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  • Dr. Brian Quinones LPC

Pax Unplugged Panel - Play Therapy: The Benefit of Games for People with Autism

Updated: 6 hours ago

Disclaimer


Full disclaimer – I do own copies of many of the games that I will be talking about, but I do not own any stock in their companies, did not create, or help create any of these games for profit. I will mention whenever I mod a game or change it from its original intent to fit my clients needs. It is important to note that yes I am a therapist, but this blog is not intended to be therapy. I will offer advice, tips, and other guidance on my blog with the intent to illustrate important life skills, provide entertainment, inform, and at times empower the reader.

If you or a loved one is struggling with mental illness or are facing any kind of crisis seek local professional help, and/or contact authorities or emergency professionals for assistance.





Pax Unplugged Panel - Play Therapy: The Benefit of Games for People with Autism



Introduction


The odd part about writing a bunch of blog posts in advance and never releasing them is you have this formula in your head that never really lines up. With every major event that happens I push back something else on the que. It leaves me in the awkward position of introducing information without fully repeating what I just said and what I will say. With today’s blog post will focus on our Pax Unplugged Panel- Play Therapy: The Benefit of Games for People with Autism. I will be discussing in broad strokes the reasoning for me to seek certification in Autplay and to become a Registered Play Therapist and how that has influenced our practice.



My Thoughts on the Benefit of Games for People with Autism




Your Doing What?

You would think that after years of having to explain what I do and why I would somehow be more comfortable at it. Even knowing that I am going to be having this conversation at Pax Unplugged, one of the only places that would welcome this concept with open arms there is still some trepidation. For anyone who has ever experienced imposter syndrome you know what I am talking about. It feels icy, almost as if all your surefootedness is gone. I am a professional, I am post license nearly ten years now, running my own companies for six years, I know what I am doing. But when I am sitting in front of a room full of parents, case managers, and teachers sometimes I still clam up when I hear,


All your doing is playing during session.”

Yes,” I reply

Why,” is the response

Because it works,” I say and then break it down on a behavioral level.


I take board games, storytelling games, roleplaying games, puzzles, kinetic sand, or expressive arts and use them to lower maladaptive or self-stimulating behaviors. It is not magic, but it sometimes feels like I am doing a slight of hand trick. The parents see that it is working, but they cannot put their finger on why, and for a long time I was ok with that. As I was researching for my dissertation that notion of it is just working came up a couple of times. Therapist found that just being there, in the home, accepting the family in their own environment was more important than the “how,” or the therapists’ modality of intervention. For many in-home or in-community practitioner’s rapport became king. Early on in my career, when I was a behavioral assistant, I was taught that games like Uno, Chess, and Monopoly were a way to build rapport but the real therapy was something else entirely and that would be left up to the master’s level or licensed level clinicians.


The Words We Use and the Games We Play


I had my bachelors; I was in family’s homes to help kids with their impulsivity and decision-making problems. The difference between myself and the therapists at the time, I knew what it was like to build a deck for Pokémon or Magic the Gathering. If a kid comes up to me and shows me their Yu-Gi-Oh! Collection, well I understood the importance of building their own deck and getting to battle with it. I did not have the words at the time, I knew something was there but not how to prove it.


It would not be until I started learning the language of cognitive behavioral therapy (CBT) that I could start coming up with a rationale behind the games we played. At first, I did not like CBT, it was just homework to handout to my clients. I found specific branches of CBT that did a good job of teaching it as a philosophy that helped. But once I started relating it to chess, it all made much more sense to me. Your moves are the behaviors that you make based off your thoughts and feelings. I would use a chess clock with my clients to provoke a sense of anxiety to help them work through it. To improve their decision-making skills, I would remember board positions and rewind the game back to a pivotal moment and let them make a different choice to see how else things could have turned out, for better or worse. Only focusing on my job as a Behavioral Assistant, I was using chess for the development of anger management, stress reduction, and problem-solving skills. Do not get me wrong, it is a lot easier for me to say this now, I have a whole system in place to help me say that, but I want to make the point of, having the right words to say what you do can help you tremendously.


