Part 2: CBT token systems – CBT Cards, a free download

These free download cards are designed to accompany my CBT Videos for Kids.

CBT token systems – CBT cards, a free download

Cognitive behavioral therapy, whether it’s for a kid or an adult, can be hard and discouraging. After all, the main work involves the arduous process of finding and rooting out automatic negative thoughts that get stuck in our minds. When we are doing CBT with children, we obviously can’t turn this therapeutic activity into something “fun,” but by adding some game-like elements we can can help propel our work forward.

This article introduces a game-like token system with a free download. It is a set of cards you can use along with the CBT YouTube Videos for Kids (these videos are explained in much detail here).You use the cards to reward the child for identifying automatic negative thoughts in the videos and in their own minds.

How to make the cards

Print the cards on card stock, or on paper that you will then laminate. If you want to get fancy, print the decorative back before printing out the front of the cards.

Picture shows how to cut out the cards.
Picture shows the decorative backing of the cards.
The back of the cards.

How to use the cards

Once you have introduced the five Poison Thought categories, you can keep five piles of the Poison Thought Cards handy while viewing the CBT Videos for Kids. Then, you can hand out the cards one by one to children in order to recognize and reinforce a child’s success in:

a. Identifying a Poison Thought experienced by a child in the video

b. Identifying one of their own Poison Thoughts

c. Thinking of  Antidote Thoughts which might apply.

Picture shows each of the five cards.

Certain kinds of children tend to like token systems like the CBT cards

I have often used these cards when doing CBT activities with children on the higher end of the autism spectrum. I have found that children and teens with ASD are often very receptive to these game-like devices in therapy. First, young people with ASD might not notice or be sufficiently reinforced by the subtle, spoken encouragement offered by clinicians during therapy sessions. They may actually prefer a small pile of CBT cards as tangible evidence that they are “getting it” during therapy. Second, neurotypical children, when they approach teenage years, tend to become averse to these playful gambits and they can feel manipulated by them. But teenagers with autism are actually seldom put off by these CBT cards, so with them I use them often.

I have used cards like this in my work for years. I have to say that it is a really straightforward and useful tool to use. It adds a little levity to hard work without undermining the serious nature of CBT. If you print out these cards, you probably will end up using them over and over when you work with the CBT Videos for Kids.

Picture shows an example for the Searching For The Bad card.
Picture shows an example of Predicting without Proof from the CBT Videos.
Picture shows an example of Blaming Yourself Too Much from the CBT YouTube videos.
Picture shows an example of Rigid Thinking from the CBT YouTube videos.
Picture shows an example of Black and White Thinking from the CBT YouTube videos.

Joel Shaul, LCSW


Follow these links to other posts in this series.

Intro: Refinements to Make CBT Better Suited for Kids [link]

Part 1: About CBT YouTube Videos & How to Use Them [link]

Part 2: CBT Token Systems – CBT Cards, a Free Download [link]

Part 3: More CBT Token Systems – Using Mr. Yuk Stickers [link]

Part 4: Creating Thought “Enemies” and “Heroes” in Child CBT [link]

Part 5: Tailoring CBT Methods & Media to the Individual [link]

Part 1: About the CBT YouTube videos and how to use them

(click HERE to link to the CBT Videos for Kids)

About CBT YouTube videos and how to use them

Many years ago, I had noticed that many children and teens appeared disengaged and discouraged in cognitive behavioral therapy.

First, lots of children and teens found the conventional CBT terminology too complex and the automatic thought categories too numerous. Second, the heavy and exclusive focus on the child’s problem thinking seemed too intense for many children, causing them to back away from the work.

In 2014, I developed the eight CBT videos in an effort to address these sources of resistance in CBT work.

Fewer categories and simpler language

Finding the conventional 10 CBT thought distortions too numerous, wordy and overlapping for children, I crunched them down to 5 categories, using language that is less complicated. I then created icons to go with each category. I found that most children could grasp the basics of these  five modified categories of automatic negative thoughts, so I made them the foundation of the CBT videos.

On the left side below are the 10 original automatic negative thought categories. On the right are the 5 “crunched together” categories I created. Children seem to be able to grasp these fewer categories more easily.

