Autism and Play Skills

Babies first interact with the world by wiggling their arms and legs with no apparent purpose other than enjoying movement. Over time, they learn to control their head and arm movements in order to look at toys and other objects, reach toward and grasp them, and eventually manipulate them using their fingers. Depending on their background, professionals may describe these skills progression as motor development, play, environmental stimulation, social interaction, or cognitive learning- and indeed, it is all these things at once.

What is Play?

Meet Suzie:

Nine-month-old Suzie sits on the kitchen floor, laughing at the sounds she makes by banging pots and pans. She is engaged, sitting with good postural control, manipulating objects, vocalizing, and sharing her joy with her father. But more than that, Suzie is PLAYING!

Suzie's play is fun, spontaneous, and deliberate. Nobody is telling her what to do, and she is not trying to accomplish anything. Suzie is simply enjoying banging the shiny objects together. She does not plan her actions, but she persists in them because she likes the sounds, sights, and feel of the pots and pans.

Play can be defined as "an activity freely entered into that is fun or enjoyable and that is appropriately matched to one's skills to represent an attainable challenge." (Kuhaneck, Spitzer and Miller, 2010)

What constitutes an attainable challenge depends on the child's age and skill level: for a three-year-old it might be to roll play dough snakes, but for an eight-year-old it might be to draw a self-portrait.

For babies and toddlers, play usually involves

  • social, interactive exchanges with caregivers, such as "peek-a-boo"
  • body play and movement such as sucking on toes or clapping to music
  • simple manipulation of toys and objects such as shaking a rattle or banging on a keyboard

The Progression of Play Skills

A nine-month-old baby engages in simple manipulation play whereas a toddler uses objects with purpose- for example, bringing a real or toy phone to the ear. Suzie, the baby introduced above, might progress from banging pots and pans to pretending her finger is a spoon ladling some soup out of the pot in order to give her doll a a taste.

The latter activity involves both functional use of objects (mimicking the purpose for which the objects are used, such as cooking in a pot) and pretend play (such as imagining that her finger is a spoon). Children on the autism spectrum typically continue to engage in simple manipulation play, such as lining up cars, after their peers have advanced to these higher levels:

  • Functional play: driving toy cars into  garages
  • Pretend self-play: pretending to eat a pie made out of play dough
  • Substitution play: opening and closing the index and middle fingers to mimic cutting with scissors

Studies indicate that children with ASD have specific play preferences. (Kuhaneck, Spitzer and Miller, 2010). They tend to be motivated by toys with sensory properties such as flashing lights or vibration. They prefer predictability, repetition, and familiar characters such as Thomas the Train or Sesame Street puppets. Some children seek out rough-and-rumble play such as jumping in puddles or Tug-of-War that meets their sensory needs for movement and deep pressure, and many show a clear preference for or avoidance of messy substances such as mud or finger paint.

The two-year-old child shown below is motivated to place rings over a toy that lights up, vibrates and makes sounds.

Children with ASD and Play Skills

Children with Autism Spectrum Disorders (ASD) and other developmental disabilities tend to engage with objects and develop motor skills differently than typically developing children do. These children may seem to

  • be unusually visually focused on object or parts
  • May remain in the solitary (then parallel) stage for years
  • Overstimulation may lead to play withdrawal

Children on the autism spectrum may have  delays in developing cognitive, communication, or social skills related to learning and playing with others such as

  • Imitation skills/gestures
  • Symbolic/imaginative play
  • Gazing at same object
  • Dyad (taking turns)
  • Triad- shared looking or pointing at object
  • Awareness of other person’s awareness

My husband and son demonstrated a dyad below as they took turns making sounds!

The photo below demonstrates a triad. My son and I share looking at the bird while having his photo taken.

Strategies to Promote Social/Play Skills

Children with ASD may easily become overstimulated  when playing in groups. Try to offer play in small groups of 2 or 3 children. Older playmates may be more accepting, provide a good social role model and be more accepting of differences. It may be helpful to offer a large quantity of toys such as a bucket of blocks so that nobody needs to wait for their turn. Play or games that are simple and concrete such as rolling down hills, making mud pies or Tug-of War  limit the challenges of learning complex rules, sequencing steps or verbal communication while providing sensory stimulation.

Visual Schedules 

Some children benefit from visual schedules that may be on a tablet, a wall chart using words, icons, photos or other symbols that provide reassurance that an event is expected. My son developed anxiety when a play date or social event was coming up and he repeatedly asked such as

  • where it would take place?
  • when play would begin?
  • How long would it last?
  • who would be there? or
  • whose toys would they use?

His anxiety lessened when I made a picture or chart that helped address his concerns.  I also added preferred activities to the schedule that did not cause social anxiety such as eating ice-cream or a bedtime story with daddy.

Focus on Strengths

As you know, every child has their individual strengths. Temple Grandin often wrote and spoke about how her family helped her to shine by excelling in crafts, building materials and caring for animals. My son's strength was creativity and fine-motor skills which we fostered at every opportunity. And Grandin was correct when she said that children on the spectrum especially need to develop hobbies that foster respect and social relationships. For my son, it's been bee keeping....

References

Heather Miller Kuhaneck, Susan L. Spitzer, and Elissa Miller, Activity Analysis, Creativity and Playfulness in Pediatric Occupational Therapy: Making Play Just Right (Burlington, MA: Jones & Barlett Learning, 2010.)

Temple Grandin and Margaret M. Scariano, Emergence: Labeled Autistic (Novato, CA: Arena Press, 1986)

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