.” After he completed
his puzzle, the therapist asked him if he would like to play with bubbles.
He indicated he loved bubbles and balloons. The therapist explained the
Together Balloons activity, which Jace completed with interest, assertiveness,
and good attunement. In this intervention two people face each other and
hold hands. They must hit a balloon and work together to keep it in the air
while their hands are held. We were able to keep the balloon in the air for
over five minutes, which demanded a lot of Jace’s patience and social inter-
action to describe his subsequent movements and/­or needs. This session was
the doorway toward an integrative and more directive FMA.
298 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

I would prepare multiple activities for him per session, and he would pick
one. Jace would also have the opportunity to decide if his aunt would par-
ticipate in these sessions. In session ten, Jace was still timid and unable to
engage with his aunt during conjoint sessions. On the other hand, he fol-
lowed my lead once he picked up an activity, game, or toy. Later, Jace would
teach them to his aunt and redo them with his brother or uncle. LEGO
Emotional House was implemented with multiple modifications in three ses-
sions. In this intervention the child is instructed to build some type of house
out of LEGO bricks and different colors or pieces will represent feelings the
child has about their home and family. LEGOs provided a positive sensory
experience, and he would modify it with some assistance. First, I explained
that we would be building some houses, cars, or robots to identify multiple
feelings. Jace picked to build a house with different colors that represented
different feelings. While building, he would describe his feelings or situation
where he displayed those feelings (­usually frustration and sadness). For the
first time, he was able to express his feelings of sadness regarding being in
foster care and his sadness regarding his inability to live with his mother and
help her when needed. Second, he wanted to keep working with LEGO’s, so
we worked on cars while he helped this therapist to work on a specific model.
Third, he worked on a school building, which allowed him to describe his
frustration at school with schoolwork and peers. Jace not only succeeded at
this technique but was able to teach it to his little brother at home with his
aunt’s assistance. Jace utilized this technique to describe one feeling per day
at home with his aunt when he had a rough school day.
Bean Bag Toss was also implemented. In this intervention the adult and
child try to toss bean bags into a bucket. Each bean bag has a feeling word
written on it. Whatever bean bags/­feelings get in the bucket, the person has
to share about the feeling. Jace was very competitive, and he was good at it.
Again, he modified this technique, and it was utilized throughout the sub-
sequent three sessions. I wrote six basic emotions and the ones Jace picked
on ten bean bags while he arranged the playroom to his liking. He shared
situations for the feeling bean bags he got into the bucket. He then came
up with the option of acting out those feelings. Later, he asked his aunt to
join us, and she was also instructed to share situations where she felt those
emotions.
In session 15, Jace wanted to play Feelings Don’t Break the Ice which allowed
him to differentiate positive from negative feelings. In this intervention the
board game Don’t Break the Ice is used, and the child has to talk about a
feeling each time they knock one of the pieces of ice out. He also modified
this activity, including his aunt and his little brother. We also participated in
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 299

various sand tray play because Jace loved sand. He connected with me and
utilized multiple social tools when requesting more water, sand, or pebbles.
In order to address his social navigation needs, What I am? was implemented.
In this intervention the child has to guess what is on a card they have been
given without looking at it. The adult has seen it and answers the child’s
questions about what it could be. Jace could utilize index cards to ask this
therapist questions to guess what was written on the cards. He invited his
aunt who was able to join us in the following session. Interview Me also
helped to address his social needs. In this intervention, the child creates
a list of question and interviews another person. The therapist introduced
the technique while Jace was able to interview me. He decided to add more
questions to the original format and invite his aunt to the playroom in the
following session to ask his unique questions.
Great improvement was shown in session 25. Jace no longer showed s­elf-​
­harm behaviors, aggressive behaviors decreased, and overall, emotional reg-
ulation and social navigation improved to healthier levels to keep everybody
safe in the playroom and at home.
We completed the implementation of the FMA until session 30. Jace was
able to engage in more directive play interventions without displaying s­ elf-​
­harm behaviors such as punching his head, banging his head on the wall,
scratching his arms or face, squeezing his face and nose until he turned an-
other color, and so forth. Jace successfully graduated by session 40 as he had
met all his therapy goals. Later, Jace was able to engage with his school coun-
selor to address more specific ­school-​­related goals.

Case Example “­Lio” by Canace Yee

Lio began play therapy at age 4 and participated in eight sessions (­first phase)
and then stopped therapy for more than 1.5 years due to ­Covid-​­19. She then
returned to therapy and started a new phase of 16 sessions (­second phase).
She lived with her parents and had one younger sister. At age 4, Lio was
diagnosed with an autism spectrum disorder. Her first speech assessment was
completed around age 4, which demonstrated that her language compre-
hension skills were satisfied but vocabulary and concept understanding was
weak. Pronunciation and language expression was also weak, but word utter-
ance was satisfactory.
It was difficult for her to assimilate into the social occasions, especially in
environmental adaptability and interacting with others. She had difficulty
300 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

engaging in play with peers, she needed a long time to adjust and feel com-
fortable in public and school situations. Lio also appeared to struggle with
emotional regulation capability, she would become anxious frequently in
different social settings. She would hide her face, lower her head, and some-
times would cry when she noticed her parents/­caretakers were not around
her. She showed limited ability to manage in interacting with people. Her
parents brought her to play therapy because they expected Lio to improve
her social navigation and functioning, relationship development and con-
nection, and reduce anxiety levels.
I first met her in a ­two-​­week social class when she was age 4. She became
highly anxious and cried seriously when her parents would say goodbye to
her. She needed my full attention to comfort her, and it took some time for
her to enter into the playroom during that t­wo-​­week social class. From the
social class, she was referred to have individual play therapy sessions with me.
Our first phase was in 2019 and I applied the FMA primary focusing on Child
Centered Play Therapy methods to build relationship in order to help her in
reducing her anxiety level. I found Lio to be timid, she would speak very little,
would not ask questions, and showed no confidence in getting any toys from
the shelves. I tried to move some toys (­such as LEGO, miniatures, and doll
house) closer to her. She seemed to be more comfortable in this arrangement
and began engaging with me to a higher degree during the first eight sessions.
Therapy goals for the second phase involved working on improving Lio’s sep-
aration anxiety, building trust, improving emotion regulation, and building
on social competence. I implemented an integration of Child Centered Play
Therapy, the AutPlay Therapy FMA, and EMOplay as this seemed to best
algin with Lio and our therapy goals.
The first five play therapy sessions followed a more nondirective FMA and
Child Centered Play Therapy protocol. In the first two sessions, Lio needed
the door to be opened to ensure her mother was there. She focused on LEGO
play and this was used as the intermedium to help reduce her anxiety levels.
She was very persistent that small LEGO bricks should be on a small LEGO
baseplate, and she worked on creating a LEGO animal world. She seemed to
regularly seek encouragement in her play. In session three, she still wanted
her mother near the door, but I advised her mother to stand a few steps back
and Lio did not notice the distance had changed. She continued to play with
LEGO bricks but also started playing with cooking toys and preparing meals.
In session four, I tried to ask Lio if the door could be closed because we could be
having a proper and quiet cooking time and she agreed. It greatly improved the
connection and relationship between her and I as she felt more comfortable
 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A ) 301

and ease in the playroom. In session five, I continued with the FMA and Child
Centered Play Therapy. Lio entered the playroom happily and let the door
close behind her, she continued to cook and prepare meals and she started to
focus on things being done in the “­right” and “­wrong” way. She showed an
increase in comfort with myself and the environment, she started to enjoy
playing more, often laughing and making connection with me. Her level of
anxiety was decreasing significantly, and her parents also notified her changes.
From session six to eight, structured play therapy interventions were im-
plemented, with the aim to further increase engagement, connection, and
relationship development. I introduced a ­role-​­play game that utilized Lio’s
play interest in cooking. We took turns being a customer ordering food or
the chef cooking and serving the food. I showed Lio how we could design
funny names for the food dishes. Lio would laugh when I created some silly
names for the dishes, such as “­­tall-​­boy takeaway,” and “­Lio’s clumsy kitchen
chicken.” I encouraged Lio to create funny names for the dishes and de-
sign dishes by herself. With minor assistance from me, Lio happily designed
dishes and created some funny names for the dishes, and most importantly
she showed less concern on things being “­right” or “­wrong” and simply cre-
ated and enjoyed herself. This ­two-​­way collaborative play process further
affirmed Lio’s strengths, ­self-​­esteem, and helped reduce fear and anxiety.
An integrative approach of Child Centered Play Therapy, the AutPlay
FMA, and EMOplay, were implemented during sessions nine and ten with
the goal to focus on emotional regulation and enhancing social navigation.
The AutPlay FMA was continuously applied in these sessions as Lio con-
tinued her cooking menu play for “­Lio’s clumsy kitchen” and I would join
in her play. Her level of connection, communication, and social navigation
were greatly improving. Lio began shifting her play to the dollhouse, and she
began to express her feelings more through these toys. The dollhouse people
would display feelings and I would reflect the feelings back. In session 13,
I introduced EMOplay bean bags. There was a total of nine bean bags and
each of the bean bag carried two feelings (­positive and negative feelings). I
placed the bean bags under a whiteboard and Lio boldly suggested to throw
some sticky objects on the whiteboard (­which would gradually roll down
and fall onto one of the bean bags). I demonstrated to Lio that when it fell
onto one of the bean bags, we would share that feeling. I modeled how to
share a feeling with the emotion displayed on the bean bag. Lio and I took
turns to sharing stories when the sticky objects randomly fell on the bean
bags. With this integrative play approach, Lio learned how to recognize and
understand different emotions, how to express feelings in a fun, playful way.
Her emotional regulation ability began to increase significantly. I discussed
302 T h e A u t P l a y ® T h e r a p y Fo l l o w M e A p p r o a c h ( F M A )

Lio’s progress with her parents and encouraged them to play with Lio at
home in ways that supported her therapy goals. They were excited to witness
the positive changes in Lio, especially in the areas of relationship connec-
tion and the social/­emotional growth. It was discussed with the parents and
agreed to further work on the parent/­child relationship to help in building
Lio’s ­self-​­confidence and ­self-​­esteem.
Session 14 displayed a new play for ­Lio – ​­she played in the sand tray moving
her hands around the sand and feeling it in her fingers. She displayed joy
while playing in the sand tray and periodically looked at me with an excited
expression. She began talking a lot about a sand game she was going to cre-
ate and play in a future session. After she had finished with the sand tray, I
introduced the EMOplay Capsule Machine with about 15 minutes left of the
session time. The machine contains basic rules for families to interact (­play)
together, different missions to complete as a family, and feeling expression and
rewards cards. Lio consented to invite her mother to the playroom and taught
her how to play the capsule machine game. They promised each other to
complete the missions at home within a week and they would share with me
their progress and feelings in the next session. This play intervention was im-
plemented to further help improve the ­parent–​­child relationship, feeling ex-
pression, and social navigation. The EMOplay Capsule Machine was used in
session 15 and 16 as per Lio’s request. Lio and her mother proactively involved
Lio’s younger sister in the game and they all completed different missions at
home. This mission exercises strengthened the ­parent–​­child relationship and
­self-​­empowerment by guiding Lio in a manner that encouraged her belief in
her own abilities and potential for positive growth. This further allowed Lio
to rely on her inner strength and sense of s­elf-​­belief to meet and overcome
difficulties. This helped create a strong foundation for Lio to believe in her
ability to overcome personal challenges and struggles in the future.
Lio seemed to progress more quickly with her therapy goals after 16 lessons.
Her engagement ability and social navigation were more present and ad-
vanced. I suggested that Lio decrease her individual play therapy sessions to
­bi-​­weekly with a focus on helping her maintain social/­emotional support and
growth. I further encouraged her to join group play therapy with three to four
other children to continue to develop her social and relational navigation
and sense of competence. Lio progressed well in her play therapy time. The
integration of the AutPlay FMA, Child Centered Play Therapy, and EMO-
play was a positive fit for Lio and created a play experience that aligned with
her individual presentation and therapy needs.
 14
Social Navigation Interventions

Social Navigation

The term “­social navigation” actually functions as an umbrella term, cov-

ering a wide scope and variety of social related awareness, strengths, needs,
and experiences which range from simple to more complex (­Grant, 2017). A
person’s social navigation is often interpersonal, specific behaviors that per-
mit an individual to interact with others in an environment. The extent to
which an individual would be considered to have social navigation needs has
often been determined by others. This is especially true for neurodivergent
children and adolescents as they have often been judged by a neurotypical
standard and expectation.
Historically “­social skills work” has been devaluing and harmful to neurodi-
vergent individuals. Some programs and methods have used the term “­social
skills” to implement protocol that has not valued differences and forced neu-
rodivergent children to try and become something they are not, which has
produced poor s­elf-​­worth, depression, and anxiety. When implementing a
group or individual therapy focused on social interaction and work/­needs, it
is vital to check your process and make sure it is always affirming of the per-
son of the child and their ways of being, preferences, and differences.
Autistic and neurodivergent children can have true social related needs.
Helping children with social related needs can be an important component
of play therapy. If needs are left unaddressed it can create a myriad of addi-
tional issues. Some constructs for play therapists to consider when addressing
social navigation needs include:

• What is considered social (­skills, expectations, norms, navigation) will

vary from family to family, city to city, region to region, country to coun-
try, and culture to culture. It is a subjective construct.

DOI: 10.4324/9781003207610-15
304 Social Navigation Interventions

• It is an invented construct by someone or a group who decides what is

and is not okay. It has historically been someone in power who deter-
mined the “­right way” to navigate.
• It is important to remember children should not be forced to perform a
certain social “­skill” because it is what has been deemed the norm. Much
of this is based on a neurotypical construct which has not valued differ-
ences or a different way of navigating.
• Often the issue is an inflexible, unkind, and rigid environment or person
the child is experiencing. It is not an actual social problem with the
child, the problem is with others and there may need to be advocacy
implemented on behalf of the child.

Social situations can be confusing as the social rules or expectations can vary
from one person to another, environment to another, culture to another.
Often there are hidden ­rules – ​­things that are understood by many in a par-
ticular environment but would not be clear to someone new to the environ-
ment. Often social expectations can seem contradictory and do not make
logical sense, for example, telling a child to work on “­not ignoring others”
and the very next day to work on “­ignoring a particular child.” Many social
expectations involve a great deal of nuance which can be confusing. Many
neurodivergent children get labeled as not understanding “­social skills.”
Often this is due to a conditioned expected performance and if that is not
demonstrated, the erroneous belief is that the child must not understand and
needs to learn/­change.
Many neurodivergent children do understand social navigation. Typically, if
there is a true cognitive lack of understanding or awareness, there is a cog-
nitive issue such as intellectual developmental disorder or a traumatic brain
injury. Conversely, any child, neurotypical or neurodivergent, can have spe-
cific social needs. A child’s specific social needs should be carefully assessed
and always addressed through a neurodiversity affirming process. If possible,
the child should have a clear voice in communicating what they believe
their social needs are and what they would like to work on. Consider the
following four questions.

1 Does working on the social need help the child better get what they
want?
2 Does working on the social need address an issue/­struggle the child is
having?
3 Who’s need is it, the child’s, or someone else’s?
4 Does the therapeutic process implemented clearly stay affirming for the
child?
 Social Navigation Interventions 305

Bailin (­2019) stated that we should not pretend that autistic and neurodiver-
gent children don’t have needs. But we also don’t assume that neurological
and behavioral differences are always problems. For example, there’s nothing
inherently wrong with disliking social activities. Not wanting to socialize is
different from wanting to participate and being unable to. Both are possi-
bilities for autistic and neurodivergent children. One requires acceptance,
the other requires assistance. Play therapy interventions, whether addressing
social navigation or any therapy needs, should always be scrutinized to avoid
ableist concepts such as masking and code switching. Interventions should
always be affirming in their message and application.
The AutPlay Therapy framework can help address the social navigation
needs a child may be experiencing. Structured play therapy interventions
can be used to address the child’s specific needs while honoring the child’s
play therapy preferences. Children are first assessed to understand their
strengths and needs. Assessment is done by having parents and other car-
egivers complete the AutPlay Social Navigation Inventory, parent and
child reports, and by therapist observations. Once a child’s social navi-
gation needs have been identified, directive play therapy techniques that
align with the child’s strengths, play preferences, and interests can be
implemented.

Social Needs Cross Off

Therapy Needs: Social navigation

Level: Child and adolescent
Materials: Social Needs Cross Off sheet, and a plastic chip
Modality: Individual, family, and group

Introduction

Neurodivergent children and adolescents may struggle with one or more so-
cial navigation needs. Social Needs Cross Off is an easily individualized play
therapy intervention (­game) that can be played to help address a variety of
possible needs. The c­ ross-​­off component of this play intervention provides
a fun and engaging way for children to explore their needs while creating a
game format to follow until the cross off sheet (­or game) has been completed.
It can also be replayed.
306 Social Navigation Interventions

Instructions

1 The therapist explains to the child that they are going to play a game
and explore some possible social needs/­questions.
2 On a piece of white paper, the therapist and child will create a ­6–​­12
space grid (­see example in the Appendix).
3 The therapist and child will work together to think of and write down
some social needs that child may be having. One need is written in each
of the spaces.
4 The therapist may write some of the needs specific to the child’s social goals,
but the therapist should ask the child for suggestions and listen to the child’s
voice regarding what they feel they have questions about or need help with.
5 The therapist and child take turns flipping a plastic chip or a penny onto
the grid. When a social need is landed upon, the therapist and child can
talk about, explore, and/­or role play the need.
6 Once it has been covered, the child crosses that need off the grid.
7 The therapist and child keep playing until all needs have been addressed
and crossed off the grid. When the grid is completed, the child can earn
a small prize for finishing the game.

Rationale

Social Needs Cross Off helps children and adolescents address a variety of
social related needs. The needs that are written on the grid can be any social
related need the child has or wants to place on the grid. If the game is played
repeatedly, the needs can be changed each time the game is played. The
needs can also start out basic (­a four space grid sheet) and become more com-
plex as a child plays the game (­creating a six or nine space grid sheet). Par-
ents can be taught how to play the game and given ideas for needs to write
on the grid. Parents should try to play the game at home periodically and in-
volve other family members. The more the child can address the needs, the
more likely they will be able to implement them in real situations. A sample
Social Needs Cross Off sheet is provide in Appendix at the back of the book.

Social Navigation Pick Up Sticks

Therapy Needs: Social needs, emotion expression, and connection

Level: Child and adolescent
 Social Navigation Interventions 307

Materials: Pick Up Sticks game and social needs sheet

Modality: Individual, family, and group

Introduction

This play therapy intervention provides an engaging game format to help

children and adolescents address various social related needs. The common
game of Pick Up Sticks is used with an additional element designed to ex-
plore social and emotional needs. Therapists are encouraged to create in-
dividualized social need sheets for each child to address the child’s specific
therapy goals and highlight the child’s interest.

Instructions

1 Using the game Pick Up Sticks, the therapist creates a sheet of paper
with each pick up stick color listed and several social and emotional
needs to discuss, explore, and practice under each color (­see example in
the Appendix).
2 The therapist and child play a game of Pick Up Sticks following the
normal Pick Up Sticks rules.
3 When the child or therapist picks up a stick of a certain color, they must
look at the paper and pick one of the social/­emotional needs listed under
that color to discuss and/­or practice.
4 Needs should not be repeated, and play continues until all the sticks
have been taken and/­or all the needs practiced.
5 It is important to note that some children will have trouble picking up
some of the sticks without moving them. The therapist should be lenient
on this as the point is for the child to acquire a stick so they can explore
a social/­emotional need.

Rationale

This play therapy intervention helps address social needs, emotion expres-
sion, concentration and focus, and fine motor skills. Social Navigation Pick Up
Sticks can be played several times and the social need sheet can be changed as
needed to work on new or more complex goals. The therapist should create
the social needs list that matches the stick colors prior to the child beginning
308 Social Navigation Interventions

their session. Parents are taught the intervention, given a copy of the social
needs sheet, and encouraged to purchase a Pick Up Sticks game. They are
asked to play at home with their child between sessions. Parents and child
can create their own social needs sheets as they like. A sample Social Naviga-
tion Pick Up Sticks guide is provided in the Appendix at the back of this book.

Magazine Minute

Therapy Needs: Social navigation, emotion expression, and connection

Level: Child and adolescent
Materials: A variety of magazines
Modality: Individual

Introduction

Neurodivergent children and adolescents can often experience high anxiety

levels associated with social navigation and often this can lead to children
trying to avoid social situations. This play therapy intervention focuses on
helping children identify and explore various social situations and address
any situations that may be creating anxiety or dysregulation.

Instructions

1 The therapist explains to the child that they will be using magazines to
play a game that focuses on social situations.
2 The therapist provides the child with several magazines. It is best to have
magazines that display a lot of people doing different things. Also, the
therapist will want to monitor to make sure the magazine contents are
appropriate for the child’s age.
3 When the therapist says “­go,” the child will have one minute to go
through the magazines to find and describe examples of someone doing
something social. The child can find and share anything they ­want – ​­it
does not have to be positive or negative.
4 The therapist keeps track of how many examples the child presents in
one minute.
5 The therapist also pays attention to the examples the child shares.
 Social Navigation Interventions 309

6 After the minute has passed, the therapist can ask questions about any of
the examples and/­or process anything the child shared.
7 The child can have several turns to see if they can increase their number
each turn.
8 The therapist and child can also switch roles with the child timing the
therapist and the therapist finding the social examples.
9 The switching of turns provides the therapist with the opportunity to
model and talk about various social situations, especially ones that the
child may be struggling with.

Rationale

Magazine Minute helps address a variety of possible social navigation needs

or questions, especially helping children to identify and talk about social
situations. If the child is struggling with finding examples and seems unsure,
this intervention may be too abstract or advanced for them. A variation of
the play intervention is used to work on emotion identification. Instead of
finding social situations and explaining them, the child tries to find examples
of someone showing an emotion and explain what is happing. Parents can
be taught this game and encouraged to implement the play intervention at
home.

Action Identification

Therapy Needs: Social navigation

Level: Child and adolescent
Materials: None
Modality: Individual

Introduction

Children and adolescents may struggle with understanding expected and

unexpected behaviors in various situations or contexts. Action Identification
is a fun and interactive game that helps children recognize expected versus
unexpected behavior to do in certain situations and provides the opportu-
nity to practice responses. Many children get mislabeled as “­bad” and given
310 Social Navigation Interventions

consequences for behavior that others are not wanting to see from them.
This intervention takes the judgment out of behaviors and gives the child a
safe space to explore and learn about their own behaviors.

Instructions

1 The therapist and child write various behaviors/­actions on index. These

can be anything from running out of a room to playing a video game.
They do not have to be “­negative” behaviors. If the child cannot write,
the therapist can ask them to think of a behavior.
2 The therapist and child try to not show each other their cards. They take
turns acting out one of the behaviors on one of their cards and the other
person has to guess what the behavior is.
3 For example, the therapist acts out an action such as running, talking, read-
ing a book, playing a video game, eating, etc. The child has to guess what
the action is and then share in what situations it would be expected to do
that action and in what situations it would be unexpected to do the action.
4 The child would go next and act out one of their actions (­yelling, pick-
ing your nose, bouncing a ball, sleeping, taking your shirt off, and playing
with friends) and the therapist would guess and share when (­what con-
text) it would be expected and when it would be unexpected.
5 The therapist and child take turns and can go through several different
behaviors/­actions. If the child cannot identify the expected versus the un-
expected places and situations to do the behavior, the therapist should
help the child think if ideas. For example, the child had the action of
hitting another person but could not think of a context where it would be
okay. The therapist might share it would be unexpected to hit your brother
because he was bothering you, but it would be expected to hit another
person if you were a boxer, and you were competing in a boxing match.
6 Their may be an action or behavior that would never be expected or
unexpected. In this case, the therapist would have a conversion with the
child about this and explain there would never be a context where this
would be okay.

Rationale

Action Identification helps address possible social navigation issues by explor-

ing behaviors as expected or not expected in different contexts. Children
enjoy acting out the action component and they can think about and process
 Social Navigation Interventions 311

their own behaviors through a nonjudgmental lens. The actions that the
therapist selects (­writes down on their index cards) should include actions
that the child currently has difficulty with. If the therapist is unsure, then ask-
ing the parents for suggestions would be appropriate. Parents are taught this
technique and are instructed to play the technique at home each day focusing
on a few specific actions/­situations that the child is having difficulty with.

Social Needs Bag

Therapy Needs: Social navigation and connection

Level: Child
Materials: Paper bag, art decorations, markers, paper, and scissors
Modality: Individual and group

Introduction

This play therapy intervention provides a child with repetitive practice of

social needs they may be wanting to address or are having trouble with. The
social needs can be related to anything such as making friends, decreasing so-
cial anxiety, or generalized to any social desire the child is wanting to explore.

Instructions

1 The therapist explains to the child that they will be using a paper bag to
make a social navigation bag.
2 The therapist gives the child a small paper bag and instructs them to
decorate it anyway they like and try to include things on the bag that
describe themselves.
3 Once the bag has been decorated, the therapist and child work together
to write on seven strips of paper (­one for each day of the week) different
social goals that the child needs or wants to address.
4 After they have been written, the strips are put into the bag. If there is
time remaining in the session, the therapist and child can practice some
of the social needs.
5 The child is instructed to take the bag home, and each day they will
draw out one of the strips of paper and practice that social goal three
different times that day (­child practices with parents).
312 Social Navigation Interventions

6 In the next therapy session, the child, parents, and therapist review how
the practice time went at home. The social goals practiced will be cho-
sen by the child and therapist and the therapist may have to help the
child translate the goals into something that can be practiced. Goals
may be something ­like – ​­I need help standing and waiting in line or there
is a child I would like to talk to, but I don’t know how.

Rationale

This play therapy technique is designed to work on a variety of possible

social navigation goals. Parents are involved in this play intervention and
should be taught how the social needs bag works and instructed on how to
play and practice at home. It is important that the parent and child try to
practice the goal around three times each day. The more practice, the more
it will help the child accomplish their goals. If a child wants to continue this
play intervention at home addressing the same goals, then the same bag can
be practiced for another week or more. Also, a new social needs bags can
also be created at any time to work on more social goals. A variation of this
play technique is an emotion bag which would focus on one emotion such as
worry, and the strips of paper would each have instructions on how to process
and express worry. The same process would be followed with the child draw-
ing one strip of paper out of the bag each day and practicing the idea for how
to express their feelings of worry.

Friendship Universe

Therapy Needs: Social navigation and connection

Level: Adolescent
Materials: Paper, markers, and a pencil
Modality: Individual and group

Introduction

Autistic and neurodivergent adolescents may struggle with accurately

identifying what constitutes a friend. Some adolescents might label a child
at school that they have spoken to once as a good friend. Others might
 Social Navigation Interventions 313

consider someone a friend, who is actually bullying them and treating them
poorly. Friendship Universe helps adolescents learn about and understand
different levels of relationship, how well a person is known, how the person
treats them, and what to expect from a friend. It provides the opportu-
nity for the therapist and adolescent to discuss current friendships in the
adolescent’s life and serves both as an assessment and social navigation
intervention.

Instructions

1 The therapist explains to the adolescent that they will be doing an activ-
ity that identifies the adolescent’s current friendships.
2 The therapist and adolescent draw planets on a piece of paper (­see exam-
ple in the Appendix).
3 The adolescent writes their name in the largest circle of the planet sys-
tem. Each planet in the system will represent different friends in the
adolescent’s life.
4 The adolescent will write the names of the friends who are closest
(­emotionally) to them in the planets closest to the adolescent. The
friends who are not as close to the adolescent will have their names
written in the planets that are farther away from the adolescent’s name.
Friends can include family members.
5 Once the adolescent has finished, the therapist and adolescent will talk
about what the adolescent has created and the different levels of friend-
ships (­close friends versus acquaintances).
6 The therapist will likely have to spend time discussing how well the
adolescent knows some of the people they have written down and con-
ceptualizing what constitute a close friend.
7 The therapist can also discuss how to know if someone is a friend and
how to know if someone is not treating you well.

Rationale

This play therapy technique focuses on addressing social navigation related

to friendships and relationships. This play technique can be shared with par-
ents so they can further discuss with their child friendships and help rein-
force the concepts. It is not a play technique that needs to be practiced at
home throughout the week. It can be revisited in sessions with the thera-
pist. The therapist may have the adolescent create a new friendship universe
314 Social Navigation Interventions

periodically to see if there are changes. A sample Friendship Universe work-

sheet is in the Appendix at the back of this book.

