Play Therapy for Developmental Delay in a Child with NAS: Psychology

This report focuses on a case study of a 15-month-old girl, Missy, diagnosed with Neonatal Abstinence Syndrome (NAS) and exhibiting developmental delays due to her mother's substance abuse. The report explores the effectiveness of play therapy as an intervention to address Missy's speech and motor development delays, stemming from her premature birth and exposure to drugs in utero. It highlights the rationale for play therapy, emphasizing its role in emotional expression and cognitive development, particularly for children who struggle to articulate their feelings. The report details the theoretical underpinnings of the intervention, including actualization, play as communication, and the need for positive regard. The intervention plan involves weekly 30-40 minute sessions using various play resources like dolls, blocks, and role-playing to facilitate self-expression and exploration. The report concludes by emphasizing a client-centered approach, aiming to create a comfortable environment where Missy can express herself and explore her surroundings, while acknowledging potential challenges like aggression or repetitive play that would be addressed through symbolism, art, and the involvement of her foster mother. The report uses academic sources to support the intervention.

Running head: PSYCHOLOGY 1
Play therapy and Neonatal Abstinence Syndrome
Name of the Student
Name of the University
Author Note

PSYCHOLOGY 2
Introduction
The patient who will be provided therapy is a 15 month old girl Missy, who was a
premature infant and had been diagnoses with Neonatal Abstinence Syndrome (NAS). This
can be accredited to substance abuse behaviour in her mother. It has been found that
following her removal from her mother, she had been placed in countless foster homes and is
recently staying with a foster family for almost a year. Though her mother has been to
rehabilitation and wants to take her back, she has developed a strong attachment with her
foster mother and typically appears shy and clingy in presence of others. She also shows
delayed motor development and has not yet developed speech, apart from few words. Hence,
this essay will deal with the play therapy that needs to be provided for addressing
developmental delay in Missy.
Development
NAS refers to withdrawal syndrome occurring in infants soon after their birth, owing
to exposure to dependence drugs. The chemicals and drugs generally pass through the
placenta connecting the mother to the baby, following which if the mother continues
substance abuse within weeks of delivery, the infant becomes dependent during birth
(McQueen & Murphy-Oikonen, 2016). Owing to the fact that the baby is no longer exposed
to the drug after birth, symptoms of withdrawal begin to appear. There is a growing body of
evidence for the fact that children who are born with NAS display an increased likelihood of
being affected with language or speech impairment or developmental delay during early
childhood, in comparison to children who take birth without NAS (Miller et al., 2020).
Moreover, NAS also leads to the onset of particular conditions such as, emotional
disturbance, functional delay, intellectual disability, orthopaedic impairment or specific
learning disability (Fill et al., 2018). Children generally reach developmental mileposts at
their own stride. Minor, provisional delays are typically no reason for apprehension, but a

PSYCHOLOGY 3
continuing delay or manifold delays in attainment of the developmental milestones, as in this
case can be a mark there Missy will face several challenges later in life, if not provided help
immediately.
Under normal circumstances, most children are able to life up their head by three
months, are able to sit without assistance by six months, and generally walk properly prior to
24 months. Likewise, the language learning procedure commences when an infant is able to
communicate hunger by crying. By the age of six months, most infants are capable of
identifying basic language sounds and by they are 12-15 months old they are expected to
speak three or more simple words (Morse & Cangelosi, 2017). Child development generally
persists on a continuum and the development of most kids can be aligned to the middle of the
continuum. A child is most commonly described to be showing atypical development if one
of the two circumstances arise namely, (i) reaching developmental milestone after children of
same age, or (ii) reaching developmental milestone prior to children of same age (Simic &
Rovet, 2017).
It is imperative to focus on children who demonstrate development, slightly different
from the normal course. They are generally referred to as ‘gray area’ kids since they show
typical development in several domains. This prevents them from qualifying to obtaining
services in developmental domains where they face challenges, particularly during the
formative years (Mody, 2019). This calls for the need of monitoring their progress and
particularly supervising the areas where the kids lag behind the peers. Therefore, it can be
suggested that the maternal use of drugs at the time of pregnancy is the most significant
factor that has triggered atypical development in Missy. This can be associated to the
complex interaction between a range of neurotransmitters like serotonin, dopamine and
glutamate, differential neuronal circuit maturation, and inadequate expression of delta and
kappa opioid receptors (LaRosa & Aponte-Patel, 2019).

