While limited empirical research has been done on the effectiveness of therapies for FASD, practice-based evidence tells us that Play Therapy is beneficial for many children and teens with FASD. Therapist Suzanne Hall shared this case study with NOFASD, with permission from the family involved. Read it below. 

Over the past two years, I’ve had an opportunity to work with a delightful family. My interaction with this family has been just as enriching for me as, I hope, it has been for them. The mother came to me as a last resort. After trying many therapeutic approaches for her son with FASD, she came across Filial Therapy on our website.

I am a psychologist, who works primarily with children through play therapy, but I also teach a hybrid of Filial Therapy and Child Parent Relationship Therapy – an approach that teaches parents and carers the basic skills to conduct play therapy sessions at home with their child. This approach appealed to the mother, as her son often shut down with other professionals and the parents then experienced an escalation in aggressive behaviours from him afterwards.

When the mother first came to see me, I was practicing Child Centered Play Therapy exclusively. More recently I have incorporated Synergetic Play Therapy into my practice, which has made all the difference to this family. But more on that later. Child Centered Play Therapy (CCPT) was founded by Virginia Axline over 60 years ago and is based on Carl Roger’s Person Centered Therapy. Essentially, the tenets of this approach are to accept the child exactly as they are and to form a relationship of complete acceptance and non-judgement. Synergetic Play Therapy is much more recent in origin; founded by Lisa Dion in 2008. It incorporates the latest findings from Neuroscience and Interpersonal Neurobiology (Dr Dan Siegel). One of the most important aspects in Synergetic Play Therapy is that it helps clinicians act as the external regulator for children’s dysregulated states. The result is much faster therapeutic progress.

Both approaches use play as the primary means of healing, and are non-directive. This means that, rather than the clinician choosing what therapeutic activities will help the child heal, the clinician trusts the child to lead the clinician to the exact source of their concerns, through play. In practice, this means that the child chooses what, and how, they play. When this safe and trusting relationship is established, children naturally begin to play through their issues. The clinician’s job is to stay present and attuned to the child and to facilitate a deepening of their play, and therefore, their emotional issues. Whilst doing this, the clinician brings the child’s awareness to what and how they are playing and facilitates their awareness of the emotion that arises (or lack of). Because most children play, it is a very gentle and effective means of helping children. They are not cognitively advanced enough to talk through their concerns. Instead, they can unconsciously project their issues onto toys. For example, the dinosaur can chase the frightened mouse, or the doll can be sad.

 For children with FASD, play therapy can be particularly appropriate:

  • Play does not require verbal skills, so children do not have to rely on the complex task of turning thoughts into words.
  • Children with FASD often struggle to emotionally regulate. Play therapy helps them to gently become aware of their difficulties in this area, and creates a space for experimenting with different ways of being and acting.
  • CCPT provides a consistent and predictable environment that can allow the child’s nervous system to take a deep relaxing breath. For 45 minutes, once per week, the child can experience an environment free of the myriad threats and challenges that constantly bombard their nervous system.
  • Often, children with FASD have many therapies to help them ‘be as normal as possible’. The tenets of CCPT are to accept the child as they are, and through this acceptance comes growth and healing. For a child who is inundated with (well-meaning) indirect messages of ‘you are not ok the way you are, you need to change’; play therapy can be a much-needed sanctuary and respite.
  • Likewise, CCPT provides a space free from behavioural restrictions. While there are of course limits which keep child, therapist and toys safe, the therapist strives to place as few limits on the child’s behaviour as possible. For children who are so used to being told “no!” (with good reasons no doubt!), this freeing space can be just what they need to emotionally express frustrations, anger, sadness or any other pent up emotion.

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