Monday, April 14, 2014

Play Therapy Part 1

A year ago I sat in my living room with a team from Early Intervention trying to explain my concerns for my then 18-month old. One of the things I expressed several times was that I was especially concerned about her regular disinterest in play. They seemed to not quite understand what I meant. Especially since she seemed plenty interested, even borderline obsessive about a couple of the toys they had brought to use in their analysis. It was challenging for me to explain. It still is.

As an infant, she had intense interest in only about three particular toys, for months. After that, she had no interest in playing with toys at all. The only things she would hold, examine, and of course chew on were not technically toys. They were usually household items, and her favorites were the metal lids from jars (the start of her love for circles?), her baby hair brush, and toilet paper rolls. This is not surprising to me now that I better understand her sensory seeking tendencies. The metal lids were cooler, and provided a stronger taste than plastic, and the brush and any paper products were very stimulating to her tactile senses, especially in her mouth, which is still where she craves the most stimulation.

As an older baby, she still didn't "play" with her toys. She took them one by one out of the basket until it was light enough to dump the whole thing. If someone attempted to put the toys back into the basket, she cried and yelled at us and physically tried to stop us. She didn't explore them, investigate, or interact with us when we tried to play with them with her. Just dump and scatter. By the time she was 18 months, she had figured out that helping put toys back in containers meant another opportunity to dump them, so she became a willing helper in cleaning up, only to dump them again, and then have a major fit when we took them away. Yes, this is typical toddler behavior, the disruption lies in the intensity and endurance of her repetitive obsession with it long after typical toddlers have moved on.

Shortly thereafter she did begin to show more interest in examining things. In fact she would examine things for very lengthy periods of time, and in unusual ways. When she played with the basket of cars. She took them out one by one, of course, and studied it very carefully. She felt it for smoothness? Uniformity? She turned it upside down and tested how well the wheels turned. Then she would appear to drive it on the table or floor, but after watching her for a while, I figured out that she was actually feeling how uniformly it rolled. Those she liked were put in one area, those she didn't either got thrown back into the basket with great heft, or pushed into a pile farther from herself. And those that were particularly bothersome were handed to me to get far away from her. She liked the monster trucks best it seemed because they rolled the smoothest. She also liked the motorcycles, but was easily frustrated that they would not stand independently, so they were often thrown back into the basket after several futile attempts. 

It wasn't long at all before she started lining up the ones that met her approval in long lines side by side and sometimes bumper to bumper. Not too long after that came color coordination. And within no time there were lines of objects everywhere she had been. Quirkle blocks. Playing cards. Poker chips. Playdoh tubs. Glass beads. Books. Movies. Baby dolls. Shoes. But that was the extent of her play. And in the bathtub she was interested in no toys at all, just plastic hangers which she would slide on and off her legs over and over or pick up one by one and sign the colors for each one as she sorted. Keep in mind that she was 19-22 months during this period.

So it's easy to see why helping her learn to "play" was a big priority for me. She was for the most part happy enough while engaged in these limited and repetitive actions, but I was aware how quickly they can take hold as an obsessive and compulsive habit (they already were mildly) which produces anxiety both when they are engaged in them and when they are not. When we finally got her diagnosis and qualified for early intervention, interestingly, her Speech Therapist provided several ideas on helping her with play skills, because, a lot of these have a lot do do with encouraging speech. And Occupational Therapy began to help her brain get organized so that she was able to have a calmer body and calmer mind. Gradually, we started seeing her play!

To encourage this I engaged in "Play Therapy" with her nearly every day, often several times a day. Modeling and telling how to play. Her big brother and sister were invaluable in helping with this without even knowing they were helping with "therapy"! What ever her special interest was, I would find little ways to expand how she used them and gradually try to expand more and more. When she was comfortable with those types of play, I began to introduce more complex play, with multiple steps. By this point, she began to generalize some of these play skills, and was starting to show interest in things she never had before. She began playing cooking with the tea set and play pots, and making coffee and sharing it with us! And a lot more voluntary eye contact while she was engaged in play! That was so exciting!

She has made huge progress in the way of play! In fact, I would say that her play skills are finally on par with her peers for the most part, even advanced in some areas. She is still sometimes slow to show interest in regular play, especially in a new environment with new people around, but she has come so so far!

Below and in the next post are just a couple of things we do for Play Therapy, which over time I'm happy to say has become mostly just regular "play'!

Not to long ago I read an interesting post. In it was this sentence, which felt enormously reassuring:

  • Study #2 showed that kids whose moms and dads are more engaged in their treatment early on have better verbal and daily living skills as teenagers. Unpublished data showed that the kids with the best outcomes (e.g., able to attend college with no extra support) all had moms and dads who had been involved in their treatment beginning at age 2 (this should not be interpreted as assigning blame to parents if their kids do poorly though).

I'm glad that we didn't even wait until she was 2! Play skills are the foundation for practically every other skill we want our kids to develop, and it's essential to happiness! It seems a contradiction that some kids need to be taught how to play, but it is very true for some kids. For them, this might just be one of the most important life skills we ever teach them!

Play dough is a great sensory toy/tool to help develop a variety of play skills and serve as part of a sensory diet as well. Also certain movements, like rolling snakes or balls strengthens the hands and helps to integrate the reflexes. And it gets everybody involved! 

Pulling off stickers and placing them on a sheet of paper is also great for many different skills. It helps develop hand-eye coordination, fine motor skills, and creative thinking. Kit still prefers to sort them though. :)

And she refuses to use the broken ones! :)

We play games to mostly help her learn to take turns, and follow simple directions, as well as engaging with others. Candyland is fantastic because the colors are exceptionally motivating to her!

Especially the purple ones!

Purple is definitely one of her favorite colors!

Stay tuned for Part 2!

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