Fast forward over fifteen years and I sought out certification in Autplay and Play Therapy for the same reason, they give me the words that explain what I am doing. In the last six years I have worked solely with child, adolescents, and adults within the autism community. I still use gaming but in different ways, I have sought out a much more integrative approach to gaming and therapy and have broaden the terms I use when doing so. For example, I might look at deck building games as more self-expression than just creative problem solving or peer play. Additionally, games with premade decks can be self-expression, when I say I want to play as Team Leader Tachyon from Sentinels of the Multiverse, that is not just because I like the cards in her deck. The cards are the same as her other variants, I believe this is an express of how I intend to protect the other members of my team. In my previous post about game design I talked about my use of play therapy benefits as being the focus of how I determine what skills I am working on with a client. Similarly, I mentioned the primary and secondary treatment goals I address in session. As to avoid repetition here I will put links to various resources below. So instead of specifically talking about goals, interventions, benefits here I will talk about where Autplay comes from.


The Road to Autplay


Autplay, created by Robert Jason Grant, it is an evidence-based form of play therapy that is specifically designed for the Autism population. The approach combines several forms of play therapy such as Behavioral Therapy, Cognitive Behavioral Play Therapy, Family Play Therapy, Filial Therapy, and Theraplay. It focuses on the use of toys, games, and other play therapy techniques specialized in such a way as to be effective with the Autism population between the ages of 4 and 18. There is some flexibility regarding age based on cognitive level and that might be one of the strongest aspects of this approach. It dovetails in perfectly from client’s cognitive age, developmental age, and level of play age. It is that last aspect that really sold me on the approach, for years there was something nagging at me in the back of my mind. The definition of play, and its meaning for different children.


When I first started working Intensive In-Home with the Autism population, I noticed that some of my clients had what I called a play deficient. Coming from Intensive In-Community I saw teens do everything from play board games, video games, sports, art, there was always some way for me to connect with them. Here not so much, I had one kid who barely noticed I was in the room for weeks on end, in multiple cases there was no sign of cooperative play. Part of the Autplay intake examines the different types of play and assesses the client’s strengths in functional play, symbolic play, cooperative play, sociodramatic play, peer play, constructive play, and representational play. Looking back, I now know how I started bridging those gaps with my clients, I played with them at the level they could play with me, in those cases it was parallel play. They were doing there own thing, but they allowed me to sit with them and eventually we worked our way up to turn taking with some of their toys.


"I noticed that some of my clients had what I called a play deficient."

This leads me to my next point, my personal style as a therapist is more directive than most play therapists that I have met. To the point where people were asking if I was a Board-Certified Behavior Analyst (BCBA) or an Applied Behavior Analyst (ABA). I am not that organized, nor that directive, but I am starting to see why some would ask that since I work with the Autistic population and that approach is historically the most recommended. In the play examples I just gave, there was no way a more directive approach would have worked, and in the two clients that I am thinking of right now, talk therapy was not happening either. They both responded to sign language but were generally not communicating verbally other than basic needs and wants. As part of Autplay the concept of letting your client lead the way is called the Follow Me Approach. Essentially you remain nondirective in session until the client lets you become more directive, and if there is too much resistance you go back to the Follow Me Approach. So, the phases of Autplay is Intake and Assessment, Directive Play Intervention Phase, and Termination Phase, so in those cases you are trying to see if it is possible to get to directive learning. In my situation just observing the client, seeing that he was responding to sign language as oppose to any of the other languages in the home, observing his play style, and finding ways to sit along side him, take turns, know when to engage and disengage was important to building up the relationship and opportunity for more directive interventions.


I can go into the goals of Autplay but I am sure I have done that in previous posts, will do that in person, and in future posts. Rather I want to tie this back into gaming before closing. How does play therapy in general and Autplay specifically help us with board gaming and story telling games in the Autism population? In my opinion, that intake and assessment is crucial. Had I known about the different ages and levels of play developmental when I first started working as an Intensive In-Home therapist, I could assess what types of games or activities would be most beneficial to each child, adolescent, or adult. I was doing that with the general population without realizing it, whenever I asked what video games they played, I was assessing for cooperative verses competitive play, and so on. Now that I am running groups it makes much more sense to me but let me put it like this, Escape, First Orchid, Forbidden Island, and Pandemic are all cooperative board games set at different age limits. In all those games either the team wins or loses, but First Orchid works well with clients who only do parallel play, whereas the others would be much harder to do that with. The reason is not just because First Orchid is for two years old and up, it is because winning or losing is not dependent on interaction between players. You roll the dice, you see which fruit you can get, you pass the dice, in between turns you wait to see if the crow moves closer to eating the fruit. You could be playing this on your own and it would not change how the game functions. Autplay is an evidence-based approach, and though it focuses on more than gaming, the attention it places on play styles helps to teach current limits and how to push past them.


