An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn

by Rogers, Sally J.

  What if my child does not add new actions to the play? First, make sure your child is interested in the play. Is he reaching for the materials, taking turns doing things with the materials, and watching your actions? Your child needs to be interested in the materials and enjoying the activity to learn how to do new actions. Second, be sure to model new actions when your child is watching; otherwise, he won’t see the new skills you’re trying to teach. Third, resist physically teaching your child to do things. Instead, model the action several times with your toy, add fun effects to increase motivation, and encourage your child with words and gestures. If you have to help physically, be sure to use it as the last resort, and continue to practice the new action so your child can strengthen his skills.

  Chapter Summary

  In this chapter we have focused on expanding your child’s play abilities with a wide range of objects, using a wide range of actions. There are two main purposes for focusing so much on toy play: (1) to build your child’s thinking, language, and social skills, and (2) to prepare your child well for participating in typical early childhood settings. Building your child’s play skills with a typical range of toys found in any early childhood setting is crucial for both these purposes. In doing so, you are also building your child’s curiosity, awareness of others, and sense of competence.

  We have also focused on building children’s independent play skills. The ability to play alone constructively for periods of time is an important skill for every child. Preschools expect that children will have independent play skills. We have provided steps for building up both your child’s independence in play and your child’s range of play skills. Constructive play is only one type of play that we want to encourage in young children with ASD. The other type is pretend play, also referred to as symbolic play. The next chapter will focus on this.

  12

  Let’s Pretend!

  Chapter goal: To give you strategies for helping your child develop pretend play that is spontaneous, creative, and flexible.

  WHY PRETEND PLAY IS SO IMPORTANT

  Pretend play (or symbolic play, as many people refer to it) helps expand children’s thinking abilities, because it involves play ideas that come from a child’s imagination rather than from the physical environment. When a child picks up a toy animal and makes it walk, growl, or eat, those ideas are coming from the child’s mind, in contrast to picking up a puzzle piece and putting it in the puzzle—actions for which the goals are built into the physical materials. The mental aspect of pretend play is deeply connected to language and other kinds of thought, and it is thus a very important part of young children’s mental or cognitive development.

  What’s Happening in Autism?

  Young children with autism have difficulty learning and using pretend play. Although they typically have many object interests, the world of pretending does not seem to come naturally to them. Young children with ASD may be very adept at playing with puzzles, blocks, shape sorters, and even letters and numbers, and yet when faced with a doll, a toy bottle, a spoon, and a plate, they may seem to have no idea what to do with the objects. Pretend play goes beyond using an object as it was intended (such as picking up a fork and putting it in your mouth), though that is an important beginning point; it involves using ideas that come from the imagination, rather than from the objects themselves (such as pretending there is ice cream in a bowl and scooping up the ice cream, eating it, and then getting another “scoop of ice cream” and saying, “Want some ice cream?”).

  By about 2 years of age, children typically start to use pretend play. You will see them treating a block as if it were a piece of cake, “combing” a doll’s hair by using a rectangular block, and so on. However, this development of pretend play doesn’t emerge naturally in most young children with autism; it needs to be taught. One theory regarding why it does not develop naturally is that parts of the brain that are important for abstract thinking, such as the frontal lobe, develop more slowly and aren’t as well connected to other parts of the brain in autism. The parts of the brain that are responsible for perceiving and remembering the concrete world and for understanding concrete information and facts appear to be functioning well—in fact, more strongly than in other children in some cases. This helps us understand why many people with autism have excellent memories for concrete details but some difficulty with pretend play and, later, abstract thought.

  Imaginary play skills are closely linked to language skills. In fact, studies have shown that when a child with autism develops pretend play, his language abilities also increase, even if therapy has focused only on improving pretend play skills and not on language directly.1 Why? Pretend play activities teach a child skills that allow him to develop a “shared experience” with another person, a joint focus of attention. This provides a context for developing, using, and practicing language.

  Why Is It a Problem?

  As just explained, the close relationships among symbolic play, language development, and abstract thought highlight an important area of relative weakness in autism. The themes of pretend play are about people and their lives; developing pretend play skills helps young children with autism expand their knowledge about the social world. Pretend play abilities also help young children with ASD join in such play with their typically developing peers and expand the learning opportunities available through such interactions. It allows them to learn what others are thinking and feeling by pretending to experience what others are experiencing. And finally, in pretend play, the world of ideas overpowers the physical world. This capacity for thought to overrule the physical world is quite important for children with ASD, for whom the physical world seems to speak very strongly. When a block becomes a key for a car engine, a bar of soap for a baby’s bath, or a handful of food for a toy horse, the child’s ideas are molding and shaping the physical world into the child’s mental world.

