ACTNOW Fact Sheet 20

Pre-schoolers with autism: Work and Play

by Dr Avril Brereton

An important aspect of each child’s development is the ability to fill in their day with useful activity and social contact. For most typically developing young children, the day is spent in a combination of activities involving relating to other children and adults in their world, eating, resting and for many hours each day, playing. This range of daily activities is not typical for the child who has autism.

Lack of creative and imaginative play is one of the diagnostic features of autism (see Fact sheet 6). The ability to play generally has to be taught and so, in a way, becomes work for children with autism. They may much prefer to spend their time engaged in rituals and repetitive routines that exclude social contact and interest in what is going on around them. These behaviours can become so entrenched that there is no time left for useful activity. Teaching children with autism to play is hard work! Hard work for the teacher (can be the parents/carers or teachers at the EI programme, child care or pre-school) and hard work for the child who would generally much rather he/she be left alone to do his/her own thing!

Is play important?

We now know that the earlier play skills can be taught to young children, the better the chance that rituals and routines may decrease. We also know that intrusion on the child’s isolation is an important way of establishing contact. This can be done by offering toys and objects and establishing play routines/games that the child finds enjoyable. Teaching the child to play, by themselves and with others therefore serves a number of important functions:

• Children learn about their world through play
  
  
• Children’s ability to communicate relates to their ability to play symbolically. Improved play skills can lead to improved communication skills
  
  
• As play skills increase, rituals and routines usually decrease
  
  
• Interactive play can increase social skills such as learning to take turns, sharing, and co-operating
  
  
• Play with toys provides an opportunity to teach the child new skills that are important for later formal education. Some examples are: attending to others, attention to task, turn-taking, following instructions, and opportunities and topics for conversation.

1. How to be intrusive.

It is important to intrude upon the autistic child’s isolation. However, there are ways of doing this that are more successful than others. Intrusions for no reason other than to gain a child’s attention will not be very rewarding for the child or you, the adult. It is possible to intrude in a way that is gentle, persuasive and also interesting for the child, but it does take practice. If we want children to be less isolated then it follows that the contact they have with others needs to be pleasant and rewarding for them. If the result of our intrusion on children is neither pleasant nor rewarding for them, we will probably achieve the opposite and turn them even further away from us! You are more likely to intrude successfully by offering the child something to look at or do. This is where play and toys come into the picture. Intruding, by offering a toy to play with, provides the opportunity to gain the child’s attention and start some pleasant interaction. By intruding through the offer of a toy and then teaching the child how to play with that toy opens a wider range of possibilities for further interaction and involvement together.

2. Teaching eye contact/attending to task and others.

• Eye contact between people is important because:
  
  
• It establishes a connection between people.
  
  
• It is a means of letting the other person/persons know that you are attending to what they have to say.
  
  
• A child cannot learn if he/she is not looking or attending
  
  
• It is necessary to attend to an instruction before it can be learnt (e.g. learning signs)

There are lots of ways to encourage eye contact and attending. Here are some suggestions:

1. Get down to the same level as the child
   
   
2. Say the child’s name and touch him/her if necessary to get his attention.
   
   
3. Say: “look at me” before you say anything else.
   
   
4. Gently touch the child’s chin to orient his face to your face.
   
   
5. Point to your eyes when you are telling the child to look at you.
   
   
6. Hold toys or food or whatever you have for him/her up at your face level to encourage him/her to look up and attend to your face, rather than down.
   
   
7. Always tell him/her when he’s got it right! “Good looking!”

3. Staying on task.

Having gained the child’s attention and gaining eye contact, it is then important to keep it going! Children must be able to attend for learning to take place. If the child cannot sit and attend to you and your instruction, it is unlikely that you will have any success with teaching new tasks. For example, if the child cannot watch and copy/imitate a simple body movement such as raising his/her arms above his/her head, s/he will be unable to imitate more complex actions required in sign language. This would then indicate that you need to work further on basic attention and watching before you can progress to more complicated skills. Staying on task can be learnt and improved upon with practice. Play is an ideal way of creating an activity to teach this skill to young children.

Here are some suggestions:

1. Start with an activity that has a definite finishing point e.g. a one-piece puzzle. Put in the piece together and the task is complete and your child is ready for a reward. Attention to task can be increased by making the task longer. E.g. gradually build up to a 10 piece puzzle and you have increased your child’s attention for that activity X 10!
   
   
2. Stay away from open ended activities that have no definite end point, e.g. painting which can go on for as long as the child likes, or be as quickly done as the child likes, about 2 seconds!
   
   
3. If things are getting bogged down, use modelling and hands – on assistance to complete the activity together so that you can give a reward quickly and keep the child motivated and feeling successful.
   
   
4. Talk your way through the task. Say it as you do it. E.g. “push the button”.
   
   
5. Use simple, clear language, and not too many words.

To increase eye contact, attending and staying on task, remember:

• Regular practice is essential and incidental teaching should become a part of your daily routines and activities.
  
  
• It will become automatic for all of you if you follow the suggestions often enough!
  
  
• Use simple, clear language that tells the child what to do (not what not to do)
  
  
• Always praise the child when he/she gets it right!