PSYCHOLOGY 4
Intervention
One of the principal reasons that play therapy has been considered suitable for the
developmental delay faced by Missy is that children of her age are generally not able to
articulate problems or process emotions to parents and caregivers. Play therapy helps in the
development of a suitable and effective environment that deals with the brain development of
the child and it offers a way for the children to express their feelings and emotions through a
self-guided, natural, and self-healing procedure (Goodyear-Brown, 2019). As the intentions
and knowledge of a child are generally communicated through play, the therapy acts
imperative for them to grow and develop. As claimed by Jean Piaget, play delivers the kid
with the dynamic, live, individual language crucial for the manifestation of the subjective
emotional state for which shared language unaccompanied is insufficient (Meadows, 2017).
Play has also been recognised to provide assistance to a child grow mastery over the
distinctive capabilities, subsequently leading to the generation of a sense of value and skill.
For the duration of play, all children are generally driven to address the indispensable need of
discovering and understanding the surrounding environment (Mora, van Sebille & Neill,
2018).
The effectiveness of the therapy can also be accredited to the fact that play directly
contributes to the progression of creative thinking during later stages. Play likewise delivers a
method for children to manifest strong opinions and feelings, thus making them feel
reassured. Throughout the therapy, the children are taught to play out life events by
fragmenting them to smaller events, releasing emotive states or sense of mind, assimilating
every involvement to basic understanding and gaining increased degree of mastery.
According to Ray (2019) play promotes the holistic development of children by enhancing
their language, social, emotional and cognitive development. The intervention of play therapy
encompasses three vital theoretical underpinnings that are actualisation, play as

PSYCHOLOGY 5
communication, and need for positive regard. Actualisation considers humans to get
encouraged by their distinctive tendency of developing healthy and constructive capacities,
thus will help Missy to actualise her inner potentials and become autonomous. Moreover, the
theory holds that all individuals are in need of respect, acceptance and warmth from
significant others. With growth and development, the requirement for positive regard will get
transformed to a learned desire for self-regard, thus enhancing Missy’s development.
Effectiveness of this therapy can be associated to the fact that play acts in the form of
a natural communication medium (Reddy, Files-Hall & Schaefer, 2016). The therapy sessions
will last for about 30-40 minutes and held weekly. An estimated 15-20 sessions will be
required for resolving the identified problem of atypical development. Stuffed animals, dolls,
balls, toy telephone, balloons, blocks, role play and costume play will form essential
components of this therapy. Often children do not have the capability to use appropriate
words, as in this case scenario, however, with the help of play therapists, an understanding
and communication can be fostered. Play creates the provision where children can challenge,
create, engage, imagine and explore different activities. Apart from accepting Missy as she is,
a sense of permission will be established to allow Missy express herself freely. Moreover, the
therapy will be based on demonstrating respect for the child, while preventing attempts to
direct her actions or conversations in any way.
Conclusion
To conclude, developmental delay is the most significant problem identified in Missy
and can be addressed by implementing play therapy. Play therapy will engage the child Missy
in play and by providing different resources, knowledge and materials, the underlying issues
of developmental delay can be addressed. Therefore, the intervention will be based on a
client-centred approach where Missy will be engaged in play to resolve the imbalance
between her environment and herself, with the aim of facilitating natural growth and self-

PSYCHOLOGY 6
improvement. Hence, the basic idea of play therapy is to allow Missy to settle into a
comfortable environment where she will display a willingness to express herself more and
will also try to explore her surroundings without assistance. However, Missy might become
aggressive, express herself symbolically or might manifest repetitive play during the sessions.
These need to be addressed by using symbolism and art, in addition to involving her foster
mother during the sessions, which in turn would make Missy comfortable.

PSYCHOLOGY 7
References
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Jones, T. F. (2018). Educational disabilities among children born with neonatal
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Goodyear-Brown, P. (2019). Trauma and play therapy: Helping children heal. Routledge.
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LaRosa, J. M., & Aponte-Patel, L. (2019). Iatrogenic Withdrawal Syndrome: a Review of
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