Playful Role Play

Therapy Needs: Social navigation

Level: Child and adolescent
Materials: None
Modality: Individual, family, and group

Introduction

Children and adolescents can sometimes benefit greatly from ­role-​­playing

through situations they might be struggling with. Therapists can try to iden-
tify situations where a child or adolescent may need help with different so-
cial scenarios or issues. ­Role-​­playing should be about the child and their
need, not something that the therapist has decided they want for the child.
­Role-​­plays should also be designed to be fun and engaging and can include
props and other people.

Instructions

1 The therapist explains to the child that they are going to ­role-​­play some
social situations.
2 Ideally the therapist and child would discuss social situations the child
would like help with or would like to practice how to navigate.
3 The therapist and child will decide on various social situations to ­role-​
­play and how the ­role-​­play will be ­conducted – ​­what props, toys, or ma-
terials are needed.
4 Some examples might include recognizing when someone does some-
thing on purpose or accident, how to respond when winning and losing,
how to ask a teacher a question, how to respond to a bully, how to tell
someone you like them, etc. ­Role-​­plays should be practiced several times
throughout a session. Repetition and practice will help increase under-
standing and application. The more the child can ­role-​­play situations,
the more likely they will be able to manage during a real situation.
 Social Navigation Interventions 315

Rationale

This play therapy technique helps address social navigation needs through
a ­role-​­play. The therapist and child can work on a whole variety of social
goals. One of the best ways to work on social navigation for children
is through ­role-​­play. The therapist can pick any scenario and ­role-​­play
through it with the child and explore how to act, respond, or handle the
situation. When doing a ­role-​­play, it is best to avoid working in a meta-
phor or an approximate to the child’s situation; instead focus should be on
directly talking about the child and what they are trying to accomplish in
a situation. ­Role-​­plays can be taught to parents and parents can practice
the ­role-​­plays at home with their child. Parents can also ­role-​­play any
situation that comes up and that they feel needs attention. Some com-
mon ­role-​­play scenarios are listed below but the therapist should caution
to listen to the child about what they want help with and not decide for
the child.

Common ­Role-​­Play Scenarios

• How to respond when winning and losing a game

• How to communicate needs
• How to ask a teacher a question
• How to notice an unsafe situation or person
• How to navigate eating at a restaurant
• How to order your own food in a restaurant
• How to ­self-​­advocate
• What is safe and unsafe to do in car
• What to do when your sibling makes you mad
• How to ask someone for help
• How to recognize when someone is being mean to you
• What to do if someone is being mean to you
• How to navigate when you are getting your ­hair-​­cut
• How to navigate when you are in the doctor’s office
• How to tell someone you like them
• How to take care of a pet
• How to play with other children
• How to navigate waiting in a line
• How to handle peer pressure
• Understanding and recognizing humor
316 Social Navigation Interventions

Candy Kindness Activity

Therapy Needs: Social navigation and connection

Level: Child
Materials: Paper, aluminum foil, markers, art decorations, and glue
Modality: Individual, family, and group

Introduction

This play therapy intervention offers a fun and expressive way for children
to recognize how to be kind to others and practice acts of kindness. Children
can sometimes be unsure how to express their feelings of care and kindness
to someone else. This play intervention helps children recognize what a kind
action toward another person would look like and gives the child the oppor-
tunity to implement kind actions.

Instructions

1 The therapist explains to the child that they are going to be making
pretend candy and learning about ways to show kindness to other
people.
2 The therapist and child write on small pieces of paper various kind things
the child could do for or to other people.
3 The child then creates and decorates candy wrappers out of other pieces
of paper, aluminum foil, or any material.
4 The small pieces of paper with kind things written on them are placed
inside the candy wrappers (­one for each candy wrapper).
5 The therapist and child can make as many of the kindness candies as
they want, but at least seven should be made (­one for each day of the
week).
6 The child takes the candies home and unwraps one a day and will try to
practice/­do that kind thing that day. The therapist will explain the inter-
vention to the parents and the parents will help the child with execution
at home.
7 The child will report back to the therapist at the next session how they
did with implementing the kind actions and process any questions or
feelings they may have.
 Social Navigation Interventions 317

8 This play intervention can be repeated several times with new kind ac-
tions being created or repeating previous ones.
9 The therapist will likely help suggest kind ideas that the child could do
but should ask for the child’s input. If the therapist is providing sugges-
tions, they should make sure the kind actions are appropriate for the
child and the child approves and is okay with the action. The child has
veto power. This is not a space where the therapist exerts their personal
morals or values onto the child.
10 If there is any remaining time left in the session, the therapist and child
can practice the kind actions.

Rationale

Candy Kindness Activity helps explore the concept of being kind especially
toward other people and doing something kind for them. This play therapy
technique is explained to parents, and the parents are instructed to partic-
ipate in unwrapping one candy per day and helping their child implement
the kind action. If the child wants to continue to play this intervention, they
can practice for another week or more. Also, new candies can be created in
session or at home to conceptualize new ways to show kindness. The actions
placed in the candy wrappers do not necessarily have to directly involve
another person, they can focus on animals, the earth, etc.

My Safety Wheel

Therapy Needs: Social navigation

Level: Child and adolescent
Materials: Paper and a pencil
Modality: Individual and group

Introduction

There can be a great deal of concern and need for neurodivergent children
and adolescents to learn about safety. Research indicates that neurodiver-
gent children can be easily victimized in various ways and they are typi-
cally not sure how to handle themselves when they are in unsafe situations.
318 Social Navigation Interventions

Some autistic and neurodivergent children may have a difficult time rec-
ognizing unsafe situations. This play therapy intervention presents a visual
representation of safe and unsafe people, things, and places that the child
can take home and keep as a reminder.

Instructions

1 The therapist explains to the child that they will be completing an ac-
tivity focused on safety issues.
2 The therapist and child divide a piece of paper into eight quadrants (­see
example in the Appendix).
3 The quadrants are labeled: safe places, safe people, safe activities, safe
objects, unsafe places, unsafe people, unsafe activities, and unsafe
objects.
4 The child can decorate the quadrants if they would like. The therapist
asks the child to identify safe/­unsafe things or people for each quadrant.
5 The child writes the safe/­ unsafe things down in each appropriate
quadrant.
6 The therapist talks to the child about the meaning of “­safe” and “­unsafe.”
The therapist may need to help the child if they are not familiar with
who and what is safe and unsafe.
7 It is likely the therapist will add things to each quadrant, but the child
should write everything they can think of first.
8 The therapist may have to keep explaining the concepts of safe and un-
safe and the therapist may have to do the writing if the child cannot
­write – ​­picture examples can also be used.

Rationale

This play therapy technique helps develop safety related social awareness
and will likely look different for children versus adolescents in terms of con-
tent. The therapist should make sure that safe/­unsafe things and people are
covered adequately. If the child leaves something out, then the therapist
should add it to the quadrant. This play technique should be taught to par-
ents, and parents can periodically reinforce the concepts at home by going
through the safety wheel with their child. Children will gain the most bene-
fit from this intervention if they revisit it periodically and continue to prac-
tice learning what is safe and unsafe. A sample My Safety Wheel worksheet is
in the Appendix at the back of this book.
 Social Navigation Interventions 319

Conversation Bubbles

Therapy Needs: Social navigation and connection

Level: Child and adolescent
Materials: Conversation Bubbles worksheet and a pencil
Modality: Individual

Introduction

Conversation Bubbles helps children and adolescents practice what to say and
how to say things in certain situations. It also provides the child with a writ-
ten narrative to take home to help them remember what to say in certain
conversations. This play intervention can address general reciprocal conver-
sation but can also be targeted toward a specific type of conversation that the
child may want help navigating.

Instructions

1 Using the Conversation Bubbles worksheet (­template provided in the

Appendix), the therapist begins by writing something in the first con-
versation bubble to begin the conversation.
2 The child will then write a response in the next bubble.
3 The therapist then writes a response to what the child wrote in the next
bubble. This goes on until an appropriate end occurs.
4 Once the conversation has ended, the therapist should process through
with the child how they felt being in the conversation and address any
areas that need to be discussed further.
5 The therapist and child can then begin a new conversation with the
child going first.
6 If the child is having difficulty coming up with a response, then the ther-
apist should help the child by giving them some examples.
7 The conversations can be about anything but are most helpful if the con-
versations are covering real situations that the child is needing help with.
8 Conversation Bubbles in not designed to teach a child to communicate in
a neurotypical manner. They should be implemented to help child nav-
igate to get something they want or need. This can even include how to
self advocate.
320 Social Navigation Interventions

Rationale

This play therapy technique works on helping children navigate in social

conversations. If the child can write, it also works on fine motor skills and
handwriting skills. The therapist and child can complete as many Conversa-
tion Bubbles worksheets as they want, covering many topics. Parents can also
be trained in the play technique and given a copy of the Conversation Bubbles
worksheet. Parents can periodically practice with their child at home espe-
cially covering any new situation the child may experience. The completed
worksheets can help the child gain confidence and feel more prepared to
address and communicate their needs. A sample Conversation Bubbles work-
sheet is in the Appendix at the back of this book.

What to Say? What It Do?

Therapy Needs: Social navigation and emotion expression

Level: Child and adolescent
Materials: Index cards and a pencil
Modality: Individual

Introduction

Social related anxiety issues can be a need for many autistic and neurodiver-
gent children and adolescents. Feeling unsure about what to do or say and
how to navigate can become very dysregulating. This play therapy inter-
vention provides the opportunity to discuss and practice a variety of social
related needs that a child or adolescent may want help in navigating. The
therapist can individualize this play intervention and address specific situa-
tions that are known to be challenging for the child.

Instructions

1 The therapist explains to the child that they are going to explore various
social situations that may be troubling for the child.
2 The therapist writes down several brief story scenarios on index cards
(­this may be done before the child arrives for their session or be done
with the child in the session).
 Social Navigation Interventions 321

3 The therapist reads one of the stories to the child. The child has to an-
swer one or two questions about the story; “­What would you say?” and/­or
“­What would you do?”
4 The stories should focus on scenarios that relate to the child’s life. An
example might be: One day a boy named Daniel (­the client’s name) was
walking down the sidewalk. An older boy ran up to Daniel and told him
he had to smoke a cigarette (­a real situation that happened that the cli-
ent did not handle well). The child will try to answer what they would
do in this situation and/­or what they would say?
5 The therapist will address any responses or struggles and help the child
learn how to decide things to do and say in various scenarios.
6 The therapist and child should go through multiple stories discussing
the child’s responses. If the child is having a difficult time thinking of a
response, then the therapist should help with ideas and encourage the
child.

Rationale

This play therapy intervention can work on a variety of social needs and
should be focused on empowering the child in navigating social situations
that are a­ nxiety-​­producing, confusing, etc. The therapist can address inter-
actions, emotional responses, and connection elements with this interven-
tion through the stories that are created. The therapist can write several
stories before the session but should try to include the child and see if they
can think of stories to explore. An additional element to this play technique
would be to r­ ole-​­play out the scenario after it is read and responded to with
the child showing what they would say or do. Parents can be taught this play
technique to implement at home and practice periodically with their child.

Bubbles Social Interaction

(­Adapted from Liana Lowenstein’s ­Technique – ​­Bubbles found in More Cre-

ative Interventions for Troubled Children & Youth)
Therapy Needs: Social navigation and connection
Level: Child
Materials: Bubbles
Modality: Individual
322 Social Navigation Interventions

Introduction

Children can find themselves in all types of social situations that are confus-
ing and a­ nxiety-​­producing. Often children can feel confident and empowered
in social situations when they have the opportunity to practice scenarios and
responses. This play therapy intervention uses bubbles to engage and provide
sensory input as a child practices various social scenarios that are relevant
for the child’s needs. Several different social “­scripts” or situations can be
created using the intervention bubble blowing process.

Instructions

1 The therapist explains to the child that they are going to work on ad-
dressing social situations while blowing bubbles.
2 The therapist begins by creating a script to use with the bubbles.
3 The therapist reads the script to the child and tells the child that they
are going to practice implementing the script using bubble blowing.
4 Some examples include: (­1) Playing with another ­child – ​­The therapist
and child take turns blowing bubbles, one turn blowing the bubbles for
each person. The therapist starts by blowing the bubbles, the child then
says, “­Can I play with the bubbles?” The therapist says, “­Yes, I will share
with you” and hands the child the bubbles. The child says, “­Thanks.”
The child then blows the bubbles once, and the script is repeated back
and forth. This will likely continue several times for practice. (­2) Telling
others you don’t like something and hearing them tell you they don’t
like ­something – The
​­ child blows the bubbles; the therapist then says,
“­I don’t like bubbles, please don’t blow them by me.” The child says
“­Sorry, I will blow them over here.” Then the therapist says, “­Thanks.”
(­3) Some other ideas might include handling a bully, communicating a
feeling, and asking the teacher for help.
5 The therapist should create scenarios that are real social navigation
needs for the child. The therapist should also ask the child if they have
any examples they want to practice.

Rationale

This play therapy technique helps children navigate various social situa-
tions. Parents can be taught Bubbles Social Interaction to practice with their
 Social Navigation Interventions 323

child. Parent and child are encouraged play Bubbles Social Interaction at home
practicing any scenarios the child would like to address. The therapist will
likely need to help conceptualize different scripts and teach the scripts to the
parents, making sure the scripts are scenarios that match the child’s needs.

The Social Brick Road

Therapy Needs: Social navigation

Level: Child and adolescents
Materials: Paper, markers, index cards, and candy
Modality: Individual

Introduction

The Social Brick Road is a fun and creative way for a child or adolescent to
work on addressing social navigation needs. The therapist can design the in-
tervention to address specific needs and repeat the game anytime to address
new needs. Providing a small prize at the end of the play intervention can
create extra incentive for the child to participate.

Instructions

1 The therapist and child create five to seven pieces of paper drawn like
bricks.
2 The therapist and child then discuss some social situations that are not
going well for the child and write those on the back side of the brick
paper.
3 The therapist and child then discuss a way to address, react, or respond
for each situation and write them on the back of the corresponding brick.
4 The therapist then places each paper brick on the floor around the play-
room; the bricks should be placed in an order with a starting point and
an ending point.
5 The child is instructed to walk up to the starting brick and pick it up and
read the social situation and the suggestions for addressing it.
6 The therapist and child will then ­role-​­play a scenario experiencing and
addressing the social situation. The child then moves on to the second
324 Social Navigation Interventions

brick and repeats the process until they get to the final brick where a
small prize waits for them.

Rationale

This play therapy technique can help address various social navigation
needs. The therapist should focus on social situations that the child needs
help with and provide encouragement for the child as they r­ole-​­play sce-
narios. This play intervention can be played several times with new social
situation bricks. Parents can be taught this technique and encouraged to play
the game at home several times. The prize at the end of the brick road should
be something that the child would enjoy earning such as stickers, a piece of
candy, or a small toy. If considering candy or any type of food as a prize, the
therapist should discuss this with the parents first to inquire about any aller-
gies or special diets the child may have.

Divide and Conquer

Therapy Goals: Social navigation, connection, and executive functioning

Level: Child and adolescent
Materials: Balloon
Modality: Individual, family, and group

Introduction

This play therapy intervention focuses on goals of working together with an-
other person to accomplish a task, connection, and executive functioning. This
play intervention provides and fun and engaging game to help children and
adolescents notice others and work with other people in a cooperative format.
It incorporates a teamwork concept and gives the child choices and control.

Instructions

1 The therapist explains to the child that they are going to play a game
and they have to focus on working together as a team.
 Social Navigation Interventions 325

2 The therapist and child each choose an area to stand in the playroom.
3 The therapist explains to the child that they can position themselves and
their feet anywhere in the playroom but once in place, they have to pre-
tend that their feet are stuck to the floor, and they cannot move their feet.
4 The therapist and child hit a balloon in the air back and forth and try to
keep it from touching the ground without moving their feet.
5 The therapist and child should spend time discussing and strategizing
how they will work together to keep the balloon in the air and that the
only way to succeed at the game is by paying attention to each other and
working as a team.
6 The therapist and child can also strategize and develop a plan decid-
ing where each person will stand to cover the most playroom space. If
the balloon hits the ground, the therapist and child can stop and r­e-​
­strategize on different places to stand and start over seeing if they can
keep the balloon in the air longer. The therapist should empower the
child to lead out in creating a plan.

Rationale

This play therapy technique helps with social navigation related to working
as a team and working with another person to accomplish a task. It further
promotes body awareness, connection, and executive functioning. The ther-
apist and child will try to work together to keep the balloon from hitting the
ground. The therapist and child should focus on coordinating where they are
going to stand to try and cover as much space as possible in the playroom and
discuss how they are going to keep the balloon from touching the ground.
This play intervention can also be implemented in group format and can be
taught to parents to play at home with their child and other family members
can also participate.

Pose

Therapy Needs: Social navigation, emotion expression, sensory processing,

and connection
Level: Child and adolescent
Materials: Mirror
Modality: Individual
326 Social Navigation Interventions

Introduction

Autistic and neurodivergent children and adolescents can have sensory issues
in understanding their own bodies and the body language of others especially
when they are in various social situations. This play therapy intervention
focuses on helping children and adolescents learn how to notice their affect,
body language, and body responses. It also helps children understand how to
better recognize other people’s body language.

Instructions

1 The therapist explains to the child that they are going to be working on
body awareness.
2 The therapist creates a list of various poses that the therapist and child
are going to perform.
3 Each pose demonstrates a different type of body expression.
4 The therapist and child will each perform a pose from the list and per-
form it in front of a mirror so they can see themselves.
5 As the child performs the pose, the therapist will point out the different
components of the child’s body language and what the pose could mean
or represent and examples of when that type of body language could be
helpful. The therapist should also encourage the child to notice how
their body feels in each pose.
6 The therapist can make the intervention more engaging by including
props such as wigs, hats, and dress up clothes.
7 The therapist should go through several poses with the child and this in-
tervention can be repeated from session to session. Some example poses
might include happy pose, sad pose, unfriendly pose, friendly pose, leave
me alone pose, I want to play pose, tired pose, confused pose, proud pose,
excited pose, normal pose, scared pose, out of control pose, feeling calm
pose, etc.
8 The child should be encouraged to create poses the therapist and child
can complete.

Rationale

Pose play therapy intervention helps children and adolescents work on im-
proving social navigation, connection, sensory processing, and emotion
expression. Many children and adolescents may present “­flat” and have a
 Social Navigation Interventions 327

difficult time understanding and being aware of their body presentations and
recognizing other people’s body signs. This play intervention provides the
opportunity to practice awareness. Parents can be taught this intervention
to implement at home and encouraged to play with their child regularly and
note any gains when the child is able to display a variety of body understand-
ing and awareness components in real situations.

References

Bailin, A. (­2019). Clearing up some misconceptions about neurodiversity. Scien-

tific American. https://­blogs.scientificamerican.com/­observations/­­clearing-­​­­up-
­​­­some-­​­­misconceptions-­​­­about-​­neurodiversity/
Grant, R. J. (­2017). Play based interventions for autism spectrum disorder and other de-
velopmental disabilities. Routledge.
 15
Emotion Identification and
Expression Interventions

Identifying and Expressing Emotions

Emotion identification and expression can be a helpful awareness for any

child. A lack of awareness can often lead to additional issues and/­or struggles
both interpersonally and in relationships. A child who struggles to under-
stand emotional presence, may become overly emotional, may not display
emotions, may lack appropriate emotional expression, may not understand
or be able to differentiate emotions, may not recognize emotions in oth-
ers, or may not be able to regulate their emotional states which can lead to
dysregulation. If children cannot regulate their emotions, it can be a very
frightening experience for the child. Being able to regulate, begins with
identification and awareness.
Autistic and neurodivergent children and adolescents may struggle with
identifying their emotions and with being able to express their emotions.
Some children may have ­Alexithymia – ​­an inability to identify and describe
emotions that one is experiencing. Some of the signs of Alexithymia include
a lack of impulse control, dysregulated or disruptive outbursts, indifference
towards other people, difficulties with articulating emotions, difficulties with
naming different kinds of emotions, struggling to identify emotions expressed
by others, and heightened sensitivity to sights, sounds, or physical touch.
Identifying and expressing both positive and negative emotions can be a
challenge, and often without affirming and supportive help, these children
and adolescents will produce negative, unwanted behaviors when they be-
come dysregulated. Some of the signs of emotional dysregulation include
mouthing or chewing on objects or fingers, holding or needing comforting
objects, increases in ­stimming – ​­tip toe walking, rocking back and forth,
hand flapping, humming and making random noises, becoming aggressive,
becoming withdrawn, attempting to remove themselves from a stressful

DOI: 10.4324/9781003207610-16
 Emotion Identification and Expression Interventions 329

situation, and seeking out extra routine and/­or predictability. Adults will
need to pay close attention and recognize the signs that a child is struggling
with emotional regulation needs and move quickly to provide affirming sup-
port instead of accusations, consequences, and threating with punishments
if the behavior does not change.
In AutPlay Therapy, there are six categories of emotion identification and
expression that are loosely conceptualized. The categories include identify-
ing emotions, understanding and expression of emotions, emotion/­situation
recognition, recognizing emotions in others, sharing emotional experiences,
and overall awareness and managing of emotions. The categories are not se-
quential in development and can mix and overlap at any time. Further, each
neurodivergent child may display and possess identification and expression
in their own way that does not look the way a neurotypical child may display
emotion identification and expression. There is not one right way, neurodi-
vergent children can possess identification and expression in the ways that
make sense for them.
The six emotion identification and expression categories are defined below:

1 Identifying Emotions refers to a child’s ability to identify emotions, accu-

rately label emotions, and reference several emotions as a­ ge-​­appropriate.
2 Understanding and Expression of Emotions refers to a child’s ability to un-
derstand specific emotions they may be experiencing, such as frustration
versus anger, and being able to express the emotion they are feeling in a
way that is adaptive and helps process the emotion, such as communicat-
ing their feelings to others.
3 Emotion/­Situation Recognition refers to a child’s ability to recognize that
certain emotions would typically correspond to certain situations such as
a woman attends a funeral, this would likely make her feel sad.
4 Recognizing Emotions in Others refers to a child’s ability to recognize emo-
tions and emotional expression in other people such as recognizing when
a parent is sad or angry, or when another child at school is feeling lonely.
This often works in conjunction with relationship development.
5 Sharing Emotional Experiences refers to a child’s ability to mutually partic-
ipate in sharing emotion with another person, such as connecting with
another in excitement while participating in a mutual activity.
6 Overall Awareness and Managing Emotions refers to a child’s overall ability
to be aware of and process their emotions, such as identifying feelings
and being able to express them in an adaptive way and understanding
how to handle negative emotions they may experience.
330 Emotion Identification and Expression Interventions

In AutPlay Therapy, play therapy interventions that focus on emotion iden-

tification and expression can be individualized to each child and adolescent
to help address their specific needs. Play therapy interventions should be
natural, playful, and engaging to children. Play therapy interventions should
also align with the child’s play preferences and interests. Many play therapy
interventions can be implemented repeatedly with the therapist in session
and at home with parents if it is something the child wants to continue to
play. During the intake and assessment phase, a child’s emotion identifica-
tion and expression strengths and needs should be assessed using the AutPlay
Emotional Regulation Inventory, parent and child feedback, and therapist
observations. It is critical that emotion identification and expression needs
are thoroughly assessed during the intake and assessment phase. Remember
that neurodivergent children can possess identification and expression in the
ways that make sense for them which may not look that same as it does in
neurotypical children. Proper assessment will help identify the strengths and
needs of the child and the play preferences of the child, which would all be
considered in selecting structured play therapy interventions.

Feeling Face Fans

Therapy Needs: Emotion identification and expression, regulation, and

connection
Level: Child and adolescent
Materials: White paper, construction paper (­or paper plates), wood sticks,
glue, and markers
Modality: Individual, group, and family

Introduction

Neurodivergent children may have needs and difficulty identifying and ex-
pressing their feelings. Some children may need help with regulating their
feelings which may begin with recognizing a feeling and being able to name
it and connect their feelings to real life situations. This play intervention
creates a strong visual aid that children can keep and help them remember,
identify, and connect their feelings to applicable experiences. The fan design
provides children the ability to express in a manner that does not rely on
verbal expression.
 Emotion Identification and Expression Interventions 331

Instructions

1 The child is instructed to cut two round circles (­or any shape) out of
white pieces of paper (­white paper plates can also be used).
2 On one of the circles, the child draws a feeling face and writes the feeling
word on the piece of paper that corresponds with the feeling face.
3 On the other piece of paper, the child draws a different feeling face and
writes the feeling word. The therapist should instruct the child to try and
think of opposite feelings like mad and happy for their feeling fans.
4 The child glues both sides together with a wooden stick in the middle.
5 The child can make several feeling face fans representing several differ-
ent opposite feelings.
6 The therapist and child talk about the feelings the child has chosen and
the concept of opposite feelings.
7 The therapist and child practice making faces that match the feeling
face fans the child drew initially and talk about a time or situation when
the child has experienced the feeling.
8 If the child is having a difficult time thinking of an experience, the thera-
pist can ask some helpful questions like “­What do you feel in school dur-
ing PE class?” or “­How does your brother make you feel?” These types of
questions may help the child connect the emotion with a real experience.

Rationale

This play therapy technique helps the child work on identifying emotions
and understanding and expressing emotions (­especially the concept of op-
posite emotions and connecting emotions to real experiences). This play
technique may also help with recognizing emotions in others. The child may
have difficulty identifying feelings and identifying opposites. The therapist
can participate, model, and work with the child to identify feelings and con-
struct the feeling face fans.

Me and My Feelings

Therapy Needs: Emotion identification and expression, and regulation

Level: Child and adolescent
Materials: White paper, construction paper, markers, scissors, and glue
Modality: Individual and group
332 Emotion Identification and Expression Interventions

Introduction

Me and My Feelings is designed to help children and adolescents identify and

make a connection with the emotions that they experience. It incorporates
a strong visual element to help the child recognize their emotional self and
begin to talk about and process their emotions.

Instructions

1 The therapist explains to the child that they will be working on identi-
fying emotions.
2 The child draws an outline of a person on a white piece of paper.
3 The therapist explains that the person is going to represent the child.
The child makes the person look like themselves (­they draw their own
face and hair on the person).
4 The child is instructed to think about different feelings they have had
(­for some children it might be helpful to give them a specific topic to
connect their feelings to such as school, their family, or going on vaca-
tion). Using construction paper, the child cuts out different colors to
represent different feelings the child has felt. The construction paper
should be cut in different sizes to represent different levels of feelings;
small pieces are feelings that are not felt as often, while larger pieces are
feelings the child has more often.
5 The child glues the pieces on their paper person, placing them wherever
they want.
6 The child then writes the feeling on the piece of construction paper that
they have glued onto their person.
7 Once the child has finished their feeling person, The therapist discusses
with the child the feelings that they selected and talks about situations
or experiences when they have felt that way.

Rationale

Me and My Feelings helps children and adolescents work on identifying emo-

tions and understanding and expressing emotions. The child also works on
fine motor skills and verbal communication with this technique. The child’s
feelings may change ­day-­​­­to-​­day, and the level that the child is feeling will
also change from ­day-­​­­to-​­day. This is a concept that can be discussed with
 Emotion Identification and Expression Interventions 333

the child along with helping the child understand that all people experience
various emotions at different times. Parents can be taught to implement this
intervention at home with their child and encouraged to complete a Me
and My Feelings person periodically to help their child gain more practice in
identifying and discussing emotions. F­ igure 15.1 provides an example of a
completed Me and My Feelings intervention.

Feelings Scenarios

Therapy Needs: Emotion identification and expression, and social navigation

Level: Child and adolescent
Materials: Index cards, and a pencil
Modality: Individual

­Figure 15.1 Me and My Feelings Example.

334 Emotion Identification and Expression Interventions

Introduction

Autistic and neurodivergent children and adolescents may struggle with

being able to express their emotions. This play therapy intervention helps
children and adolescents make a connection between emotions they may
experience, specific scenarios that trigger those emotions, and how to express
their emotions. This play intervention can be tailored to cover real life sce-
narios that the child has struggled with in the past.

