Child-led play-based therapy
Rachel Cohen, OTR/L
Occupational therapy aims to help people participate in everyday activities or “occupations”, through the use of everyday activities. An important occupation for children is play! (It’s also important for adults). There are different ways occupational therapists incorporate play during treatment sessions… sometimes as a means, sometimes as an end, and sometimes as both.
Here I share 3 aspects of child-led play-based occupational therapy that I find helpful to keep in mind during treatment sessions. I will use examples I have had with a child (I’ll refer to as Ryan) whom I’ve had the pleasure of working with. Ryan is 7 years old, diagnosed with autism, and is non-verbal.
Approach 1: Create an opportunity for children to play in their own way.
Explanation: Play involves participation in experiences/activities that a person enjoys. The therapeutic value of play includes being restorative, regulative, joyful, explorative, and a place of learning. Play is individualistic, as it is not up to others to determine what play is for someone else. What’s play for one person, may not be play for another. Providing an opportunity for self-directed play can be therapeutic in and of itself.
Example: Ryan’s recent desired play activity has been meticulously arranging toy cars/trucks/trains/etc. to create what appear to be “crash” scenes. By providing an opportunity for Ryan to participate in this activity, he becomes fully immersed and regulated. He shares his joy and enthusiasm with others, smiling as he points to what he has created. When I attempt to join Ryan in creating these scenes, he typically brushes me aside or starts to become agitated. This may be because by joining him, particularly with a lot of verbal dialogue, the activity and expectations completely change. It becomes more like “work” than actual play for him. So, just creating the opportunity for him to play in his own way, is a play-based treatment approach that facilitates regulation, self-directed learning, and can lead to natural social interaction.
Approach 2: Modify aspects of the environment during desired play activities.
Explanation: Children are inherently gaining skills through play. Modifying aspects of the environment can further facilitate those skills and target other developmental skills.
Example: There are many skills Ryan is working on as he creates these crash scenes. When I sit back and observe, I realize his fine motor skills are improving as he persists with connecting the tow truck hook to a small car. I realize other skills that are involved, and think about ways to modify the environment as appropriate to further those skills. Changing the location of where the bin of toy cars is located, to improve visual perceptual skills and flexibility. Placing certain items out of reach to facilitate planning and gross motor skills to retrieve and climb onto a step stool. Putting weights into containers for more proprioceptive input and strengthening. Hiding cars in a dry bean sensory bin, for increased tactile interaction. The list really could go on and on.
Approach 3: Present new ideas that go along with the child’s desired play activity.
Explanation: Presenting new ideas in a way that has meaning for a child, can expand their interests. New interests can lead to new forms of play and gaining skills in other areas. Sometimes a new idea is a hit, and sometimes it is not. It’s more about exploring than imposing.
Example: I play around with introducing new ideas to Ryan’s desired play activity, although without the expectation for him to participate in the new idea. I do so in hopes to spark interest in other areas. One day, I started verbalizing what was going on in each scene that Ryan created. Ryan started nodding his head “yes” when he agreed with my version of the narration. Then one day, I created a book with the agreed upon narrations, along with drawings of each scene. Ryan followed along as I read the book, smiling and correcting me by shaking his head “no” if I skipped a word. He was interested! Mom stated that that night, for the first time, Ryan brought a book over to her and his dad to read to him. Reading books had become a new interest!
One of the 7 core values of OT is Freedom: Allowing the personal choice, values, and desires of the client to guide interventions. To me, this pretty much sums up child-led play-based therapy and what makes being an occupational therapist so special and rewarding. It’s a lot less about compliance and more about getting creative in helping children develop skills in a way that is meaningful and builds self-determination.