  What You Can Do to Increase Your Child’s Symbolic

  Play Skills

  Young children with autism can learn to produce and enjoy symbolic play, just as they can learn to use and become proficient with language. They need exposure, practice, and guidance to develop these skills, but parent–child daily toy play is a powerful tool for developing pretend play. You can teach symbolic play in just the same way that you have taught the other play skills in Chapter 11—through joint activity routines. The time to start introducing symbolic play is after your child is playing with many different toys, combining objects in play, and combining several different actions in his play with individual toys. Your child needs to know how to imitate, how to engage in joint attention, and how to use many objects in functional play spontaneously and reciprocally before it is time to move forward and build more imaginative, make-believe play.

  Symbolic play involves three types of play skills:

  1. The first is called animate play and involves using dolls and animals as if they were alive and could act on objects themselves, such as having a doll pick up a cup and drink from it, or having an animal brush its own hair or fur with a comb.

  2. The second is called symbolic substitution and involves using objects as if they were something else, as when a child uses a Popsicle stick to stir in a cup as if it were a spoon, or flies a block in the air as if it were a helicopter.

  3. The third type involves symbolic combinations—putting together several different pretend play acts to create a more complicated scene. An example would be stirring pretend water in a teapot, putting the lid on, pouring the water into cups, and then taking a drink, making sipping noises, and maybe using a spoon to stir the cup. This sequence involves six different symbolic actions that together make a logical flow, the way the scene really happens—a symbolic combination.

  There are five specific steps you can carry out to facilitate these three different types of pretend play skills:

  Step 1. Teach conventional, or functional, play skills.

  Step 2. Animate dolls and animals.

  Step 3. Mo
ve from imitation to spontaneous symbolic play.

  Step 4. Teach symbolic substitutions.

  Step 5. Develop symbolic combinations.

  In the following pages, we describe how to carry out each of these steps, give you some ideas for activities to try, and suggest what you can do to solve problems that may come up. Be aware that this sequence takes a long time for young children to develop. Toddlers typically develop these skills beginning at age 12 months and continuing to 36 months and beyond. Think of this as a longterm activity that may take a year or two to complete, but one that you can start immediately.

  Step 1. Teach Conventional, or Functional, Play Skills

  Rationale. Conventional (functional) play involves playing with objects whose meanings are defined socially—that is, by how people use them. Conventional play teaches children the social meaning of people’s actions: Objects carry significance beyond their physical attributes or cause-and-effect relation. In other words, an object has a meaning defined by society rather than by its sensory characteristics. Let’s use a comb as an example. A comb’s meaning, or identity, is defined by how people use it—in contrast to, say, a jack-in-the-box, whose meaning is defined by its physical causality (the relationship between turning the lever and the clown popping out of the box). The cause-and-effect relationship defines the jack-in-the-box, but the meaning of a comb, a toothbrush, a tissue, or a spoon is defined by how people functionally use each object. Conventional or functional play is being used when a child picks up a play tea set and stirs a spoon in the empty cup or pretends to drink by putting cup to mouth, or picks up a hairbrush and briefly touches it to his hair, or puts a hat on Dad’s head, or tries to put on Mommy’s sunglasses. It is as if the child is saying, “I know what people do with this; it’s for your nose,” or “This is for drinking.” The child is “naming” and giving a social meaning to the toy with his gestures in his play.

  Activity: Teach Your Child to Use Realistic Objects

  during Conventional Play

  Conventional play is an important step in play development, because it means that the child has learned certain actions from watching other people. This demonstrates social learning—attending to what other people are doing and imitating what they do. You can help your child develop conventional play skills through adapting the steps of your regular joint activity framework, as follows:

  1. Introduce the object(s) during setup (e.g., a toy phone).

  2. Model and prompt the main theme (e.g., putting the phone to your ear and saying, “Hello?”).

  3. Use imitation to help your child coordinate actions on her body and on yours (e.g., give the phone to your child and encourage her to answer it and put the phone to her ear).

  4. Vary and expand the play to include other “characters” (e.g., putting the phone up to a doll’s or another family member’s ear).

  5. Expand the play into other activities, especially self-care and household tasks (e.g., have Dad call on the real phone and let your child answer it).

  Here are ideas for adapting the steps:

  Setup: Offer functional play objects like toy animals, comb, brush, cup, fork, tissue, hat, beads, mirror, toy food, dolls, tea sets, doctor kits, sunglasses, phones, and toothbrushes in a box to your child. If she shows some interest, let your child choose an object and explore it, just as in any other object play routine.

  Theme: For your turn, model the “conventional” (social) action with the object, using relevant action words (“Brush hair” while briefly brushing your hair or your child’s; “Zoom, zoom” while rolling a car fast; making drinking noises with a cup and saying, “Yum, good juice”; etc.). After your demonstration, hand the object back to your child and encourage him to imitate, prompting, shaping, and fading your prompts just as you have done in teaching any other kind of object imitation.