Instructions

1 Before the session, the therapist writes down different situations or sce-
narios that would evoke different feelings (­typically the therapist will
write down on index cards, situations the child has experienced in the
past or is experiencing in the present).
2 The therapist should try to think of situations that would be relevant for
the specific child.
3 The therapist explains they are going to read scenarios that could cause
someone to have one or more feelings.
4 The therapist and child take turns reading the situations and showing
what feeling(­s) would be appropriate in the situation using their body
and facial expressions or saying the feelings.
5 Once the feeling(­s) has been expressed, the therapist and child can dis-
cuss the feeling(­s) appropriate for the situation and discuss if the child
has ever been in that situation and felt that way.
6 The therapist can further discuss with the child ideas for how to appro-
priately express the emotions that might be felt in the situation.
7 Once all of the scenarios have been completed, the therapist can ask the
child if they have any scenarios they would like to practice.

Rationale

This play therapy technique helps with identifying emotions, expressing

emotions, recognizing emotions in others, and understanding emotion/­
situation recognition. This play technique also helps the child become more
comfortable talking about feelings. This play intervention can be used to talk
about specific situations that are difficult for the child to handle in terms of
their emotional self. If the child is comfortable, a further process question
could be to ask the child what they could do to help with uncomfortable
 Emotion Identification and Expression Interventions 335

emotions in the situation. Parents can be taught this intervention and they
can continue to practice with their child at home.

Examples of Possible Feelings Scenarios

• A student at your school tells you that you are stupid.

• You are playing your favorite video game and your mom tells you that
you have to stop and go to the grocery store with her.
• Your mom and dad tell you that you are going on a trip to Disney World.
• Your sister breaks your favorite toy.
• You win an award at school for best behavior.
• You have an excellent school report card.
• You are playing at home and accidently break one of your parent’s
pictures.
• You are at the mall with your parents and get lost from them.
• Your teacher gives you a surprise math test, and you do not know how
to do it.
• When you get home from school, you want to play on your computer but
discover it is broken.
• Your dad tells you that you must go watch a school play that your brother
is participating in.
• Your teacher tells you that you will not have any homework for a whole
week.
• You are playing at recess and some other students ask you to play with
them.
• You are playing at recess and no one else will play with you.
• You are riding in your car and your brother and sister are being extremely
loud.
• Some other students at school start making fun of you.
• Your parents buy you a present that is your favorite new toy.

Feelings Detective

Therapy Needs: Emotion identification and expression, regulation, and social

awareness
Level: Child and adolescent
Materials: Paper, and a pencil
Modality: Individual and group
336 Emotion Identification and Expression Interventions

Introduction

Autistic and neurodivergent children and adolescents may have challenges in

recognizing their own emotions and have a difficult time recognizing emotions
in others. This play therapy intervention helps children and adolescents learn to
identify emotions in others and in themselves. It also helps children with social
awareness in noticing what other people are doing and how they are behaving.

Instructions

1 The therapist will type or write on a piece of paper a list of feelings the
child will try to find during the week before their next session (­an exam-
ple can be found in the appendix).
2 The therapist explains to the child that they will be the therapist’s feel-
ings detective, and the child is to take the list home to observe people
and try to identify each feeling on the list.
3 If the child thinks they observe a person displaying one of the feelings,
they will write it down on their feeling’s detective sheet. If they cannot
write, their parent can help them. If they are not sure about the feeling
they observe, they can ask their parent for help.
4 The child brings the list back to the next session, and the therapist and
child go over the list together and talk about the feelings that the child
found.
5 This is usually followed by creating another feelings list and sending it
home, this time with the instructions being that the child has to try and
find the feelings in themselves.
6 When they notice they are having one of the feelings, they write it down
on their feeling’s detective sheet.
7 The child is instructed to bring the list back to the next counseling session
to discuss with the therapist. New lists can be created with different feelings
if the intervention is something the child would like to continue to play.

Rationale

Feelings Detective helps work on identifying emotions and recognizing emo-

tions in others. This play technique also works on social awareness in the
areas of observing others and paying attention to what they are doing. The
therapist can create a list of basic feelings to begin with such as happy, sad,
mad, etc. or create the list with the client. More lists can be created at a later
 Emotion Identification and Expression Interventions 337

session with more advanced feelings. Parents should be instructed to assist

their child in completing the list by helping the child verify feelings and
providing opportunities for the child to observe other people.

An Emotional Story

Therapy Needs: Emotion identification and expression, regulation, and exec-

utive functioning
Level: Child and adolescent
Materials: Paper and a pencil
Modality: Individual and group

Introduction

This play therapy intervention helps children work on identifying and ex-
pressing feelings. It also helps with executive functioning struggles in the
areas of maintaining attention and listening for key words or phrases. It can
also help children recognize when someone is experiencing an emotion and
why another person might be experiencing a certain emotion.

Instructions

1 Before the session, the therapist writes one to three short stories that
reference people feeling various emotions (­some examples are provided
at the end of the intervention description).
2 The therapist reads one of the emotion stories to the child.
3 As the therapist is reading the story, the child is instructed to listen to
the story, stop the therapist at any point, and identify every time an emo-
tion is expressed in the story.
4 The child is asked to share what emotion is expressed, who in the story
is expressing the emotion, why the person in the story is expressing the
emotion, and if they would feel that way in the same situation.
5 These are questions that can be asked by the therapist each time the
child stops the story to identify an emotion.
6 After the story is finished, the therapist can read another story or ask the
child if they want to write their own emotion story.
338 Emotion Identification and Expression Interventions

7 If the child writes their own emotion story, they can then read the story
and have the therapist identify the emotions.
8 When reading the story to the child, it is likely the child will miss some
emotions. The therapist can stop the story and mention to the child that
there was an emotion that the child missed and ­re-​­read that section of
the story to provide the child an opportunity to identify the emotion.

Rationale

This play therapy technique works on sharing emotional experiences as well

as several other emotional regulation categories. The difficulty and length of
the story could vary depending on the child’s age. Several different stories
can be written referencing many different situations and stories can be writ-
ten that reflect the child’s life. Children who struggle recognizing the emo-
tions in the story may need to start by reading the story themselves, circling
all the emotions they find in the story, then discussing the emotions.

Example Emotional Story ­1 – ​­Sam’s First Day of School

Sam was awakened by his alarm clock. It was 7:00 am and time to get up and
get ready for the first day of school. Sam was feeling tired and really didn’t
want to get out of bed. Sam’s mother told him he had to get out of bed and
get dressed; she was worried he would miss the school bus. Sam got out of bed
and started getting dressed. Sam was excited to see some friends he had not
seen all summer but anxious that there might be a bully at school. Sam got
dressed and ate his breakfast which gave him a sick feeling in his stomach.
Sam continued to feel anxious as he got on the school bus. There was a lot
of noise on the bus, and Sam was getting irritated by all the loudness. The
bus finally got to school, and Sam went into his classroom. Sam was feeling
relieved to finally be at school. Sally, one of Sam’s best friends, came and
sat beside him; this made Sam happy, and he thought maybe school was not
so bad. Sam started to feel excited about going to school this year even if it
meant he had to get up at 7:00 am every morning.

Example Emotional Story ­2 – ​­Sally’s Brother

Sally walked into her room ready to play with all her toys and have a lot of
fun! As she walked into her room, her mood changed from excited to angry!
 Emotion Identification and Expression Interventions 339

Sally’s little brother Michael was in her room, and he had broken several
of her toys. Sally was so angry that she yelled at the top of her lungs for
Michael to get out of her room! Michael seemed surprised and scared at the
same time. Michael quickly ran out of Sally’s room. As Sally looked around
her room, she felt sad, many of her favorite toys were broken. Sally’s mother
heard Sally yell at Michael and came into Sally’s room. She saw Sally look-
ing sad and upset and realized what had happened. Sally’s mother told Sally
that everything would be OK; they would replace all the toys that had gotten
broken. Sally started to feel happy. Sally’s mother also told Sally that they
would get a special lock for her door so her brother could not get in. Sally
was excited to get some new toys and relieved that her brother would not be
able to get in her room.

Example Emotional Story ­3 – ​­Video Game

Liam was so excited! Today was the day his new video game would arrive
at his home. He had ­pre-​­ordered it a month ago and had been waiting anx-
iously and patiently and was ready to get this game in his hands. He saw the
van pull into his driveway and the delivery person drop a package off on
his porch. He could hardly control himself; he was so elated! He was sure
this would be the happiest day of his life. He retrieved the package from the
porch, opened it and saw ­it – ​­Warp Racing 3. He was about to escape into
peaceful fun when suddenly he heard his mom say, “­No video game until
your room is cleaned.” Liam was devastated, he felt a mix of sadness and
frustration. He wanted to play his game now, he felt so impatient he couldn’t
wait. Luckily, Liam was able to calm himself down and created a plan to
clean his room quickly. Liam moved faster than he had ever moved and got
his room cleaned in 10 m­ inutes – ​­a new record! He felt pretty proud of his
plan and effort. He then settled into his favorite chair for a long, pleasing,
play time of Warp Racing 3.

Alphabet Feelings

Therapy Needs: Emotion identification and expression, and regulation

Level: Child and adolescent
Materials: Alphabet Feelings list, feeling face cards, poster, or pictures
Modality: Individual
340 Emotion Identification and Expression Interventions

Introduction

Autistic and neurodivergent children and adolescents may benefit from hav-
ing a visual aid or accommodation to help them identify their feelings. This
play therapy intervention covers identifying emotions, noticing emotion
in others, talking about emotion producing situations, and how to handle
negative emotions. It also incorporates social awareness of noticing others,
specifically in regard to emotional expression.

Instructions

1 The therapist explains to the child that they will be talking about feel-
ings using the letters of the alphabet.
2 The therapist instructs the child to pick one letter from the alphabet and
turn it into a feeling word such as A=Angry (­see example list at the end
of this intervention description).
3 If needed, the therapist can help the child identify a feeling.
4 The therapist then shows a picture of someone expressing that feeling
(­pictures can be cut out from a magazine or presented from a deck of
feeling face cards).
5 The therapist asks the child to show what they might do or look like if
they were having that feeling.
6 The therapist then asks the child to think of a time when they have felt
that way.
7 The therapist then asks how they might express the feeling if they needed
another person to know how they were feeling.
8 If it is a negative feeling, the child can be asked to try and identify some-
thing that helps them feel better.
9 After the feeling has been completed, the therapist and child can pick
another letter and complete the process with another feeling. It is not
necessary to get through the whole alphabet and not necessary to go in
alphabetical order.

Rationale

Alphabet Feelings is an intervention that focuses on a full range of possible

emotional regulation needs. This play therapy technique helps work on
overall awareness of emotions as well as several other emotional regulation
categories. Depending on the age of the child, the therapist may do a great
 Emotion Identification and Expression Interventions 341

deal of assisting in this play technique. This play intervention is also easily
adapted to address whatever components the therapist and child want to
address. This play technique can be completed multiple times using all the
letters of the alphabet and identifying multiple feelings for each letter. Par-
ents can be taught how to implement this intervention at home and work on
completing the entire alphabet addressing a variety of different feelings. The
child can also be given a copy if the Alphabet Feeling list to take home and
use as an aid to help them identify feelings.

Alphabet Feelings List

­A – ​­angry, annoyed, amused, anxious, awkward, abandoned, afraid, affec-

tionate, aggressive, arrogant, admired, adventurous, ashamed.
­B – ​­brave, bold, blissful, bitter, bored, battered.
­C – ​­calm, caring, cheerful, confident, confused, comfortable, cooperative,
curious, considerate, combative.
D – ​­
­ defiant, discouraged, disappointed, dedicated, dejected, daring, de-
lighted, depressed, devoted, dumb, distracted, different, destructive.
­E – ​­excited, enraged, envious, energetic, encouraged, eager, ecstatic, embar-
rassed, empty, excluded, enthusiastic.
­F – ​­fearful, fearless, frightened, free, fierce, fragile, fun, funny, furious, frus-
trated, frail, friendly
­G – ​­genuine, glad, grateful, guilty.
­H – ​­happy, hateful, healthy, helpless, honest, hopeless, hopeful, horrible,
hostile, humiliated, hurt.
­I – ​­Impatient, inconsiderate, insecure, inspired, insulted, interested, intense,
intrigued, irritated, isolated.
­J – ​­jealous, joyful.
­K – ​­kind.
­L – ​­lonely, loving, loved, lousy, lovely, livid.
­M – ​­mad, mean, miserable, moody, mournful, manic, malicious.
­N – ​­nice, nasty, needy, nervous, negative, neglected.
­O – ​­optimistic, outraged, overjoyed, overwhelmed.
P – ​­
­ peaceful, proud, panicked, patient, pathetic, peaceful, pessimistic,
pleased, polite.
­Q – ​­quiet.
­R – ​­rejected, rebellious, rage, regretful, rejected, relieved, rotten, ruined,
resentful.
­S – ​­sad, satisfied, scared, secure, sensitive, shy, spontaneous, strong, surprised,
sweet, sympathetic, stressed, sleepy, smart, stupid.
342 Emotion Identification and Expression Interventions

­T – ​­terrified, terrific, tender, tense, thoughtful, threatened, thrilled, tough,

trustworthy, tired.
­U – uncomfortable,
​­ understanding, unappreciated, uncertain, unloved, un-
worthy, useless, unusual.
­V – ​­vulnerable, violent, violated, vivacious.
­W – ​­weird, weak, warm, wild, worried, worthless, worthy.
­X – ​­can you think of a feeling or create a new one?
­Y – ​­young, youthful, yucky.
­Z – ​­zany, zealous.

Worry Tree

Therapy Needs: Emotion identification and expression, regulation, and anx-

iety reduction
Level: Child and adolescent
Materials: Construction paper, markers, scissors, and glue
Modality: Individual and group

Introduction

Neurodivergent children and adolescents may be strong visual learners and

presenting information in a visual format can help increase understanding.
Worry Tree creates an expressive art visual aid that children can keep at home
to help them remember approaches and ideas for calming and ­regulating –​
­various strategies to decrease their worry and anxiety.

Instructions

1 The therapist tells the child they will be working on ways to help the
child calm and regulate when they are feeling anxious and dysregulated.
2 The therapist instructs the child to draw a tree on a piece of construction
paper.
3 The child then makes several leaves out of construction paper and tapes
them on the tree.
4 The therapist and child write different things the child worries about on
the leaves. The therapist and child talk about the different worries and
 Emotion Identification and Expression Interventions 343

if each worry is a legitimate thing to worry about or something that is

not realistic (­this is a good time to talk about realistic versus unrealistic
worries, as children can have several unrealistic worries).
5 The therapist and child then talk about a calming technique that can be
done for each worry.
6 The calming techniques are then written anywhere on the tree. The
therapist and child role play through scenarios that create anxiety and
practice a calming strategy.
7 The child takes the tree home and is encouraged to reference it to help
them remember the calming techniques when they are feeling worried.
8 If the child discovers that there is something on a leaf that they no longer
worry about, they can remove that leaf from the tree and they can also
add leaves if they discover something new that creates anxiety.

Rationale

This play therapy technique helps children and adolescents work on under-
standing and expressing emotions and regulating negative emotions of worry
and anxiety. The tree can be modified to represent any emotion the child might
need help with such as an angry tree or a scared tree. Younger children may re-
quire assistance from the therapist in terms of identification of situations that
create dysregulation and calming techniques to help regulate the child. This
intervention would be a good option for children who prefer more expressive
play interventions. F­ igure 15.2 provides an example of a completed Worry Tree.

Schedule Party

Therapy Needs: Emotion identification and expression, regulation, anxiety

reduction, and executive functioning
Level: Child
Materials: Various party toys, and ­schedule-​­making materials
Modality: Individual and family

Introduction

Many autistic and neurodivergent children are visual learners and they of-
ten use and benefit from a variety of visual schedules. These schedules can
344 Emotion Identification and Expression Interventions

­Figure 15.2 Worry Tree Example.

also be appealing for providing routine and predictability. One type of visual
schedule that is helpful for regulation and helping to stay calm during transi-
tions is a weekly visual schedule. This play intervention describes a fun and
engaging way for children and parents to create a weekly visual schedule.

Instructions

1 The therapist works with the parents to teach them how to create a
visual schedule displaying the child’s weekly activities.
2 There are a variety of ways to present the schedule and parents should
choose the method they feel will work best. A dry erase board works
well but other examples would be a paper schedule, one made with a
computer program, one displayed on the child’s tablet, or a homemade
Velcro schedule.
 Emotion Identification and Expression Interventions 345

3 The therapist teaches the parents how to have a “­Scheduling Party.”

Parents should establish a time each week to create the next week’s
schedule and have the child participate (­the parent and child work on it
together).
4 This should be called a scheduling party and the parents should have
party hats to wear, noise makers, balloons, etc. Parent and child should
go through each day and after each day has been scheduled, the child
should get a piece of candy, blow a noise maker, hits some balloons, etc.
5 The idea is to have a small celebration after each day has been scheduled.
6 The parents are encouraged to keep the atmosphere fun and engaging for
the child.
7 Weekly schedules typically include each day of the week, and each day is
broken down hourly from the time the child wakes until they go to sleep.
8 The parent explains to the child they can look at the schedule regularly
and see what is happening each day. The “­party” format is designed to
help engage the child toward the schedule and view it as something pos-
itive. The child can look forward to the fun time with their parent each
week.

Rationale

This play therapy technique helps children work on general regulation and
feeling positive and comfortable with the use of a weekly visual schedule.
The scheduling party presents the opportunity for the parent and child to
have a playful interaction and for the child to feel positively about their
visual schedule. Visual schedules in general are helpful for decreasing dys-
regulation and helping children transition. The format of the schedule will
depend on the child’s age (­words vs pictures) and interests (­it could be a
Minecraft themed schedule). Several weekly visual schedule examples can
be found online by searching for visual schedule examples.

New Plan/­Same Plan

Therapy Needs: Regulation, and anxiety reduction

Level: Child
Materials: Foam or cardboard pieces, markers, various art decorations, and glue
Modality: Individual
346 Emotion Identification and Expression Interventions

Introduction

Neurodivergent children may have a difficult time with transitions, sponta-

neous happenings, and changes to the original plan the child was expecting.
This expressive play therapy intervention provides parents with an aid to
help children handle changes to the plan or schedule and produce a more
calm and regulated response from the child.

Instructions

1 Using card stock, cardboard, or foam pieces, the therapist and child will
create two cards.
2 One card will have a large S (­same) drawn on it and the other will have
a large N (­new) drawn on it.
3 The child will decorate both cards anyway they like. The therapist will
talk about how sometimes there is a plan, and something happens, and
it changes (­the N card) and sometimes the plan stays the same (­the S
card). The therapist and child will practice several situations where the
plan has changed unexpectedly and the child is given the N card and
given some regulation ­affirmations – ​­“­The plan has changed, you are
going to hear a new plan, and this is okay.”
4 The child will take the cards home and give them to the parents. The
parents will use the cards to help the child understand when there is a
new plan.
5 The child and parents are both instructed that the parents will keep the
cards and when there is a new plan (­a change has happened), the parents
will present the N card to the child and wait a few seconds to let the
child process that they are about to hear a new plan. Then, the parents
will tell the child what the new plan is.
6 The S card is used when the child asks if there is a new plan or if things
are the same. The parent can present the S card to the child if the plan
is the same.
7 These cards give the child a visual and tactile aid that is designed
to help them regulate when there is a change from what they were
expecting.
8 Some parents have found it helpful to make more than one set of cards
to have in different locations.
 Emotion Identification and Expression Interventions 347

Rationale

This play therapy technique helps children with managing dysregulation in

regard to transitions and spontaneous or unplanned changes. The therapist
should emphasize to the child that the N card represents a new plan, and the
S card represents the same plan. It is important that the child understand
when they receive the N card that a new plan, different from what the child
was expecting, is about to be presented and this will be ok. This helps the
child make an association that it is ok to hear a change and begin to pre-
pare themselves. Parents are taught the approach so they know when the
child brings home cards, what the cards are for. Parents may want to make
more than one set of cards to carry one in their car and keep one at home.
­Figure 15.3 provides an example of completed N and S cards.

Potato Head Feelings

Therapy Needs: Emotion identification and expression, regulation, and

connection
Level: Child

­Figure 15.3 Same Plan New Plan Cards Example.

348 Emotion Identification and Expression Interventions

Materials: Mr. and Ms. Potato Head toys

Modality: Individual, family, and group

Introduction

Autistic and neurodivergent children may struggle with identifying emo-

tions. This play therapy intervention involves constructive play and creates
a playful way to engage children in identifying emotions. Several different
emotion expressions can be made with potato head accessory pieces. It is best
for the therapist and child to each have their own potato head and both be
making feeling faces and expressions.

Instructions

1 Using Mr. or Ms. Potato Head (­Hasbro Toys) and various accessory
pieces, the child will create as many potato head faces as they can show-
ing as many feeling face expressions as they can think of to create.
2 The therapist also participates and creates potato head feeling faces.
3 Once a face has been created, it is shown to the other person and the
other person has to try and identify the feeling face.
4 Once the correct feeling has been identified, the child and therapist try
to make the feeling expression on their own faces.
5 The therapist can also ask the child to share about a time that they have
felt that way.
6 The therapist and child should try to create as many potato head feeling
faces as they can think of. The process should be fun and silly, using all
kinds of parts that may not even make sense.
7 It is helpful if the therapist has collected several accessory pieces.

Rationale

Potato Head Feelings works on identifying emotions and understanding and

expression of emotions. It also works on fine motor skills and connection
related to the playful interaction between the therapist and child. The ther-
apist will need to purchase a Mr. or Ms. Potato Head; the more accessory
pieces the better for more options in creating various feeling faces. Potato
Head Feelings is a positive and playful way to engage children through a
 Emotion Identification and Expression Interventions 349

popular toy and it works well for children who prefer constructive play. This
intervention can be implemented in a group setting and taught to parents
to implement at home with the whole family participating and playing with
the child.

What Are They Feeling?

Therapy Needs: Emotion identification and expression, regulation, and social

awareness
Level: Child and adolescent
Materials: Magazines, index cards, pen, and glue
Modality: Individual, and group

Introduction

Neurodivergent children and adolescents may have a difficult time recog-

nizing and understanding emotions in other people and being aware of what
is possibly happening with another person. This play therapy intervention
helps children think about and identify what another person might be feel-
ing, why they might be feeling that way, and noticing the actions of another
person for possible caution or safety concerns.

Instructions

1 Using magazines, the child is instructed to cut out pictures of people

showing different emotions, actions, or states of being. The therapist can
participate and help the child with cutting out examples and help the
child with any of the processes in the intervention.
2 Once the child has gathered several different examples, the child glues
the pictures on index cards and writes on the pictures the emotion(­s) they
think the person is showing. The therapist could also use the pictures to
discuss if the person seems safe or unsafe or do they seem suspicious.
3 On the back of the index card, the child writes all the things they be-
lieve could make the person feel that way.
4 If the emotion(­s) identified is a negative one, an additional question for
the child might be “­What would help that person feel better?”
350 Emotion Identification and Expression Interventions

5 Instead of making the cards from magazines, therapists may want to buy
cards that display people in different situations showing different emo-
tions. These cards can usually be found at education supply stores.
6 Depending on the child’s emotional regulation needs, they may need help
in identifying emotions. The child may also need help in thinking of rea-
sons a person may be feeling the emotion. The therapist should guide and
help the child through each step of this play intervention taking advan-
tage of opportunities to help the child gain information about emotions.

Rationale

This play therapy technique helps children and adolescents work on iden-
tifying emotions, understanding and expressing emotions, and recognizing
emotions in others. Children also work on fine motor skills and social safety
related issues. Children and adolescents can create a whole deck of different
feelings and reasons why someone would feel the emotions. Children can
also be continually adding to their deck; when a child identifies a new feel-
ing, they can create a new card and add it to their card deck. These cards
should be created and sent home with the child. The child can use the card
deck to reference emotions they might identify in themselves, or emotions
identified in other people. Parents can also be taught to create new cards at
home with their child.

Feelings Paint Swatch Key Ring

Therapy Needs: Emotion identification and expression, regulation, and anx-

iety reduction
Level: Child and adolescent
Materials: Paint chips (­swatch), hole punch, markers, and a key ring
Modality: Individual, family, and group

Introduction

Autistic and neurodivergent children may struggle to communicate to others

what they are feeling, especially when they are very dysregulated. This inter-
vention provides children and adolescents with an aid they can use to help
 Emotion Identification and Expression Interventions 351

communicate what they are feeling and gives adults a better understanding
of what is happening with the child.

Instructions

1 The therapist explains to the child that they are going to use paint sam-
ple swatches to make a feelings swatch key ring.
2 The therapist gives the child several paint chip samples that have been
cut into smaller sizes.
3 There should be a variety of colors available for the child to choose from.
4 The child thinks of different feelings they experience sometimes and
chooses a different paint chip color to go with each feeling.
5 The child writes the feelings on the paint chips.
6 Once all the paint chips are completed, the child uses a hole punch on
each chip and then places the chips on a key ring.
7 The child has created a feelings swatch key ring that they can carry
around and use to show others what they are feeling.
8 Once the feelings swatch key ring is complete, the therapist and child
review each feeling together and talk about times the child has felt each
feeling.
9 The therapist and child can also practice scenarios where the child might
use their key ring.
10 It is recommended to begin with 8­ –​­10 feelings. More feelings can be
added at any time. The therapist will want to make sure that feelings the
child typically struggles with are included on the key ring.

Rationale

This play therapy technique helps work on identifying emotions, emotion

expression, communicating feelings, and regulation. This play technique
represents an accommodation aid that the child can use at home or school
to help communicate to others what they are feeling. The child can add
feelings any time. When creating the feelings swatch key ring, it will likely
be necessary for the therapist to add some feelings that the child leaves out.
It is important to make sure that feelings the child often has are represented
on the swatch. Parents are taught about the swatch key ring and instructed
to encourage their child to use the swatch. Parents can also help the child
add feelings to the swatch key ring. F­ igure 15.4 provides an example of a
completed Feelings Paint Swatch Key Ring.
352 Emotion Identification and Expression Interventions

­Figure 15.4 Feelings Paint Swatch Key Ring Example.

Feeling Face Cards

Therapy Needs: Emotion identification and expressions, regulation, social

navigation, and connection
Level: Child and adolescent
Materials: Deck of feeling face cards
Modality: Individual, family, and group

Introduction

Using a deck of feeling face cards (­which can be purchased from several
education and therapy stores), the therapist and child will play various pop-
ular card games with an emotion focus twist. Example games might include
Feelings Go Fish, Feelings Memory, or Feelings Bingo.
 Emotion Identification and Expression Interventions 353

Instructions

1 Feelings Bingo is played by separating all the feeling matching cards into
two piles. From one pile, lay two rows of five cards face up so each player
has two rows of five cards (­this creates the bingo card showing the feeling
faces the player is trying to match). Take the remaining cards and shuffle
them in with the other pile. Place the pile down between the players,
each player draws a card and tries to find a match. All the matches must
be drawn for someone to win. Each time there is a match, that person has
to share the definition of the feeling.
2 In Feelings Go Fish and Feelings Memory, each time a match is found,
the person has to share a time that they have felt that way.
3 All three of these games can have multiple variations and multiple games
can be created with a deck of feeling face cards.
4 The therapist may also develop several ways to add an emotion focus to
other popular card games.
5 The Feelings Playing Cards by Jim Borgman contain instructions for sev-
eral popular card games that can be adapted to address emotion identifi-
cation and expression elements.

Rationale

Feeling Face Cards play intervention can potentially address any emotion
expression or regulation need depending on the variation of the games. The
therapist will want to consider the age of the child when selecting a card
game. Parents can easily be taught the games and are encouraged to purchase
a deck of feeling face cards and periodically play the card games with their
child. This play intervention provides an opportunity for the whole family to
participate. Several different games can be played and repeated.

Perspective Puppets

Therapy Needs: Emotion identification and expression, regulation, executive

functioning, and social navigation
Level: Child
Materials: Puppets
Modality: Individual
354 Emotion Identification and Expression Interventions

Introduction

This play therapy intervention works on helping children learn about how
their feelings can be different from someone else’s f­eelings – ​­understanding
that others can have beliefs, desires, and thoughts that are different from
our own. Children sometimes need help with perspective taking and how to
manage differences.

Instructions

1 The therapist explains to the child that they will be using puppets
(­miniature people or animals could also be used) to talk about how peo-
ple have different opinions and can feel differently about the same thing.
2 The therapist chooses three puppets (­people puppets are preferable) and
creates a simple story.
3 Each puppet has a different thought and/­or feeling about the same thing.
For example, each puppet tastes an apple pie; one puppet loves it; one
puppet hates it; and one puppet says the pie is okay.
4 Then the puppets taste a different kind of pie such as a chocolate, and
again, each one expresses a different thought and feeling about liking or
disliking the pie.
5 This type of story should be presented three to four times.
6 The therapist should then try to get the child to participate in the story
by pretending to taste a pie and giving their thoughts and feelings.
7 If the child is successfully engaging, then the therapist should try to get
the child to create a similar puppet story, or the therapist and child can
create one together.
8 The therapist can practice this intervention several times implementing
several different stories all with the same theme of each puppet having a
different perspective.

