AutPlay® Therapy and the Virtual Sandtray App (VSA)

Research supports that individuals with autism spectrum disorder (ASD) are often drawn to technology more so than their neurotypical peers (Goldsmith & LeBlanc, 2004), and incorporating technology-based interventions (especially those that have shown promise in addressing ASD issues), becomes a logical treatment process. The increasing popularity, affordability, accessibility, and availability of technology devices have influenced research on ASD. Because of the popularity and versatility of technology devices, utilizing these devices as therapy tools has become an acceptable practice. The implementation of technology-based devices provides a variety of possibilities for improving intervention services to children with ASD (Kim & Clarke, 2015).

The Virtual Sandtray App (VSA) was created by Dr. Jessica Stone and is one example of a technology tool that can be used with children and adolescents with ASD. AutPlay® Therapy (Grant, 2017) and the VSA partnered to create an expansion pack within the VSA app which is specifically designed for children with ASD. The expansion pack includes several models/miniatures which were designed or added that better represent children and adolescents with ASD and related conditions. The expansion pack also includes 20 directive tray prompts designed to help increase social skill, emotional regulation, and connection deficits.

Before implementing the VSA with a child with ASD, the therapist should introduce the app to the child explaining basic navigation. The therapist should give the child a tour of the app, show the child the categories and models/miniatures and demonstrate creating a tray. The therapist should explain to the child that models/miniatures can be used literally (a little boy miniature with brown hair can represent a little brother who has brown hair) or they can be used symbolically (a car miniature can represent a little brother because he likes to play with cars). It would be appropriate time to fully explain the concept of symbolism. The child with ASD does not have to fully understand symbolism – if they can understand it on a basic level then they can participate in using the VSA and use the app to increase their symbolic and pretend play skills.

Through the AutPlay® expansion pack, the therapist can use one of the 20 directive tray prompts to align with treatment goals for children with ASD. These prompts are specifically designed to use with the functions of the VSA including models/miniatures and target primary issues such as social skill and emotional regulation deficits. The therapist may want to reiterate the concept of symbolism each time the child is given a directive tray to complete. The therapist may also assist the child in completing trays if the child is struggling with the instructions. The therapist should allow the child time to process (children with ASD tend to have slower processing times) and complete the tray on their own, but the therapist must always be available to implement a psychoeducational approach in helping the child navigate the tray process. The more prep work the practitioner does with the VSA process, the more successful it will be for the child with ASD.

Five benefits of using the VSA with children with ASD:

1) Virtual sandtrays create a strong visual which is the primary learning style for children with ASD. Pictures can be taken of trays, trays can be saved, and children can reference them at home. Additionally, tray pictures can accompany social stories.
2) Some children with ASD have an aversion to real sand due to sensory issues and physical limitations in grasping miniatures. The VSA is an effective alternative for these children.
3) The VSA provides a portable option for sandtray work and can easily be taken into the home setting, a hospital, or a residential setting.
4) The electronic element is engaging to children with ASD and virtual sandtrays can promote skill development such as turn taking, interacting with another person, and group task completion – especially when implementing one of the 20 directive tray prompts designed for children with ASD.
5) The VSA can be shared and used through a telehealth process which allows the therapist and child to interact via a video-based session.

A growing number of research studies (Goldsmith & Leblanc, 2004), including a meta-
analysis review, have been conducted which highlight the use of various technology
interventions for treatment of ASD. Technology-based interventions have proven successful in teaching new skills to children and adolescents with ASD and the VSA and AutPlay® pack provides another option for therapists in their work with children with ASD.

Goldsmith, T. R. & LeBlanc, L. A., (2004). Use of technology in interventions for children with autism, Journal of Early Intensive Behavior Intervention, 1(2), 166-178.

Grant, R. J. (2017). AutPlay therapy for children and adolescents on the autism spectrum: a behavioral play-based approach. Routledge.

Kim, S. & Clarke, E. (2015). Case study: an iPad-based intervention on turn-taking behaviors in preschools with autism, Behavioral Development Bulletin, 20(2), 253-264.

ASD and Bullying

It was a Wednesday afternoon and John, a 14-year-old with an autism spectrum disorder (ASD), was coming in for his third counseling session. He had shared little during his last two sessions and mostly sat and stared around my office. John and I had been working on rapport and by his third session, he had begun to feel comfortable with me and started telling me about his troubles at school, which mainly dealt with peers. He started slowly, but eventually disclosed to me the daily bullying he was experiencing at his school. John spoke about other peers calling him names (I will not list them here as they are highly offensive), being laughed at, made fun of, being hit, pushed, tripped, and having false stories made up about him.

John had never told anyone in authority at his school that he was being bullied (typical of children with autism) and he had disclosed little of what was happening to him to his parents. John did not fully understand what was meant by bullying and why other students were treating him badly. He knew it felt bad, he knew it created a great deal of anxiety for him, he knew that he excluded himself to avoid being hurt, and he knew that school was a place he did not want to attend.

