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Replays: How to Turn Problem Behaviors into Opportunities for Fun
By Karen Levine, PhD, and Naomi Chedd, LMHC
Your son refuses to put on his shoes—sometimes several times a day. He whips them across the room, screams, and hurls himself on the floor in a fit of rage and frustration. You would like to do the same, but you’re the grown-up! Already you’ve lost several shoes at the mall, and once he threw a rubber boot out the car window. You’re at your wit’s end.
Or maybe… Your daughter is very motivated to succeed at school. That may not sound like a problem, but it is–because she can’t stand to make a mistake. In anything. Ever. If she gets a grade less than 100% she becomes angry and selfdeprecating, announcing to everyone, “I’m dumb! I can never do anything right! I hate school!”
If these scenarios remind you of someone you know and love, you’re not alone. From toddlers to adolescents and beyond, many people with Asperger Syndrome (AS) display challenging, inappropriate, or disruptive behaviors— occasionally, several times a week, or so frequently that they prevent families from enjoying their time together, and each school day begins and ends on a sour note. As one mother put it, “Every bath is a battle; every trip to the grocery store is a voyage of dread and despair.”
Replays to the Rescue!
At least 50% of children with Autism Spectrum Disorders (ASDs) have substantial behavioral challenges surrounding many aspects of daily living, due to intense emotional responding. Professionals and parents everywhere have endless discussions about the most effective ways for dealing with such challenges, because there isn’t one foolproof approach that can turn a tantruming child or teen into a calm, rational human being, who is ready to listen and learn.
Replays is a new intervention: an innovative, interactive, play-based approach for decreasing distress and anxiety, and increasing compliance, in children with ASDs. It can be effective for minimizing or even extinguishing the negative feelings and dramatic behaviors that occur prior to, during, or as a result of routine activities of daily living or health care procedures (teeth cleaning, getting dressed, medical check-ups), as well as extreme reactions to sensory experiences (loud noises, slimy foods), and even for common fears, anxieties or obsessions. It can be used in concert with other approaches, such as Positive Behavioral Supports, Social Stories™, Picture Schedules, Sensory Integration, etc.
We are not suggesting that Replays will solve every problem, every time it occurs. However, it will give you a vehicle for approaching a problem, and a common language through which you and your child, student, or client can communicate, in a positive and mutually enjoyable way, about a dramatic or traumatic event.
How do you do Replays?
Replays involves engaging the child in an interactive, highly animated, and playful re-enactment of their own experience of regularly occurring and upsetting events. This should not occur in the heat of the moment when the child is totally out of control, and unable to access any coping skills, but at a calmer and more relaxed time.
First, the adult re-enacts the event in an exaggerated, usually silly fashion, using symbolic objects and toys, such as dolls, action figures, stuffed animals, props, etc. The dramatization incorporates the specific actions that took place as well as the child’s own maladaptive responses. For example, a doll may yell “NO!” and try to run away, as the adult tries to put a tongue depressor in the doll’s mouth. Or the action figure may scream when the adult tells him it’s time for a bath, or another daily event that elicits a predictably negative response. Gradually the child becomes more interested and engaged in the performance, often participating, and taking on different roles, correcting reactions, or expanding the story line. Even children with little or no symbolic play appear to understand and participate in re-enactments if the playful actions and behaviors are part of their own behavioral repertoire.
We have found that many children, including some under age 2 who reportedly have previously engaged in no symbolic play, have learned some pretend play routines through watching and then participating in Replays. Children older than 12, who allegedly are “too old for pretend,” happily engage in fantasy play if Spiderman, Obi-Wan Kenobi, McQueen, or other popular characters are used.
Often children want to play the event over and over, as they begin to master the uncomfortable feelings they previously experienced. They enjoy the humor, and the interaction with a trusted adult in a safe setting, as they get the guidance and practice they need to overcome negative feelings. With repeated Replays, such as before a predictably dreaded event (going to the doctor for a shot; putting on an itchy hat, scarf and mittens) the event becomes less evocative, less toxic, and the child’s intense negative reactions diminish.
After replaying the event several times, it is often helpful to write and illustrate a brief story of the event. Keep it simple: use stick figures, cuts-outs from magazines, digital photos, or pictures downloaded from the Internet. (We especially like Google Images, but there are dozens of others.) The child can carry the story around and “study” it, or read it aloud to others—or another family member or babysitter can read it to the child.
What are the Mechanisms for Change?
We’re not sure. (Several research projects involving Replays are currently underway.) However, there is a sound basis for a number of related interventions:
Traditional Play Therapy gives children the opportunity to re -enact traumatic experiences in a safe, loving context. The adult typically follows the child’s lead in playing out events, supporting the child who is attempting to master his or her intense emotions. This approach, however, is not always accessible to children with ASDs, due to limited social and, sometimes, symbolic skills.
Systematic Desensitization helps people overcome phobias and extreme emotional responses to commonly occurring events through gradually increasing exposure to the stimulus eliciting a negative response, while simultaneously pairing it with a neutral or pleasant event (favorite music, reassuring voice). The individual gradually learns to tolerate the stimulus.3 Replays is similar, but it also includes a playful incorporation of the child’s reactions, thereby desensitizing the child to the event and their own experience of being upset.
