Joining us this week is developmental, behavioural pediatrician Dr. Rick Solomon who is the medical director and founder of the PLAY Project, which is derived from the Developmental, Individual differences, Relationship-based (DIR) model. He discusses what the PLAY Project is, how it came about, the research behind it, and how it is a solution for the huge wait lists for autism therapies.
The P.L.A.Y. Project with Dr. Rick Solomon
What is the P.L.A.Y. Project?
The mission of the PLAY Project is to connect parents with their children in a joyful way and the vision is to reach and train professionals to coach parents to help bring out their child’s potential through play. P.L.A.Y. is an acronym for Play and Language for Autistic Youngsters. Its focus is on young children with autism, involving parent training, or Parent Implemented Models (PIM), that uses a developmental, relationship-based framework. Empowering parents to be their kids’ best play partner so they can engage with their children all day long is the goal.
The PLAY Project is now in 30 states and 9 countries, and 5-600 professionals have trained. As the evidence grows, the interest is growing, which means Dr. Solomon is getting requests for training all the time. People are realizing that Applied Behavioural Analysis (ABA) alone can’t meet the demand. The PLAY Project is cheaper and easier to train parents. You can’t have thousands of children on wait lists for services that won’t begin for years. It’s critical to have alternatives, if just from a public policy standpoint.
Evidence Base and Training
Dr. Solomon spent a few minutes on the podcast reviewing the research. It demonstrates that parents can be trained and children’s social abilities can improve with parent-implemented interventions. Over a dozen randomized controlled trials show that these models are evidence-based. A review article by Amanda Binns was featured on our podcast a couple months ago.
Autism was been determined to be a medical condition under the Obama Administration in the United States. Under the Early Periodic Screening Diagnosis and Treatment (EPSDT), if you have a medical diagnosis then medicaid is mandated to provide treatment. More and more insurance companies are now starting to cover evidence-based practices. This is revolutionizing how autism will be treated going forward. Dr. Solomon says that it makes sense as a public policy approach to train parents to help support their children because it’s 1/10th the cost of therapists.
The PLAY Project trains play consultants. There are three main groups trained: early interventionists (birth to age 3 workers), medical rehab service professionals such as Speech and Language Pathologists and Occupational Therapists, and community health workers. One play consultant can train 25 families. It’s intensive because parents are asked to put in 15 hours per week. Even working parents are spending 45 hours per week with their children. Parents can be coached to put in playful interactions throughout their daily activities. It’s powerful.
The PLAY Project vs. ABA
There are fundamental differences between ABA and developmental models. First, in a developmental, play-based approach you are always following and honouring the child’s idea. In ABA, it is almost always program directed. You are teaching the child and prompting the child to make gains in their IQ and language skills. They are very different models but can work together, Dr. Solomon believes. ABA companies are becoming interested in what they do to supplement what their therapies lack.
As ABA has evolved they’ve become more playful, but they still always have their agenda. We’re always following the child’s idea and building on that. That’s how we get the child to make progress developmentally.
Wooing a Child’s Developmental Potential
I asked Dr. Solomon to define ‘developmental‘ as this is often a harder concept for parents to grasp versus concrete skills that are taught in ABA. He described Vygotsky’s three zones of learning. The comfort zone is in the middle. This is the autistic child. This is where they are stuck, Dr. Solomon says. They want to keep the world the same because of their neurology which is due to their genetics. The child finds it very comforting to stay in a narrow range where things make sense.
When we do what they love, they will love to be with you. They will come out of their comfort zone because it’s fun.
The next zone up is the zone of proximal development and this is where you challenge the child to do something new. In the PLAY project you’re challenging the child to come out of that comfort zone, but we make it really fun, Dr. Solomon says.
The danger is that we play too high in the zone of potential development. We don’t want to play there with our children because it’s too hard for them and they will feel they can’t do it, which is upsetting.
The PLAY project challenges the child in that zone of proximal development. We are honouring and joining their lead in a fun way so the child wants to be with you. Parents love it. It’s fun. It’s playful. There’s no crying and screaming and it works. The research shows it. Children made gains in all aspects of their development, including language. It generalizes because they aren’t prompting. It’s child-centered so when they learn it, they learn it deeply. You don’t have to keep prompting them. When they want you to play with them, they come and get you, Dr. Solomon says.