The ones on the right I devised to create simpler categories for children.
CBT Automatic Negative Thoughts
5 “Poison Thoughts,” screen shot from CBT Video Number 3

Initial focus on hypothetical examples

In the videos, I placed less initial emphasis on the problem thinking of the child viewing the video, and instead directed attention to hypothetical problems of other children. I found that by beginning the work in this manner, children subsequently were more confident and successful in assessing their own self-defeating thoughts and actions.

The videos were designed for children with ASD, but you can use them with neurotypical kids.

I created these videos originally for use with children on the higher end of the autism spectrum.  You will notice that  quite a few of the hypothetical scenarios deal with challenging situations typically encountered by autistic children. However, quite a lot of the videos’ content concerns problems that neurotypical children would also encounter, and in fact I have gotten feedback from many clinicians who use the videos with neurotypical kids and just skip over the parts that appear tailored for autism.

How to use the videos

The videos are designed to be viewed with an adult, with very frequent pauses for discussion. Although the first three videos are important to view in full, it is not always necessary to watch every subsequent video or every part of any video that you start. You can skip around, placing more emphasis on the videos that address the most relevant concerns.

Video Number One is shorter and simpler than the remaining seven. It introduces Poison Thoughts (automatic negative thoughts) and Antidote Thoughts.

Video Number Two takes the viewer into the minds of various children experiencing Poison Thoughts, and demonstrates how these can be countered with Antidote Thoughts.

Video Number Three (see screen shot above) introduces the 5 Poison Thought categories, showing examples of each in the minds of various children.

Videos Four through Eight go over each of the 5 Poison thought categories in turn, using many examples of how various children are affected by the thoughts. In each example, after first identifying and “fixing” the problem shown in the example, the viewer is asked whether they themselves are affected by such thoughts. Again, pausing frequently for discussion, especially when a child is talking about their own “Poison Thoughts,” is important.

Picture shows step one in the videos: Examining a hypothetical child's automatic negative thought.
Step two is thinking of possible Antidote Thoughts for this child.
Step 3 is asking the child if they themselves have eve had a similar thought.
Video number 3 introduces the five Poison Thought categories.
Videos four through eight follow the same 3-step format for each Poison Thought category. The vides then explore whether the viewer also experiences thoughts like these.

Joel Shaul, LCSW


Here are links to the other parts of this series, Refinements to help make CBT more suitable for kids.

Intro: Refinements to Make CBT Better Suited for Kids [link]

Part 2: CBT Token Systems – CBT Cards, a Free Download [link]

Part 3: More CBT Token Systems – Using Mr. Yuk Stickers [link]

Part 4: Creating Thought “Enemies” and “Heroes” in Child CBT [link]

Part 5: Tailoring CBT Methods & Media to the Individual [link]

Intro: Refinements to help make CBT better suited for kids

Refinements to make CBT better suited for kids

Cognitive behavioral therapy was developed originally not for children, but for educated adults. Over time, child psychotherapists have incorporated various refinements to make CBT accessible and useful for children.

This 5–part series pulls together some of my own efforts to make CBT as helpful as possible for young people.


The titles for each part are listed below. Read them in order or select any one by clicking on the link.

Intro: Refinements to Make CBT Better Suited for Kids [link]

Part 1: About CBT YouTube Videos & How to Use Them [link]

Part 2: CBT Token Systems – CBT Cards, a Free Download [link]

Part 3: More CBT Token Systems – Using Mr. Yuk Stickers [link]

Part 4: Creating Thought “Enemies” and “Heroes” in Child CBT [link]

Part 5: Tailoring CBT Methods & Media to the Individual [link]

A few ways to use music in therapy & social skills teaching for kids with ASD

Introduction

I am an amateur (not at all accomplished) guitarist and very untrained singer. I have no musical training and I have not studied music therapy.  Nevertheless, in my psychotherapy and social skill training work with young people on the autism spectrum, I have periodically employed music. This article summarizes some of what I do, in case colleagues working in speech, mental health or education might find something worthwhile to try in their own work.

