Intervention & Education for Children with Intellectual Disability

Using Play Therapy to Manage Behaviour in Children with Intellectual Disability

Last updated on:

April 6, 2026

When a child with an intellectual disability acts out repeatedly, throws objects, withdraws, or erupts in frustration – it’s easy to focus on the behaviour itself and miss the message underneath it. Many of these children have limited verbal ability, which means they cannot simply tell a caregiver or teacher what is bothering them. They need a different outlet. Play therapy offers exactly that – a structured, evidence-based approach where play becomes the medium through which children express, process, and begin to resolve their inner emotional world. Far from being casual free time, it is a carefully designed therapeutic intervention that has been used for decades to support children with intellectual and developmental disabilities.

Play as a natural language
How play therapy works
Selecting the right play materials
Real-life and nurturing toys
Aggressive and acting-out toys
Creative expression toys
The role of the therapist and the importance of limits
Why talk isn’t always enough

Play as a natural language

For most young children, play is the primary way they make sense of the world – and this is especially true for children with intellectual disabilities (IDs). Research published in Family Therapy Magazine notes that play is a universal activity that enables children to make sense of the world around them, express emotions, and develop social skills – and for children with IDD, these benefits remain crucial to their developmental progress, even if they manifest differently.

Children with intellectual disabilities often have significant gaps between what they feel and what they can say. A child experiencing fear, grief, or anger may have no words for those states – but they can still show them. According to The Refuge Center for Counseling, play therapy allows children to process their inner experiences and feelings through play, symbols, role-play, fantasy, and art. In this sense, play is not a substitute for communication – it is communication, expressed in the only language the child fully controls.

A study in the Shanlax International Journal of Education affirms that the ability to play is one of the principal criteria for mental health, and that learning opportunities through play activities are especially important for children with disabilities. When speech is limited or absent, the playroom becomes the space where a child’s inner life becomes visible.

How play therapy works

According to research published in PMC, play therapy is a space provided where a child plays out feelings and problems much the same way an adult “talks out” difficulties in verbal counselling. The therapist provides a consistently safe environment with a carefully selected set of toys and materials, then observes how the child engages with them – watching for recurring themes, emotional shifts, and symbolic patterns.

Consider a child who witnessed or experienced something frightening. Instead of trying to describe it verbally – something most adults would struggle to do after trauma – the child might pick up a family of dolls and begin acting out a scenario that mirrors the experience. A documented case from Family Therapy Magazine describes how Carlos, a six-year-old primarily non-verbal boy diagnosed with ASD and IDD, gravitated toward a dollhouse in his first session and re-enacted his traumatic experience through the dolls – without needing a single word. This re-enactment, without verbalization, is a demonstration of how play therapy creates space for emotional processing and trauma healing in children with IDD.

From a neuroscience perspective, this PMC study explains that the effects of trauma reside in the nonverbal areas of the brain – the hippocampus, amygdala, thalamus, and brain stem – while the ability to articulate them resides in the frontal lobe. The symbolic and role-play activities in play therapy help move traumatic experiences from the nonverbal brain toward the frontal lobe, where they can be processed and integrated. This is precisely why play works where words often cannot.

A systematic review in the Journal of Intellectual Disabilities Research found that play therapy can be an effective intervention for issues in the areas of emotional growth and externalizing behavioural problems in children with mild intellectual disability – though the authors note the evidence base is still growing and more research is needed.

Selecting the right play materials

The toys used in play therapy are not chosen at random. Every item in a play therapy room is selected with therapeutic purpose, and the Center for Play Therapy at the University of North Texas – which draws on the foundational work of Dr. Garry Landreth – identifies three broad categories of therapeutically appropriate toys.

Real-life and nurturing toys

This category includes doll families, dollhouses, puppets, kitchen sets, toy phones, and animal families. A practitioner-focused review in PMC describes these as “ice-breaker” toys – they come with their own implied rules, require little limit-setting, and gently invite a child into play without pressure. They are particularly useful for withdrawn or timid children who need time to feel safe before expressing deeper emotions. A child arranging a doll family, for instance, may be revealing how they understand the relationships around them.

Aggressive and acting-out toys

This includes items such as a bop bag, foam sword, toy soldiers, and rubber knife. These are not included to encourage violence – they serve a specific therapeutic purpose. The Multicultural Play Therapy Center at UNC Charlotte explains that this grouping allows for the release of emotions that are typically not permitted expression in other settings. A child who feels powerless or is carrying suppressed anger needs a safe outlet – pounding a bop bag, for example, can release emotional tension that has no other acceptable exit.