Rationale

This play therapy technique works primarily on helping children understand

others can have a different feeling or thought about something and this is
okay. When a child can understand that other people can have different
thoughts and feelings from themselves, it aids in social relationships and bet-
ter awareness of emotions. The story can be about anything, as long as each
puppet expresses a different thought and feeling. The puppet story should be
 Emotion Identification and Expression Interventions 355

animated and fun and the therapist should look for opportunities to get the
child involved in the story and practicing taking different perspectives.

My Emotions Cards

Therapy Needs: Emotion identification and expression, and regulation

Level: Child and adolescent
Materials: Blank deck of cards, and markers
Modality: Individual

Introduction

My Emotion Cards provides the opportunity for children and adolescents to

create their own feelings card deck. The finished card deck can be used to
play several games that help the child identify and share emotions. The ther-
apist can work with the child and the parents to establish several games that
can be played with the card deck.

Instructions

1 The therapist explains to the child that they are going to create their
own card deck that focuses on feelings.
2 Using a blank deck of cards (­which can be purchased at most educa-
tional supply stores), the child is instructed to draw feeling faces on the
cards and write the feeling word on the card as well.
3 The child should make two of each feeling card so there is a matching
card.
4 The therapist may have to help the child with writing and spelling and
even identifying several feelings.
5 The therapist can also provide a feeling chart for the child to look at.
6 The child should try to create as many feeling faces cards as they can
think of and draw the faces as best as they can. The child can decorate
the cards any way they like.
7 It is also appropriate for the therapist to make some cards and add them
to the child’s deck, especially if they are emotions that the therapist
knows that the child needs help with.
356 Emotion Identification and Expression Interventions

8 After the child has finished the card deck, the therapist and child play
some feeling card games together. Some examples would include Feel-
ings Go Fish and Feeling Matching. The therapist and child should try
to think of other games that they could play with the feelings card deck,
maybe even creating a new game.

Rationale

This play therapy technique can potentially address any emotional regula-
tion need depending on the variation of the games. The child can take the
card deck home and play games with their parents. Several different games
can be played, and the games can be played repeatedly. The child will likely
not use all the blank cards, so they can take them home and add to the card
deck as they discover new feelings. The therapist will likely have to share
card game ideas with the parents and encourage them to think of new games
to play.
 16
Connection (­Relationship
Development) Interventions

Connecting and Engaging

Autistic and neurodivergent children and adolescents possess a sense of

connection, engagement, and desire for relationship development. Many
children would likely do poorly if they were suddenly removed from their car-
egivers and those important to them. A great myth has existed that autistic
and neurodivergent children do not form relationships, connect with others,
or care about these processes. This could not be further from the truth. These
children, like all children, have a desire, longing, and an importance regard-
ing relationship development. Many autistic and neurodivergent children
are misunderstood and neurotypical individuals often do not recognize the
relationship development processes of neurodivergent children.
Neurodivergent children (­like all children) may have difficulty displaying
and expressing connection in meaningful ways and they may have a dif-
ficult time expressing connection in a neurotypical socially constructed
“­acceptable” way. Also, it is possible that other needs (­issues) are interfering
with the child being able to engage in relationship in the ways they would
like. This might include social anxiety issues, trauma responses, sensory
challenges, etc. Therapy goals for addressing connection and relationship
development may mean addressing the issues that are creating blocks to the
natural experience of relationship and connection.
Connection and relationship development cannot be considered without a
focus on the ­parent–​­
child relationship. This is the beginning and essence of the development of
these constructs. What is happening between child and parent cannot be
undervalued. Parent and child need to feel connection between themselves
as the child utilizes the healthy ­parent–​­child connection to reach out and

DOI: 10.4324/9781003207610-17
358 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

explore connection in other ways with other people. Often neurodivergent

children establish closeness with others in which they feel safe. In this rela-
tionship, they will seek support from adults with whom they are comfortable
and show enjoyment in their close relationships. In AutPlay Therapy con-
nection related goals may be established more for the parent than the child.
It may be that the parent needs help with connection and relationship work,
and the parent and child will participate in the AutPlay family play therapy
process together with this therapy goal in mind.
The connection and relationship development play interventions in this
chapter are designed to increase connection between child and caregiver,
increase relationship development between child and other significant re-
lationships, teach children and adolescents how to be more successful in
achieving their connection and relationship development goals, and provide
a fun, natural, playful atmosphere for children and adolescents to explore,
heal, and grow regarding relationship and connection needs.
The connection and relationship development play interventions in this
chapter range from simple to more complex by design. Therapists should
be mindful of the age of the child they are working with and choose in-
terventions that are most appropriate. Therapists should also be mindful of
the parent/­child relationship and the parents own mental health needs. The
therapist would not want to engage or entrust the parent to be a safe and re-
liable partner in the process if the parent is not in a healthy space to produce
this type of attunement with their child. Forcing a child or parent to partic-
ipate in a connection based play intervention in which they are uncomfort-
able with, or that is beyond their current relationship processes, will likely
result in a myriad of poor outcomes. It may also result in the parent and child
becoming resistant to participating in future connection based interventions
and/­or therapy in general.
It must be understood that autistic and neurodivergent children univer-
sally have a desire for greater connection with others and a longing to have
deeper relationship experiences at least to a level that they feel comfortable
with. Consequently, children dealing with these issues are not experienc-
ing the level of connection and relationship which they desire and seem
to struggle with how to attain the level of connection they would like to
have. Through consistent and mindful introduction and implementation of
play therapy interventions designed to increase a child’s opportunities for
creating and maintaining meaningful connection and relationships at their
desired comfort level, children can feel fulfilled and content in this area of
their lives.
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 359

It is likely that each child and adolescent will present with different goals/­
needs in terms of how much connection they develop, what level of rela-
tionship each child and adolescent is seeking, and what they are comfortable
with. It is not necessary for every person, neurotypical or neurodivergent, to
possess the same desire and level in relationship development. There is some
subjectivity that should be implemented in determining what level of con-
nection each child and adolescent may need and what level they may want
to achieve in terms of greater connection and relationship development with
others.
AutPlay Therapy connection focused play interventions provide for struc-
tured, or directive play therapy techniques that the parent and child can do
together that helps foster relationship development and connection. Par-
ents can complete the AutPlay Connection Inventory during the Intake and
Assessment Phase to better identify any connection related needs. These
play techniques are designed to be fun and connecting for both the par-
ent and child. It is important to note that there is connection (­relationship
development) work happening throughout the AutPlay Therapy protocol.
Relationship development is considered a core change agent and is imple-
mented, and role modeled by the therapist from the beginning of therapy
to the end. Regardless of the therapy goals and/­or the specific focus of play
approach or intervention, relationship development and connection are
happening.

Make My Moves

Therapy Needs: Connection (­relationship development), sensory processing,

social engagement, and anxiety reduction
Level: Child
Materials: None
Modality: Individual, family, and group

Introduction

Make My Moves is a ­movement-​­based play intervention. It is designed to

help increase awareness of another person, increase connection with others,
improve relaxation ability (­anxiety reduction), turn taking, work on sen-
sory related issues (­specifically vestibular and proprioceptive), and help with
360 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

regulation. This intervention is simple yet fun and engaging and can incor-
porate many different elements. It can also be played repeatedly and easily
taught to others.

Instructions

1 The therapist explains to the child that they will be playing a game
where they have to follow each other’s movements.
2 The child and therapist stand facing each other. One person is desig-
nated the leader. The leader makes various movements such as moving
arms up and down, moving legs, moving head back and forth, and mov-
ing around the room in various ways.
3 The follower must mimic or follow the moves that the leader is doing.
The follower should try to observe closely what the leader is doing and
do the same thing, If the leader is moving around the room, the follower
should move around the room in the same pattern.
4 Whoever begins as the leader, should lead for a few minutes, and then
switch the leader. The therapist and child can continue to switch back
and forth in the leader role until the game is over.
5 The moves can vary in complexity and in speed (­slow down and speed
up). For decreasing anxiety and helping the child to regulate, the ther-
apist should incorporate ­mid-​­line crossing ­moves – ​­moves that activate
the whole brain and cross the right and left hemispheres. Several ­mid-​
­line crossing moves can be found in the book Brain Gym by Paul and
Gail Dennison.
6 The child and therapist continue to play the game until the child is no
longer interested.

Rationale

This play therapy intervention is designed to work on connection and rela-

tionship development. It also has additional social and regulation benefits
such as turn taking, following another’s’ lead, whole body movement, and
midline crossing moves. The technique can be played individually with the
child or including the parent with each person rotating roles as the leader.
The therapist will likely want to begin with slow and simple movements
and progress as the child gets used to the technique. The therapist should
be mindful of the child’s comfort level and any possible physical challenges.
This intervention works best with children who enjoy movement play and
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 361

is facilitated in a space that is large enough for engaging movement around

the room.

Where Am I Going?

Therapy Needs: Connection (­relationship development), social engagement,

and executive functioning skills.
Level: Child
Materials: None
Modality: Individual, and group

Introduction

This play intervention involves moving around a room. There will need to
be enough space so the child and therapist can easily navigate around a room
in different directions. This intervention helps children address and work on
developing connection, social engagement, discernment, focus, and calcula-
tions in a fun and engaging manner. It also involves turn taking and can be
easy modified for younger or older children.

Instructions

1 The therapist explains to the child that they will be playing a game that
involves moving around the room.
2 The therapist and child hold hands and stand facing each other.
3 One person is designated the leader (­ideally the therapist would be the
leader first to help model how the game is played).
4 The therapist explains that no words will be spoken, and the leader will
move around the room in different directions (­forward, backward, left,
and right) and the follower must follow the leader and maintain holding
hands.
5 The child and therapist will create signals to indicate which direction
the leader will be moving. For example, a squeeze of the right hand for
moving to the right, a squeeze of the left hand for moving to the left,
stomping the right foot to move forward, and stomping the left foot to
move backward. Both players will have to remember what each signal
362 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

means or they may get their “­signals crossed!” This can be challenging
for executive functioning processing as the leaders forward would be the
followers backward and vice versa.
6 After about five minutes of play, the roles can be switched, and the child
can become the leader.
7 The child and therapist can play the game repeatedly switching back and
forth in the leader role until the child is no longer interested in playing.

Rationale

This play therapy technique can help children feel more comfortable in con-
nection and relationship development with others. It can also help improve
executive functioning skills and confidence in social engagement. The game is
often fun and silly as someone usually forgets a signal and the two players may
be moving in opposite directions. If someone forgets or gets the signals crossed.
It should be laughed off and the game restarted. The therapist should start as
leader and begin with simple and slow moves, giving the child plenty of time
to process the signal. The speed and complexity can increase as the child gets
used to the technique. The therapist should be mindful of any frustration from
the child and aware of any motor or physical movement issues. The therapist
may need to remind the child what the signals mean and to continue to hold
hands. Parents can be taught the intervention and instructed to play at home
with their child. This intervention can also be implanted in a group format.

Body Part Bubble Pop

Therapy Needs: Connection (­relationship development), social engagement,

anxiety reduction, and regulation
Level: Child
Materials: Bubbles
Modality: Individual

Introduction

Body Part Bubble Pop utilizes bubbles in a simple, playful game. Many children
enjoy bubble play and find bubble blowing and popping regulating. This play
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 363

technique helps address connection and relationship development needs. It

also provides a level of social engagement and interaction and can help re-
duce anxiety and serve as a regulation intervention. This intervention might
be especially beneficial for children with higher needs or children who do
not do well attuning to another person or following structured interventions.

Instructions

1 The therapist explains to the child that they will be playing a game to-
gether using bubbles.
2 The therapist instructs to the child that they will start blowing bubbles
and the child has to try to pop the bubbles before the bubbles hit the
ground.
3 After a few minutes of play, the therapist tells the child that they must
try to pop all the bubbles before they hit the ground using a specific body
part. For example, the therapist might instruct the child that they must
try to pop the bubbles using their thumbs only.
4 After a few minutes of popping the bubbles this way, the therapist might
instruct the child that they will switch and now try to pop the bubbles
using only their elbows.
5 This continues for several rounds. Other body part examples include fin-
gers, ear, nose, feet, shoulders, knees, head, and butt (­a favorite of many
children).
6 The child and therapist can also switch roles with the therapist popping
the bubbles however the child decides.
7 Play should continue with the child and therapist switching roles period-
ically until the child is no longer interested in playing the game.

Rationale

Body Part Bubble Pop helps children increase comfort in connecting with
others and increasing relationship development. It also helps address attune-
ment and social engagement (­in a fun and anxiety reducing manner) with
another person. An added (­advanced) element to this technique would be
to have the child say positive things about themselves or a family member
while they are trying to pop all the bubbles. This advanced element would
help with whole brain activation, regulation, and executive functioning
skills. This play intervention should start very basic with simply blowing the
bubbles and having the child pop them, as the child is capable, more specific
364 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

instructions can be added. This play technique can easily be taught to par-
ents and parents can play the intervention with their child at home. The
therapist should be mindful of space and make sure there is enough space to
move without running into something. The therapist should also be mindful
of any physical limitations the child may have.

Family Name

Therapy Needs: Connection (­relationship development), assessment, and

family issues
Level: Child and adolescent
Materials: Paper, markers, art decorations, and glue
Modality: Individual, and family

Introduction

This play therapy intervention provides the opportunity to connect with and
learn more about the child and their family. It also gives the child and parent
(­if they are participating) practice thinking about, understanding, and ex-
pressing connection with their family members. This technique can provide
a positive interaction between parent and child if therapy goals include ad-
dressing parent/­child strained relationship. This is an expressive activity; the
child can be as creative as they like or as simple as they like in their creation.
The therapist may assist the child if needed. F­ igure 16.1 shows a completed
example of the Family Name activity.

Instructions

1 The therapist explains to the child that they will be creating an art pro-
ject that describes the child’s family.
2 The child draws the child’s last name in bubble letters on a piece of paper
(­for younger children or children with higher support needs, the thera-
pist will likely assist the child in drawing their last name). If the parent
is participating, they can create their own family name or the child and
parent can work on one together.
3 The child’s last name is then decorated by the child with things that
remind the child of their family.
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 365

4 Once the child is finished, the therapist processes with the child what
they created and how it reminds them of their family.
5 The child takes the finished name home and keeps it in their room or
hangs it up somewhere in the home. If the parent does not participate in
the play intervention, the child is encouraged to share what they made
with their parent.
6 This can also be done as a family play therapy intervention with the
whole family participating. Each family member can create their own
and then share with each other or they can all work together to create
one.

Rationale

Family Name works on connection and relationship development specifically

with parents and other family members. It can also serve as an assessment play
therapy intervention providing information for the therapist about the child’s
family and the child’s relationship with their family. It is designed to help the
child think about their family and create something that shows the child’s
feelings of connection with their family. It also has the potential to reveal
strain or relationship needs in the family. The child will be creating something
that is a concrete representation of a connection with their family which can
be positive for other family members to see. The therapist can process with the
child helping them express positive emotions and/­or unmet needs or concerns.
­Figure 16.1 provides an example of a completed Family Name.

Construction Paper Decoration

Therapy Needs: Connection (­relationship development)

Level: Child and adolescents
Materials: Construction paper, string, art decorations, scissors, and glue
Modality: Individual, family, and group

Introduction

Construction Paper Decoration helps the therapist increase connection and

relationship development with the child. It also helps children feel more
366 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

­Figure 16.1 Family Name Example.

comfortable and less anxious in interacting with others. The child and the
therapist participate in a constructive and expressive play intervention de-
signed to focus on thinking about another person and doing something nice
for that person. It also presents the opportunity to work on fine motor and
executive functioning skills.

Instructions

1 The therapist explains to the child that they will be creating things for
each other out of construction paper and other materials.
2 Construction paper, string, aluminum foil, or any other appropriate ma-
terials can be used in this intervention.
3 The child and therapist make items out of the chosen materials to give
to the other person. The items are decorative items the other person can
wear such as rings, hats, necklaces, bracelets, glasses, crowns, ties, belts,
pins, etc.
4 Once an object has been made, the person who made it physically places
it on the other person as a gift.
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 367

5 The child and therapist can make several things for each other and com-
pletely decorate the other person.
6 The play intervention continues until the child and therapist have fin-
ished making everything they want to create for the other person.
7 It is recommended to have a mirror present so the child can see them-
selves wearing the different items the therapist has placed on them.

Rationale

This play therapy technique provides an opportunity to work on connec-

tion and relationship development with the child. It involves components
of thinking about another person, attuning to that person, and doing some-
thing nice for another person. It is important that the process be recip-
rocal; the therapist should make items and physically place them on the
child, and the child should make items and physically place them on the
therapist. If the child is uncomfortable with the therapist physically plac-
ing the items on the child, the therapist can hand the items to the child.
This play technique can also be taught to parents to complete with their
child at home. It can also be implemented by the therapist as a family play
intervention.

All Around Me

Therapy Needs: Connection (­relationship development), assessment, and

family issues
Level: Child and adolescent
Materials: Miniatures
Modality: Individual

Introduction

All Around Me is designed to help increase connection and relationship de-

velopment and help children think about and express positive sentiment
about their family members. It also serves as an assessment intervention that
helps the therapist learn more about the child and the child’s family mem-
bers and relationships. There is a symbolic component in this intervention
368 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

where the child is asked to select miniatures to represent each person in

their family. It is important to note that some children may struggle with
symbolism. The therapist should try to be aware of this before implementing
this intervention.

Instructions

1 The therapist explains to the child that they are going to play a game
using miniatures.
2 The child picks a miniature to represent each person in their family.
3 The child sits on the floor and places the miniatures around themselves,
so the miniatures are surrounding the child with each miniature facing
the child.
4 The child then turns and faces each miniature one at a time and tells the
therapist who the miniature represents and tells the therapist something
positive about that family member. If the child cannot think of anything
positive, they can say anything they like about the family member.
5 The therapist can also ask questions about each family member trying to
help the child expand on talking about each family member.
6 The play intervention ends once the child has discussed each family
member.

Rationale

This play technique works on connection and relationship development

specifically in regard to family relationships. It is important that the thera-
pist listen to the child and provide the child space to share whatever they
want about each of their family members. The therapist can also ask ques-
tions about each family member as the child is sharing about that particu-
lar family member. Many children will likely not share much information
about their family members, so the therapist can look for opportunities to
ask questions. This play technique can be repeated several times in several
different sessions with the therapist. Parents can participate in this play
technique with their child in session but are not expected to complete the
intervention at home. Most parents will not have a miniature collection
to be able to conduct this technique at home. One variation that parents
could do at home is to have the child draw something to represent each
person in their family.
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 369

Guess Touches

Therapy Needs: Connection (­

relationship development) and sensory
processing
Level: Child
Materials: Several tactile objects
Modality: Individual

Introduction

This play therapy intervention works on improving connection and rela-

tionship development and addresses sensory processing needs. Guess Touches
works on helping children become more comfortable with connection
through physical touch. It also addresses sensory processing issues related to
touch (­tactile) needs. Therapists should fully explain this play intervention
to the child before beginning, especially to confirm that the child is com-
fortable with closing their eyes and experiencing touch/­tactile sensation. It
is essential to acquire the child’s consent before implementing any interven-
tion that includes touch. The therapist should explain and demonstrate on
themselves so the child understands what will be happening.

Instructions

1 The therapist explains to the child that they will be playing a game using
several different items and touching them to each other’s skin.
2 The therapist displays all of the objects that may be used (­typically
around ten objects). The child should look at the objects and touch
each one to see how it feels. The therapist should ask the child which of
the objects feels the best (­most satisfying).
3 The therapist instructs the child to close their eyes and the therapist is
going to touch some part of the child’s skin with one of the objects. This
is done very quickly, and the therapist should touch the child on an arm,
nose, ear, etc. nothing that would be too invasive or personal.
4 The therapist will then tell the child to open their eyes and the child has
to tell the therapist which object was used and where the object touched
them on the skin.
370 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

5 The therapist will go through approximately ­5–​­6 objects. Once the ther-
apist has used the objects, the child and therapist can switch roles. They
can keep playing the game switching back and forth until the child is no
longer interested.
6 Some examples of objects that can be used include a feather, a cotton
ball, a Kleenex, a piece of material, ribbon, sandpaper, buttons, a pipe
cleaner, a paint brush, a stuffed animal, a LEGO, etc.

Rationale

This play therapy technique focuses on connection and relationship devel-

opment and sensory needs, especially in regard to becoming comfortable
with touch sensation. This play technique can be played repeatedly with
new objects being selected. The therapist should try to think of as many ob-
jects as they can to use in the game (­the more variety, the more interesting
the game will be). If the child is not comfortable with the game concept or
becomes uncomfortable at any point, the therapist should not continue with
the intervention. The play technique can be taught to parents and parents
can play the technique at home with their child. Whether in session with
the therapist or at home with parents, it is important to be sensitive to the
sensory comfort level of the child with implementing this intervention.

Here Comes the Candy

Therapy Needs: Connection (­relationship development), social engagement,

and anxiety reduction
Level: Child
Materials: Candy
Modality: Individual, and group

Introduction

Here Comes the Candy works on connection and relationship development

as well as sensory processing issues especially related to helping children be-
come more aware of themselves, the space around them, and others. Candy is
used as a guide for completing sensory based (­proprioceptive and vestibular)
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 371

activities. The therapist should make sure the child eats candy and discover
some favorite candies. The therapist should also make sure the child is not
on any special restriction or diet. If the child does not eat candy, then many
things can be substituted such as stickers or small toys as long as it is some-
thing the child enjoys.

Instructions

1 The therapist explains to the child that they will be playing several
games and the child will have a chance to receive a piece of candy as
each activity is finished.
2 The therapist should pick one of the child’s favorite candies, such as
M&Ms (­it is best to use a candy that has multiple pieces).
3 The therapist will explain they are going to do various activities and at
the end of each activity the child will get a piece of candy.
4 Activities are short and focused on connecting with another person and
addressing sensory related needs.
5 The therapist introduces an activity and explains how it is done. The
therapist and child both complete the activity and then the child re-
ceives a piece of candy. The therapist then introduces the next activ-
ity. The therapist will want several activities to compete, approximately
­10–​­12.

Rationale

This technique works on connection, relationship development, body aware-

ness, and vestibular and proprioceptive sensory processing. The child and
therapist are connecting in a playful way through the activities. The child
is also working on proprioceptive and vestibular sensory processing needs
though the activities which are selected for this purpose. Candy is used but
an alternative can also be implemented. If candy is used, it is important to
select a candy such as M&Ms or Skittles, so one piece can be given after
each activity. Some of the activities will go quickly. The therapist can also
repeat activities if it is something the child enjoys. The play technique can
be taught to parents to do at home.
Example Activities for Here Comes the Candy

• Spin around in a circle

• Give yourself a tight hug
372 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

• Do some jumping jacks

• Act like you are flying around the room
• Make your body into your favorite animal
• Hold hands and spin around the room
• Play patty cake
• Skip around the room
• Roll yourself in to a ball
• Hit a balloon back and forth
• Do some wall roles
• Hop around the room
• Bend down and touch your toes
• Balance on one foot
• Play the hand stack game
• Dance together

Hats and Masks

Therapy Needs: Connection (­

relationship development) and social
engagement
Level: Child
Materials: Various hats and masks
Modality: Individual

Introduction

Hats and Masks is a fun and interactive play therapy intervention for children
that can be easily implemented for autistic and neurodivergent children. It
includes a reciprocal element that helps children improve relationship and
connection with others. It also involves paying attention to others and hav-
ing fun together. The implementation is typically n ­ on-​­invasive, and chil-
dren respond positively.

Instructions

1 The therapist explains to the child they are going to play a game using
several different hats and masks.
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 373

2 This play intervention is usually done in a play therapy room but can
be implemented in any setting if the therapist provides several hats and
masks and has access to a mirror.
3 The therapist presents several different hats and masks to choose from
and the therapist and child take turns placing different hats and masks
on each other (­creating a “­look” for each other) and then looking in a
mirror to see how they look.
4 The therapist and child each choose the hat and mask they want the
other person to wear and place that hat and mask on the other person. It
is important that each person put the hat and mask on the other person,
this process works on improving connection.
5 It is also important to have a mirror close by so when the hats and masks
are put on, the child can see themselves.
6 The child and therapist can play this intervention several times choos-
ing several different hat and mask combinations for each other.
7 The play technique can be expanded by seeing what other objects in the
playroom can be turned into hats or masks and/­or using other dress up
items.

Rationale

This play therapy technique works primarily on connection and relation-

ship development, especially in the areas of attuning to another person and
interacting with others. It is important that the intervention is reciprocal;
the therapist should place hats and masks on the child, and the child should
place hats and masks on the therapist. This provides opportunity for the
child to pay attention and be aware of others. It also provides opportunity
for both child and therapist to join together in the fun and silliness of the
intervention. The play technique can be taught to parents and parents are
instructed to play the technique with their child at home several times
throughout the week. If parents do not have a hat/­mask collection, they can
vary the intervention using other objects around the house that could be
used as hats or masks.

Tell Me About Your Family

Therapy Needs: Connection (­relationship development) and assessment

Level: Child and adolescent
374 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

Materials: Sand tray, and miniatures

Modality: Individual

Introduction

Autistic and neurodivergent children and adolescents may have a difficult

time connecting with others even in their family relationships. Tell Me About
your Family works on increasing positive expression and connection with a
child’s family members. The therapist should be aware of the symbolism in-
volved in this intervention (­miniatures are chosen by the child to represent
members of their family) and the sensory element of the sand (­sand trays
are typically used) and make sure the child is comfortable with both before
beginning.

Instructions

1 The therapist explains to the child that they will be completing an ac-
tivity using a sand tray and miniatures.
2 The therapist should make sure the child is comfortable working in the
sand. The child may not like the sand, have a sensory issue, or may have
an allergy. If the sand will not work, an alternative tray can be used such
as beans, rice, or confetti. It is also possible to simply use the miniatures
and no trays.
3 The therapist instructs the child to select a miniature to represent each
person in their family and place the miniatures in the sand tray (­wherever
and however they want to place them in the sand tray).
4 After the child is finished, the therapist asks the child to share who each
miniature represents and tell something about that family member.
5 The therapist can also ask questions about the family members.
6 The therapist may have to help the child choose miniatures and help the
child talk about their family members. If a child is having trouble select-
ing miniatures, then the therapist could ask questions such as “­What does
your mom like to do?” or “­Does your brother like computers?” The thera-
pist could help the child select a miniature based on the child’s answer.
7 After the child has finished the sand tray and the sand tray has been
discussed, the therapist can take a picture (­with the child’s permission)
of the sand tray and the child can take the picture home and share the
picture with their family.
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 375

Rationale

This play therapy technique works on connection and relationship develop-

ment especially related to family relationships. It also serves as an assessment
intervention providing opportunity for the therapist to learn more about the
child and their family. The play technique can be done several times in sev-
eral different sessions with the therapist (­the child may have new things to
share each time). It is unlikely that this play intervention will be taught to
parents and implemented at home, as most parents will not have a sand tray
or a collection of miniatures. The child is able to take a picture home and
can share the picture with their family.

Write and Move

Therapy Needs: Connection (­relationship development), regulation, and

sensory processing
Level: Child and adolescent
Materials: Paper, and markers
Modality: Individual

Introduction

Write and Move is a play therapy intervention that incorporates sensory pro-
cessing with relationship development. This play intervention is designed to
work on physical connection between the child and another person as well
as potentially address one or more of the eight sensory processing areas: sight,
smell, taste, hearing, touch, vestibular, proprioceptive, and interoceptive.

Instructions

1 The therapist explains to the child that they will be creating and acting
out a poem together.
2 The poem will focus on the eight sensory areas. The therapist may begin
by briefly explaining the eight sensory processing areas.
3 The therapist and child work together to create an eight line poem.
4 Each line represents a different sensory area.
376 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

5 The therapist and child write the poem and create a movement to go
with each line of the poem.
6 The movements should try to connect the child and therapist physically.
7 After the poem has been written and the movements have been decided,
the therapist and child will read the poem and act out the movements
together.

