Kevin B. Hull, Ph.D., RPT
Gregory enters the therapy room briskly and flops into the bean bag chair.
“Hurry up and get your iPad” he says to the therapist, “I have a bunch of new stuff to show you! The therapist gets his iPad and opens the Minecraft app and joins Gregory in the ‘world’ that Gregory has created. “Wait til you see what happens when you spawn in!” Gregory shouts.
“Remember that we can’t play our game with loud voices,” says the therapist.
“Fine, okay, but hurry up!” says Gregory in a loud raspy whisper.
“Whoa! Where did I go?” exclaimed the therapist as his character joined in the game. The therapist’s character was in a dark room with no doors or windows. “Why am I in a dark room? How will I get out?”
“Ha! I got you!” exclaimed Gregory. “You’re my prisoner and you’ll have to figure your way out!”
“Oh no,” said the therapist, “I’m feeling alone and a little scared. I wonder what I should do next.”
“Ha,” said Gregory, “Now you know how I feel when I’m at school and all I want to do is go home. Good luck figuring this one out, and I might as well tell you that there are traps all around so be careful, even though it won’t help cuz you’re not getting out and even if you do you’ll probably die!”
It is no secret that clients diagnosed with Autism Spectrum Disorder (ASD) love technology. In the past 20 years, I have incorporated technology in the form of video/computer games into my counseling work. In recent years, smart phone and tablet apps have been very useful in helping my ASD clients overcome challenges and broaden their perspectives. While many practitioners may fear technology and be hesitant in allowing a client to bring their tablet or video game system into the therapy room, I find that it has opened new doors of communication, growth, and change particularly when working with ASD clients.
The Challenges of ASD
Clients with ASD face immense challenges. Developmental delays and disruptions in emotional and cognitive functioning create a myriad of difficulties relating to others and forming relationships. The constant rapid-fire activation of the sympathetic nervous system wreaks havoc on the ability of the individual to understand and control emotional reactions, not to mention creating many physical problems like gastrointestinal problems and auto-immune disorders (Hull, 2017). One of the main issues that arises with ASD is a lack of perspective-taking. The activation of the sympathetic nervous system (fight/flight/freeze) results in the individual staying stuck in a state of self-preservation as a result of not feeling safe. Thus, the individual seeks to be in an environment that he or she can control. When this isn’t possible, the individual often adopts a series of behaviors that help ‘soothe’ the tension of feeling out of control. The state of self-preservation creates ‘tunnel vision’ that makes the individual seem as though they lack empathy and awareness (Hull, 2011). Certainly, this isn’t true – in fact, many ASD clients report feeling compassion for both animals and people and have strong emotional reactions but they don’t feel safe enough or know how to express these emotions.
A second major challenge for ASD clients is the expression and understanding of emotions, both in the self and interpreting the emotions of others. This condition, known as alexithymia, causes problems socially, as well as internally and leads to isolative behaviors make the ASD client feel misunderstood and very alone (Hull, 2011). Not being able to control emotions or understand what others might be feeling can lead to major disruptions in forming and sustaining relationships. For children in particular, baffling emotions create a sense of paralysis and frustration due to delays in brain development that further disrupt relationships and peers often reject the child on the spectrum. This results in a damaged sense of self and leaves the child feeling confused and abandoned. Other themes of ASD include problems with impulse control, obsessive behaviors and thinking, and problems with adjusting to new people/situations or unexpected changes in routine.
Benefits of Technology and ASD
Familiarity and a sense of control are two of the main benefits of incorporating technology with ASD clients. In the case of Gregory, it is evident that Gregory is excited about coming to therapy because it involves a game that he enjoys and knows on his personal IPad. For many ASD clients, a portable device such as an IPad or video game console is very much like a security blanket. Also, Gregory is in complete control of the game play which creates a sense of safety. This sense of safety forms a foundation of trust between Gregory and the therapist, which paves the way for future work in the form of problem solving, perspective shifting, and helping Gregory develop self-representation. As previously mentioned, forming relationships is difficult for those with ASD, as well as adjusting to new people and places which the therapy process demands. Through using a tool that is familiar, the therapy process is not as daunting.
Therapeutic benefits of incorporating technology include using themes and metaphors, overcoming challenges, and increasing emotional awareness and impulse control. For example, when the therapist tells Gregory that he feels alone and afraid, Gregory responds “Now you know how I feel when I’m at school and I want to go home.” This interaction with the therapist and the comment reveals multiple issues with Gregory. First, his way of playing with others is to be in complete control. Second, the emotional content related to how he feels about school is important to note and address later on in the therapy process. Through playing with Gregory, the therapist can model responses that can provide insight for Gregory and emotional awareness, as well as gradually shaping Gregory’s tolerance of not always having to be in control.
My future blog posts will address these therapeutic benefits in detail and demonstrate how technology is used with ASD clients.
Hull, K. (2011). Play Therapy and Asperger’s Syndrome: Helping Children and Adolescents
Grow, Connect, and Heal through the Art of Play. Lanham, MD: Jason Aronson.
Hull, K. (2017). Play therapy with children with ASD and chronic illness. In L. Rubin (Ed.), Handbook of Medical Play Therapy and Child Life: Clinical Interventions for Children and Adolescents. New York: Routledge/Taylor & Francis.
Kevin B. Hull, Ph.D., RPT https://drkevinhull.com/
Dr. Hull is a licensed counselor in Lakeland, Florida and his life’s passion is helping people. He is honored to represent the counseling profession as a therapist, professor, and author. Dr. Hull is a Registered Play Therapist (RPT) and Certified Group Psychotherapist (CGP). One of his specialties is working with children, adolescents, and adults diagnosed with neurodevelopmental disabilities. He also helps families of all kinds overcome many types of challenges. Dr. Hull use many innovative types of therapy such as play, solution-focused, and cognitive therapies and conducts groups with children and adolescents to help them understand themselves and learn to use their amazing gifts and find their place in the world.