Creative expression toys

Sand, clay, paints, crayons, musical instruments, and craft materials make up this category. According to the Play Strong Institute, sensory toys like sand trays and play dough are especially vital for children who have experienced trauma or have sensory processing challenges, as they help children calm down, focus, and communicate in tactile ways. Art materials similarly provide a non-verbal mode of expression that gives therapists insight into a child’s inner world.

Critically, the selection process also involves deliberate exclusion. Toys that are overly complex, mechanical, or that require adult assistance are avoided in play therapy. The Center for Play Therapy’s recommended guidelines specify that toys should be simple, durable, and easy to operate – they should allow the child to experience success independently. Toys that constantly break down or need fixing shift the child’s attention away from emotional expression and toward frustration with the object itself.

The role of the therapist and the importance of limits

A common misconception is that play therapy simply involves leaving a child alone with toys. In reality, the therapist’s role is active, observational, and highly skilled. Restore Counseling & Therapy describes the therapist’s work as tracking recurring themes – fear, power, nurturing, chaos, control – and noting how these shift over time. When a child moves from chaotic, dysregulated play themes to more organised and resolved ones, it signals growth in emotional mastery.

The therapist does not direct or instruct the child in a child-centred approach. Instead, they follow the child’s lead, reflect feelings back, and create an environment where the child feels fully accepted. The Refuge Center emphasises that the therapeutic relationship must provide safety and empathy, so the child can experience full acceptance without judgment – a corrective emotional experience for many children who have only known criticism or misunderstanding.

However, the session is not boundless. Limit-setting is a critical component of effective play therapy. Core Wellness CEU explains that limit setting manages the therapeutic space, ensuring it remains nurturing and conducive to growth. Limits are not punishments – they are consistent boundaries that teach children that actions have consequences, that some behaviours are not acceptable, and that there are healthier ways to respond to strong emotions. Research cited by Core Wellness found that effective limit-setting within child-centred play therapy not only clarifies boundaries for young clients but significantly improves their ability to self-regulate emotions.

For a child with an intellectual disability who may have a history of difficult behaviours, this is especially significant. Cadabam’s Child Development Center notes that through therapeutic activities, children learn to process overwhelming feelings like frustration, anger, and anxiety constructively – equipping them with healthy coping mechanisms that reduce disruptive behaviour over time. The playroom, in this way, becomes a practice ground for self-control that gradually extends into the child’s real-world behaviour.

Why talk isn’t always enough

For children with intellectual disabilities – many of whom have significant limitations in verbal expression and abstract reasoning – conventional talk therapy is often inaccessible. The expectation to sit, reflect, and articulate feelings places demands that go far beyond what many of these children can manage developmentally.

Arrow Behavioral Health puts it clearly: play therapy uses a child’s natural language – play – to express feelings, practice coping, and build new relationship patterns. Talk therapy, by contrast, relies on verbal reflection and abstract skill application, which requires a level of cognitive development that children with IDs may not yet have reached. Even a verbal child may not be able to access emotions through words when those emotions are stored in non-verbal parts of the brain.

A doctoral study from the University of North Texas specifically examined child-centred play therapy for children with intellectual disability, proposing it as a holistic treatment that fosters emotional, developmental, and social growth – precisely because it works at the child’s developmental level rather than demanding adult-level verbal processing. The study noted that children with intellectual disabilities are significantly more likely to exhibit emotional and behavioural disorders than non-disabled children, underscoring the urgency of accessible, developmentally appropriate intervention.

Additionally, PMC research on play therapy as an effective option for school-age children highlights that Piaget identified symbolic play emerging as early as age two – long before children can engage in meaningful abstract verbal reflection. Play therapy aligns with this developmental reality. It does not ask a child to skip ahead to verbal processing. It meets them in the stage where they already are, and works with their natural strengths.

The result, across multiple sessions, is a child who gradually moves from confusion, distress, or explosive behaviour toward a clearer internal narrative – not because they were told what to feel, but because they were given the tools to discover and express it themselves.

What do you think? If a child with an intellectual disability is displaying difficult behaviours at school or home, how might adults around them shift their approach if they understood that those behaviours are often unexpressed emotions rather than deliberate defiance? And in what ways could educators support the carry-over of what a child learns in a play therapy session into the everyday classroom environment?

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References

PDF 📄

Using Play Therapy to Manage Behaviour in Children with Intellectual Disability

Table of Contents

Play as a natural language 🔗

How play therapy works 🔗

Selecting the right play materials 🔗

Real-life and nurturing toys 🔗

Aggressive and acting-out toys 🔗

Creative expression toys 🔗

The role of the therapist and the importance of limits 🔗

Why talk isn’t always enough 🔗