Reasons I sometimes use music in my work

To practice fundamental words and phrases in social communication

Children with ASD often skip over essential elements of conversation such as greetings, goodbyes and words of validation. I have used two kinds of songs to help with this. The first kind of song is kind of a promotion or “advertisement” for an element of speech such as greetings. Here is one example. Click on the picture to view it on YouTube.

A second kind of song for teaching elements of conversation is one that children sing along with me to facilitate practice and memorization.

I believe that many kids on the autism spectrum are unusually good at learning and recalling the repetitive words and phrases in some of these songs. Maybe this is some functional manifestation of delayed echolalia.

Here below is an example is a song I have often used with younger children to help them get used to greeting / saying goodbye and using the names of other children in a social skills group.

The two songs below are to teach and practice what I call words of validation. These are common words to convey interest and maintain reciprocal flow in conversation, and many young people with autism need help mastering language like this.

To facilitate communication exchange within a group

In the hundreds of social skills groups I have run, my most most important task has been to enable the participants to talk with each other and learn about one another. Here is a call and response song I created to help with this.

To promote and reinforce an important message / lesson in therapy

These are songs that I use to focus on central therapy issues. I sing them to the child, or the child can join in if they like. I have often used variations of “If you’re happy and you know it…” to practice identifying emotions and talking about feelings. For children who have become over-enthralled with pretend and fantasy, I made up a song called, “Don’t Let Pretend Get Too Big.”

Here is a song by Cathy Bollinger about eye contact.

I made up this song about tattling many years ago and I use it occasionally.

To break up the routine of therapy and provide respite and levity

We ask our young clients to do really hard work, week after week, often for years. For many of these kids, a little music now and then helps maintain energy and morale.

To increase focus, comfort and commitment during therapy sessions

Many children with ASD have certain songs or music styles they like to listen to repeatedly. I have occasionally encouraged a child to let me play their favorite music in the background while we work during sessions.

Other ways I have used music in my work

Watching social skills song videos

I don’t do this too much myself, preferring instead to make up my own songs. Some videos out there contain good and useful songs, and others are not so great in my opinion, employing overly complex language and annoying features.

Exploring the child’s musical interests to identify strengths and concerns

I have often explored YouTube with young clients to learn more about children’s interests. I have sometimes discovered that my clients have found music that is helpful and inspiring and which furthers my own therapeutic agenda. Occasionally, I have discovered that a child is into music with negative and harmful messages.

When to not use music

If you are someone like me who enjoys music, you need to be careful that you don’t obligate a kid to participate in some musical activity just because it happens to be part of your therapy routine. I put away the guitar the instant any kid shows disinterest or aversion.

What I have not yet tried with music in therapy activities

As I stated in the Introduction, I am not a music therapist. Music therapists do all kinds of things I can’t do and they have all kinds of cool musical equipment to enable children to participate in a variety of meaningful ways. It would be fun and worthwhile to spend time observing music therapists at work with kids on the spectrum.

Conclusion

Whether you are a musician, or an avid musical dabbler like me, you might consider making music a part of your therapy repertoire when you are working with kids on the autism spectrum. It has often been worthwhile for me.

Joel Shaul

Role play practice in social skills work for children with ASD. How to do them. Free printables to help.

I have used role plays frequently in my work with autistic youth. It is an essential component of my therapy repertoire.

Role playing is an essential social skills training method when we are working with young people on the autism spectrum. Most of us probably employ them often in our work. But years ago when I was learning how to use role plays, I muddled through it on my own, and if there was anything out there that instructed professionals how to do role plays, I was unaware of it.

Here is a summary of using role plays for social skills training, with links to free download resources which support the use of role plays.

Role plays are for rehearsing and troubleshooting certain important types of communication.

When we are teaching young people with autism what to say and do in social situations, we should never just expect them to implement this learning on their own. They need to practice it in a safe setting where they can be coached, guided and encouraged.

Children with autism usually like role plays. Navigating social situations feels something like an act to them anyhow.

We should be doing role playing often enough in our work that our clients expect it. I have a few clients who actually ask for it.

One style of role play is when the child is playing the role of themselves.