An Additional Note


I am part of the Autplay Group on Facebook and have been in talks with other therapists asking for advice and feedback prior to Pax Unplugged. During the writing of this blog post a notification was addressed to me about a new book, it is called “Game Play: Therapeutic Use of Games with Children and Adolescents,” edited by Dr. Jessica Stone and Dr. Charles E. Schaefer, they are both heavy hitters in the field of play therapy. Dr. Stone specializes in Play Therapy and the use of digital tools in therapy and Dr. Schaefer is considered to be the “Father of Play Therapy.” The book was released November 12th 2019 and I am going to be pouring over this with one week to go before Pax Unplugged. Dr. Robert Grant does have a chapter in the book, in his chapter on page 209 he illustrates


“12 strategies for successful introduction and implantation of game play with Children with Autism Spectrum Disorder"

1. Identify games that seem to match the child’s developmental and functional levels.

2. Identify games that match the child’s interests.

3. Introduce the game by showing it to the child and explaining its basic idea. Be sure to emphasize the fun and playful parts of the game.

4. Introduce the child to any materials or game pieces that will be used, and explain how they will be used in the game.

5. Complete a brief example of role-play of the how the game will be played.

6. Ask the child if he or she has any questions before beginning the game.

7. Once the game is in play, monitor for any confusion or distress the child might be experiencing.

8. Model for the child how to participate in the game appropriately.

9. Use game play to work on shaping the skills, responses, and behavior that are desired from the child.

10. Prompt the child at each step or phase of the game to help him or her learn the game skills and continue to progress through the game.

11. Keep the game play positive and fun even when prompting and correcting the child.

12. Once the game has been completed, evaluate for effectiveness in addressing treatment goals, the child’s ability to move through the game successfully, the child’s enjoyment of the game, and any modification or adjustments needed.”


Expect a book review soon, I know for me and how I address the state of New Jersey it is going to be pivotal for my growth.


Summary


During this post I talked about some of the specific reasons I use Autplay therapy in session, and some of the directions I feel play therapy can take my understanding of the use of game play for individuals and groups. This is still a part of the field that is growing and changing, I can see how different modalities are trying to adjust to the interest of games in session and what it means to make and use therapeutic games. Hopefully this post will give you an idea of my thought process going into our panel December 7th 2019 at 4:30pm during Pax Unplugged. I have a lot of reading to do before Pax, but I think I will start with the chapter by Game to Grow’s Adam Davis.

As always thank you for taking the time to read our work, Please feel free to write comments or questions here or any of our other social media locals. I am still new to blog posting and would love to hear ideas for topics to explore.


REFERENCES


Autplay therapy for children and adolescents on the autism spectrum: a behavioral play-based approach

Robert Grant - Routledge – 2017


Game play therapy: therapeutic use of games with children and adolescents

Jessica Stone-Charles Schaefer - John Wiley & Sons Inc. – 2020


Home-based services: From the therapists' perspective

Brian Quinones- Argosy University/Sarasota – 2013


Play-based interventions for autism spectrum disorder and other developmental disabilities

Robert Grant - Routledge – 2017


Quinones, B (2019, November 25). How to make a therapeutic game Retrieved from https://www.therapyinplay.com/post/how-to-make-a-therapeutic-game


Quinones, B (2019, November 12). New jersey competency levels: supportive, professional, and clinical Retrieved from https://www.therapyinplay.com/post/new-jersey-competency-levels-supportive-professional-and-clinical


Quinones, B (2019, November 5). “Help wanted! Desperately seeking games to promote social skills!” Retrieved from https://www.therapyinplay.com/post/help-wanted-desperately-seeking-games-to-promote-social-skills


#Therapyinplay, #Autism, #Playtherapy, #TherapeuticByDesign, #paxunplugged, #boardgames, #boardgamegeek

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