And they make progress. In the beginning that looks like more back-and-forth interaction which is the foundation for growth and development. When they make this progress having fun with people, being engaged with people, and having the back and forth, then the gestural, receptive, then expressive language emerges.
Dr. Solomon follows hundreds of children per year, thousands over his life and he’s seen so many autistic children make developmental progress. There’s slow movers, medium movers and fast movers. Our job, he says, is not to make them typical, but about 15% become indistinguishable from neurotypical children as their development progresses. Dr. Solomon says the potential in autistic children is to reach the heights of human potential just like anybody else.
Origins of the PLAY Project
Dr. Solomon was never interested in autism, but in infant mental health. In Pennsylvania, parents of autistic kids sued the state and won. They came to him in Pittsburgh in 1989/90 and said please order ABA therapy for us, which Dr. Solomon had never heard of, but it looked like operant conditioning to him. He was able to subscribe 40 hours per week of ABA for families of one-on-one therapy in the home with a trained ABA therapist.
But he wasn’t even fond of ABA therapy. He did a fellowship with Dr. Stanley Greenspan and invited him to Pittsburgh to do a presentation. After that, Dr. Solomon implemented play therapy and started prescribing it to families along with ABA. Dr. Solomon learned that intensity matters and that children with autism have tremendous potential. He so loved the Greenspan framework that when he moved back home to Michigan and realized there were no therapy laws, he dove right into creating the PLAY project.
When he opened his doors, dozens of families flocked to get the PLAY project. In the first 2 years, 75 families signed up and the chairman told Dr. Solomon that he needed to do resesarch. So Dr. Solomon took the 75 families and published the work in 2007. He used that pilot study to get the big National Institute of Health grant that funded the randomized controlled study.
Funding PLAY Project through insurance
In the United States, Dr. Solomon encourages families to reach out to their insurance companies and ask for coverage to pay for parent-implemented models. He has offered to reach out to insurance companies if you contact him. On the Play project website under the Parents tab then under Family Resources, you can find the document 5 reasons why insurance companies should cover Parent-Implemented Models. They also have a letter for families to send to their insurance companies you can contact them to get.
Why it Works
The PLAY project is actually a highly structured approach for parents. It’s not just ‘go play’. There’s techniques, methods, and video examples on the website, Dr. Solomon says, that are designed to teach families the simple steps and coaching that can really empower parents and caregivers. Although the focus and commitment is to early intervention, it works with adults too because you’re still using the DIR model which helps anybody, Dr. Solomon says.
Their research showed that the stress of parents who participated in the PLAY project went down dramatically and their depression was significantly improved compared to a control group. At the beginning of intervention, 40% had scored high on the depression scale. The PLAY Project teaches them to connect with their child which is joyful. And once the child is understood, connected, and more socially playful, they are happier and less anxious as well.
Dr. Solomon's book "Autism: The Potential Within"
Dr. Solomon also wrote a book called Autism: The Potential Within. The second section is on the PLAY Project which is a parent-training manual. The main client in the book, Jacob Grant, is followed from the time of diagnosis until he is 5 yrs old. The story follows the family in the form of a series of office visits with Dr. Rick. There is a chapter called the Language Mountain that tells parents how language develops in autistic children, and a chapter just about behaviour challenges that families face. Each visit is a problem for the family, so each visit is like a story in the book.
Find out more about the PLAY Project
The PLAY project is an application of the DIR theoretical framework. It’s specifically focused on young children with autism and parent training and they train on a large-scale. For example, the state of Ohio is trained state-wide. Children aged birth to age 3 get it for free in Ohio. See the family resources page on the website and how you can find a PLAY project consultant near you. You can follow the PLAY Project’s blog here and sign up for their e-newsletter at the bottom of the page.
There are online introductory courses that anyone interested can view. There are also YouTube videos. Beyond that, there’s also a two-day training that anyone can take. For professionals interested in becoming certified, there is a basic training and then a six-week online award winning course followed by supervision. Research shows that once completed, these professionals have really learned the methods and can apply them successfully with families.
Thank you to ‘Dr. Rick’ for taking the time out of his busy schedule to discuss the P.L.A.Y. Project with us! If you found this post, podcast, or video helpful or informative, please consider sharing it on Facebook or Twitter, and please do share any comments, questions, or relevant experiences with us in the Comments section below!
Until next time, here’s to affecting autism through playful interactions!