Social Stories™ teaches children and adolescents appropriate behaviors by using a simple story with pictures to learn and understand the rules and sequences of events. Unlike some Social Stories™, Replays includes and often emphasizes the child’s own emotional response and subsequent recovery.
Floortime, a variation of play therapy, is designed to access the child’s interests and emotions through the authentic expression of the adult’s emotions. The child typically takes the lead and the adult follows along, making suggestions, enhancing the story, and becoming more actively engaged. Replays has some similarities, but is more focused on problem behaviors and is more adult-directed.
The effectiveness of Replays may be a result, at least in part, of the activation of mirror neurons, a new area of neurological investigation. Sometimes called empathy neurons, mirror neurons fire both when an animal (possibly a human) acts and when it observed the same action performed by another member of its species. Think about how you feel when you see another person fall down, eat your favorite flavor of ice cream or greet a loved one at the airport. Your emotional responses may be a result of mirror neuron activation. Mirror neurons may also offer a partial explanation of why children “get” Replays. Or it may be the result of the child’s acquiring new emotional memories and behavior patterns through repeated Replays, or even a single session. Simply put, the child learns to associate fun and laughter with a previously traumatic event. In behavioral terms, the child pairs the stimulus with a reward in addition to, or in some cases instead of, such feelings as fear or anger. Hence, the negative behavior diminishes.
Who can do Replays?
If you are a parent, teacher, school counselor, PT, OT, or aide, you can! You just need to learn the basics, have repeated opportunities to work with the child who is having difficulties, and be willing to slightly alter your usual approach to behavior management or modification.
You also need to be flexible and willing to try variations of the Replays, as your first attempt may not lead immediately to the desired outcome. If the child doesn’t immediately catch on, simplify the Replay, or use a sillier, louder or softer, higher or lower voice. If the child becomes scared or upset, or if the re-enactment makes him anxious because it is “too close to home,” substitute an animal and a related situation: a dinosaur who won’t eat his dinner, instead of a boy doll who won’t eat his breakfast. The more comfortable the child becomes with this type of play, the closer you can get to replaying the actual traumatic circumstances.
A variation on dramatic re-enactment that can be especially fun and effective with children with AS, particularly older and more verbal children, is co-writing. During the process co-writing, an adult can hand write, or sit at a computer and type, as the child or adolescent dictates the story of a difficult interaction, horrible experience, or frightening incident. The adult can ask “leading” or clarifying questions, such as “How mad were you (or was Spiderman)? A TRILLION GAZILLION mad?” or “You mean you really didn’t want to do your homework?” The advantage of the computer is that is uniquely designed to help the writer express and record feelings, immediately change or delete them if desired, and even add graphics. For example, if a child really dislikes homework, have the character in the story say, “NO! NO! NO!!!! I’M NEVER EVER EVER GOING TO DO ANY HOMEWORK!! NOT THIS YEAR! NOT NEXT YEAR! NOT EVER!!!!” Go ahead: use 30 pt type—in red—and fill the entire page! You may be surprised how much fun this is for the child—and for you. It is unlikely that the student has had an opportunity to fully express authentic, uncensored negative feelings to that degree—to truly blow off steam, and feel heard.
And finally…
One of the most appealing aspects of Replays, besides it being fun, is that the technique can be used in tandem with virtually every instructional approach. Whether the child is getting ABA/ DTT therapy, Floortime, or RDI, or is in a classroom that uses the SCERTS Model (Social Communication, Emotional Regulation and Transactional Support) or another approach, Replays can augment those techniques and play a part. It is a technique that particularly lends itself to one-to-one therapy sessions (e.g. speech, social skills, or OT). However, it can also be used in small groups, especially if several students are experiencing similar difficulties, such as not knowing when to stop talking about a special interest, getting upset about how certain clothing feels, or having to sit next to the window in every class. And while doing Replays may not take every ounce of angst out of the next fire drill or surprise assembly, regular sessions may elicit a more relaxed, less intense or frantic response. And best of all, it is a enjoyable and creative way to play, have fun, and ease the emotional pain—at least a little and maybe a lot—of a troubled child.
Karen Levine, PhD, is the former Clinical Director of the Center for Autism and Developmental Disabilities, Center for Child and Adolescent Development, at the Cambridge Health Alliance, and an instructor at Harvard Medical School. She has recently opened a full-time practice in Lexington, MA, evaluating and treating children and consulting to schools and families. She and her family live in Bedford, MA.
Naomi Chedd, LMHC, is a Licensed Mental Health Counselor and Educational Consultant in private practice. She consults to families and schools and conducts evaluations and in-service trainings. She lives with her family in Brookline, MA.
Karen and Naomi share more than 12 years of professional collaboration and friendship. They are frequent invited speakers at local and national conferences and are coauthors of Replays: Using Play to Enhance Emotional and Behavioral Development for Children with Autism Spectrum Disorders. London: Jessica Kingsley, 2007. Among their current projects is a new book on the uses of humor in the classroom.
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