The poem should follow the following script:

I see… I hear… I smell… I taste… I feel… I Move… I Also Move…
My body…

Rationale

This play therapy technique works on connection and relationship develop-

ment by having the child work with the therapist in creating a poem and
movements. This play technique also works on regulation and sensory pro-
cessing needs in one or all of the eight sensory areas. It can be easily taught to
parents to complete at home. The parent and child can be encouraged to cre-
ate several different sensory poems at home and during the next session, show
the therapist some they have created. It is important that the movements that
are created be sensitive to what the child can do physically. Ideally the move-
ments would connect the child with the therapist and/­or parent. If this level
of contact is not comfortable for the child and/­or a physically connecting
movement cannot be thought of, the movement can be anything the child
and therapist do at the same time. This play intervention involves a level of
physical touch. The therapist will want to make sure the child is comfortable
with the physical touch (­demonstrate) before implementing the intervention.

Sample Poem with Movement Idea

I see the light through these glasses (­put glasses on each other and look at
the light together)
I hear the drum (­one person holds the drum, the other person beats the drum)
I smell the essential oil spray (­one person sprays in the air and they both hop
up in the air to smell it)
I taste this piece of candy (­each person hands the other person a piece of
candy to eat)
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 377

I feel this flow ring (­the two people holds hands and let a flow ring move up
and down their arms)
I Move around with other people (­both people holds hands and spin around
the room)
I Also Move up and down (­each person bends down to touch their toes and
comes back up and gives each other a high five)
My body feels a lot of ways (­each person takes a turn giving the other person
a hand massage)

You, Me, and LEGO

Therapy Needs: Connection (­relationship development) and social navigation

Level: Child and adolescent
Materials: Several LEGO bricks (­regular or Duplo depending on the age of
the child). Off brand of bricks can also be used.
Modality: Individual, and group

Introduction

Many autistic and neurodivergent children and adolescents respond posi-

tively to playing with LEGO bricks. This play therapy intervention incorpo-
rates brick play (­a form of constructive play) and provides the opportunity
for children to focus on their family members and practice working with
another person to complete a task.

Instructions

1 The therapist explains to the child that they will be completing an ac-
tivity that involves working with LEGO bricks.
2 The therapist and child begin by each one building something out of the
bricks.
3 The therapist instructs the child that they can build anything they want
but whatever they build, it has to be something that would be in a family.
4 The therapist also builds something that would be in a family.
378 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

5 Once the therapist and child are finished, each one should share what
they built and how it can be found in a family.
6 The therapist then instructs the child that they must work together and
combine what each one has created and make one object
7 The new combined object also must be something that would be found
in a family.
8 More bricks can be added in the joining together phase, and after the
therapist and child are finished, each one can talk about what they made
together and discuss the process of working together to create something.

Rationale

You, Me, and LEGO works on connection, relationship development, and

social navigation related to cooperation and working with others to com-
plete a task. The therapist should have a significant LEGO brick supply
available to complete this play therapy technique and the therapist may
want to limit the individual creation time to ­10–​­15 minutes. It is important
that the therapist and child work together to combine their creations. The
therapist should not do all the work, nor should the therapist let the child
do all the work; it should be a collaborative approach. The therapist should
spend some time talking to the child about what it feels like to work with
someone else and have someone else share and implement their own ideas.
The therapist might ask the child about how they felt when they had to work
with others to accomplish something.

Family Bubbles

Therapy Needs: Connection (­relationship development) and social navigation

Level: Child and adolescent
Materials: None
Modality: Family, and group

Introduction

Children and adolescents and their family members may need to work on
better relationship connection and developing positive interactions. Family
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 379

Bubbles is a play intervention that works on increasing relationship develop-

ment. In addition, there are some social navigation elements which include
having the family participate together in a playful and interacting game.

Instructions

1 The therapist explains to the family that they will be playing a game
together to work on connection.
2 The therapist explains that the family members are going to pair up and
hold both hands with their partner. For example, if there were six family
members, there would be three pairs.
3 The therapist will ask the family members to begin walking around the
room while holding hands with their partner.
4 The pair cannot touch any other family pair, if they do touch another
family pair then they both “­pop” and they have to sit out until only one
or no family pair remains.
5 The therapist should periodically change the instructions for the family
pairs such as instructing them to hop around the room, skip around the
room, walk in slow motion around the room, or move quickly around the
room.
6 This intervention works best when there are enough family members to
for at least three pairs. The therapist can also participate if needed (­if
there is an odd number of family members).
7 If there is only a couple of family pairs, the therapist can participate by
moving around and trying to run into the pairs while the pairs work to-
gether to try and avoid the therapist.

Rationale

This play therapy intervention works on improving connection and relation-

ship development as well as social navigation awareness related to working
with another person and joint attention. It is designed as a family inter-
vention but can also be used in groups, especially social/­relational focused
groups. The therapist will want to make the play intervention fun and posi-
tive and focus on the experience not a competition to see who can win. The
intervention can be played repeatedly with the pairs switching to another
family member so the child experiences being in a pair with each of their
family members. Parents can implement this game at home with their family
and play periodically between sessions.
380 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

Hula Hoop Exchange

Therapy Needs: Connection (­relationship development), social awareness,

and sensory processing
Level: Child and adolescent
Materials: Two hula hoops
Modality: Individual, family, and group

Introduction

Autistic and neurodivergent children and adolescents may have needs re-
lated to participating in a reciprocal way with others whether through an
activity, a conversation, or in play. This play therapy intervention addresses
increasing relationship with another person, working with another person
in a reciprocal capacity, and sensory processing in the areas of vestibular and
proprioceptive experience.

Instructions

1 The therapist explains to the child that they will be playing several in-
teractive games using hula hoops.
2 The therapist and child stand about ­4–​­5 feet from each other facing each
other.
3 The therapist and child each hold a hula hoop in their right hands. When
the therapist says “­Go” the therapist and child will roll their hula hoops
to the other person to catch. This goes back and for the several times.
4 Another play intervention involves the therapist and child each holding
a hula hoop on their right hand and when the therapist says “­Go” the
therapist and child will each gently toss their hula hoop to the other
person to catch. This goes back and forth several times.
5 An additional intervention involves the hula hoops being placed on the
floor beside each other.
6 The therapist and child each stand in one of the hula hoops.
7 When the therapist says “­Switch” the therapist and child will jump into
the other persons hula hoop. This goes back and forth several times.
8 The therapist should demonstrate each hula hoop game before imple-
menting with the child. Each hula hoop game can be played several
 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s 381

minutes, and the child can be given an opportunity to think of other

connecting hula hoop games.

Rationale

Hula Hoop Exchange works on increasing relationship connection, social

awareness, and sensory processing in the areas of vestibular and propriocep-
tive. The therapist should be aware of the child’s physical abilities and adjust
each hula hoop game accordingly. The therapist will also want to make sure
that nothing is attempted at a level that could injure the child. This play
therapy intervention can be taught to parents to play at home with their
child. Hula Hoop Exchange can also be implemented in a group format.

Let’s Stick Together

Therapy Needs: Connection (­relationship development), social awareness,

and sensory processing
Level: Child and adolescent
Materials: None
Modality: Family, and group

Introduction

Autistic and neurodivergent children and adolescents may need help in

working on sensory processing issues, body awareness, interactions with oth-
ers, as well as connection skills. Let’s Stick Together is a fun and engaging
play therapy intervention that incorporates movement to work on the above
mentioned needs. It is mainly designed to be implemented in a family set-
ting but is also applicable to group work, especially social/­relational focused
groups.

Instructions

1 The therapist explains to the family that they will be playing a game
together that works on increasing relationship connection.
382 Co n n e c t i o n ( R e l a t i o n s h i p D e v e l o p m e n t ) I n t e r v e n t i o n s

2 The therapist explains that each person in the family will begin by mov-
ing around the room in a certain way that the therapist decides. After a
few minutes the therapist will state a new way to move around the room.
The moving around the room can be things like walk around the room,
skip around the room, hop around the room, walk backward around the
room, act silly as you walk around the room, etc.
3 Each family member moves around the room as instructed and tries to
avoid the other family members.
4 If two people touch in any way then they are now stuck together and
they continue moving around the room together, pretending they are
physically stuck to each other.
5 Once two family members have gotten stuck together, they will purpose-
fully try to catch (­stick to) other family members.
6 Moving around the room in different ways continues until the whole
family (­or group) is stuck together.
7 Once the whole family is stuck together, the therapist can spend a few
minutes having the whole family try to move around the room in differ-
ent ways with them all stuck together. The therapist can also participate
if more people are needed.

Rationale

This play intervention helps children work on strengthening relationship

connection especially with their family members. It also works on social
awareness and sensory processing in the areas of vestibular, proprioceptive,
and tactile (­touch). This game can be played repeatedly with family mem-
bers taking turns deciding what the movements will be. It is important to
keep the intervention fun and noncompetitive. The therapist should em-
phasis that the family focus on being playful and enjoying the game together.
 17
Anxiety Reduction, Sensory
Integration, and Regulation
Interventions

AutPlay Model of Dysregulation

In AutPlay Therapy, regulation is broadly defined and applied to the self.

It is considered the pursuit of a desired system state that provides for emo-
tions, behavior, cognitions, sensory areas, and body movement to be aligned
and manageable when faced with a challenging situation which is creating
a dysregulated reaction. Regulation must be understood in conjunction with
dysregulation, which is defined as a state of being where a person’s system
has become overwhelmed with an inability to organize and navigate their
emotions, sensory areas, behavior, cognitions, and reactions. It is not p­ re-​
­meditated and is usually a very upsetting experience for the individual.
The following presents the AutPlay Therapy model of dysregulation. The
child’s dysregulation can be visualized like water in a glass, the water can
rise (­increase in dysregulation) or decline (­decrease in dysregulation or reg-
ulation increasing). Many things can cause dysregulation to increase in a
­child – social
​­ struggles, sensory struggles, unexpected changes, anxiety, new
situations, physical issues, inability to modulate emotions, etc. When the
water (­dysregulation) gets to the top of the glass and overflows, this is the
stereotypical dysregulation meltdown.
Dysregulation creates inconsistent b­ ehavior – ​­a child may accomplish some-
thing one day that seems very challenging and have a negative behavior
reaction to something the next day that seems very easy. These “­behavior
reactions” (­which is what usually gets the attention of others) will depend
on the level of dysregulation in the child (­water in the glass). Some level of
dysregulation is usually present in a neurodivergent child. When it reaches
a level the child can no longer contain, outward behavior happens, and the
child feels like they are in an out of control state with little to no ability
to regulate. The dysregulated state and accompanying behavior is often

DOI: 10.4324/9781003207610-18
384 Anxiety Reduction, Sensory Integration, Regulation Interventions

mislabeled and misunderstood. The dysregulated behavior is not p­ re-​­planned

or ­pre-​­meditated on the part of the child. It is not the child trying to get at-
tention, trying to get out of something, or personally trying to “­get” an adult.
The child is likely feeling extremely unsettled, scared, and out of control.
When a child is in a full dysregulated state, the best approach is to let the
child calm down in a quiet, safe, private place. Consequences will not change
dysregulated behavior. A preventative approach needs to be implemented.
Identifying, addressing, and improving the areas that are creating the dysreg-
ulation is critical. Helping children learn about their own regulatory system
is one of the most beneficial and empowering things that an adult can do for
a neurodivergent child.
Many interventions and activities can help children regulate, understand
their body’s regulation and dysregulation processes, and build up their regu-
latory system. Most involve sensory and movement interventions, expressive
art techniques, and traditional relaxation but each child will be different re-
garding what helps them regulate their system. It is important for the adults
around the child to understand what is happing to the child, do not label it
as misbehavior, recognize the discomfort and often fear the child is experi-
encing, do not punish a dysregulated state, apply ­co-​­regulation, support and
empower the child, and work to prevent dysregulation through sustainable
processes. The key is the child’s ability to regulate. This is something that
often takes time, ­self-​­understanding, support, ­co-​­facilitation and regulation,
and caring adults who are willing to walk through the process with the child.

Movement and Whole Brain Activation

In AutPlay Therapy many regulation and sensory processing interventions

are movement play based. It is well understood that children are not bio-
logically designed to sit in one place and think critically. Children like to
move, explore, and play. Often children will engage with the world through
playful action and movement. The play therapy process should be a space for
movement expression with ­age-​­appropriate, ­action-​­oriented techniques or
the ability for n
­ on-​­directive movement in the playroom. Having movement
tools in the playroom communicates that movement play preferences are
valued and supported and for those children who prefer this type of play, it
gives them their play outlet for addressing their needs.
Some children may seek or prefer movement more than other children. This
can take on many “­looks” from bouncing on an exercise ball while they talk,
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 385

to playing an animal movement game, to large full body sensory focused

movements. Movement strengthens both the prefrontal cortex (­which is in-
volved in executive functioning) and the hippocampus (­which plays a key
role in memory and learning). In this way, movement supports a child’s abil-
ity to regulate, think creatively, make decisions, focus, understand their body
system, and retrieve key information.
Physical activity also increases levels of serotonin, norepinephrine, dopa-
mine, and endorphins that support emotional ­well-​­being, motivation and
response to stress. Strong evidence supports the connection between move-
ment, regulation, and learning. Evidence from imaging sources, anatomical
studies, and clinical data shows that moderate movement activities can en-
hance cognitive processing. Whole brain movement means activating both
the left and right side of the brain to function as a whole. When we use
both sides of our brain instead of just the left or right, we are able to apply
both logical thinking and creative thinking to the same problem. There are
numerous benefits to implementing whole brain m ­ ovement-​­based play inter-
ventions. Some of the benefits include higher levels of thinking, increased
creativity, better understanding of emotions, decreased anxiety, regulation,
and the ability to utilize all processes of thought.
­ alher-​­Moran (­2018) stated that the right side of the brain is generally re-
M
sponsible for nonverbal (­bodily) communication and for creative processes.
It is also responsible for play and autobiographical expression. The left side
of the brain is connected to logic, language, and organization. Children, es-
pecially young children, are generally ­right-​­brain dominant. They express
through play and creative processes. By allowing the right side of the brain
to be active in therapy through movement, play, and action, a therapist can
meet the child at the developmentally appropriate level. Furthering the pro-
cess with ­age-​­appropriate verbal reflection assists in integrating both sides of
the brain.
­ alher-​­Moran (­2018) furthered that the lower part of the brain governs
M
automatic responses, including the fight, flight, or freeze response to dan-
ger. The higher, outer part of the brain is involved with judgment, p­ roblem-​
­solving, and thinking through situations. The higher, thinking part of the
brain has limited capacity when the lower brain is activated. Not feeling
safe, experiencing new situations, and/­or having a history of trauma are just
a few ways the lower brain may be activated. Regulation of the lower brain
generally comes from interventions involving the senses. Smell, sound, body
movements, grounding, play, expressive art, and breathwork might all be
used to assist a child with lower brain regulation.
386 Anxiety Reduction, Sensory Integration, Regulation Interventions

Before implementing any structured play therapy interventions to address

regulation and sensory goals, the therapist should have a clear understanding
of the child’s therapy needs and the child’s play preferences. Interventions
should be chosen that address the therapy needs and align with the child’s
play preferences. In AutPlay Therapy, typical regulation and sensory related
play interventions are simple brain based, sensory, and movement interven-
tions which focus on one or more of the following: understanding of the self
and internal systems, whole brain activation, midline crossing, “­resetting”
thoughts, decreasing anxiety and dysregulation, creating a calm and relaxed
state, processing sensory areas, and executive functioning.

Midline Mirror Moves

Therapy Needs: Regulation, sensory integration, anxiety reduction, executive

functioning, and connection
Level: Child and adolescent
Materials: None
Modality: Individual, group, and family

Introduction

Autistic and neurodivergent children and adolescents often need help with
regulating their system. There is a whole myriad of things that can accompany
each day that dysregulates the child’s system. This play therapy intervention is a
simple game that helps children regulate, reduce anxiety, and increase connec-
tion and relationship development. This play intervention involves movement
play and it requires no materials. It can be easily implemented in any setting.

Instruction

1 The therapist explains to the child that they will be playing a game
where they mirror each other’s movements.
2 The therapist and child stand across from each other.
3 Typically the therapist will go first, and the child will mirror the therapist.
4 The therapist instructs the child that they will do all the moves the ther-
apist does like a mirror.
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 387

5 The therapist begins moving their hands, arms, legs, body in different
ways and the child mimics the moves. The therapist should be sure to
move slow enough that the child can keep up with the moves.
6 The therapist is purposeful in making several midline crossing moves.
These are moves that cross the right and left hemispheres of the brain
and thus activate the whole brain. Any move that is crossing over body
parts from one side to the other is usually an effective midline crossing
move. If the therapist is unsure what a midline crossing move would be,
they can do a quick internet search.
7 The therapist will lead for a few minutes and then the child can have a
turn leading and the therapist follows the child’s moves.
8 The therapist and child can switch back and forth every few minutes.
9 The game continues until the child is no longer interested in playing.

Rationale

A common therapy goal involves helping children regulate and reduce anxi-
ety levels. Midline Mirror Moves is a play therapy intervention that addresses
these needs. Midline crossing movements have also been shown to help with
sensory processing and increasing focus and attention. The intervention is
implemented in a playful and engagement way that also helps increase con-
nection between the therapist and child. This play intervention can be easily
taught to parents and the parent and child can play the game at home.

Running All Ways

Therapy Needs: Regulation, sensory integration, and anxiety reduction

Level: Child and adolescent
Materials: None
Modality: Individual, family, and group

Introduction

This play therapy intervention is designed to help children regulate their

system, improve sensory processing needs (­proprioceptive and vestibular),
and reduce anxiety. It is a simple game that can be played in any setting and
388 Anxiety Reduction, Sensory Integration, Regulation Interventions

requires no materials. It is a ­movement-​­based play activity that asks the child

to run in different ways. The therapist should be mindful of any physical
needs the child may have that would prevent them from engaging in this
intervention.

Instruction

1 The therapist explains to the child that they are going to do an activity
together that involves running in a variety of ways.
2 The therapist and child each pick a spot on the floor where they are go-
ing to try and stay while they are running (­running in place). Once the
spot is decided, a piece of tape can be put on the floor to mark the spot.
3 The therapist will begin by calling out different types of styles of running
and both the therapist and child will do that type of running. For exam-
ple, the therapist might say, “­Run fast.” The therapist and child would
both run in place fast (­trying to stay in their spot) until the therapist
called out a different style.
4 The therapist will call out a different style of running after about ­10–​­20
seconds, styles can also be repeated.
5 The therapist will be the lead for a few minutes, then the child can have
a turn at being the lead and calling out different running styles.
6 Some examples of running styles include running fast, in slow motion,
easy jog, like an animal (­a specific animal can be named), like you are
scared, silly, on your tippy toes, bending over, with your hands on your
head, etc.
7 The therapist and child switch back and forth on who calls out the run-
ning styles and continue to play the game until the child is no longer
interested.

Rationale

Running All Ways is a simple play therapy intervention but can help address
a variety of therapy needs. The primary focus would be on giving the child
an activity they could do to help regulate their system, reduce anxiety, and
address sensory processing needs. The running styles can and should be fun,
silly, and constantly changing to keep the activity engaging. For an added ele-
ment, the therapist could include props like trying to bounce a ball while you
are running or holding a balloon on your head while you are running. This
play intervention can be easily taught to parents and implemented at home.
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 389

Backward Moves

Therapy Needs: Regulation, sensory integration, and anxiety reduction

Level: Child and adolescent
Materials: None
Modality: Individual, family, and group

Introduction

Backward moves is a m ­ ovement-​­based play therapy intervention that

asks the child to do several different moves with all of them being done
backwards. This play intervention activates the whole brain and helps
address needs related to regulating, sensory processing, and anxiety re-
duction. It requires no materials and can be implemented in a variety of
settings.

Instruction

1 The therapist explains to the child they will be doing a game together
where they have to do several different moves, but they all have to be
done backwards.
2 The therapist should have prepared a list of moves that they and the
child can do such as walk, hop, dance, etc. backwards.
3 The therapist will begin by saying “­let’s walk around the room back-
wards.” After around a minute the therapist will switch the move to
something else such as “­let’s hop backwards around the room.” The ther-
apist will switch the move periodically.
4 After a few minutes, the child can lead out and suggest moves to do
backwards.
5 The intervention does not have to be just movements. The therapist and
child can also try to think about how to say a word backwards and how
to write or draw something backwards.
6 Additional moves could include act like you are swimming backwards,
act silly moving backwards, move in slow motion backwards, and crawl
backwards.
7 The therapist and child keep playing the game until the child is no
longer interested.
390 Anxiety Reduction, Sensory Integration, Regulation Interventions

Rationale

This play therapy intervention is a simple m­ ovement-​­based game that can

help children with regulation needs, sensory issues related to proprioceptive
and vestibular areas, and anxiety reduction. It provides the child with a tool
they can use to help them that is executed in a fun playful experience. The
intervention can be done with music playing in the background if the child
would prefer music. This intervention can be taught to parents and played
at home.

Fast and Slow Balloons

Therapy Needs: Regulation, sensory integration, and anxiety reduction

Level: Child and adolescent
Materials: Balloon
Modality: Individual and group

Introduction

Many children have issues with regulating their system and understanding
the concepts of how their system feels regulated versus dysregulated. Fast
and slow or up and down play interventions can help children better un-
derstand their body systems and how regulated/­dysregulated feels. This play
therapy intervention utilizes balloons in a game format that helps address
regulation and sensory needs and helps children learn about regulation
processes.

Instruction

1 The therapist explains to the child that they will be playing a game using
balloons.
2 The therapist or child blows up a balloon and ties it off.
3 The therapist and child position themselves across from each other with
about ­5–​­10 feet between them.
4 The therapist explains that they are going to be hitting the balloon
back and forth and they are going to change the speed periodically. The
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 391

therapist will say “­fast” or “­slow” and both of them will hit the balloon as
instructed.
5 The therapist begins by saying “­slow” and the therapist and child hit
the balloon back and forth slowly. If the balloon gets out of control, the
person will slowly go get the balloon and continue to hit is slowly.
6 After a bit of time the therapist will say “­fast” and immediately the ther-
apist and child begin hitting the balloon fast. If the balloon gets out of
control (­and it will), the person gets the balloon as fast as they can and
continues to hit it.
7 Periodically the therapist will change the speed, the speed changes can
even happen quickly back and forth.
8 After some time, the therapist can ask the child if they want to be the
one who calls out the speed changes. The therapist and child can take
turns calling out the speeds.
9 If appropriate, the therapist can process with the child how it feels to
shift from slow to fast and how it feels in their body (­system). The thera-
pist can make the connection to how their body shifts from regulated to
dysregulated.
10 The therapist and child continue to play until the child is no longer
interested.

Rationale

Fast and Slow Balloons utilizes a common fast/­slow up/­down process in help-
ing children regulate and better understand their regulatory system. The
process can also be done utilizing musical instruments or simply running in
place. Therapists should be aware of any balloon related allergies and/­or any
fears a child might have about balloons before introducing this intervention.
It can be taught to parents to play at home with their child.

Bubble Pop Brain Blast

Therapy Needs: Regulation, sensory integration, anxiety reduction, and ex-

ecutive functioning
Level: Child and adolescent
Materials: Bubbles
Modality: Individual, family, and group
392 Anxiety Reduction, Sensory Integration, Regulation Interventions

Introduction

This play therapy intervention uses bubble blowing in a fun, fast, and silly game
that helps address dysregulation issues, sensory processing (­proprioception),
and anxiety reduction. It should be implemented in a space that provides for
some movement.

Instruction

1 The therapist explains to the child that they are going to play a game
that involves blowing and popping bubbles.
2 The therapist will begin as the bubble blower and will blow bubbles
while the child tries to pop them before they touch the ground.
3 There is an added ­twist – ​­while the child is trying to pop the bubbles,
they must also be naming off things from a p­ re-​­chosen subject like an-
imals, fruits, sports, feelings, etc. The popping and naming should be
happening concurrently.
4 The therapist’s role is to keep popping the bubbles and encouraging the
child to pop and name.
5 This is a challenging whole brain activation activity. It would be highly
unlikely that someone would be able to pop all the bubbles before they
hit the floor and be consistently naming off different things from a cho-
sen subject. It ultimately becomes silly and that is the goal.
6 The therapist will want to clarify that it is not competitive and is just for
fun.
7 After a few minutes the therapist and child can switch roles. The ­pre-​
­chosen category can keep changing to whatever the therapist and child
want it to be.
8 The therapist and child continue taking turns blowing the bubbles until
the child no longer wants to play the intervention.

Rationale

This play therapy intervention helps address regulation needs, sensory pro-
cessing work, and anxiety reduction. There is also an element of executive
functioning involved. It is a playful interactive game and is easy to imple-
ment in any setting. The intervention can be taught to parents to play with
their child at home.
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 393

Pool Noodle Sword Battle

Therapy Needs: Regulation, sensory integration, anxiety reduction, and ex-

ecutive functioning
Level: Child
Materials: Pool noodles
Modality: Individual

Introduction

Pool Noodle Sword Battle is a play therapy intervention that involves using
pool noodles as swords. It also requires enough space to safely move around.
This play intervention is designed to help children with dysregulation strug-
gles, sensory processing needs, and anxiety reduction. It is a ­movement-​­based
play intervention so the therapist should be mindful of the child’s physical
needs before implementing this intervention.

Instruction

1 The therapist shares with the child that they will be playing a game that
involves using pool noodles as swords and they will be having a pool
noodle sword battle (­it is easiest to buy one pool noodle and cut it in half
to make two swords).
2 The therapist and child each pick a pool noodle sword and the therapist
explains that the child is going to learn some battle moves.
3 The therapist introduces simply hitting each other’s sword back and
forth in a typical sword battle fashion. The therapist then introduces the
child to dunk and jump moves.
4 For the dunk move, the therapist will say “­Dunk” and the child dunks
down as the therapist moves their sword swiping toward the child’s head
(­the therapist is deliberate to not actually hit the child in the head). For
the jump move, the therapist says “­Jump” and the child jumps as the
therapist moves their sword swiping at the child’s feet (­again the thera-
pist is deliberate to not actually hit the child’s feet).
5 The therapist and child practice the dunk and jump moves for a few
minutes.
394 Anxiety Reduction, Sensory Integration, Regulation Interventions

6 The therapist then introduces the spin around ­move – spin

​­ to the left or
spin to the right. The therapist will say the direction and spin and the
child spins around and then keeps participating in the sword battle.
7 The therapist and child practice the spin move for a few minutes.
8 The therapist and child are now ready for a full battle. They will sword
fight and periodically the therapist will call out one of the moves and
the child will do the move. The therapist can even call out moves in a
sequence.
9 For regulation purposes, it is important that the therapist call out dif-
ferent moves or combinations of moves regularly. The therapist and the
child can also think of additional moves to add to the battle.
10 The therapist and child continue to play the intervention until the child
is no longer interested.

Rationale

Pool Noodle Sword Battle is a fun and interactive game that helps children
regulate, process sensory needs (­proprioception), and reduce anxiety. The
game can take many looks with different moves being added to the game.
It is important that moves help activate the whole brain in order to get the
regulation benefit. Pool noodles should be used as they are soft in case some-
one accidently gets hit. This play intervention can be taught to parents to
implement at home with their child.

Punching Bag Moves

Therapy Needs: Regulation, sensory integration, anxiety reduction, and ex-

ecutive functioning
Level: Child
Materials: Punching bag
Modality: Individual

Introduction

This play therapy intervention utilizes some type of punching bag. It can be
a standard punching bag or some type of bop bag. The punching bag is used
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 395

to deliver a variety of movements that help regulate a child’s system. This

intervention focuses on helping children regulate, process sensory needs, and
reduce anxiety levels. It is a ­movement-​­based intervention so the therapist
should be mindful of any physical needs the child has and provide plenty of
space to implement the intervention.

Instruction

1 The therapist explains to the child they will be doing an activity that
uses a punching bag. It is helpful for the therapist to have some type of
punching gloves available for children to wear if they desire this.
2 The therapist states they are going to be learning some punching bag
moves.
3 The therapist begins by having the child punch the bag with their fists
in a typical punching movement.
4 The therapist then introduces kicking the punching bag alternating the
right and left feet.
5 The therapist then introduces kneeing the bag, again alternating be-
tween the right and left knees.
6 Finally, the therapist introduces a right or left spin around and then a
punch or kick move.
7 The child practices each of the moves to become more familiar with
them. Once the child is ready, the therapist will begin calling out differ-
ent moves for the child to do. Th therapist can combine moves and can
slow down or speed up the action.
8 The therapist and child can create additional moves and come up with
unique moves.
9 The therapist and child continue to play the intervention until the child
is no longer interested.

