There’s a growing shift toward play-based therapy for autistic kids – and it’s rooted in both science and experience. Research, lived experience, and practitioner insight all point to the same truth: children learn, connect, and thrive when therapy honors their neurology, not when it asks them to suppress it.
Compliance-based methods often prioritise “following directions,” sitting still, or performing behaviours on command. But autistic children consistently tell us – later, as teens and adults – that these approaches can feel stressful, invalidating, and even harmful. Play-based therapy, on the other hand, centres joy, autonomy, co-regulation, and authentic communication. Instead of teaching a child to appear more neurotypical, it supports them in being more themselves.
During her interview at The 2025 Play Conference, Cari Ebert – a neurodiversity-affirming speech-language pathologist and parent of an autistic child – summed up this shift with striking clarity. Because she understands both the clinical and parenting perspective, her message is grounded, compassionate, and refreshingly practical:
“Autistic children become autistic adults, and therapy is not to rid the child of their autistic traits or make the autistic child act in more neurotypical ways.”
This blog explores why play-based therapy better supports development and what truly sets it apart from compliance-based practice.
What Is Compliance-Based Therapy?
Compliance-based therapy prioritizes instructional control. The therapist leads. The therapist decides. The child’s role is to follow, imitate, or earn access to preferred items through correct responses.
Here are key characteristics of compliance-driven intervention:
1. Power and control sit with the therapist
Lesson plans are pre-set. Activities are chosen in advance. Expectations are based on adult goals, not the child’s internal state. This creates an asymmetrical, hierarchical relationship, ultimately the therapist chooses control over connection, co-regulation, and compassion.
2. The goal becomes “behaving more neurotypically”
Children are expected to sit still, respond on command, play by adult-defined rules, and socialize in neurotypical ways. Well-intentioned though these expectations may be, they send a message that the child’s natural ways of processing, communicating, and interacting are wrong.
3. Reward systems shift the focus from connection to compliance
In many compliance-based models, a reward system is used to control behaviour – food, toys, comfort items or preferred activities are withheld until the child performs the desired action. This turns therapy into a transaction rather than a relationship. As Cari explains, when “first…then” is used to make a child earn an item, activity, or even a basic need, the message is clear: your access to what you love depends on your compliance.
However, “first…then” can be used in a completely different, and appropriate, way with neurodivergent children. When it’s used simply to outline the sequence of events (“First we’ll do this, then we’ll go there”), it functions as a visual schedule, offering predictability and reducing anxiety. In this context, the second activity isn’t a reward for completing the first; it’s just information about what’s coming next.
4. Prioritizing compliance ignores safety, autonomy, and the child’s nervous system
Children’s protests, refusals, or expressions of discomfort are often labeled as “problem behavior,” even though all children – autistic or not – have the right to advocate for themselves. Focusing solely on obedience can lead to long-term mental health challenges or, in worst cases, place children at risk by teaching them they cannot refuse unwanted touch or direction.
5. Compliance-based therapy increases stress – and shuts down learning
Stress triggers fight, flight, freeze, or fawn responses, which block learning. Many autistic children, particularly girls, rely on fawning – masking, pleasing, and suppressing their own needs – to navigate compliance-driven therapy. This creates a cycle: perceived noncompliance leads to removal of a preferred item, escalating stress, meltdowns, and more misinterpreted “challenging behavior.” Once a child is dysregulated, no amount of instruction can facilitate learning.
6. Non-compliance is seen as a sign of willful disobedience.
When a child doesn’t follow a direction, adults frequently assume willful disobedience rather than exploring underlying causes:
- Comprehension difficulties: Some children, especially gestalt language processors, may speak fluently without fully understanding instructions.
- Activity isn’t meaningful or comfortable: Refusal may reflect sensory sensitivities or lack of relevance.
- Motor planning challenges: Praxis difficulties can make tasks physically hard.
- Dysregulation: An overwhelmed nervous system prevents readiness to learn.
- Unmet basic or emotional needs: Hunger, fatigue, lack of trust, or disrupted emotional safety can all inhibit participation.
7. Compliance-based therapy is deficit-driven and rooted in “fixing” autism
At its core, this approach seeks to “fix” autism by shaping behavior toward neurotypical norms. When therapy focuses on correcting perceived deficits rather than supporting the child, it loses its purpose. True autism acceptance involves valuing the child’s neurology and respecting their unique ways of communicating, learning, and being.
