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Description of Replays: Replays is a fun, playful approach to helping children work through and ultimately minimize challenging behaviors, designed for parents, teachers and therapists. It has its roots in play therapy and integrates what we know about the roles of adult-child interaction and communication in the development of regulatory capacity in typically developing children. Replays is especially effective for situations that once were truly aversive for the child (e.g. tooth brushing or putting on shoes for a toddler with heightened sensory sensitivities), and to which the child has developed learned patterns of intense responding, even though the original sensitivity level has improved. Through Replays the adult playfully acts out with the child as an audience and then eventually as a participant, using familiar props, everyday situations that are predictably troubling to the child. The child increasingly participates in these re-enactments, taking on different roles, experiencing limited but tolerable amounts of negative emotions triggered by the events, paired with amusing, high affect replaying, with a trusted adult (parent, teacher or therapist). Ultimately the trigger situation loses its potency for the child, who, through practicing and developing new affective memories, becomes able to tolerate and master previously aversive experiences.
Unique to Replays is the incorporation of the child's own intense emotional responses, such as crying, wriggling away, pushing away the aversive trigger , such as shoes or the toothbrush, but with playful and often funny, exaggerated affect. The goal of Replays is to help the child decrease their intense and maladaptive upset responses and develop more adaptive responses.
The incorporation of undesirable behavior, while at first counterintuitive, allows for direct work with the child's emotional system, beginning with emotional responses the child knows well and gradually shaping these into more adaptive responses. These behaviors are playfully incorporated by the adult, and are specific, familiar and frequently demonstrated by the child.. This kind of play fosters immediate emotional recognition from the child and often establishes an immediate connection between adult and child.. The playful style of demonstrating the intense responding is t highly motivating and amusing to the child, who increasingly wants to try to participate in the play. This replaying enables the child to re-experience the aversive event and their own response in a slower, less threatening and happier format in which they have increasing control. Once their own intense responding is decreased, the child already knows and then is able to engage in the correct' behavior (e.g. to put their shoes on or tolerate toothbrushing).
For children who can process at a more advanced level, stories can be created with Replays, incorporating the child's intense responses and ending with a resolution. This allows the child to read over' their experiences as often as they need to and practice new response patterns with a parent, teacher or counselor. Through repeated interactive playful re-enactment, many children become desensitized to trigger' aspects of dysregulation, form new emotional memories and master their responses to the event.
Many behavioral challenges resulting in intense emotional responses to seemingly small events can be resolved in one or two sessions. Parents can quickly learn these techniques and practice at home, often just prior to predictably upsetting events, such as visits to the doctor or getting a haircut.
We have been using Replays for the past 6 years in our clinical practices with great success and very positive response from children and their families. Unlike most behavioral interventions, Replays is fun for the adults as well as children and creates a series of happy interactions around issues that have had negative associations for all members of the family. This alleviation of parental stress around trigger' events likely also contributes to improved child regulation and more positive family interactions..
We have found that children who have challenges that were likely originally sensory- based but have become learned patterns, such as tantrums in response to the introduction of clothes/shoes/ medicine/band aides/haircuts, as well as OCD tendencies ( e.g. changes in routine, broken or missing toys, out of order objects, making mistakes, not being first and for coping with unexpected disappointments) and phobias are likely to respond most quickly, while more internally driven regulation problems are more complex and require multiple approaches. We have also found that Replays can be effective for children who have not yet demonstrated symbolic play skills. We hypothesize that the explanation lies in the fact that the replayed' scenarios have such strong emotional salience to the child and hence require less abstraction or less of a symbolic leap.
Background Developmental and Research Literature;
The model for Replays, which will be discussed in our workshop, is based on the integration of several bodies of clinical and research literature. In order to provide a context for reviewers, we will outline it briefly: Typically developing infants begin life very dysregulated, and increasingly develop regulatory capacities , in part, through social interaction, communication and play experiences. Typically developing toddlers spontaneously begin to use symbolic play to re-enact and master day-to-day emotional challenges (e.g. separation anxiety). Deficits in social, symbolic and communication development have been posited to further contribute to difficulties for children on the autism spectrum in gaining increased emotional and behavioral regulation through adult-child affective or symbolic interactions or through their own symbolic play. A variety of treatment approaches for these behavior problems exist, including positive behavioral supports, sensory integration approaches, teaching key functional communication skills, and multiple uses of visual supports.