A simple role play set-up can be carried out by printing these How Was Your Day? script sheets and then following the prompts, with both you and the child being yourselves.

Another role play style is when two kids do a role play together, under the direction of the adult.

In my own work, my clients are accustomed to me saying things like, “Okay, I am going to play the role of Maria, a girl in your lunchroom.” You might assume that children with autism are too concrete to allow this, but actually that is seldom the case.

When you are setting up role plays like this, make your own role as executive director clear. A fun accessory is this free download to create a “Director” lanyard for you to wear when you are running the role plays.

Using puppets can be a useful tool in role play. The puppets can talk to each other, or one puppet can talk with the adult and child.

Here is a guide to using puppets in teletherapy – something you really should try if you do teletherapy.

To support the role plays, a script with large lettering can be used as a prop. This picture shows a script of useful language to use when expressing sympathy to someone.

On my website, I have a great many written scripts to help guide role plays. Shown above is part of a free download on empathy / showing concern skills. A related empathy kit sets up role plays with pictures and brief scenario descriptions.

It is possible to rehearse scripts for role plays while singing simple songs. I have on YouTube some examples of songs to rehearse scripts.

Don’t worry if you are kind of a bad singer (like me). Here is a short YouTube video in which I demonstrate a simple demo of useful language to “script” for showing concern for another person.

Short role play videos are available on the internet. These are useful when preparing for role plays.

Everyday Speech Videos (shown above) are invaluable for setting up role plays. You get them via subscription – they are well worth the cost. Here is a free sample on YouTube.

One useful kind of role play is when the adult demonstrates both the right and the wrong way to handle a given social situation.

It is very useful for the adult to show what the incorrect social response looks and sounds like. Don’t have the child do it – just you, for instructional purposes. The image above is from a set of illustrated social skills print-outs on dealing with losing and disappointment.

Another role play method is for the adult to demonstrate a socially flawed interaction, and the child plays the role of the instructor to correct the flaw.

Children receiving social skills training get sick of being scrutinized, criticized and corrected by adults all the time. They always appreciate the opportunity to be the “expert” and point out flaws in somebody else. There are no downsides to using this “flawed adult” technique – I do it all the time in my own work.

Written prompts can help a lot with role plays. I have several prepared scripts available on the website to download.

The scripts shown above are Validation Word Prompts and Question, Compliment and Friendly Comment prompts (go to page 8 of download).

Other common gestural prompts include the one for “Cut!” and the one-handed gesture signaling “That’s enough…wrap up what you’re saying.”

The resources shown above are Volume Meters and Compliment Picture Word Prompts.

There are many good, free props on my website to use in role plays. This picture shows the Train Conversation train car props.

It might sound strange if you have never tried it, but it can be very engaging and effective to conduct role pays at the same time you are manipulating objects between the role play participants, or having them move the objects themselves. The balance (shown above) is an extremely useful, moveable prompt for reciprocal role plays. I explain how to use it here. The Train Conversation Printable Kit is used to map out a conversation in real time while it is happening, with beginning, ending, changing topics and “off track.” The picture cards shown are two pairs of matching 23-card decks which two conversation participants use to compare interests and find common ground (Green Zone Picture Card Activity).

Using visible props can be used to reinforce learning during role plays. Such as the token play money which is available on my website.

You can use token prompts in a variety of ways in role plays. For example, if you are trying to get a child to practice hellos and goodbyes, or give compliments, you could hand out these free downloadable money tokens (shown above).

It can be extremely helpful to video and play back videos to review and critique role plays.

I shoot video and replay video all the time in my sessions. It almost always makes role play work better. Most young people like it a lot. I honestly cannot figure out why other clinicians don’t use video cameras very much these days, except to avoid having to fill out permission forms and so forth.

I have a very good tutorial on using video cameras, and some nice download accessories, on this website. (The photo above shows some of the downloadable accessories.)

Many of the card game activities on my website have role plays built into the game. One of them, Fix the Problem Game, is shown above.


I hope this information, and these resources, help to make your role play work engaging and productive.

