Tuesday, December 11, 2007

Play Therapy

Play Therapy
Karen Wang

I've worn out another perfectly good pair of pants, my last good pair, in fact. The knee ripped open, as it always does, while I was playing on the floor with my five- year-old son. We were driving the cars in his toy parking garage, and he was telling me where his little people were going: to the theater for a concert, to a bookstore, then back home. He was re-enacting things that we had recently done together, transferring his ideas, memories and feelings to his characters. I had never seen him do this before. I was witnessing a developmental leap. All those ruined pairs of pants were paid for in that moment.

I think most adults underestimate what playing with a child, giving a child full attention for short periods throughout the day, can do for the child's health and development. When I explained to my sister that we planned to pursue one-on-one play with our son as his primary therapy, she told other family members that we had chosen to do “nothing” for our autistic son. I'm not sure I would have believed in the benefits myself without seeing them firsthand in my son Malcolm. He was an unusually active, alert baby, often fussy and anxious. I was looking for ways to balance his intense emotions and energy. I knew instinctively that the balance had to begin with our mother-child relationship. I sought out activities that brought peace and joy to us both: long walks, singing, reading, puzzles and balls. But my son was still missing out on something big; at 19 months of age, he was having panic attacks and could not tolerate any length or type of separation from me. To relieve his anxiety, Malcolm needed to learn the most basic social skills from the ground up, and the only people qualified to teach him this were those to whom he was most attached, his parents.

I remember my husband once saying, “Malcolm has work to do. Play is his work.” Play is the most important thing that happens in our house. Everything, and I mean everything, comes after it. We don't cook or do housework unless we can find a way to involve Malcolm playfully...laundry, dishes and vacuuming are all standard “games” around here. I recently started buying cheap cans of shaving cream after becoming annoyed at the filthy bathroom counters. “I want to make a mess,” Malcolm said to me one rainy afternoon. “Yes, we can make a big mess in the bathroom!” I gleefully responded. He helped me put away all the shampoo bottles and toothbrushes first, then I handed him the shaving cream. Because of his fine motor delay, I had to teach him how to press down on the button to release a fluffy cloud of shaving cream – but he was a motivated learner. Within a few minutes the counters, sink and cabinet doors were covered in shaving cream and we were both sporting “Santa Claus beards.” We “painted” each other's arms, traced words on the snowy surfaces and clapped our hands to make the foam fly around in a surreal wintry scene.

There was an academic method to our giddy madness. I had read about using shaving cream to reduce my son's sensory issues; I also wanted to create a new situation to stimulate conversational and emotional exchanges, eye contact and shared attention. My scheme worked: Malcolm was giggly and chatty, and far from fearing the squishy texture of the shaving cream, he explored and fully enjoyed it. He kept looking up into my eyes to share his excitement and happiness, and I felt my heart ready to burst from his sweetness. When the can of shaving cream was finally empty, Malcolm announced that it was time to clean up. We wiped everything down with damp washcloths and watched the thinned-out froth dissolve down the sink. The bathroom sparkled for the cost of 67 cents and a dash of imagination, but all I saw was the spark between us.

All children work out their fears and questions through play, and it can be difficult to find the answer they seek. Sometimes Malcolm gets stuck in a repetitive pattern (often representing his anxiety) that needs to be playfully disrupted. One day he was repeating a story over and over: “Once upon a time Malcolm was crying because the pool was closed.” He turned to me and asked me to re-tell the same story. I held him gently so that our faces were almost touching. I kissed him softly and said, “Once upon a time Mommy ate Malcolm's ear. (nibble) Once upon a time Mommy ate Malcolm's nose. (nibble) Once upon a time Mommy gave Malcolm a raspberry. (big raspberry on the tummy) Once upon a time Malcolm gave Mommy a razzzzzzberry.” Laughing, he collapsed in my arms, comforted at last.

If shaving cream and raspberries are the mortar, then beanbags are the cornerstones of play therapy. My little monkey-boy was bouncing off the walls and climbing the bookcases by the time he was 10 months old, but he always became calm and attentive when his body sank down firmly in his big red bean bag. Every time I saw bean bags chairs and giant pillows on clearance, I bought more. We began making bean bag towers and forts, playing pillow catch and, at the end of the day, sitting back and listening to music together. Before we knew it, the family room was decorated entirely in a “Hot Wheels-Bean Bag” motif, devoid of any other furniture.

Last night, sitting cozily in our bean bags, my husband and I talked about Malcolm's play goals for the week, and my assignment was to work on building block towers with him and to act out certain scenarios with the towers. But when we woke up this morning, the rain had finally stopped and the sun was shining. Malcolm and I snuggled under the covers to read some books, and after breakfast we walked through the wet grass and mud to the park. (I was wearing a pair of pants with a small hole in the right knee.) Before school, my son drew a picture of his best friend and his best friend's little brother, and he asked me to invite them over to play.

When I dropped off Malcolm at preschool, he made me promise that he could ride his bike “around the block the long way” if it wasn't raining after school. At 3:30, the weather was glorious, so Malcolm raced ahead of me on his bike, smiling and pointing out everything that interested him, occasionally pausing to allow me to catch up with him. In my mind I saw the clinical textbooks stating, “The autistic child is unable to co-ordinate eye contact, verbalization and gestures simultaneously; he may speak in a monotone and his face may bear a flat affect.” I laughed aloud at the thought. When my husband came home from work, Malcolm greeted his dad with a hug, gazed into his eyes and said, “Malcolm is happy today.”

Resources for play therapy:

· Playful Parenting by Lawrence Cohen, Ph.D. (www.playfulparenting.com). The author explains how one-on-one play enriches the development of all children.

· The Child with Special Needs or Engaging Autism by Stanley Greenspan, M.D. (www.floortime.org). Dr. Greenspan recommends following a child's interest and lead in play, then gradually introducing new patterns into play. This method is widely practiced for children with developmental disabilities.

· Relationship Development Intervention with Young Children by Steven Gutstein, Ph.D. and Rachelle Sheely, Ph.D. (www.rdiconnect.com). This type of therapy follows the same developmental model as Dr. Greenspan's Floortime, except that the parent leads the child through each playful exercise. Special emphasis is given to the development of “episodic memory,” the integration of emotion, cognition and past experience that allows individuals to adapt to new experiences. All of my bean bag games come from this book.

· The Out-Of-Sync Child Has Fun by Carol Kranowitz. This book is full of messy ideas to help children with extremely high or low sensitivity to texture, taste, smell, sound and light. I found the shaving cream idea here.

· The Joyful Child by Peggy Joy Jenkins. The author writes in a New Agey, hippie style that may grate on some people's nerves, but her point is that joy is tangible and contagious. The first song my son ever sang was “I Am Happy” from this book.

No comments: