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interactive play. Several evidence-based traditional clinical approaches (e.g., behavioral, cognitive-behavioral, social skills-based, and animal-         


Traditional Clinical Approaches Available evidence-based therapeutic approaches that work with children and adolescents who meet criteria for autism range from emphasizing cognitive or behavioral components to the use of animals. These approaches employ highly trained specialists and often intensive methods to help children and adolescents with ASD make functional gains.


Applied Behavioral Analysis Applied behavioral analysis (ABA) is an evidence-based behavioral approach that


focuses on reinforcing functional behavior while


discouraging nonfunctional, problem behaviors. Researchers have shown that ABA and similar behavioral interventions can improve intelligence test scores, language skills, and academic performance of young children with ASD (Peters-Scheffer, Didden, Korzilius, & Sturmey, 2011). Some researchers also have shown some improvement in behavior, personal, and social skills (Cohen, Amerine-Dickens, & Smith,                  learned through behavioral interventions to contexts outside of the clinical setting (Osnes & Lieblein, 2003).


Cognitive Behavioral Therapy Cognitive behavioral therapy (CBT) programs target changing behavior by using a cerebral approach. At the heart of CBT is a challenge to a person’s belief system. CBT is commonly used to treat anxiety, which tends to be co-morbid for people with ASD, and “spikes sharply after  component of the thoughts, feelings, and behaviors CBT triangle can be challenging for children with ASD because they typically have       CBT protocol with early adolescents to address comorbid anxiety. In          supplemental activities, such as engaging in “booster sessions” help children and adolescents with ASD to obtain the greatest positive outcomes for the longest period of time.


Social Skills Interventions Social skills interventions are popular approaches. These interventions (e.g., social skills groups, social stories, and comic strips) focus on the hidden curriculum of social and communication rules and skills that neurotypically developing individuals tend to intuitively understand. Those with ASD often struggle to acquire these same rules and skills, requiring more direct intervention (Shuster, Perry, Bebko, & Toplak, 2014).


Equine-Assisted Therapy Equine-assisted therapy (EAT) may be used as a complement to a more intensive treatment program. Children with ASD and other


CLINICAL EDITOR’S COMMENTS:


 several traditional and play therapy approaches.


developmental disabilities work with horses through activities to assist with emotional bonding (i.e., caring for the horse), to improve communicative


and cognitive


skills (i.e., following and giving


instruction while riding the horse), and to reinforce learned skills (i.e., grooming, understanding parts of the horse). Additionally, riding the horse provides a comforting form of vestibular stimulation that those with ASD often seek. Borgi et al. (2016) found that EAT improves social and executive functioning, including imitation, emotional expression, eye contact, social motivation, attention, and sensory processing.


The literature offers promising evidence for each of the above approaches for children and adolescents with ASD. However, we highlight two limitations common among them: access and adaptability. Although behavioral therapies, such as ABA and CBT, can be effective for children and adolescents with ASD, they require development and execution by trained clinicians and a considerable time investment (e.g., greater than 40 clinical hours a week for some ABA programs). Similarly, EAT requires access to trained interventionists, consistent and routine time investments, and horses and trainers. These requirements  as feasibility of use concerns in non-clinical settings, such as home or school. Play-based therapeutic approaches offer similarly promising          


Play Therapy Approaches Play therapy, “the systematic use of a theoretical model to establish an


interpersonal


process wherein trained play therapists use


the therapeutic powers of play to help clients prevent or resolve  (Association for Play Therapy, n.d., para. 1), is a valuable addition to this list of therapeutic approaches for children with ASD. Researchers have deemed play therapy effective for social skill and emotional  Two approaches, AutPlay®, which has a behavioral, directive emphasis (Grant, 2017), and Floortime, with a nondirective, relationship-based         diametrically opposed approaches work with clients with the same  for therapists.


www.a4pt.org | March 2019 | PLAYTHERAPY | 21


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