Joel Shaul, LCSW

“Fix The Problem” Social Skills Game – Free Download

Fix the Problem
The Fix the Problem Game for young people with autism. A complete downloadable social skills game with cards, questions, play money.

In German: Problemlösungs-Spiel


In my work as a psychotherapist and social skills trainer in individual and group settings, I spent years developing game-like activities to engage autistic youth in learning challenging social and emotional skills. The Fix the Problem Game evolved over about ten years of experimentation and refinement. Children and teens usually like it a lot. It is frequently downloaded by users of this website, who have provided positive feedback regarding its usefulness.

These are the 40 character scenarios to read aloud, representing a range of social and emotional problems.

The first download includes 40 first-person character scenarios to read aloud, representing a wide range of social and emotional problems.

Also included are 40 game character cards (shown above), to cut out or display on a screen.

Special game money (shown above) is provided. You give it out to players who provide the most useful suggestions on “fixing the problem” presented by the game character.

This 5-dollar game money is harder to earn – the player must describe a time when they themselves experience the problem described by the game character.

More about the Fix The Problem Game

Children with autism spectrum disorders often get tired of scrutiny and criticism. They may be quite aware of their need to work on things like conversation, social skills and difficult emotions. But it can feel confrontational and discouraging to have parents, teachers and therapists pointing out their problems all the time.

The Fix the Problem Game takes a different approach which many children find more relaxed, engaging and even fun. Rather than zeroing in immediately on the child’s own difficulties, we back off and look at other people’s problems instead. Often, when children learn about somebody else’s problem, they are able to examine the situation objectively and come up with useful solutions. This indirect problem solving seems less personal – more like a game or puzzle. Then, once children experience the success of solving a hypothetical problem, they are more open to an examination of their own issues.

The Fix the Problem Game is designed to help children with ASD to examine their own social and emotional challenges by engaging them in the process of analyzing somebody else’s problems first. The game features 40 child characters and 40 first-person scenarios, each describing problems experienced by many young people on the spectrum. For each scenario, the reader is asked by the game character to “fix my problem.” Afterwards, the game questions ask, “What about you? Have you ever had a problem like this?”

After experiencing success helping game characters, children are often more insightful and confident with their work on their own similar problems.

This is Joel Shaul's very best social skills game for young people with autism.

Don’t miss these other free social & emotional skills games, worksheets and teaching / therapy resources for children & teens with ASD:

Free social skills games & activities, emotional regulation skills for kids with ASD

Free social skills games & activities, communication / conversation skills for kids with ASD

Free social skills games & activities, social interaction skills for kids with ASD

 

The Conversation Train Book

Green Zone Book Cover Click to Learn More

 

 

What I should have done different – A simple worksheet for children to work on a problem

In counseling and psychotherapy, children can at times become overwhelmed with having to maintain a spoken exchange for a whole session. They can even freeze up entirely, particularly if the therapy topic is painful for them to discuss.

I created various drafts of this worksheet over the years of my own work with children on the spectrum. This is my final version. It is to be filled out by the child during a break while the spoken exchange stops, and the child quietly thinks, writes and draws independently to get their thoughts and feelings down on paper.

It has a very simple design, allowing the child to fill it out quickly. There is a large space for drawing, but some children prefer to just write and leave this part blank.

This simple resource gets downloaded a lot from this website. I hope you find it useful.

problem solving CBT worksheet for children

German translation of this resource: Was-ich-hätte-anders-machen-sollen-ein-einfaches-Arbeitsblatt

en español – Lo que debe hacer diferente

What I Should Have Done Different Telehealth Version

Hebrew translation of this resource

anger management worksheet for children

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If you are looking for the telehealth version of this resource, click on this link:

What I Should Have Done Different Telehealth Version



Your comments on these resources are most welcome, and often helpful. Click HERE to send an email.

Don’t miss these other free worksheets, games, and teaching / therapy resources for children on the autism spectrum:

Free social skills games & activities, emotional regulation skills for kids with ASD

Free social skills games & activities, communication / conversation skills for kids with ASD

Free social skills games & activities, social interaction skills for kids with ASD

ASD Feel Better Promo square directing to JKP