For children with autism, these seemingly small events are experienced as truly traumatic. Many therapies have been developed to help typically developing children who have experienced emotional reactions to true' traumas, such as witnessing a house on fire or car crash. These approaches, such as more traditional play therapy, involve fostering use of the child's symbolic play to re-enact and master the emotions associated with these traumas. Children with autism have been found to be able to develop symbolic play skills, with adult scaffolding, and high affect modeling, especially when play themes involves imitation of their own activity. However, teaching symbolic play schemas to children with autism, centered around the themes of the child's emotional and behavioral dysregulation used as a tool to help them master emotionally challenging situations, has not been described with young children with autism.
Systematic desensitization is also used as a component of therapies for otherwise typically developing children who have developed phobias in response to a traumatic event or as a result of biologically based anxiety. Replays incorporates aspects of typical development, play therapy and systematic desensitization.
Children with mood disorders including Bipolar Disorder, who do NOT have the social and communication deficits of children with autism often benefit from a combination of psychopharmocology and talking therapies such as Cognitive Behavioral Therapy (CBT) or Collaborative Problem Solving (CPS). These therapies, while extremely helpful for their target populations rely on strong verbal and interactive skills. By combining play and high affect, however, as in CPS, the child increasingly becomes a' partner' in regulating their response, and as in CPS and CBT, the child also develops a new perspective on what was previously perceived as traumatic.
Hence the tools used to develop increased state regulation (e.g. reading of subtle nonverbal cues from caregivers; spontaneous use of symbolic play to master upsetting events; verbal communication interactions with caregivers around these events) by typically developing infants and young children do not naturally occur for children with autism due to their core deficits. . The therapies developed to help children who have experienced trauma, (e.g. play therapy; systematic desensitization) or who are biologically dysregulated but not on the autism spectrum (CBT; CPS) are not readily accessible to children with autism due to the heavy reliance on language and interaction.
Replays uses the language' of the child's familiar emotional experience sequences, highlighted with familiar props and made playful and motivating through high affect interaction, to help the child form new emotional memories associated with prior triggers' for dysregulation.
Workshop Agenda
In this workshop we will briefly review the relevant bodies of literature upon which Replays is based. The emphasis will be on the how to / implementation of Replays for children at a variety of social and symbolic levels and for a range of behavioral challenges. Specifically, techniques for using Replays for young, preverbal and seemingly pre/early symbolic children as well as for older children and/or more verbal children will be discussed and illustrated with examples and video clips. Approaches for using Replays for specific, challenging behaviors and across home and school environments will also be discussed. Parents, therapists and educators will gain sufficient knowledge of the technique to begin to incorporate some of the strategies directly into their work.
How Replays can be used in conjunction with other approaches simultaneously to address the same regulatory based behavioral challenges, including positive behavioral supports, Social Stories TM, sensory integration, environmental adaptation, and communicative supports will be illustrated. How Replays can be incorporated as a tool, in conjunction with most comprehensive treatment models embracing a broad range of approaches (e.g. ABA; SCERTS; DIR) will also be discussed.
While the presentation is tailored for parents, therapists and educators will also learn how to apply this technique directly in their practice with individuals and with small groups..
Workshop outline:
1. (5 minutes) Brief overview of Replays 2. (5 minutes) Theoretical and research underpinnings 3. (20 minutes) Examples (with short video clips) of uses of Replays for a. Young and/or preverbal children to address i. Sensory based challenges (haircuts; clothes, noises) ii. Anxiety / phobias (getting dirty; separation; fear of dogs) iii. Obsessive related challenges (stuck favorite color; endless bedtime routines etc) 4. (20 minutes) Examples of uses of Replays for older or more verbal children for a. Obsessive related challenges i. (needing to finish; needing to be first; making mistakes) b. Unexpected disappointments i. (toy store closed; changes in schedule) 5. (5 minutes) Integrating Replays with other intervention approaches 6. (5 minutes) Trouble shooting FAQs a. What if the child becomes scared or upset b. What if the child is not interested c. What if the behavior increases instead of decreases 7. (5 minutes) Research initiatives 8. (10 minutes) Questions / Discussion
Learning Objectives:
Content Area: Behavior Issues and Supports
Karen Levine
Ph.D. Clinical Director, Autism Program, Instructor, Harvard Medical School
Cambridge Health Alliance
Naomi Chedd, M.A., LMHC
Educational Consultant
Educational Consulting