John’s story is like the stories of many children with an ASD. It is not uncommon for children with ASD to become victims of bullying. It is also not uncommon for children with ASD to not tell teachers, or even their parents about bullying they are experiencing. It is often challenging for children to understand what is happening and how to handle it. Some children with ASD may even believe they deserve to be treated badly, while others may not even realize they are being bullied and think the bully is their friend. Bullies are not discriminating, and children with an ASD are too often easy targets for a bully’s emotional abuse.

Most children with ASD struggle to learn effective ways to handle bullies. Aggressive social skills training focused on dealing with bullies can be a worthwhile approach, but often an adult – parent or school official, needs to intervene and provide help. Every school has an anti-bullying policy and those policies should be followed. If you have a child in school who is being bullied, it is important to report the issue to the school. Many schools will follow school policy and actively pursue eliminating the bullying. It is also important that children learn how to report bullying and become comfortable with reporting. Therapists, parents, and school personnel should establish a simple protocol for children to report bullying behaviors and actively encourage children to report. If the school will not help, parents need to know what their options are (see below). Children with ASD have enough to handle without being exposed to bullying behaviors. We must acknowledge and eliminate bullying; it cannot be ignored and invalidated as something that just happens. It is a child’s right to be in a bully free environment.

What is Bullying? What does Bullying look like?

Bullying: unwanted, aggressive behavior among children that involves a real or perceived power imbalance (physical strength, access to embarrassing information, or even popularity) used to control or harm.

Types of Bullying:

  • Verbal: saying or writing mean things (teasing, name-calling, taunting, threatening to cause harm)
  • Social: hurting someone’s reputation or relationship (leaving someone out on purpose, telling others not to be friends with someone, spreading rumors, embarrassing someone in public)
  • Physical: hurting a person’s body or possessions (hitting, kicking, pinching, spitting, tripping, pushing, breaking someone else’s things, making mean or rude gestures)
  • Grooming and Scapegoating: Setting someone else up to take the fall for their behaviors
  • Bullying can happen in person or online (cyber bullying).

Bullying Resources:

Safe Place https://www.nationalsafeplace.org/bullying
ABC: Anti Bullying Coalition http://antibullyingcoalition.blogspot.com.
Stop Bullying www.stopbullying.gov
Stomp Out Bullying www.stompoutbullying.com
Stop Cyber Bullying www.stopcyberbullying.com

What are the laws about bullying?

Every school district is required to have an anti-bullying policy, per Section 160.775 RSMo.

 Steps to take to keep your child safe from a bully at school (if the school doesn’t act).

If a crime has been committed, call 911.

If a person is feeling hopeless or is having thoughts of suicide, call 800-273-8255.

Contact Courage 2 Report – 1-866-748-7047

Look into getting help from a counselor or therapist.

Contact the necessary individuals or departments with the following chain-of-command: I) the teacher, II) school counselor, III) principal, IV) superintendent, V) State Department of Education, VI) U.S. Department of Education (Office for Civil Rights), or the VII) U.S. Department of Justice (Civil Rights Division), if necessary.

(Note: “John” is not a specific client but an example of common experiences when working with children with ASD who are experiencing bullying).

A Deficit in Autism Services

Autism awareness month is coming to an end for 2020. Most of my days of the year are spent working with children, adolescents, adults and their families who are affected by autism spectrum disorder. I facilitate several trainings each year related to autism, participate in resource fairs, attend meetings, participate on boards and in groups related to autism and write books, book chapters, and articles on the subject. I find that I am well integrated into awareness, education, and providing services every month of the year, not just April.

I have worked with countless children who have a more severe impairment regarding the manifestation of their autism disorder. These children may have no or limited verbal ability, may be lacking many skills, behind in many developmental areas, and have co-occurring issues such as Intellectual Developmental Disorder and/or genetic disorders. These children and families often struggle to find adequate educational services and professionals (mental health and otherwise) who feel confident and willing to work with them. When I began working as a mental health professional, there were very few other mental health professionals working with the autism population. Through the years many mental health professionals have begun to provide services for children with autism who are less impaired (the traditional Asperger’s child). This has also improved with other professionals and educators. Although this is a welcome improvement for part of the autism spectrum, those with a more severe impairment continue to be vastly undeserved.

Every child on the spectrum faces real challenges but there is an unfortunate reality I often see for those children who have a greater impairment; a reality where therapists, educators, organizations, friends and family members are “passing” on working with these children. I hear many reasons for this – “He is not a good fit here,” “We are not equipped to handle her issues and behavior,” “It is not safe for the other children here,” “We are not trained to work with his needs,” etc. Many of these reasons are likely legitimate, but legitimate or not, where are the services for these children and families? Where is the educator or the professional or the friend to help these children? So many parents are facing an unimaginable level of stress, anxiety, and isolation and many of their children are experiencing the same. Logic would follow that children and families who need the greatest services would be the most likely to be able to access services, yet this is not the case.

As another autism awareness month passes and we continue into 2020; maybe this year will bring a greater trend in working with those who have a more severe impairment – more educators, more mental health professionals, more support agencies, just more! No matter who you are or what your status, we can all strive to be more aware, more empathetic, more understanding, and in whatever way we are gifted, make better efforts to serve these vulnerable children and their families.

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