What is play? According to the Oxford Dictionary, play means: to engage in activity for enjoyment and recreation rather than a serious or practical purpose: to amuse oneself by engaging in imaginative pretense. Sounds great, right? It seems so simple, easy, and fun, doesn’t it? Most people, both adults and children alike, would agree that playing is one of the best parts of life. For children, playing affords them the opportunity to have fun while they are learning skills such as: vocabulary, sound production, asking and answering questions, turn taking, eye contact, social greetings, role playing, pretend play, and joint attention just to name a few. For adults, it’s the time when we can escape our reality or the day to day monotony and have fun. However, for the 1 in 68 children that the Centers for Disease Control and Prevention now estimate are diagnosed with Autism Spectrum Disorder, play is anything but easy. In fact, a skill that is innate to most human beings, is one of the greatest challenges that children with Autism face.
Many of these children are drawn to activities that require little or no social engagement. It is not uncommon for some children to become possessive of an iPad or iPhone, or stare at a light or fan, as it has been shown time and again that children with Autism are drawn to sensory activities or ones that allow them to watch moving objects repetitively. However engaging these activities might be, they are not considered play and do not elicit all the valuable lessons that a child learns when they play with another human being. Some children simply do not know how to interact appropriately with others; they can’t read body language or facial expressions, and don’t understand basic conversational exchange. So, if your child won’t play, then what? How can you play with a child that doesn’t want to be played with? What if your child simply has no understanding of what it means to play?
In my practice as a Speech-Language Pathologist, when a child who is diagnosed with Autism Spectrum Disorder comes to see me, my first challenge is to figure out what will engage them or hold their interest. As I mentioned, many of these children want only to gaze up at the Exit sign in the waiting room, the light fixtures, or play with one object of their choice over and over again. Some have language and can speak to me or repeat what they hear, others are nonverbal. Some are excited to come to me and be in a new stimulating environment, others are literally kicking and screaming as they enter the office. Clearly, I can’t work on social skills or play when I don’t have their attention or even their desire to be in my company. This is where I need to begin, and you can too. Every child has one sticking point- one item, toy, object, food that they desire. Through trial and error (and lots of help from parents or caregivers), we can find that special item and begin to work on so many different language skills and precursors to play. For example, if a child loves a toy that makes noise and lights up, we can use this toy to teach them to look at their caregiver each time they want it, point to it, or even verbally request it. As these skills develop, we can introduce joint play where the child gets the toy and plays it along with the caregiver, introduce language along with this activity, comment about it or request it, play peek-a-boo with it, and so on.
Once a child is more comfortable with the interaction, a new toy or motivator can be introduced along the same lines as the one they started with. So, the toy that has lights and noise can now be swapped for a different toy with similar features. This will open up a whole new set of language, vocabulary, and social interaction. One of the most important skills that must be present in order to attain successful play or interaction is eye contact and interest. If a child does not look at you or show any interest in the toy you are presenting to them, it makes it very difficult for social skills to improve. Many children with Autism have disordered sensory systems and difficulty handling external stimuli. This means that the toy that so many children find fun and exciting, may cause turmoil or distress for certain kids. Therefore we need to be sensitive when selecting toys to elicit play or social interaction as we want the association with these activities and lessons to be a positive, joyful one. However, once you’ve established eye contact, and desire, the possibilities are endless. For verbal children, play can include role playing or pretend play with toys like a farm, boat, or a dollhouse. If the mom or dad figurine in the dollhouse knocks on the door of the house and the other says “come in” and then greets them with “Hello,” you’ve just worked on social greetings and role playing. Sometimes hand puppets can be an effective tool for teaching social interaction or even emotions.
The best part about playing with a child or teaching them how to navigate their world amongst peers, is that almost any toy, game, or activity can be used if the child is motivated and engaged. For nonverbal children, many toys and games can be modified or adapted to address your goals. As an example, I have used a multi-modality approach where I use sign language for basic requests, or vocabulary and picture cards associated with the objects so that the child can exchange or point to them in return for an item. This skill alone, whereby a child hands a picture card to someone in return for the desired item, becomes a social skill as it requires the child to acknowledge the presence of another person, gaze at them or in their direction, and make physical contact with them by giving them the card. Again, it is these precursors and pre-language skills that enable us to go further and teach children with Autism how to play. Play should be fun, relaxing, whimsical, and a way to connect with other human beings. Not every child will develop the skills to play with ease; some may not develop it at all. However, a diagnosis of Autism Spectrum Disorder does not mean that we should abandon all expectations that these children can play and learn social interaction. It only means we need to make modifications, tap into our creativity and resources, adjust our expectations, and recognize that every step, no matter how small it may seem, is a step in the right direction.
Elise Duryea is a New York State Licensed Speech-Language Pathologist and Teacher of Speech and Hearing Handicap with a private practice on the Eastern End of Long Island. Since completing her Master of Arts at New York University 18 years ago, Elise has been providing a variety of speech and language services to children and adults. She works with children from birth through high school with Expressive and Receptive language disorders, Auditory Processing Disorders, Motor Speech and Articulation Disorders, Stuttering, and Oral Motor and Feeding issues. Elise is also a PROMPT certified clinician which enables her to utilize the therapeutic technique designed for individuals with motor speech disorders.
In addition to her work with children, Elise provides parent training and consultation services on an individual basis to help parents learn what to expect with language and social development, how to enhance their child’s skills in their homes, and what to do when developmental issues arise.
Elise holds a Certificate of Clinical Competence (CCC) from the American Speech- Language Hearing Association (ASHA), and is a recipient of ASHA’s ACE award for her commitment to continuing education. She resides in the Hamptons with her husband and two sons.
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