Play Therapy for Children With Disabilities

Carlos, a six-year-old Hispanic American diagnosed with autism spectrum disorder (ASD), is primarily non-verbal. At age two, he was removed from his home due to abuse and neglect. Carlos and his four siblings, all diagnosed with intellectual and developmental disabilities (IDD), suffered from severe neglect, often being locked in a bedroom. In one such instance, Carlos’s brother fell out of a window attempting to escape, resulting in severe injury.

At Carlos’s first play therapy session, he initially hesitated before running into the room after spotting a toy of interest. The therapist adopted a non-directive approach, following Carlos’s lead and using reflective language to emphasize his feelings and actions. After moving between toys, Carlos gravitated towards the dollhouse. He paused and stared at the therapist before being reassured, “This is your special playtime. You can play with anything you’d like.” Carlos proceeded to arrange the dollhouse furniture and positioned four dolls in the second-floor room, with two dolls lying on the first floor. As he played, one of the dolls was placed outside the window, mimicking his brother’s traumatic fall.

At this moment, Carlos exhibited distress, running around the room, vocalizing, throwing toys, and knocking items off shelves. The therapist used reflective language, affirming Carlos’s fear. Eventually, he found a toy ambulance, placed the fallen doll in it, and moved the other dolls into a toy bus, seemingly escaping the house. The therapist remarked, “They must all be so scared.” Carlos paused, made eye contact, and transitioned to a different toy.

Play Therapy for Children with Disabilities

Source: AAMFT / Used with permission

Play can serve as a primary therapeutic mode even for children with developmental challenges in similar ways it would for children not diagnosed with IDD. In Carlos’s case, the non-directive play approach allowed him to explore and process deep-seated trauma, highlighting the profound impact of play therapy in addressing non-verbal children’s emotional needs. The therapist’s empathic listening, reflective responses, and emotional validation were pivotal in fostering a safe environment for Carlos to express emotions, using play as a language when verbal expression was limited by his ASD.

Theoretical background of play

While influenced by culture, language, and environment, play is a universal activity. It enables children to make sense of the world around them, express emotions, and learn social skills (Pellis & Pellis, 2007). Research shows that play benefits cognitive, social, emotional, and physical development, and promotes psychological well-being, moral understanding, and academic success (Ginsburg, 2007; Piaget, 1962). For children with IDD, these benefits may manifest differently but remain crucial to their developmental progress (Canevska & Akgün, 2021; Mora & Neill, 2018).

Children with neurodevelopmental disorders experience unique challenges and developmental trajectories. These disorders impact the brain and nervous system, creating barriers in communication, learning, and social interaction. Therapists must understand how the family and the child navigate these challenges. Tailoring interventions can provide children a developmentally appropriate medium to express their emotions, process difficult experiences, and facilitate emotional communication within the family.

Play Therapy for Children with Disabilities

Source: AAMFT / Used with permission

Play therapy is uniquely suited for children with IDD because it capitalizes on their natural mode of expression: play. For children who struggle with verbal communication, play offers an outlet for emotional expression, problem-solving, and processing traumatic or confusing life experiences (Landreth, 2012). For children who are non-verbal, play becomes their “language”; it offers a non-threatening, symbolic space where children can safely navigate through painful or confusing experiences.

Play therapy may look different for children diagnosed with IDD. Depending on the diagnosis and individual presentation, children may engage in more concrete or repetitive activities rather than abstract play. They might struggle with understanding rules or social cues, preferring more structured play or interactions with adults. They might experience heightened or reduced sensitivity to sensory input, influencing the types of toys or activities they engage in during play. Therapists may adapt the therapeutic environment to suit the child’s needs.

Integrating play therapy into therapeutic work with children with IDD holds immense promise for enhancing their emotional and psychological well-being, offering them a path toward healing and growth.

Trent Call

Source: AAMFT / Used with permission

Trent Call, PhD, LMFT, is an AAMFT Professional member holding the Clinical Fellow and Approved Supervisor designations. He is clinical assistant professor in the Human Development & Family Studies department at University of New Hampshire in Durham.