  Role reversal: As you model conventional play acts, model them on both yourself and your child. As your child takes the object, prompt her to act on you with the object, as well as on herself. When you do this, the two of you are reversing roles! Encourage role reversal games (e.g., you put a hat on the child and the child puts the hat on you). Hats, beads, brush, cup, sunglasses, spoon, and many other toys/objects work very well for role reversal. Experimenting with double toy sets (two of each object) can turn into lovely, imitative, role reversal games. As you practice the role reversal in these games, use your name and your child’s name to mark turns (“Mama’s hair, Jerrod’s hair,” “Emily’s turn, my turn”).

  Variation: Using dolls, toy animals, hand puppets, and other people. After your child is both imitating and spontaneously producing conventional actions on you and on himself, it’s time to bring other “characters” into the play. Large dolls with clearly defined facial features; stuffed animals; hand puppets like Elmo or Cookie Monster; other family members—including these characters in your role reversal games will expand your child’s play and move your child closer and closer to symbolic play. To introduce these new characters, first model a conventional play act on yourself while labeling it (and making sound effects). Then do the same action on the doll or animal, using the same simple descriptive language, and follow that by encouraging and prompting your child to “feed Pooh,” “brush Teddy,” “hat for baby.”

  Expansion: Finally, you can expand the number of conventional objects and actions that you model and the situations in which you use them. You can model conventional actions on objects during bath time, by modeling rubbing your face or arm with a washcloth and then handing it to your child. When it’s time to brush teeth, first model toothbrushing with your own toothbrush on your own teeth. During mealtimes, model eating a bite of fruit with a fork, and encourage your child to do the same. When your child needs a messy face wiped, first model it by wiping your own mouth with a napkin, and then encourage your child to do so. If something spills, model wiping up the spill with a paper towel, and then encourage and prompt your child to imitate you. If you are mixing pancake batter or eggs and milk for scrambled eggs, model stirring for your child, and encourage her to take a turn. Help your child learn the social meanings of the many conventional objects that you handle in your child’s presence during the day. Including your child in these kinds of activities for a few minutes gives your child many more opportunities to learn from you about what people do and the words that go with objects and actions in life’s daily routines. Conventional play is the stepping stone to symbolic play.

  Here are some more activity ideas:

  Use themes your child knows: bathing, eating, dressing, going to bed, familiar songs and finger plays, playing on swings and slides. Use a washcloth to pretend that you’re washing a bear’s hands, face, and tummy. Add the “soap” to make sure the bear gets really clean. Or dress your child and his favorite stuffed animal together, taking turns to put a shirt, shorts, and socks on each one. Maybe your routine for putting your child to bed is to get a drink of milk or water, sing a song, and then kiss her goodnight. Help your child carry out these actions with her doll. Carry them out on the doll yourself as you put your child to bed, and encourage your child to do likewise.

  A community outing—especially a new experience, like going to the zoo or going to the doctor’s office—opens up a new set of experiences to act out in pretend play. During play, act out the steps involved in the recent experience: buying an admission ticket to the zoo, walking around the house to look at the different animals, and pretending to feed the nice ones; or using a doctor’s play kit to take an animal’s temperature/blood pressure, give it a shot, put on a bandage, and give the animal a lollipop.

  Sensory social routines can be acted out with animals and dolls too. If your child has a favorite song sequence, like “Ring-around-the-Rosy,” you can incorporate a doll into the routine as if it were another person. You can also hold two small action figures as if they are holding hands and have the dolls act out “Ring-around-the-Rosy.” Or if you and your child are each holding the doll or animal’s hand
, you can swing it back and forth to the tune of “London Bridge.”

  Self-care activities are great ways to incorporate this theme. When bathing your child, putting her to bed, having dinner, or brushing teeth, incorporate the same actions on yourself or on a large doll or favorite animal. Encourage your child to act on you or on the doll, just as you are acting on your child.

  During book routines, have the doll or animal sit beside your child. Show pictures and label them for your child, then for the animal.

  Household chores can also be used as character play opportunities. Your child’s dolls, animals, or characters can help water the garden, feed the dog, and participate in other activities, just as you have your child join in.

  What if my child is not interested in conventional play? Initially your play might need to focus more on the objects involved in conventional play than on the social meaning. For example, mealtime is associated with plates, bowls, and feeding utensils. Encourage your child to feed you a bite off her spoon or to share her sippy cup. Show her with your fork how to feed a doll or stuffed animal seated on the table. Add fun effects, sounds, and lots of enthusiasm and praise to each attempt your child makes to participate (even watching what you’re doing counts), to increase the social appeal of the play activity. Try extending the number of play actions or length of time your child can continue before transitioning to the next activity. This idea can also work during other daily routines, like dressing or bathing. You could take turns dressing the doll, animal, or each other, or using a washcloth to give mini-baths to each other and play objects. The goal is to keep it creative, so your child will become more interested in what you’re showing her with the materials.