There are situations where compliance is necessary – especially for safety, such as not running into the street or making sure your child is wearing a seatbelt. In these cases, caregivers and providers may use incentives or prompts to help ensure the child’s safety. The key difference is that these instances are about protection, not controlling the child’s behavior or enforcing neurotypical norms.
Before we go into play therapy and what that entails as a contrast to compliance-based therapy, one point that Cari wanted to highlight is that autistic children have brains that function differently. This means they acquire milestones differently, process sensory input differently, communicate and interact differently, and play differently. Different does not mean defective or broken. True neurodiversity-affirming practice honors the autistic neurotype and prioritizes autism acceptance.
So let’s get into it. What Is Play-Based Therapy?
Play-based therapy is a developmentally responsive, neurodiversity-affirming approach used across disciplines – SLPs, OTs, PTs, educators, psychologists, and caregivers can all use it.
The key?
Play is rooted in joy, intrinsic motivation, and connection – not control.
Cari’s three favorite definitions of play:
play is freely chosen, intrinsically motivated, and personally directed. (The Playwork Foundation)
play is an activity by children that is guided more by imagination than fixed rules. (Play, Catherine Garvey)
play is the spontaneous activity of children. (Encyclopedia on Early Childhood Development)
Intrinsic motivation increases joy, and joy releases happy hormones, not stress hormones.
Many strategies used in play-based speech, occupational, and physical therapy are rooted in Child-Centered Play Therapy (CCPT), a well-established approach from psychology. CCPT isn’t a “fly-by-the-seat-of-your-pants” method – it’s grounded in research and emphasizes relationship-based learning: connection, reciprocity, and authentic engagement between therapist and child.
Some of the key principles include:
- Developing a warm, inviting, and authentic therapeutic relationship.
- Unconditionally accepting the child as they are – true autism acceptance.
- Giving the child a sense of permission to fully express themselves.
- Allowing the child to lead, rather than directing their actions or conversations.
In pediatric practice, therapists combine these principles with discipline-specific strategies, embedding goals for cognitive, communication, motor, sensory, and self-help skills within playful activities. For example, occupational therapy techniques like hand stabilization or bilateral coordination can be integrated into play without losing joy or connection.
Regulation, connection, and instruction
Play-based therapy follows the sequence regulation → connection → instruction. New skills are introduced only once the child feels safe, regulated, and supported. Following the child’s lead is key to building authentic connection, but this doesn’t mean therapy lacks structure. Goals, like motor planning or communication, are embedded within meaningful, engaging activities, ensuring the session is both effective and respectful of the child’s autonomy.
Child-Led vs. Adult-Directed Play
Play-based therapy exists on a continuum:
- Child-led play: The child chooses the activity, and the therapist embeds goals within their play. This fosters regulation, joy, and authentic engagement.
- Adult-directed play: The therapist introduces structured games or activities while avoiding compliance-based strategies. Even in adult-directed sessions, therapy remains playful, engaging, and respectful of the child’s needs.
Research shows that when autistic children are allowed to choose the how and when of social play, they are just as motivated to interact with adults as their non-autistic peers (Yu et al., 2023). Child-led play supports natural engagement, reduces stress, and creates a safe environment for learning and connection.
Supporting the Whole Child
As therapists, it’s easy to feel like every second of a session must be packed with activity to be valuable. But the true goals of working with autistic children go far beyond constant instruction. Effective, neurodiversity-affirming, play-based therapy focuses on the whole child, prioritizing regulation, connection, communication, motor planning, and self-advocacy. We’re not trying to force skills like writing at age two or sitting still on command. Instead, we support development at the pace and in the way the child’s neurotype naturally learns. Fine motor challenges are common, for example, many autistic children still eat with their fingers at age five and not because they are behind, but because milestones are acquired differently.
Whole-child work means attending to the child’s mental health, nervous system, and authentic expression, not just their cognitive skills. By focusing on regulation and connection first, we create a safe, trusting environment where learning naturally emerges. Play-based therapy invites us to honor autonomy, reduce stress, nurture authentic communication, and see the child as a complete person.
When we follow the child’s lead, we don’t lose therapeutic value – we gain relationship, and through relationship, genuine learning flourishes.
This is just a glimpse: get the full interview plus others from leading pediatric therapists inside the Play Conference
About Cari Ebert
Cari is a neurodiversity-affirming speech-language pathologist and parent of an Autistic child. She is a passionate defender of play-based learning for all children.
Website: https://cariebert.com/