Rationale

Punching Bag Moves is designed to provide a fun activity children can do

to help them regulate their system, address sensory processing needs, and
reduce anxiety. Once the child learns the activity (­if they have access to a
punching bag), they can complete the intervention on their own anytime
they feel it would benefit them. The intervention can be shared with parents
so they can support the process at home.
396 Anxiety Reduction, Sensory Integration, Regulation Interventions

Sensory Mandala

Therapy Needs: Sensory processing, regulation, and anxiety reduction

Level: Child and adolescent
Materials: Card stock or cardboard, markers, tape or glue, and a variety of
sensory materials (­tactile and olfactory).
Modality: Individual, family, and group

Introduction

Sensory Mandala play intervention provides children and adolescents the op-
portunity to engage in an expressive play activity that can help regulate their
system, reduce anxiety, and address sensory processing needs. The child can
create a sensory mandala on their own, as part of a group process, or in family
work. The sensory element of a sensory mandala provides a unique blending
of Jungian mandala creation with sensory processing technique.

Instruction

1 The therapist communicates to the child that they will be creating a

sensory mandala
2 The therapist gives the child a copy of a mandala template (­drawn cir-
cle) on a piece of card stock or cardboard. The child can also draw their
own mandala circle outline.
3 Using a card stock instead of paper may be preferred, as some sensory
mandalas become too heavy for regular paper.
4 The therapist displays several sensory related materials that the child
can use in creating the mandala. The child is instructed to examine,
touch, and smell all the items and choose the ones that feel the best
to them. Sample sensory items include the following: Velcro, ribbon,
sandpaper, buttons, beads, glitter, glitter glue, puffy stickers, pot pourri,
feathers, burlap, cotton balls, pom poms, pipe cleaners, denim, material
(­various textures), essential oils, spices, dried pasta, and popsicle sticks.
5 The child is instructed that they can use markers or crayons and design
and/­or color anything in the mandala that they want, and they also need
to use the sensory items selected and place them in the mandala. The
sensory items can be glued or taped onto the mandala.
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 397

6 Before the child begins to create their sensory mandala, the therapist
has the child position themselves in a comfortable way, take three deep
breathes, and begin to relax. The child can then construct the sensory
mandala as they choose.
7 The child creates the sensory mandala while the therapist observes.
8 Once the child has finished, the therapist can ask the child to share
about their mandala, specifically what sensory items the child chose and
why they chose those items. The child can spend time looking at the
mandala and touching the different tactile items the child chose for their
mandala. If the child chose any scented items, they can also spend time
smelling the different items.
9 The therapist can discuss with the child that they can create mandalas
anytime they would like to help with feeling calm or relaxed, and the
child can keep all the mandalas that they create as regulation reminders.

Rationale

Mandala work, from a Jungian perspective, can be a calming, reflective, and re-
laxing experience. Adding the sensory component enhances the sensory pro-
cessing element for the child. The Sensory Mandala play therapy intervention
offers an activity that is more expressive for children who respond to and enjoy
expressive play and activities. Children can create a sensory mandala anytime
on their own when they feel like they need a regulating activity, or it can be
part of a sensory processing break that has been established for the child. Par-
ents can learn about the intervention and support the process at home.

Sensory Rock Play

Therapy Needs: Sensory processing and regulation

Level: Child and adolescent
Materials: Rocks, tub or soapy water, and sharpies or paint
Modality: Individual and group

Introduction

This play therapy intervention incorporates art and creation with sensory
processing and regulation. This intervention is especially beneficial for
398 Anxiety Reduction, Sensory Integration, Regulation Interventions

children and adolescents who need tactile, visual, and olfactory sensory ex-
periences. The therapist should prepare a tube of soapy water. The therapist
can have several ­small-­​­­to-​­medium sized rocks prepared for the activity, or
the therapist and the child can collect the rocks together. This intervention
can be a little messy. The therapist should prepare an appropriate space for
water and paint.

Instruction

1 The therapist will explain to the child that they will be painting
rocks.
2 The therapist will have a tub of soapy water, a few rocks (­­5–​­6), and
paints or sharpies ready to go.
3 The therapist explains they will begin by washing the rocks to remove
any dirt. The child should wash the rocks and then place them on a dry
towel (­it may take a while for the rocks to dry enough to paint. If there
is little time available for this activity, the therapist could provide a hair
dryer to blow dry the rocks).
4 Once the rocks are dry, the child should make sure their hands are clean
and dry and they can begin decorating and painting the rocks.
5 The child is instructed that they can use the sharpies or paints to design
the rocks however they want. The theme of the rocks is what feels good,
calm, and relaxing, so the painting of the rocks should reflect these ideas
for the child.
6 Once the child has finished designing the rocks, they can take the rocks
home and keep them to use as regulation reminders.

Rationale

Sensory Rock Play provides the child or adolescent with a tactile experience
of washing the rocks in soapy water. The therapist can experiment with dif-
ferent scents for the soap. The therapist can also provide scented markers
or paints for a more olfactory experience. The coloring of the rocks pro-
vides a visual experience and a regulating experience. The therapist will
want to make sure the child associates the whole activity and especially the
painted rocks with feeling good and regulated. This play intervention can
be repeated multiple times with the child creating and collecting several
rocks.
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 399

Ways We Cross the Room

Therapy Needs: Regulation, sensory processing, and anxiety reduction

Level: Child and adolescent
Materials: None
Modality: Individual and group

Introduction

Ways We Cross the Room is a simple interactive and playful intervention. It

is designed to help children address regulation needs and sensory processing
challenges. It is a ­movement-​­based play therapy intervention. The therapist
will want to make sure there is plenty of space to complete the intervention.

Instruction

1 The therapist explains to the child that they are going to play a game
where they cross the room in various ways.
2 The therapist and child position themselves on each side of the room.
3 The therapist begins by saying a way they both have to cross the room.
For example, the therapist says. “­We have to cross the room acting like
our favorite animal.” Both the therapist and child then cross the room
moving like their favorite animal.
4 Once they are across the room, the child goes next and says a way they
have to cross the room.
5 If the child cannot think of any way to cross the room, the therapist can
provide options.
6 This continues several times until the child is no longer interested in
playing the game.
7 The therapist should choose moves that cross the midline and activate
the whole body to help address regulation and sensory needs. Some ex-
amples include hop on one foot, skip, crawl backwards, act silly, swinging
your arms back and forth, with your body twisted like a pretzel, with your
hands on your head, etc.

Rationale

This play therapy intervention provides children with a fun and interactive
game that can help regulate their system and address sensory needs related
400 Anxiety Reduction, Sensory Integration, Regulation Interventions

to proprioceptive and vestibular needs. It can be played in any setting where

there is enough space to do the movement. No materials are needed but
props can be used such as balls to carry or bean bags to balance, etc. Parents
can be taught the intervention to implement at home with their child.

One Color Picture

Therapy Needs: Regulation and anxiety reduction

Level: Child and adolescent
Materials: Paper and markers or crayons
Modality: Individual and group

Introduction

One Color Picture play intervention implements a traditional relaxation

technique using a picture drawing concept. The intervention helps children
regulate their system and reduce anxiety levels. It involves a level of progres-
sive relaxation that might be challenging for some children. The therapist
will want to monitor for this when implementing this intervention.

Instruction

1 The therapist explains to the child that they will be creating a picture
that helps with regulating and relaxation.
2 The therapist gives the child a white piece of paper that they will draw
on. The therapist also gives the child a box of markers or crayons.
3 The therapist explains to the child that the child is going to close their
eyes and the therapist is going to have them imagine doing something
that feels relaxing, calming, or fun.
4 Many children may not understand the feeling of calm or relaxed and
may respond better to thinking about what they like to do, what feels
good, and what feels fun.
5 The child closes their eyes and the therapist asks them to image some-
thing that makes them feel or think of being calm or relaxed or having
fun. The therapist tells the child to think about the thing or place or sit-
uation and focus on doing that thing or being in that place. The therapist
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 401

tells the child to focus on the feeling of calm or having fun. Lastly, the
therapist tells the child to image one color that goes with the place or
situation and to visualize that color with the place and the feeling.
6 After the child has been in the visualization for a while (­it should not
take long), the therapist tells the child to open their eyes and find the
color they saw and draw whatever comes to mind on their paper.
7 Once the child is done with the drawing, the therapist can ask the child
to share about their experience and drawing.
8 The child can take the picture home and make a one color picture any
time they want.

Rationale

This play therapy intervention uses a traditional relaxation technique

(­guided visualization) combined with an expressive art intervention. It is
implemented to help children regulate their system and decrease anxiety.
Some children may find this type of activity regulating while others may not
like it. The therapist should monitor for the child’s preferences and reaction.
This play intervention can be taught to parents and implemented at home.

Hula Hoop Walk

Therapy Needs: Regulation and sensory processing

Level: Child
Materials: Large hula hoop
Modality: Individual and group

Introduction

Autistic and neurodivergent child may have issues with regulation and sen-
sory needs and may respond positively to ­movement-​­based play. Hula Hoop
Walk is a play therapy intervention that utilizes movement in a game play
format. The intervention helps address regulation and sensory processing
needs. The therapist will need to make sure there is a space big enough to
place a large hula hoop on the floor and to be able to move around it. The
therapist will need to make sure the child does not have any physical needs
that would prevent them from participating.
402 Anxiety Reduction, Sensory Integration, Regulation Interventions

Instruction

1 The therapist explains to the child that they will be playing a game using
a hula hoop.
2 The therapist places a large hula hoop on the floor.
3 The therapist explains they are going to be doing different moves around
and inside the hula hoop.
4 The therapist begins by saying they must walk around the hula hoop in a
circle. Both the therapist and child then walk around the hula hoop and
keep circling it until a new instruction is given.
5 After a short amount of time, the therapist might say, “­now we must
jump in and out of the hula hoop.” Both the therapist and child then
start jumping in and out of the hula hoop until a new move is stated.
6 The therapist should share a few moves and then ask the child if they
want to give the moves. If the child does not want to or cannot think of
anything then the therapist can continue.
7 Some additional moves include hopping around the hula hoop, holding
hands while facing each other and walking around the hula hoop, walk-
ing backwards around the hula hoop. Walking around in slow motion,
standing still in the hula hoop for 20 seconds, etc.
8 The intervention can continue to be played until the child is no longer
interested.

Rationale

This play therapy intervention uses a hula hoop and ­movement-​­based play in a
game format. It provides children with a playful way to help regulate their system
and address sensory needs related to proprioception and vestibular areas. The
instructions use one large hula hoop that the therapist and child share, but the
therapist can use two hula hoops with each person having their own to use. Par-
ents can be taught the intervention and play the game at home with their child.

10 Cloud Relaxation

Therapy Needs: Regulation and anxiety reduction

Level: Child and adolescent
Materials: Paper and a pencil
Modality: Individual and group
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 403

Introduction

10 Could Relaxation play intervention presents a simple visual guide for help-
ing children and adolescents practice deep breathing. This process helps ad-
dress regulating the system and reducing anxiety through deep breathing.
Many children can benefit from deep breathing but often do not implement
the practice in real application. Incorporating a visual guide helps ensure
utilization and application.

Instruction

1 The therapist explains to the child they are going to practice some deep
breathing by creating a guide on a piece of paper.
2 The therapist gives the child a piece of paper and instructs them to draw
10 clouds randomly on the paper.
3 The therapist then instructs the child to number the clouds randomly
­1–​­10.
4 Once the 10 cloud paper is completed. The therapist will demonstrate
the deep breathing guide.
5 The child is instructed to place their pencil on cloud one and take one
deep breath.
6 The child then draws a line to cloud two and then takes two deep
breathes. The child then draws a line to cloud three and takes three
deep breathes. This continues until the child gets to cloud ten and takes
ten deep breaths. At this point the child has completed the guide.
7 The therapist may need to explain the concept of taking a deep b­ reath –​
­inhale through the nose, hold for a couple of seconds, and then exhale
through the mouth.
8 Once the guide has been completed, the therapist can ask the child how
they feel and if they notice anything different after the deep breathing.
9 The therapist can emphasize with the child that they can create a 10
cloud guide anytime and do some deep breathing if they feel it will help
them regulate.

Rationale

This play therapy intervention is basically teaching the child how to do deep
breathing. It provides the child with a guide from start to finish for complet-
ing deep breathing. The guide is simple and can be completed by the child
404 Anxiety Reduction, Sensory Integration, Regulation Interventions

­anytime – ​­they only need access to a piece of paper and a pencil. This inter-
vention can be taught to parents and they can support the process at home.

Sensory Likes and Dislikes

Therapy Needs: Sensory processing and regulation

Level: Individual and adolescent
Materials: Paper and a pencil
Modality: Individual and group

Introduction

Sensory Likes and Dislikes is a play therapy intervention that helps children
and adolescents better identify what sensory needs they are experiencing
and what sensory input can be comforting or pleasing to the child. This play
intervention creates a visual reminder of positive techniques the child can
implement when they are experiencing sensory dysregulation.

Instruction

1 On a piece of white paper, the child draws a picture of each of the follow-
ing: a hand, a pair of lips, eyes, a nose, an ear, and the outline of a body.
2 On each one of the drawings, the child writes or draws things they like
and do not like that correspond with each ­sense – ​­touch (­hand), taste
(­lips), sight (­eyes), smell (­nose), sound (­ear), proprioceptive, vestibular,
interception (­body). If the child does not like to write or draw, they can
tell the therapist and the therapist can write them down.
3 Once the child has finished, the therapist and child take each area, one
at a time, and on the back side of the paper, write ideas, strategies, activ-
ities the child could do whenever they experience something related to
that sense that feels uncomfortable or dysregulating. For example, in the
eyes, bright sun is bothersome, and putting on sunglasses helps.
4 The therapist and child then role play and the child practices experienc-
ing the sensory discomfort and implementing some of the activities that
were written down for that area.
5 The therapist and child can discuss, and role play all six drawings.
Anxiety Reduction, Sensory Integration, Regulation I n t e r v e n t i o n s 405

Rationale

This play therapy intervention provides a playful and visual way for children
to work on decreasing anxiety and dysregulation that is caused by sensory
processing challenges. The therapist should have a basic understanding of
what sensory challenges the child struggles with prior to completing this
intervention. The therapist should be mindful of helping the child identify
positive coping skills that they can implement when experiencing a sensory
processing problem.

Coffee Filter Mandala (­adapted from Finding Meaning with

Mandalas by Tracy ­Turner-​­Bumberry, LPC, ­RPT-​­S)

Therapy Needs: Regulation and sensory processing

Level: Child and adolescent
Materials: Coffee filter, washable markers, small spray bottle of essential oil
(­preferably a scent the child likes), cardboard, table cloth or protective cov-
ering, black and white construction paper, and paper towels (­for cleanup).
Modality: Individual and group

Introduction

This play therapy intervention incorporates an expressive art intervention

with regulation and sensory processing. Children and adolescents with olfac-
tory (­smell) processing needs will enjoy this play intervention. The therapist
should explore with the child or adolescent what scents they typically like
before introducing this play intervention. The essential oil used should be a
scent that is appealing to the child.

Instruction

1 The therapist explains to the child they will be making a mandala using
coffee filters.
2 The therapist will place the coffee filter on top of a white piece of paper,
which is on top of a piece of cardboard or card stock for extra support,
406 Anxiety Reduction, Sensory Integration, Regulation Interventions

3 The therapist hands the child some washable markers and instructs them
to create any type of design on the coffee filter. The therapist may want
to remind the child that this picture will change quite a bit from its orig-
inal form, so it may be better to create colors and shapes rather than an
actual picture.
4 Once the child has finished, the therapist will hand the child a spray
bottle of a selected essential oil.
5 The child is instructed to spray the coffee filter as little or as much as
they desire. The therapist may want to suggest to the child to begin by
spraying just a little and notice how the design begins to transform.
6 The therapist watches with the child as the coffee filter changes into an
abstract creation and they notice the aroma of the essential oil.
7 If desired, the child can make additional coffee filter mandalas.
8 The therapist may follow up with some processing questions such as,
“­How did you notice your drawing changing while you were spraying
it?” “­How did you notice the spray scent as it was being sprayed on your
drawing?” “­How did it feel as you noticed the scent?” “­Are there areas in
your life you would like to spray away and start clean?” “­Did you notice
any feelings of calmness or relaxation while completing this activity?”
and “­When and where in your life could you complete more coffee filter
mandalas?”

Rationale

Coffee Filter Mandala intervention provides a n ­ on-​­threatening process to ex-

plore regulation and sensory processing needs. The child or adolescent can
make several mandalas using multiple essential oil sprays. If the child finds
this intervention helpful, it can be repeated regularly, and the child can learn
to implement it on their own. Parents can be made aware of the intervention
and support the process at home.

Reference

­Malher-​­Moran, M. S. (­2018). Why is engaging a child’s brain and body in therapy

important? Good Therapy. https://­www.goodtherapy.org/­blog/­­why-­​­­is-­​­­engaging-
­​­­childs-­​­­brain-­​­­body-­​­­in-­​­­therapy-­​­­important-​­0725184
 Conclusion

Neurodiversity defines a more balanced and accurate perspective of what

is really going on in human neurotypes. Instead of regarding traditionally
pathologized populations as less than, devalued, problematic, needing a cure
or fix, the emphasis in neurodiversity is placed on differences (­Armstrong,
2010). There is no argument that neurodivergent children can have mental
health needs and those needs should be addressed. The goal of the play ther-
apist is to realize that the mental health needs exist somewhat independently
of the neurodivergence. The neurodivergence is more of an operating system
so the therapy may shift or adjust to best fit the neurodivergent child in order
to help them with their therapy goals. Think of this scenario, if you were
working with a neurotypical child who had a therapy need of decreasing anx-
iety. Would you conceptualize that the child was too neurotypical and this
was creating the anxiety, thus we need to make the child less neurotypical
and then the anxiety will go away?
Children are people, they are not projects. I fundamentally believe that play
therapy is the best therapeutic approach for working with children. Nothing
else values children, empowers them, and addresses their ­self-​­worth, while
simultaneously addressing their mental health needs. For the neurodiver-
gent child, play therapy, and the therapeutic powers of play are a welcome
reprieve from the historically devaluing processes and systems these children
have been subjected. AutPlay Therapy is the aggregation of not only my
lived experience but also the fulfillment and realization of a neurodiversity
affirming mental health approach that can be implemented with children
and families.
You do not have to be neurodivergent to work with neurodivergent chil-
dren. You do not have to be neurodivergent to support, value, build rela-
tionship, and affirm neurodivergent children. But you do have to commit to
deconstructing ableist practices, you do have to believe in the neurodiversity

DOI: 10.4324/9781003207610-19
408 Co n c l u s i o n

paradigm, and you do have to apply neurodiversity affirming constructs. And

why wouldn’t you want to? It’s the better way. It is the heart of the play
­therapy – ​­for children to leave our playrooms, leave our presence feeling
better than when they came in. The only way to truly do this with neurodi-
vergent clients is to commit to being an affirming professional.

Reference

Armstrong, T. (­2010). Neurodiversity: Discovering the extraordinary gifts of autism,

ADHD, dyslexia, and other brain differences. Da Capo Press.
 Common Terms Related to
Neurodivergence

Ableism: the discrimination against people with disabilities; devaluing and

limiting the potential of people with physical, intellectual, or mental dis-
orders and disabilities. The belief (­consciously aware or conditioned) that
those without disability are superior. Ableism practices can sometimes be
conditioned, with individuals participating in ableist behaviors without
realizing.
Actual Autistic: a term that refers to individuals who are autistic and who
speak from their perspective of being autistic.
Alexithymia: is a personality trait characterized by the subclinical inability
to identify and describe emotions experienced by oneself.
Aphantasia: is a phenomenon in which people are unable to visualize
imagery.
Atypical: is not typical, or not conforming to the common type: irregular or
abnormal.
Code Switching: trying to act like others, or act in a way that gains accept-
ance from the people or group a person is around so as not to draw negative
attention to oneself.
Compulsions: are deliberate repetitive behaviors that follow specific rules,
such as pertaining to cleaning, checking, or counting.
Developmental Delay: is when a child does not reach their developmental
milestones at the expected times. It is an ongoing major or minor delay in
the process of development.
Dysregulation: is a term used in the mental health community to refer to an
emotional response that is poorly modulated and does not fall within the
conventionally accepted range of emotive response. It can be looked at as a
410 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

child’s inability to manage or regulate their emotions which typically results

in various negative behaviors.
Echolalia: is a child’s automatic repetition of vocalizations made by another
person. It is closely related to echopraxia, the automatic repetition of move-
ments made by another person. Echolalia can be present with autism and
other developmental disabilities. A typical pediatric presentation of echola-
lia might be as follows: a child is asked “­Do you want dinner?”; the child ech-
oes back “­Do you want dinner?”, followed by a pause, and then a response,
“­Yes. What’s for dinner?” In delayed echolalia, a phrase is repeated after a
delay, such as a person with autism who repeats TV commercials, favorite
movie scripts, or parental reprimands.
Expressive Language: is the use of verbal behavior, or speech, to communi-
cate thoughts, ideas, and feelings with others.
Hyperarousal: a state of increased psychological and physiological tension
marked by such effects as reduced pain tolerance, anxiety, exaggerated startle
responses, insomnia, and fatigue.
Hyperlexia: is characterized by having an average or a­ bove-​­average IQ and
­word-​­reading ability well above what would be expected at a given age. It
can be viewed as a super ability in which word recognition ability goes far
above expected levels of skill.
Hypoarousal: a physiological state where your body slows down. It may in-
clude feelings of sadness, irritability, and nervousness.
I­dentity-​­First Language: Using language that places a person’s identity first
such as saying, “­autistic child” or “­autistic person.” Research supports that
the majority of autistic adults prefer i­dentity-​­first language over p­ erson-​­first
language (­child with autism).
Individualized Education Program (­IEP): is an educational plan designed to
meet the unique education needs of one child, who may have a disability,
as defined by federal regulations. An IEP is intended to help children reach
targeted educational goals. IEPs are mandated by the Individuals with Disa-
bilities Education Act (­IDEA).
Masking: The act of hiding autism/­neurodivergent features and/­or charac-
teristics. Also, hiding one’s identity as being autistic/­neurodivergent. This is
typically done in response to neurotypical expectations to act a certain way.
Over time, this process can become psychologically distressing to autistic
individuals.
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 411

Medical Model of Disability: Regarding autism, this model views autism as

a disorder, something that is a problem that needs to be fixed, treated, or
cured.
Neurodivergent: Refers to a mind that functions in ways that diverge signifi-
cantly from the dominant societal standards of what is normal and expected.
This often includes diagnoses such as autism, sensory challenges, ADHD,
and learning disorders.
Neurodiversity: In the 1990s, an autistic sociologist named Judy Singer
coined the term “­neurodiversity.” Neurodiversity is an approach to learn-
ing and disability that argues diverse neurological conditions are a result
of normal variations in the human genome. Every person is part of neuro-
diversity; we all have a unique way that our brain is wired to operate and
navigate.
Neurodiversity Affirming: A belief and commitment in approach, which
means valuing and respecting the different ways an autistic or neurodivergent
client may process, feel, respond, communicate, and play. It means allowing
the child to be themself and not trying to change them to fit a neurotypical
standard. Further, it means giving the client a voice in the ­decision-​­making
process regarding their therapy.
Neurodiversity Movement: A social justice movement that seeks civil rights,
equality, respect, and full societal inclusion for the neurodivergent.
Neurodiversity Paradigm: A perspective on neurodiversity that includes the
belief that all humans are diverse in their neurocognitive functioning; there
is no one normal standard for neurocognitive functioning.
Neurotypical: A term used to describe individuals who are not neurodiver-
gent and of ­societal-​­viewed typical development, intellect, and cognitive
abilities.
­ on-​­Autistic: Anyone who does not have autism. This can include neurodi-
N
vergent individuals who are not autistic but have some other neurodivergence.
Obsessions: are the domination of one’s thoughts or feelings by a persistent
idea, image, desire, etc. Obsessions are thoughts that recur and persist despite
efforts to ignore or confront them.
Perseveration: refers to repeating or “­getting stuck” carrying out a behav-
ior (­e.g., putting in and taking out a puzzle piece) when it is no longer
appropriate.
412 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

Person First Language: referring to and using person before a diagnosis such
as person with autism.
Pragmatic Speech: is language used to communicate and socialize.
Receptive Language: is the comprehension of language; listening, and un-
derstanding what is communicated. It is the receiving aspect of language.
Sometimes, reading is included when referring to receptive language, but
some use the term for spoken communication only. It involves being at-
tentive to what is said, the ability to comprehend the message, the speed
of processing the message, and concentrating on the message. Receptive
language also includes understanding figurative language, as well as lit-
eral language. Receptive language includes being able to follow a series of
commands.
Regulation: is a child’s ability to notice and respond to internal and external
sensory input, and then adjust his emotions and behavior to the demands of
his surroundings.
Sensory Processing: the way the nervous system receives messages from the
senses and turns them into appropriate motor and behavioral responses. Pro-
cessing issues exist when sensory signals do not get organized into appropri-
ate responses which create challenges in performing everyday tasks and may
manifest in motor clumsiness, behavioral problems, anxiety, depression, and
school failure. The eight sensory areas are sight, smell, taste, hearing, touch,
vestibular, and proprioception.
Social Model of Disability: Regarding autism, this model views autism as a
person’s identity and not what makes a person disabled. Rather, it is society’s
views of autism that makes an autistic person disabled.
Social Reciprocity: Social reciprocity is the ­back-­​­­and-​­forth flow of social in-
teraction. The term “­reciprocity” refers to how the behavior of one person
influences and is influenced by the behavior of another person and vice versa.
Spectrum Disorder: is a term that refers to three disorders that previously
using ­DSM-​­IV criteria, fell under the umbrella of autism spectrum disorders:
Autism, Asperger’s, and Pervasive Developmental Disorder NOS.
Stimming: is a repetitive body movement, such as hand flapping, that is
hypothesized to stimulate one or more senses. The term is shorthand for
­self-​­stimulation. Repetitive movement, or stereotypy, is often referred to
as stimming under the hypothesis that it has a function related to sensory
input.
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 413

Parent Guide for Implementing the AutPlay Follow Me

Approach (­FMA)

1 Set the stage for your play times by choosing a day and time to have your
play time and a location in your home for the play time. Be mindful to
choose times and locations that will be the least distracting for you and
your child. Avoid times and locations where you or your child may be
distracted by other people, tasks, or objects in your surroundings.
2 Begin the play time with an introductory statement such as “­This is our
special play time, you can play anything you want and I will be in here
with you.”
3 Let your child lead the play time. He or she can choose to play with what
he or she wants and how he or she wants. Follow your child as he or she
transitions from one toy or activity to another. Try to stay physically
close to your child.
4 Periodically make tracking and reflective statements.
5 Periodically ask your child questions.
6 Periodically try to engage with your child in what he or she is playing
with. Look for opportunities to inset yourself into the play and notice in-
stances where your child is accepting your attempts to engage and play-
ing back with you.
7 Try to engage your child in ways that promote attunement and acknowl-
edgement skills.
8 Be mindful of your child’s limits. Do not push your child to engage with
you to the point of dysregulating your child. If you feel that your child
has reached his or her limit, then end the play time.
9 Make note of instances where your child demonstrates any of the basics
skills that have been targeted and any advances in reciprocal play or
interaction that your child produces.
10 End the play time with a closing statement such as “­In 5 minutes out play
time with be over.” After 5 minutes, “­Our play time is over; we will play
again next time.”
11 Complete the In Home Play Times Summary Sheet and bring it with you
to discuss with the therapist during your next appointment.

