How Can Play Therapy Help My Child with ADHD?

What is Play Therapy?

Play therapy is a developmentally appropriate and safe way for children to express experiences they may not be able to verbalize. Play therapy can be directive, meaning that the therapist provides a prompt to the child or engages them in a particular activity or game, or nondirective, meaning that the child chooses what they would like to engage with in the playroom while the therapist provides observations about the child’s play and undivided attention in the safe space.

Does Play Therapy Help Children with ADHD?

Yes! Many research studies have shown that play therapy is an effective way to reduce symptoms and behaviors associated with ADHD. Play therapy has been shown to improve cognitive flexibility, increase on-task behaviors, increase paying attention, decrease hyperactivity, and decrease impulsive behaviors (Wong et al., 2022; Swank & Smith-Adcock, 2018; El-Nagger et al., 2017).

Even for children without ADHD, play therapy empowers children to make their own decisions and regulate emotions inside the playroom, reinforcing that they have the tools and capacities to make decisions and regulate emotions outside the playroom as well. Because of the exploratory and safe environment that play therapy provides, children learn that the choices they make and emotions they feel are not connected to their worth and value as a human. Regardless of whether they throw the game on the floor or become angry at me for winning a board game, I see them with unconditional positive regard. This reflects their self-worth in the face of despairing situations, and improves self-esteem and confidence that they are worthy of love even if they sometimes make mistakes or have big feelings.

What Aspects of Play Therapy Target ADHD?

Non-Directive Play

Non-directive play is child-led and allows me to see a child’s inner world. Rather than telling me with words, the child shows me through their play what they are processing and may need more support with. Many children with ADHD struggle with lowered self-esteem, meaning that they may be processing a lot of emotions in play therapy related to identity and how they are seen by their families, their peers, and the world (Mazzone et al., 2013b). Through non-directive play, children can feel seen by the therapist and play out some of the situations they struggle with, leading to an increased sense of self.

Directive Play

As many children with ADHD may struggle with navigating social interactions with peers, directive play is useful for building social skills. Social skill development is extremely important for children with ADHD, as social rejection may lead to later emotional issues and decreased self-esteem (Nixon, 2001). Directive play in therapy may look like setting a social issue and then allowing the child to work through the interaction with the therapist as a support. For example, the therapist holds up two dolls and says, “Heather really wants to go outside and play, but Jenny wants to stay inside and color. They both want to play together, but can’t decide what to do. How do you think they could figure out what to do together?” The child could then work with the therapist to determine a way the two characters could navigate the social dilemma to both get their needs met.

Game Play

Many common games have therapeutic benefits for children with ADHD, such as increased social skills, emotional regulation, concentration, and memory. Game play in therapy can be either non-directive, as in the child chooses a game from my shelf and requests to play, or directive, in which I introduce the game as an activity we will be doing during the session.

Frustration Tolerance

• Trouble
• UNO
• CandyLand

When playing these games in session, I’m focusing on both building rapport with your child, and also helping them process feelings that arise, such as disappointment, frustration, or anger. Perhaps they got sent backwards on the board, and feel upset that my piece is now in front of theirs. We might take a moment to pause and regulate their emotions. I might acknowledge that they are feeling frustrated because their piece got moved backwards and then model taking a deep breath. In this way, the child learns to process their feelings through co-regulation.

Concentration & Memory

• Card Matching
• Connect Four

When playing these games in session, I might be redirecting the child’s attention to the cards or exaggerating my turns to increase the child’s attention in times that it might wander. I might vocalize my move as I’m playing to grab auditory attention as well as visual attention.

Art Activities

Art activities in therapy can be either non-directive, as in the child chooses to sit down at the table and start creating, or directive, in which I introduce a particular craft or prompt as an activity we will be doing during the session. Most art activities require a child to concentrate and focus on the project in front of them. With children who are more hyperactive and want to do something with their hands, I may prompt them to explore clay projects or slime making. Both of these are sensory-related activities that also involve focus on the big picture and the little steps that go in between.

If you think your child might benefit from play therapy, click here to schedule an appointment.