Follow Me Approach (­FMA) Skills

Starting and Ending the Play Times – ​­The parent begins by introducing the
child to the play space. The parent explains to the child that, “­This is our
414 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

special play space, and you can do whatever you like in here, and I will be
in here with you.” The parent gives a ­five-​­minute verbal and visual warning
that the play session is almost over and again at the o­ ne-​­minute mark. The
verbal statement can be “­We have five minutes left of our special play time
and then it will be over for today,” and again at the one minute, “­We have
one minute left of our special play time today and then it will be over.” The
visual can be as simple as the parent holding up their hand with five fingers
and then one finger as they are giving the verbal warnings. When the session
is over, the parent states, “­Our time is up for today.”
Nondirective Play Skill – The
​­ child leads the play in the session. The child is
allowed to maneuver around the play time and play with or attend to anything
they like. The child is also allowed to switch from toy or types of play as they like.
The child leads the time, and the parent follows the child figuratively and liter-
ally in the play time. The parent stays present and attuned with the child, paying
attention to the child, and observing the child closely. The parent does not try
to lead the play or direct the child to participate in play the parent wants to do.
Reflective and Tracking Statements Skill – ​­The parent periodically provides a re-
flective and/­or tracking statement. These statements communicate to the child
that the parent is present with them, sees them, and is attuning to them.
Example Reflective Statement would be a child struggling to get a cap off a
marker. The child is looking frustrated with their effort. The parent might
say “­That cap is frustrating you,” or “­You are frustrated that the cap will not
come off.” Another example would be if the child says “­This is my favorite”
while tightly hugging a stuffed animal. The parent might reflect “­You really
like that one,” or “­That one makes you feel happy.”
Example Tracking Statement would be if the child is scooping up sand and
putting it into a bucket, the parent might say “­You are putting the sand in the
bucket,” or “­You are doing what you want with the sand.” Another example
would be if the child paints a picture and holds it up to show the parent, the
parent might say “­You finished the whole painting,” or “­You finished that and
now you are showing me.”
Asking Questions Skill – The
​­ parent periodically will ask the child a question.
The questions are designed to communicate to the child that the parent is
present, to begin developing social navigation, and to help the parent assess
for engagement improvement. The questions asked should be in the moment
and related to what is happening in the play time. An example would be the
child painting blue on a piece of paper and the parent asking, “­Do you like
the color blue?”
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 415

Engage with the Child Skill – The

​­ parent is periodically trying to engage with
the child in whatever the child is doing (­the child’s play). Remember that
the child leads and chooses whatever the child wants to play with, and the
parent follows the child and tries to get involved with what the child is do-
ing. The parent should make attempts throughout the play time. How many
attempts, in what ways, and at what time is left to the parent’s discretion.
The following provides examples of engaging with the child:

• The child starts playing with the play dishes. The parent sits beside
the child and takes a bowl and puts it on the parent’s head and says
to the child, “­Look at my silly bowl hat.” The parent is trying to en-
gage the child by having the child look at the parent and notice the bowl
on the parent’s head. The parent might take a bowl or plate and put it on
the child’s head and say, “­Look at the plate on your head.” The parent
might ask the child to put a bowl or plate on the parent’s head and see if
they can begin to engage in this activity back and forth.
• The child starts playing with the sand tray building a sandcastle. The
parent moves beside the child and starts adding sand to the castle or asks
the child where to put the sand. The parent might try pushing sand to
the child to use for their castle. The parent might also try building their
own castle in a separate area in the sand tray.
• The child is shooting a basketball into the basketball hoop. The parent
moves beside the child and helps get the ball and hand it back to the
child after they shoot a basket. The parent might also try getting another
basketball and also shooting the ball in the basket. The parent could
try getting the child to take turns shooting the basketball or allow the
parent to pass the basketball to the child and then the child shoots it.

Being Mindful of Limits Skill – ​­The parent should be sensitive to the child’s
comfort, feelings of safety, and regulation level. Some play times may be
mostly tracking and reflecting statements if the child is displaying discomfort
with the parent’s attempts to engage. The parent should not engage or try
to get involved with what the child is doing to the point where the child
becomes fully dysregulated and has a meltdown.
Setting Limits – ​­The ­limit-​­setting approach in the FMA is fairly simple. Many
of the children that will be participating in the FMA may not understand
­limit-​­setting models that are too verbal or too cognitive and they may need
a more basic redirection. For most limit setting needs, the parent should sim-
ply redirect the child or remove the limit causing toy or material.
416 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

In Home Follow Me Approach (­FMA) Play Times Summary Sheet

Child’s Name __________________ Parent’s Name ___________________

Date of Play Time 

Description of Play Time








Issues or Questions about the Play Time








Observations Related to Improvements in Engagement or Therapy Goals







 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 417

­Limit-​­Setting Guide in the AutPlay Follow Me Approach

The three R’s l­imit-​­setting model stands for redirect, replacement, and
removal.
Redirect – ​­If the child begins to or is breaking a limit. The therapist
could begin with redirection which means redirecting the child’s focus
and energy away from a problematic situation to something that is al-
lowed. For example, away from throwing sand all over the playroom to
shooting baskets in the basketball hoop. The therapist would simply try
to redirect the child to another activity, toy, or object to transition their
attention off the limit violation. There does not need to be any dialogue
about a limit being broken or that the child needs to stop. In this situa-
tion, the therapist realizes the limit is being broken and moves to see if
redirecting will suffice.
Replacement – ​­If the child begins or is in process of breaking a limit, the
therapist could begin with implementing a replacement activity. Redirecting
and replacing are two processes can be used interchangeably. Replacement
means literally replacing what is happening (­something that is likely meet-
ing a need for the child) with something new or different that is acceptable
(­continues to meet the need for the child). For example, the child is smash-
ing a toy truck into the floor which is breaking the truck. The therapist or
parent would quickly select another object such as a rubber hammer and play
doh and put it in the child’s free hand showing them how to smash the play
doh while taking the truck away from the child. Replacement can also be
replacing a game that is being played with the child with a different game.
Where redirection is the act of transitioning the child’s attention or trying to
distract the child away, replacement is giving the child a tangible, acceptable
alternative that continues to meet their need. As with redirecting, there
does not need to be any dialogue about the limit being broken when using
the replacement strategy.
Removal – If ​­ a child is beginning to or in the process of breaking a limit,
redirecting and replacement should be implemented first. If these processes
do not work, then removal is the final option. The first step in removal is
verbally explaining to the child that they need to discontinue a ­limit-​­setting
behavior, or a toy/­material may be removed from the playroom or the play
session may end. In situations where a toy or material can be removed, the
therapist might say “­Michael in here you cannot cut the dolls hair, if you keep
trying to cut the hair, I will take the doll and scissors out of the playroom.” If
the verbal prompt does not stop the behavior, then removal is implemented.
418 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

The therapist would remove the doll and scissors from the playroom and
continue with the session. If removal involves the child needing to leave the
playroom (­usually due to unsafe behavior), the therapist could try guiding
the child into another location, possibly where the child can be alone or
minimally supervised while the child calms down. In an extreme case, re-
moval might involve ending the session and physically taking the child out
of the clinic. If physical removal is necessary, then a parent should be the one
to physically remove the child. This is done in extreme cases where the child
or others are in danger due to the child’s behavior, and action is needed to
keep everyone safe (­Table A.1).

Feeling List

Accepted Afraid Affectionate Loyal

Angry Miserable Anxious Misunderstood
Peaceful Beautiful Playful Ashamed
Brave Awkward Calm Proud
Capable Quiet Bored Overwhelmed
Caring Relaxed Confused Cheerful
Relieved Defeated Comfortable Safe
Competent Satisfied Concerned Mad
Depressed Pressured Confident Provoked
Content Desperate Regretful Courageous
Silly Lonely Rejected Curious
Special Disappointed Remorseful Strong
Discouraged Disgusted Sad Sympathetic
Excited Embarrassed Shy Forgiving
Thankful Sorry Friendly Thrilled
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 419

Fearful Stubborn Nervous Stupid

Glad Understood Frustrated Good
Unique Furious Tired Grateful
Valuable Guilty Touchy Great
Hateful Happy Helpless Hopeful
Wonderful Hopeless Humorous Worthwhile
Unattractive Joyful Uncertain Lovable
Humiliated Uncomfortable Loved Hurt
Ignored Impatient Indecisive Inferior
Insecure Irritated Jealous Worried

Table A.1 Suggested Toys and Materials ListToys

Human miniatures/­figures Animal miniatures

Car, plane, and boat miniatures Sand tray
Toy food, dishes, and kitchen area Water tray
Set of building blocks Set of LEGO bricks
An assortment of various fidgets Sensory balls and toys
Hula Hoop Rope
An assortment of hats & masks Mirror
Balloons Bubbles
Toy phone Toy computer
Basketball Basketball goal
(Continued)
420 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

Table A.1 Continued Suggested Toys and Materials ListToys

Doctors’ kit Cash register
Large cardboard bricks Toy money
Toy musical instruments Nerf guns
Foam swords (­pool noodles) Beach ball
Mr. Potato Head Game Feeling Face Cards
iPad Nintendo Switch
Expressive Materials
White paper Construction paper
Paints/­markers/­crayons Blank puzzles
An assortment of art (­decoration) Stickers
supplies
Clay/­Play Doh Magazines
Dry erase board Dry erase markers
An assortment of art (­construction) Buddha Board
supplies

Social Needs Cross Off Sheet

Flip a coin or chip onto the sheet and wherever it lands is the social need
that will be discussed and/­or practiced. Once it is finished, cross it off (­Tables
A.2, A.3, Figures A.­1–​­A.3).
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 421

Table A.2 Four Square Grid

Table A.3 Nine Square Grid

422 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

Social Navigation Pick Up Sticks Examples

RED

Name two things that make a good friend

Name three fun things you could do with other people
Ask someone in the room a question
What is your favorite feeling

BLUE

Say some ways kids get bullied at school

Name two things you can do to feel less nervous
Talk about something you did with a friend
Act like you are playing your favorite sport

YELLOW

What is a feeling you don’t like

What is a fun memory you have
Talk about a time you felt uncomfortable at school
What would you do if you could do anything you wanted

GREEN

Tell a story about something you did

Ask someone in the room a question
Say two things that make you feel nervous
Talk about something fun you do at school

BLACK

What is something that makes you uncomfortable

What is one of your favorite things to do
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 423

Figure A.1 Friendship Universe Worksheet.

424 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

Figure A.2 My Safety Wheel Worksheet.

 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 425

Figure A.3 Conversation Bubbles Worksheet.

426 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

Feelings Detective Worksheet

Name:___________________________________________________________

Find These Feelings:

Happy

Lonely

Excited

Mad

Proud

Nervous

Loved

Shy

Jealous
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 427

AutPlay Autism Checklist-​­R

Child’s Name __________________________Age_____Gender_____Date______________

The AutPlay Autism Checklist-​­Revised is a strengths-​­based autism screen-
ing instrument to help assess the possibility of autism and need for further
evaluation. Place a check by each statement that describes your child. If you
are unsure, leave the statement blank.


Seems to have their own way of communicating and interacting

Shows or seems to have strong reactions to sensory experiences
Seems to do things in a way that might not be expected
 iews relationships and interactions with peers differently than what
V
might be expected
Prefers constructive play (­Legos, blocks, train track)
Does not seem interested in and does not display pretend play
Spends time playing alone or seems to prefer to play alone
Prefers solitary activities
Prefers or displays nonverbal communication
Displays stimming (­hand or finger flapping, twisting, or spinning)
Displays stimming while talking or looking away while talking
Seems bored when talking with others
Seems drawn to or prefers technology play (­electronics)
Seems to prefer sensory based play
Has an intense focus on specific things or subjects
Preoccupation with one or more interests
Prefers a routine, schedule, or planned activity
 isplays a special interest and seems not interested in things outside of
D
the special interest
Not as interested in social processes that may be common with peers
428 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

About the AutPlay Autism ­Checklist-​­R

The checklist is based in a reframe of the D ­ MS-​­V diagnostic criteria for Autism
Spectrum Disorder and focuses on viewing the child from a more ­strength-​­based de-
scription. It is valid for children ages 4–​­11. The checklist is designed to be completed
by a parent or other caregiver who is familiar or involved enough with the child to
provide accurate feedback. Therapists should use the checklist in the following ways:

1 As part of an autism screening procedure to determine if further evaluation is

needed.
2 As an assessment tool to gain further information about a child’s strengths and
needs.
3 As an aid in developing therapy goals.

Instructions for completing the AutPlay Autism ­Checklist-​­R

Therapists should give the checklist to parents and/­or caregivers who are familiar with
the child (­this might include foster parents, school teachers, nannies, or other relatives).
Parents and/­or caregivers are instructed to complete the checklist by placing a check
next to any statement they feel describes the child. Parents and/­or caregivers are not
given a copy of the About the AutPlay Autism ­Checklist-​­R (­page 2). Therapists should
review and share results with parents and/­or caregivers and provide recommendations.

Scoring

The AutPlay Autism ­Checklist-​­R is not a diagnostic tool. When completing the
AutPlay Autism C ­ hecklist-​­R as part of an autism screening, therapists should com-
pare results on the checklist with other screening inventories or procedures as part
of a comprehensive screening protocol and consider additional factors to determine
if further evaluation is warranted. The checklist should not be the sole instrument
used for an autism screening.
The following scoring guide is designed to help inform further recommendations:

­0–­​­­1 – ​­Not indicative of further evaluation

­2–­​­­5 – ​­Possible referral for further evaluation
6 or ­above – ​­Indicative of further evaluation

Therapists looking for more resources for conducting autism screenings should con-
sider conducting a child observation, a parent–​­child observation, and implementing
additional inventories.
Therapists should refer parents and/­or caregivers for a full evaluation if there is an
indication of autism.

Child Name ____________________________ Score ___________ Date _________________

 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 429

AutPlay Child Observation Form

Child’s Name_________________________ Age_____ Gender_______ Date_____________

Communication (­does child make any verbal comments, are comments

relevant/­understandable, does child exchange in conversation, answer ques-
tions, is there other (­nonverbal) communication?)

Play (­what does the child play with, do they play with any toys, do they
play with other materials or ­non-​­toy objects, what seems to be their play
interests/­preferences?)

Relation (­how does the child seem to navigate relationally, any social inter-
action with the therapist, what social strengths are observed, are there any
observed social/­relational navigation needs?)

Attention/­Focus/­Impulsivity (­does the child seem to maintain attention for

an amount of time, do they wander around the room continuously, does the
child keep focus on any toys, complete tasks, do they appear impulsive?)

Interaction (­does the child interact with the therapist, does the child seem
to want to be alone, does child seem to notice or respond to the therapist
being in the room, do they attempt to connect with the therapist?)
430 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

AutPlay Child/­Parent Observation Form

Child’s Name_________________________ Age_____ Gender_______ Date_____________

General Child and Parent Interaction (­describe the interaction between the
parent and child, do the interactions occur smoothly or forced, does the
parent and child seem to listen to, respond to, or engage with each other?)
Joint Play, Child and Parent Together (­does the child and parent play to-
gether, describe type, quality, and quantity of play together, does play to-
gether seem forced or natural?)

Verbal and Nonverbal Communication (­does the child and parent engage
in verbal reciprocal communication, do child and parent exchange nonver-
bal communication, do they notice each other’s nonverbal communication,
what is the parent and child communication style?)

Parent Initiations Toward Child (­does the parent initiate interaction with
the child, how does the parent attempt to initiate with the child, how does
the child respond to the parents’ initiations?)

Limits (­If any limits occur during the observation, how are they handled by
the parent, what is the response of the child?)
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 431

AutPlay Assessment of Play–​­Page One

Child’s Name_________________________ Age_____ Gender_______ Date_____________

Read the following play categories and definitions and rate where you feel your child is
at in terms of possessing and demonstrating this type of play.
Functional Play is a term also used for relational play, it means denoting use of objects in
play for the purposes for which they were intended, e.g., using simple objects correctly,
combining related objects, and making objects do
what they are made to do (­setting up a bowling set and bowling).
NO–​­1  2  3  4  5  6  7  8  9  10–​­ YES
Symbolic Play refers to symbolic, or pretend play which occurs when children begin to
substitute one object for another. For example, using a hairbrush to represent a micro-
phone. The child may pretend to do something (­with or without the object present or
with an object representing another object) or be someone.
NO–​­1  2  3  4  5  6  7  8  9  10–​­ YES
Cooperative Play refers to a play where children plan, assign roles, and play together.
Cooperative play is goal-​­oriented and children play in an organized manner toward a
common end. Moreover, Cooperative play is a “true social play” in which children coop-
erate or assume reciprocal roles.
NO–​­1  2  3  4  5  6  7  8  9  10–​­ YES
Sociodramatic Play refers to play involving acting out scripts, scenes, and plays adopted
from cartoons, books. Children take/­assume roles using themselves and/­or characters like
dolls, figures, and puppets as they interact together on common themes.
NO–​­ 1  2  3  4  5  6  7  8  9  10–​­ YES
Peer play refers to interactions with one’s peers, which provide opportunities for physical,
cognitive, social, and emotional development.
NO–​­1  2  3  4  5  6  7  8  9  10–​­ YES
Constructive Play characterized as manipulation of objects for the purpose of construct-
ing or creating something. Children use materials to achieve a specific goal in mind that
requires transformation of objects into a new configuration. Lego pieces turned to cars or
houses are an example of this play.
NO–​­1  2  3  4  5  6  7  8  9  10–​­ YES
Sensory Play involves playing with toys or items for the purpose of sensory sensations or
sensory seeking. Enjoying the toy or object because of how it feels or what it produces for
the senses. Sensory balls, putty, and exercise balls are examples.
NO–​­1  2  3  4  5  6  7  8  9  10–​­ YES
Technology Play characterized by playing online and video games alone or with others.
This might involve a tablet, a game station, or playing games on a computer.
NO–​­1  2  3  4  5  6  7  8  9  10–​­ YES
432 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

AutPlay Assessment of ­Play – ​­Page Two

Child’s Name_________________________ Age_____ Gender_______ Date_____________

Please answer the following questions regarding your child’s play. Try to
think about specific times you have observed or played with your child and
answer the questions as completely as possible.
Does your child play with toys?

Does your child play independently?

Does your child play with other children?

Does your child initial play with other children or adults?

Do you have play times with your child?

Does your child interact with you during play times?

Does your child do pretend play or metaphor play?

Does your child play with objects that would not be considered toys?

If someone (­child or adult) asks your child to play, what does your child
usually do?

Does your child seem to want to play?

Does your child seem to like ­technology-​­based play?

Describe your child’s play.

 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 433

AutPlay Connection Inventory–​­Child (­3–​­11)

Child’s Name_________________________ Age_____ Gender_______ Date_____________

Rate the following connection related statements on the continuum from does
not display to displays, with a 1 being does not display at all and a 5 being fully
displays. A does not display selection does not mean an issue or problem. This
inventory is designed to better understand the child.
My child gives hugs and/­or other physical touch.
1  2  3  4  5
My child communicates, “I love you” and/­or makes other endearing statements.
1  2  3  4  
My child receives hugs and/­or other physical touch.
1  2  3  4  5
My child seems to want comfort from me or others when distressed.
1  2  3  4  5
My child displays interest and a desire to be with me or others.
1  2  3  4  5
My child indicates awareness of me or others.
1  2  3  4  5
My child appears to struggle with giving or receiving nurture/­love from me.
1  2  3  4  5
My child appears to avoid physical closeness and touch.
1  2  3  4  5
My child initiates games and play with others.
1  2  3  4  5
My child will participate if games or play are initiated by others.
1  2  3  4  5
My child responds appropriately when others engage them.
1  2  3  4  5
My child seems inconsistent in their affection toward family members.
1  2  3  4  5
My child talks about or seems interested in being with me, other family mem-
bers, or peers.
1  2  3  4  5
434 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

AutPlay Connection Inventory–​­Adolescent (­12–​­18)

Child’s Name_________________________ Age_____ Gender_______ Date_____________

Rate the following connection related statements on the continuum from does not
display to displays, with a 1 being does not display at all and a 5 being fully displays.
A does not display selection does not mean an issue or problem. This inventory is
designed to better understand the adolescent.
My adolescent engages in, seeks, seems comfortable with physical affection (­hugs,
touch, etc.).
1  2  3  4  5
My adolescent communicates, “I love you” and/­or makes other endearing statements.
1  2  3  4  5
My adolescent seems comfortable receiving hugs and/­or other physical touch.
1  2  3  4  5
My adolescent will display sad, hurt, or vulnerable emotions if the situation warrants
such a response.
1  2  3  4  5
My adolescent displays empathy toward others.
1  2  3  4  5
My adolescent makes appropriate acknowledgment of others.
1  2  3  4  5
My adolescent seems inconsistent in their affection toward me, family members, and
others.
1  2  3  4  5
My adolescent appears unable to give or receive love.
1  2  3  4  5
My adolescent appears to avoid physical closeness and touch.
1  2  3  4  5
My adolescent initiates games or “hang out” time with others.
1  2  3  4  5
My adolescent will participate if others initiate games or “hang out” time.
1  2  3  4  5
My adolescent participates in or seems to want to participate in family activities.
1  2  3  4  5
My adolescent seems to have an appropriate parent/­adolescent connection.
1  2  3  4  5
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 435

AutPlay Emotional Regulation Inventory–​­Child (­3–​­11)–​­Page One

Child’s Name_________________________ Age_____ Gender_______ Date_____________

Rate the following emotional regulation statements on the continuum from
does not display to displays, with a 1 being does not display at all and a 5
being fully displays. A does not display selection does not mean an issue or
problem. This inventory is designed to better understand the child.
My child verbalizes positive emotions.
1  2  3  4  5
My child verbalizes negative emotions.
1  2  3  4  5
My child shows appropriate body language to match an emotion.
1  2  3  4  5
My child can differentiate between at least 5 emotions (­as age appropriate).
1  2  3  4  5
My child recognizes when another person is feeling something.
1  2  3  4  5
My child can accurately identify an emotion in another person.
1  2  3  4  5
My child understands anxiety and can ­self-​­calm.
1  2  3  4  5
My child understands anger and knows anger reducing strategies.
1  2  3  4  5
My child can verbalize when they feel angry or anxious.
1  2  3  4  5
My child shows emotions in pretend or symbolic play.
1  2  3  4  5
My child can verbalize when they feel confused.
1  2  3  4  5
My child can identify an emotion that goes with a certain situation such as
what someone would feel when they are at a funeral.
1  2  3  4  5
436 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

AutPlay Emotional Regulation Inventory–​­Child (­3–​­11)–​­Page Two

Please answer the following questions regarding your child’s emotional reg-
ulation. Try to think about specific times you have observed with your child
and answer the questions as completely as possible.

1 Describe a situation in which your child expressed an emotion.

2 Describe a situation where your child was expressing a negative emotion

and was able to ­self-​­calm.

3 Describe a situation when your child accurately identified an emotion in

another person.

4 Describe how emotions are shown and expressed in your family.

5 Describe how emotions are currently taught and/­or modeled for your
child.
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 437

AutPlay Emotional Regulation Inventory–​­Adolescent (­12–​­18)–​

­Page One

Child’s Name_________________________ Age_____ Gender_______ Date_____________

Rate the following emotional regulation statements on the continuum from
does not display to displays, with a 1 being does not display at all and a 5
being fully displays. A does not display selection does not mean an issue or
problem. This inventory is designed to better understand the adolescent.
My adolescent indicates positive emotions.
1  2  3  4  5
My adolescent indicates negative emotions.
1  2  3  4  5
My adolescent shows appropriate body language to match an emotion.
1  2  3  4  5
My adolescent can differentiate between at least ten emotions.
1  2  3  4  5
My adolescent recognizes emotions in others.
1  2  3  4  5
My adolescent can accurately identify an emotion in another person.
1  2  3  4  5
My adolescent understands anxiety and can ­self-​­calm when anxious.
1  2  3  4  5
My adolescent understands anger and knows anger reducing strategies.
1  2  3  4  5
My adolescent can indicate when they feel angry or anxious.
1  2  3  4  5
My adolescent shows emotion regarding peer and family relationships.
1  2  3  4  5
My adolescent seems to understand and express empathy.
1  2  3  4  5
My adolescent can identify an emotion that goes with a certain situation
such as what someone would feel when they are at a funeral.
1  2  3  4  5
438 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

AutPlay Emotional Regulation Inventory–​­Adolescent (­12–​­18)–​

­Page Two

Please answer the following questions regarding your adolescent’s emotional

regulation. Try to think about specific times you have observed with your
adolescent and answer the questions as completely as possible.

1 Describe a situation in which your adolescent expressed an emotion.

2 Describe a situation where your adolescent was expressing a negative

emotion and was able to ­self-​­calm.

3 Describe a situation when your adolescent accurately identified an emo-

tion in another person.

4 Describe how emotions are show and expressed in your family.

5 Describe how emotions are currently taught and/­or modeled for your
adolescent.
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 439

AutPlay Social Navigation Inventory

Name____________________________ Age_______ Gender_________ Date_______________

How would you describe your child’s social navigation?





Does your child play with or hang out with others? Please describe.




Please describe any of the following possible needs your child may be having–
​­experiencing bulling, peer rejection, safety awareness concerns, social anxi-
ety, misunderstood by others, ­self-​­esteem struggles, ­self-​­awareness, unhappy
with current peer/­friendship situations.




What is your child’s social and other strengths?





What does social navigation look like in your family?




440 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

AutPlay Special Interests Inventory

Child’s Name__________________________ Age_______ Gender_________ Date_______________

What do you like to do for fun?

If you could wake up tomorrow and do whatever you wanted, what would
you do?

What do you talk about a lot?

What do you think about a lot?

Do you have a favorite game?

What do you do that feels good to you?

What things are you interested in?

How do you spend your free time?

 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 441

AutPlay Dysregulated Behaviors Assessment–​­Page One

Child’s Name_________________________ Age_____ Gender_______ Date_____________

Please answer the following ­open-​­ended questions regarding your child’s be-
havior. Try to recall specific situations and behaviors. If you are unsure, leave
the question blank.

1 Does your child seem to have sensory issues? If so, what type?

2 Do you understand the difference between a dysregulated “meltdown”

vs. a more intentional behavior response?

3 What does your child’s unwanted behaviors look like? Please describe
context, actions, words, etc.

4 Are there specific times and or situations when you child is more likely
to have unwanted behaviors? Please describe.

5 Do you notice specific triggers that seem to create/­precede unwanted

behaviors?
442 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

6 What is the typical intensity and duration of unwanted behaviors?

7 How frequently, in a week’s time, does your child have an unwanted

behavior?

8 Does your child have unwanted behaviors at school? If so, describe.

9 How do you currently address or manage your child’s unwanted behaviors?

10 Does your child seem particularly dysregulated or “edgy” right after

school?

11 Have you discovered anything that seems to help your child calm when
they are having unwanted behaviors?
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 443

AutPlay Behavior Communication Assessment

Child’s Name ______________________ Age_____ Gender______Date____________

Reporting Source for Assessment:
Parent Observation Teacher Observation Therapist Obser-
vation Other
Describe the behavior, the intensity of the behavior, the frequency of the
behavior, the duration of the behavior.




Describe where the behavior occurred, the place, the time, the people
involved.




Describe what preceded the behavior, what is happening before the behavior
occurs, what is happening in the environment, what are other people doing?




Describe what the observed response to the behavior is, how do other people
respond, how does the child’s caregiver (­adult) respond?




What appears to be the purpose of the behavior? What could the child be
communicating?




What could be adjusted or modified that might help prevent future behavior?




444 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e

AutPlay Parent Self Care Inventory

Please complete the following questions. Try to reflect on and think about
each question and answer as thoroughly as possible. If you are unsure, leave
blank.

1 Do you have support people in your life? If so, who and in what ways do
they provide support for you or your family?

2 Are you involved with any community agencies or programs that pro-
vide support services? If so, what type of support are you receiving?

3 Do you have any leisure time that is child free? If yes, describe the leisure
time.

4 What do you do for relaxation?

5 What does self care mean to you? Describe your current level of self care.

6 What would be your ideal balance of child care and self care? (­Table A.4).
 Co m m o n Te r m s R e l a t e d t o N e u r o d i v e r g e n c e 445

Table A.4 Play Therapy Intervention Tracking Sheet

Therapy Goal/­Need AutPlay Therapy Session Date

Addressed (­Emotional, Intervention
Social, Connection, etc.)
 Index

Note: Bold page numbers refer to tables; italic page numbers refer to figures.

ableism 33; counseling practice 11; anxiety reduction 150, 169, 203; Backward
deconstructing ableist ideas 180–182; Moves 389–390; Body Part Bubble
defined 8; as harmful bias 9; look like 10, Pop 362–364; Bubble Pop Brain
10; personal 8–9; realness of 10; systemic Blast 391–392; 10 Cloud Relaxation
issue 36 intervention 123, 402–404; Fast and Slow
ableist microaggressions 10 Balloons 390–391; Feelings Paint Swatch
acceptance 33 Key Ring 350–351, 352; Here Comes
Acceptance Commitment Therapy 42 the Candy 370–372; Make My Moves
Action Identification 173, 309–311 intervention 359–361; Midline Mirror
ACT limit setting model 167 Moves intervention 208, 386–387; New
actual autistic 70, 73 Plan/Same Plan 345–347, 347; One Color
Adlerian Play Therapy 110, 151 Picture 400–401; Pool Noodle Sword
adult led play 97–98 Battle 393–394; Punching Bag Moves
adverse childhood experiences (ACE) 74 394–395; Running All Ways 387–388;
affirming therapies: music therapy 80; Schedule Party 343–345; Sensory
occupational therapy 79; play therapy 78, Mandala 396–397; Ways We Cross the
79; speech therapy 79 Room 399–400; Worry Tree 342–343, 344
agents in AutPlay Therapy: direct teaching Armstrong, T. 7
123; positive emotions 123; positive art play 97
peer relationships 122; self esteem 123; Asperger, Hans 67, 68
self-regulation 123; social competence Asperger’s Syndrome 39–40, 48, 52, 68, 116
123; stress management 123; therapeutic Association for Play Therapy (APT) 109,
relationship 122–123 118–119, 175, 177; Paper on Touch 83;
alexithymia 64, 78, 328 seminal theories of 110; website (a4pt.
All Around Me 367–368 org) 84
Alphabet Feelings 339–342 attention-deficit hyperactive disorder
alternative communication device (ADHD) 31, 58, 65, 73, 110, 148, 187,
(AAC) 81 291, 295; assessment 275; AutPlay
American Psychiatric Association: Therapy 168; diagnosis 51, 53–54, 59, 60,
Diagnostic and Statistical Manual 64, 87, 102, 231, 244, 290, 411; distracted
(DSM) 11 by noise 55; genetic predisposition and
Animal Assisted Play Therapy 111 environmental interaction 6; glittery
448 Index

brains 60; high-risk activities 57; innate research support 117; on theoretical level
forms of neurodivergence 7; medication 117; traditional communication methods
38, 59; negative feedback 54; play therapy 117; valuing the child 117
147; undiagnosed 54, 57, 59 AutPlay® Therapy Process 1, 2, 111, 117,
autism 31, 67; AutPlay Therapy 1; deficits 118, 290; autism screening process 16;
in social communication and interaction basics of 168–169; case example 171–173;
12, 14; defined 15; deserve understanding children and adolescents 158–159;
and acceptance 15; innate forms of child’s play preferences 151; developing
neurodivergence 7; My Life with Autism relationship 158; directive play therapy
(case) 34–35; non-pathology affirming 149–150, 159–161; FMA (see Follow
perspective 12, 13–17; problems with Me Approach (FMA)); framework and
autistic play 153; regulation struggles implementation 148–149; integration
(case) 1; repetitive behavior or interests (synthesis) 118; limit setting with
12–13, 14; school sickness 3; sensory AutPlay Follow Me Approach 166–168;
issues 2; social challenges 2; strengths- neurodivergent and play therapy
based (Strength-Based Autism Diagnostic journeys 2; neurodivergent children
Criteria) 14 and adolescents 150; nondirective play
Autism Self Advocacy Network (ASAN) 15 therapy 149; overview of 147–151;
Autism Society of America 68 partnership or partnering 151–152;
AutPlay see Follow Me Approach (FMA) personal reflections 157–158; play
AutPlay Assessment of Play Inventory 271, 152–156; play techniques 156–162; play
431–432 therapy approach 150; play therapy rooms
AutPlay Autism Checklist- R 16, 427–428 164–166; Registered Play Therapist 147;
AutPlay Behavior Communication research 169–171; R’s limit setting model
Assessment 443 166; session protocols 162–163; strength-
AutPlay child observation form 429 based perspective 16–17; toys, games, and
AutPlay child/parent observation form 430 materials 163–164, 419–420; variety of
AutPlay Connection Inventory 271, concerns 150
433–434 Axline, V. 80, 109, 130, 144, 234–236,
AutPlay Dysregulated Behaviors Assessment 287; Dibs: In Search of Self 109; Play
441–442 Therapy 109
AutPlay Emotional Regulation Inventory
271, 435–438 Backward Moves 123, 389–390
AutPlay Parent Self Care Inventory 444 Baggerly, J. 137, 192
AutPlay Social Navigation Inventory Bailin, A. 305
271, 439 Ballou, E. P. 35; Sincerely, Your Autistic
AutPlay Special Interests Inventory 440 Child 35
AutPlay® Therapist: competent practice Banerjee, M. 118
of 177–179; deconstructing ableist Beard, Spencer: neurodivergent child 47–50
ideas 180–182; descriptors for defining behavioral programs 148
179–180; foundation and framework Behavioral theory 110
of 185–186; guidelines for practicing Biel, L. 192
therapy 184–185; issues of diversity and Bipolar Disorder 39
intersectionality 182–185; play therapist Blom, R. 139
175–180; understandings of 185–188 Blume, Harvey 6, 68
The AutPlay® Therapy Handbook (Grant) body autonomy 83–84
116–119; clinical outcomes 118; play body language 81
interventions and experiences 116–117; Body Part Bubble Pop 362–364
 Index 449

Booth, P. B. 132–134, 254 Hats and Masks 372–373; Here Comes

Bottema- Beutel, K. 169, 170 the Candy 370–372; Hula Hoop
Bratton, S. 113 Exchange 380–381; Let’s Stick Together
British Association for Play Therapy 381–382; Make My Moves 359–361; Tell
175–176, 176–177 Me About Your Family 373–375; Where
Bronfenbrenner, U. 24 Am I Going? 361–362; Write and Move
Brown, Rebekah: neurodivergent child 50–53 375–377; You, Me, and LEGO 377–378
Bubble Pop Brain Blast 391–392 Construction Paper Decoration 365–367
Bubbles Social Interaction 321–323 constructive play 95
Bundy-Myrow, S. 134 Conversation Bubbles 319–320, 425
Covid-19 pandemic 276
Candy Kindness Activity 316–317 Cox, E. 116
Cangelosi, D. 124 critical reflection 176
Carlson, S. E. 236 Cross, A. 153
Cavett, A. 142, 143 “curing gayness” or “passing for white” 6
Child Centered Play Therapy (CCPT) 110,
117, 118; benefits 131; goals or objectives DaVanport, S. 35; Sincerely, Your Autistic
131; influence and integration in AutPlay Child 35
Therapy 131–132; limit setting model DeFrain, J. 255
167; person-centered counseling 130; depression 74
tenets 130–131 devaluing 33–34
childhood, defined 24 developmental delay 284
Child Parent Relationship Therapy 81 Developmental (Viola Brody) theory 110
10 Cloud Relaxation 123, 402–404 Diagnostic and Statistical Manual (DSM)
code switching 75 11–12
Coffee Filter Mandala 405–406 Dibs: In Search of Self (Axline) 109
Cognitive Behavioral Play Therapy (CBPT) Digital Play Therapy 111
110, 117, 118; case example 143; discrimination and social prejudice 8
CBT methodology 142; cognitive and diverse neurotypes (identity freedom) 82–83
behavioral interventions 142; constructs diversity, defined 5
in AutPlay Therapy 144, 144; integration Divide and Conquer 324–325
and influence on AutPlay Therapy dramatic play 96
143–144; play activities 142; properties Draw My Feeling Face 206–207
141–142; spectrum of neurodivergence Drewes, A. 142, 143
145; tenets 144; theory integration/ Drewes, A. A. 120, 142
influences 144, 144; use of play 143 DSM 5th Edition 12; requiring substantial
commitment to personal development 176 support 13; requiring support 13; requiring
commitment to professional development 176 very substantial support 13
compassion 176 dyscalculia 31
compulsions 41 dyslexia 7, 31
congruence 176 dyspraxia 31
connection (relationship development) dysregulation, AutPlay model of 383–384
interventions: All Around Me 367–368;
Body Part Bubble Pop 362–364; echolalia 14
connecting and engaging 357–359; Ecosystemic theory 110
Construction Paper Decoration 365–367; educational play 98
Family Bubbles 378–379; Family Name Education and Health Care Plan
364–365, 366; Guess Touches 369–370; (EHCP) 275
450 Index

An Emotional Story 337–339 Feelings Jenga 86

emotion expression 76 Feelings Paint Swatch Key Ring
emotion identification and expression 350–351, 352
interventions: Alphabet Feelings Feelings Scenarios 333–335
339–342; An Emotional Story 337–339; Filial Therapy 81, 110, 118; aim of
emotion/situation recognition 329; 136; AutPlay Unwanted Behaviors
Feeling Face Cards 352–353; Feeling Inventory 217–218; benefits 136, 215;
Face Fans 330–331; Feelings Detective essential features 135, 136; goals of 135;
335–337; Feelings Paint Swatch Key integration, constructs 136; limit setting
Ring 350–351, 352; Feelings Scenarios model 167; parent/caregiver 216; parent–
333–335; identifying and expressing child 134; parents partner 216; skills 135;
emotions 328–330; Me and My Feelings traditional parenting skills training 217;
331–333; My Emotions Cards 355–356; values 135; working with parents 215
New Plan/Same Plan 345–347, 347; First Play 111
overall awareness and managing emotions FMA with parents: accepting child
329; Perspective Puppets 353–355; Potato invitation to play 265; asking questions
Head Feelings 347–349; recognizing skill 263, 414; Autistic Self Advocacy
emotions 329; Schedule Party 343–345; Network 257; being mindful of limits skill
sharing emotional experiences 329; 264, 415; continuous support to parents
understanding and expression of emotions 269; engage with child skill 263–264,
329; What Are They Feeling? 349–350; 415; and families 255; features of strong
Worry Tree 342–343, 344 or healthy families 255; goals 268–269; to
emotion/situation recognition 329 heal relationships 255–256; importance of
empathy 176 parents 254–257; limit setting approach
empowerment 34 265; nondirective play skill 258, 262, 414;
Erickson, Erik 66 parent guide for implementing 413; play
ethical 176 benefits 256; play times in home 266–268,
Experiential Play Therapy 111 416; reflective and tracking statements
exploratory play 96 skill 262–263, 414; role in life of child
expressive language 288–289 254; starting and ending 264–265,
Expressive Play Therapy 111 413–414; teaching and session outline
257–261
Family Bubbles 378–379 Follow Me Approach (FMA) 200; asking
Family Name 364–365, 366 questions skill 246–247; autistic and
Family Play Therapy 111, 118; application neurodivergent child 236; being mindful
of 137; description 138; integrative of limits skill 248; case examples
elements and influence on AutPlay 271–302; directive play approaches
Therapy 138–139; Kinetic Family Drawing 234; engaging with child skill 247–248;
137; parents and family members role goals for child 248–249; implementation
in 138; relationship development of 236; integrating directive elements
approaches 139 241–243; limit-setting approach
Family Systems 149 250–251; nondirective family play
Fast and Slow Balloons 390–391 therapy approach 234–236; nondirective
federal regulations 410 play skill 245; with parents (see FMA
Feeling Face Cards 352–353 with parents); participating in 243–245;
Feeling Face Fans 330–331 reflective and tracking statements
Feelings Detective 335–337 skill 246; session setup 249–251; skills
Feelings Fair 86 245–248; starting and ending session
 Index 451

250; structured intervention phase 241; Iannelli, V. 68

therapists guide for 251–252; using identifying emotions 329
playroom and toys/materials 249–250 identity-first language 21
Freeman, S. 212–214 identity freedom 34
Freud, Anna 109 identity struggles (self-acceptance, masking,
Friendship Universe 312–314, 423 code switching) 75
functional play 95 inclusion 33; advocate for 83
Individualized Education Program (IEP)
Gallo-Lopez, L. 116 40–41, 84, 196, 205, 295, 410
Gardner, K. 129 infantile autism 68
Gerlach, Jennifer: neurodivergent child inspiration porn 10–11
38–42 intake and assessment phase of AutPlay
Gestalt Play Therapy 110, 118; benefits Therapy: assessment and inventory
140–141; building therapeutic paperwork 276; introducing play session
relationship 139–140; elements of 139, (observation) 193–194; session with both
140; influential elements within AutPlay child and parent(s) (second) 192–193,
Therapy philosophy and protocols 141; 196; session with parents (first) 191–192,
principles of 139 195–196; social story 191; therapist
Gilbert, M. 127 working with child (third) 193; therapy
Gil, E. 137, 138, 214, 220, 256 goals and plan (fourth) 194–195, 196–197
goals in AutPlay® Therapy: goals for child integrative family play therapy 148
204; goals for parent(s) 204–205 integrative play therapy approach: AutPlay
Goering, S. 18 integration process 127–128; AutPlay
Grant, R. J. 21, 116–119, 138, 271–275; Therapy 129; defined 127; Ecosystemic
AutPlay® Therapy FMA case 271–275; Play Therapy 129; Flexibly Sequential
The AutPlay® Therapy Handbook 116–119 Play Therapy 129; integrated whole
Grinker, R. R. 66 127–128; integration of person and
group play 97 professional 128; integration of research
Guerney, B. G., Jr. 135 and practice 128; integration of theories
Guerney, L. 109, 135 and/or concepts and/or techniques 128;
Guess Touches 369–370 in neurodivergent care 129–130; Play
Therapy Dimensions Model 129; primary
Hats and Masks 372–373 AutPlay Play Therapy theory integration
heart and soul of play therapy 120, 124 130–145
Hendricks, S. 235 Intelligence Quotient (I. Q.) 80
Here Comes the Candy 370–372 It’s Okay to be Different (Parr) 86
Higashida, N. 36; The Reason I Jump 36
honesty 176 Jaarsma, P. 69
How to Play with an Autistic Child (Vance) Jeffreys, R. 237, 248, 256
101–102 Jernberg, A. M. 132, 134, 254
Hudspeth, E. F. 112 Jorgensen, C. 80
Hula Hoop Exchange 380–381 Jungian theory 110
Hula Hoop Walk 401–402
Hull, Kevin 116 Kaduson, H. G. 124
Humanistic theory 110 Kanner, Leo 67, 68
humble bragging 230 Kasari, C. 212–214
Hutchinson, Elaine: AutPlay® Therapy Kiyimba, N. 67
FMA case 275–281 Knell, S. M. 141
452 Index

Knobloch- Fedders, L. 237 addressing 66–70; identity struggles (self-

knowledgeable 176, 184 acceptance, masking, code switching) 75;
Koehler, C. M. 137, 192 life issues/transitions 77; neurodivergent
Kool, R. 237 therapy approaches 70–73; neurodiversity
Kottman, T. 111, 113, 151, 175 affirming play therapist constructs 80–84;
Kress, K. 200, 202 parent/child relationship 76–77; peer issues
(bullying, rejection, friends) 75; poor self-
Lambert, M. 21 worth 74–75; regulation struggles 75–76;
Landreth, G. L. 80, 84, 109, 130, 131, 157, sensory needs 76; social related needs 76;
167, 179, 235, 237, 249, 250, 257, 258, 265 symptoms of 73; trauma 74
Lawver, T. 237 Mette 183
learning disorders 7; innate forms of Midline Mirror Moves 208, 386–387
neurodivergence 7 Mittledorf, W. 235
LeBlanc, M. 113 Moran, Sarah: neurodivergent child 53–60
LEGO creation 25, 27 Mottron, L. 28
Lester, J. N. 67 movement and whole brain activation
Let’s Stick Together 381–382 384–386
Levy, David 109 movement play 97
life issues/transitions 77 Murphy, K. 100
Lin, D. 113 music therapy 80
Lindaman, S. 133 My Emotions Cards 355–356
Lomando, Patricia: neurodivergent child My Safety Wheel 317–318, 424
60–65
Look at My Strengths 123 The National Professional Development
Lowry, L. 212, 213 Center (NPDC) 170
Lowry, M. 14 National Standards Project (NSP) 170
Lyles, M. 10 neurodivergent (ND): child (see
Lyons, T. 70 neurodivergent children); defined 7, 31;
issues and struggles 4; range of 31, 32
Macdonald, J. 257 neurodivergent children: acceptance vs.
Magazine Minute 308–309 ableism 33; by Beard 47–50; by Brown
Major Depressive Disorder 39 50–53; defined 31; educating others 38;
Make My Moves 122, 359–361 empowerment vs. trauma 34; in family 37;
Malher- Moran, M. S. 385 by Gerlach 38–42; identity freedom vs.
Mallipeddi, N. V. 182 masking 34; inclusion vs. seclusion 33; by
Marie, M. 200, 202 Lomando 60–65; mental health needs of
masking 34, 75 (see mental health needs of ND children);
Mate, Gabor 33 by Moran 53–60; school challenge
matter of fact 141 37; self-acceptance 37–38; by Sripom
Me and My Feelings 123, 331–333 42–47; systemic issue 36; therapies and
Meany-Walen, K. K. 111, 113, 175 interventions 37; value vs. devaluing
medal model perspective 17 33–34
medical model of disability 11–13 “neurodivergent communication 101” 42
mental health needs of ND children: neurodivergent play: adult led play 97–98;
affirming therapies 78–80; anxiety 74; art play 97; AutPlay Assessment of Play
in AutPlay Therapy 73; case example 94; behavior-based protocol 91; case
84–89; checklist form 77–78; depression examples 102–108; constructive play
74; emotion expression 76; history of 95; constructs 93; dramatic play 96;
 Index 453

educational play 98; exploratory play O’Brien, P. 169

96; functional play 95; group play 97; obsessions 41
history 91–92; and human development Obsessive Compulsive Disorder (OCD) 31,
91; integration and complexities 39, 87, 110, 279
of 98–102; manifestations of 94; occupational therapy 79
movement play 97; pretend play 96; O’Conner, K. J. 109, 112, 177, 183, 184
reenactment play 96; Sensory Mandala Oliver, Mike 68
example 106; sensory play 95–96; Onaiwu, M. G. 35; Sincerely, Your Autistic
solitary play 96; spectrum of 100; tips Child 35
for working with 100 One Color Picture 400–401
neurodiversity 5–6, 7, 68, 407 Onstad, Daysi B.: AutPlay® Therapy FMA
neurodiversity affiming: mental health case 290–299
approach for ND children 2; multiple Oppositional Defiant Disorder 39
processes 20; principles 21; value and O’Reilly, M. 67
affirming practices 21–22; valuing child’s Organization for Autism Research 83
identity 20–21 Orlans, V. 127
neurodiversity affirming play therapist overall awareness and managing
constructs: advocate for inclusion 83; emotions 329
partner with parent/caregiver and the overwhelmed 230
child 82; play is natural language of child
84; presume competence 80; recognize Paper Friend 122
child’s play preferences and interests 82; parent and family involvement: addressing
respect body autonomy 83–84; respect parent hesitation and resistance 218;
diverse neurotypes (identity freedom) of autistic children 212–214; AutPlay
82–83; support self advocacy skills 83; use therapy and parents 214–218; child’s
strength-based approach 82; value and health and wellbeing 212; considerations
allow for multiple ways of communication with home interventions 226–228;
81; value and provide space for child’s encouragement and parent self care
voice 81; value relationship as core 228–229; parenting neurodivergent child
change agent 80–81 230–232; parents, families, and play
neurodiversity movement 7, 70, 149 therapy 211–214; play interactions 212;
neurodiversity paradigm 8, 149 suggestions for addressing parent lack of
neurotypes 31 participation 218–220; teaching parents
neurotypical (NT): defined 7; society- directive play therapy interventions
defined typical intellectual and cognitive 220–223; teaching parents relational play
development 32 times 223–226
“neurotypical communication 101” 42 parent/child: Observation 16; relationship
New Plan/Same Plan 345–347, 347 76–77
Nims, D. R. 28 parent training 136, 152, 200, 217,
non-autistic 21, 74, 78, 170–171 228, 239
non-pathology affirming perspective: autism Parker, N. 169
12, 13–17; vs. medal model perspective Parr, Todd 86; It’s Okay to be Different 86
17; strengths-based (Strength-Based passive aggressive 55
Autism Diagnostic Criteria) 14 Pattoni, L. 23
normative abilities 10 peer issues (bullying, rejection, friends) 75
person-centered therapy 109
Oaklander, V. 139, 140 person first language 180
Object-Relations theory 110 Perspective Puppets 353–355
454 Index

Pervasive Developmental Disorder 39 Radically-Open DBT 42

Peter, M. 116 Raghav, P. 230
phases of AutPlay® Therapy 190; case Ramesh, J. 230
example 205–210; intake and assessment Rapp, C. 23
phase 190, 190; structured play Ray, D. C. 109, 113, 131, 236, 237
intervention phase 197–200; termination Ray, S. G. 118
phase 200–203 The Reason I Jump (Higashida) 36
pictorial exchange communication system receptive language 161
(PECS) 285 recognizing emotions 329
Playful Role Play 314–315 reenactment play 96
Play Therapy 78, 79, 149; benefits of Reeve, D. 11
children 112; catharsis 114; definition of Registered Play Therapist (RPT) 111, 147
112; foundational theories 110; fun 113; Registered Play Therapist-Supervisor
history and theories 113–115, 116; as (RPT-S) 111
language for child 109; mastery 114–115; regulation interventions: AutPlay model
metanalysis 113, 114; and neurodivergent of dysregulation 383–384; Backward
children 115–116; origins of 109; release Moves 389–390; Bubble Pop Brain Blast
of energy 115; social development 114; 391–392; 10 Cloud Relaxation 402–404;
symbolic expression 113; systematic Coffee Filter Mandala 405–406; Fast and
review 113; theoretical orientation 112; Slow Balloons 390–391; Hula Hoop Walk
theories, approaches and modalities 401–402; Midline Mirror Moves 386–387;
110–111; therapist 3–4; variance and movement and whole brain activation
complexities 111–112 384–386; One Color Picture 400–401;
Play Therapy (Axline) 109 Pool Noodle Sword Battle 393–394;
Play Therapy Interventions 25, 113, 114, Punching Bag Moves 394–395; Running
137–139, 197–198, 219–223; Tracking All Ways 387–388; Sensory Likes and
Sheet 445 Dislikes 404–405; Sensory Mandala
Pool Noodle Sword Battle 393–394 396–397; Sensory Rock Play 397–398;
poor self-worth 74–75 Ways We Cross the Room 399–400
Pose 325–327 regulation struggles 75–76
Potato Head Feelings 347–349 Relationship Play Therapy 111; as agent
practice or policy 33 of change in nondirective play process
presume competence 80, 244 236–237; conditions based on primacy of
pretend play 96 relationship 237–238; in FMA application
primary AutPlay play therapy theory 238–239; “here-and-now” aspects 237; play
integration: Child Centered Play Therapy therapy-effectiveness 237
(CCPT) 130–132; Cognitive Behavioral respect 176
Play Therapy (CBPT) 141–145; Family Ritchie, M. 113
Play Therapy 137–139; Filial Therapy Robinson, J. E. 6
134–136; Gestalt Play Therapy 139–141; Rosa, R. 77
Theraplay 132–134 R’s limit setting model: Redirect 166,
Prizant, B. M. 71 417; Removal 167, 417; Replacement
The Progressive Balloon Game 166–167, 417–418
intervention 209 Rubin, L. C. 116
Psychoanalytic theory 110 Running All Ways 387–388
psychosis 39
Pulrang, A. 8 Safety Wheel 123
Punching Bag Moves 394–395 Saleebey, D. 23
 Index 455

Sandtray Therapy 111 423; Magazine Minute 308–309; My Safety

Schaefer, C. E. 109, 119, 120, 124 Wheel 317–318, 424; needs 303–304;
Schedule Party 343–345 Playful Role Play 314–315; Pose 325–327;
schizophrenia 39, 66, 68, 116 Social Brick Road 323–324; Social
School Based-Registered Play Therapist Navigation Pick Up Sticks 306–308,
(SB-RPT) 111 422; Social Needs Bag 311–312; Social
scoring 428 Needs Cross Off 305–306, 420, 421; social
Scuka, R. F. 135 situations 304; social skills work 303; What
Scuro, J. 9 to Say? What It Do? 320–321
seclusion 33 Social Navigation Pick Up Sticks 306–308
Secret Square 86 Social Needs Bag 311–312
self-acceptance 37–38, 75 Social Needs Cross Off 305–306, 420, 421
self advocacy skills 83 social related needs 76
self-awareness 176 sociodramatic play 96
self-care 228–229, 229 solitary play 96
self-responsibility 176 Solution Focused Play Therapy 24–25, 111
sensory differences 6–7, 31, 76, 95, 97, 105, Some Brains: A Book Celebrating
147, 148, 154, 164, 168, 187, 250 Neurodiversity (Thomas) 86
Sensory Likes and Dislikes 404–405 Sori, C. F. 214
Sensory Mandala 396–397 speech and language therapist (SLT) 285
sensory needs 76 speech therapy 79
sensory play 95–96 Sprenkle, D. 214
Sensory Rock Play 397–398 Sripom, Boontarika: neurodivergent child
sharing emotional experiences 329 42–47
Sherratt, D. 116 stimming 14, 328
Shore, Stephen 36 Stinnett, N. 255
Silberman, S. 6 Stoerkel, E. 23
Simeone-Russell, R. 134 Stoika, P. 257
Sincerely, Your Autistic Child (Ballou, strength-based perspective: AutPlay Therapy
daVanport, and Onaiwu) 35 16–17; child and adolescent 25–29;
sincerity 176 children as co-change agents (partners)
Singer, Judy 6, 68, 180, 411 25; child’s strengths and assets 23; concept
Siri, K. 70 of valuing a child 28–29; examining
Slapjack 283 child’s environment 24; neurodivergent
Smith, Kayla 35 individuals 22; neurodiversity affirming
Social Brick Road 323–324 approach 23; neurotypical individuals 22;
social model of disability 149; attitudinal and self-worth 25–29; solution-focused play
barriers 18–19; barriers 18–19; example of therapy 24–25; standards for determining
19; information/communication barriers 23–24; Strength-Based Autism Diagnostic
19; needs and differences 20; people’s life Criteria 14; therapist approaches 24; wows
experience 17–18; physical barriers 18–19 and hows 28
social navigation interventions: Action Strengths Checkers 86
Identification 309–311; autistic and structured play intervention phase 197–200;
neurodivergent children 303–305; Bubbles different “looks” 198; evaluation process
Social Interaction 321–323; Candy 200; information gathered in Intake
Kindness Activity 316–317; Conversation and Assessment Phase 197; parent
Bubbles 319–320; Divide and Conquer involvement 198–199; structure of
324–325; Friendship Universe 312–314, 197–198
456 Index

Sullivan, J. M. 236, 237 Together Balloons 208–209

Sullivan, P. W. 23 Tourette’s Syndrome 31, 39, 187
Synergetic Play Therapy 111 trauma 34, 74
TraumaPlay 111
Taylor, E. R. 24 Trotter, K. 212
Taylor, Jen: AutPlay® Therapy FMA case
281–284 value 33–34; and affirming practices
Tell Me About Your Family 373–375 21–22; and allow for multiple ways of
termination phase 200–203; active learning communication 81; and provide space
and reflection 200; Aloha lei (hello- for child’s voice 81; relationship as core
goodbye) activity 202; building blocks change agent 80–81
202; child alone or include parent valuing child: concept of 28–29; identity
(second session) 202; child engagement 20–21
and enthusiasm 200–201; goodbye Vance: How to Play with an Autistic Child
letter 203; idea to child and parent (first 101–102
session) 201–202; parents, child, and any VanDaalen, R. A. 182
other family members (third session) 203; VanFleet, R. 130, 135, 136, 167, 258
therapy goals 201; transition 201 Vormer, C. R. 182
therapeutic power of play: AutPlay Therapy
protocol 120–121, 122; categories 119, Wake, Lily: AutPlay® Therapy FMA case
122; change agents 120, 121; “direct 284–289
teaching” power of play 124; heart Walker, N. 6, 7, 17
and soul of play therapy 120, 124; as Ways We Cross the Room 399–400
mediators 119; “stress inoculation” power Welin, S. 69
of play 124; therapeutic factors 120 What Are They Feeling? 172–173,
Theraplay 81, 110, 117, 118; for autistic 349–350
children 134; in AutPlay Therapy What to Say? What It Do? 320–321
133–134; AutPlay Therapy Follow Me Where Am I Going? 361–362
Approach 133; challenge 133; defined Wilson, B. 137, 192
132; dimensions 132–133; engagement Worry Tree 342–343, 344
133; focus of therapy 132; Marschak Write and Move 375–377
Interaction Method (MIM) 133; nurture
133; structure 132 Yasenik, L. 129
Thomas, Nelly 86; Some Brains: A Book Yee, Canace: AutPlay® Therapy FMA case
Celebrating Neurodiversity 86 299–302
Thornton, K. 116 You, Me, and LEGO 377–378