Supporting play

In this section the importance of play is considered, along with the possible difficulties that children with autism may experience. Ways to support the development of exploratory and pretend play are included, along with a range of direct teaching methods that can be used to help children develop appropriate skills.

The importance of play

Play is a fun activity that young children engage in for its own sake, on their own terms. Through play, children learn how things work and what they can do. Playing with others and engaging in pretend play helps children understand social situations, develop language and social skills.

Many children with autism prefer to spend their time engaged in repetitive activities and need support to explore new activities and engage in pretend and social play. Children with autism may spend most of their time manipulating objects. Even with this type of play, they rarely explore the many different aspects of an object but can get stuck in repeating one action, such as banging or spinning.

Exploring in play

Children learn how things feel and sound by mouthing, shaking and throwing them. They also like to explore how things taste and smell. Gradually, they learn that different objects do a variety of things and they begin to treat objects differently. Children with autism may need support to learn what objects can do. They can learn this through interactional play, imitation or direct teaching. The choice of method depends on the child's ability to focus attention and willingness to attend to something an adult has introduced.

The early stages of developing exploratory play are:

• Shaking and hitting objects that make a noise
• Feeling objects with different textures, for example; soft, rough and pliable
• Examining objects that have more than one property, for example; feel and smell, look and listen
• Dropping and throwing things
• Squeezing and stretching things; for example; play dough
• Looking inside containers
• Later, children begin to bang objects together and place objects in or on others. This can lead to constructive play and is referred to as relational play. Children also pair objects that go together such as spoon/cup, hat/coat.

The next stages in developing this type of play are:

• Putting objects in and out of containers
• Banging two objects together
• Operating press button toys, for example, jack-in-the-box
• Putting objects on top of one another
• Balancing bricks and building a small tower
• Putting rings on a stick
• Turning a knob to operate a toy
• Using a finger to turn a dial

Pretend play

Pretend play starts when a child begins to repeat familiar actions or uses objects to represent real things, for example, pretending to drink from a toy cup or putting on mummy's hat. This play shows that the child understands the functions of objects, eg cups are for drinking, and hats are for putting on your head. Play then usually extends into small sequences of actions such as making tea and giving mummy a drink and then into more imaginative play where objects are used for different purposes; such as pretending a box is a boat. These skills can be taught through play situations and by direct teaching.

Achievements in developing functional and pretend play:

• Child plays in different ways that show understanding of the functions of objects, for example, pushing toy cars
• Child begins to relate the objects to herself by pretending to drink from a toy cup or using a dolls brush to brush her hair
• Child needs encouragement to involve others in play for example, offering the adult a bite of her biscuit or brushing adult's hair
• Child imitates some of the actions of others such as talking on the telephone and sweeping

During this type of play the child will use objects in a conventional way, eg a cup is used to drink out of and will not be used as a pretend helmet for a doll. The child will usually need prompting to involve the adult in her play.

At a later stage, children begin to use smaller toy objects to represent real objects and gradually their play becomes imaginative and flexible. Children with autism are likely to have great difficulty in developing this type of play. They can, however, be taught to extend their play so that it becomes more flexible. This will also help to develop their understanding and language.

• When child is able to pretend with an adult, involve a doll or a teddy in their pretend games, eg give the doll a hug or a drink
• Show her how to use small dolls and models in play, for example, play people, cars and Lego
• Show her how to carry out a short sequence of actions, eg pretend to drive the car into the garage and fill it up with petrol
• Sequences of pretend actions can be developed into scenarios such as doing the cooking, shopping, going to the park for a picnic. Start by joining her in play, and then very gradually introduce new parts
• Encourage the child to take on different roles in play and re-enact personal experiences that have made a big impression, for example, a hospital visit
• Children with autism often have great difficulty with the symbolic nature of play, for example, using a folded tissue for a dolls pillow. Careful explanations will need to be given. The child will need good verbal understanding to understand the explanations of pretence. For this reason children with autism are usually unable to grasp this concept until they are older

Direct teaching methods

The direct teaching methods advocated in this section are based on the principles of applied behavioural analysis (ABA). This method of teaching has been developed over many years and has been the subject of much research. In ABA approaches, tasks that you want the child to learn are broken down into small steps. Each step is taught systematically until it is fully mastered.

Aisha was able to work with an adult and follow simple instructions. She could work in this way for up to 20 minutes. It was decided that she needed to learn to work in a small group of children, in preparation for starting preschool. These steps were written into her plan and each one was mastered before starting on the next:

Aisha to work for five minutes sitting next to her sister. Her sister was going to make a picture on her own.

Aisha to work for five minutes on the same task as her sister. The instructions were given to both girls but each child's name was used.

Aisha to work for five minutes on the same task as her sister. The instructions were given without the use of Aisha's name.

Aisha and her sister to take turns in the task and to concentrate for five minutes

Aisha to work alongside her sister, following instructions with a radio playing quietly

These are the first steps of the programme. As the programme increases, the time and number of children in the group will also increase, along with the level of noise and distraction. This is an example of the detail and care that is needed to plan programmes with small steps.

How to use behavioural teaching methods

Discrete trial teaching

Each teaching session involves repeated trials. A trail has a distinct beginning (when the instruction is given) the child does the task and is given a reward for successfully completing it. This is the end of the trial. For example, if you are teaching a child to identify the names of objects, you may choose two objects, lay them in front of the child and say; 'Show me the apple'. When the child responds correctly you reward her and move onto the next trial.

Rewards

Rewards are used as one of the fundamental principles of this approach. A behaviour is more likely to be repeated if it achieves something positive for the child.

A reward is something that increases the likelihood of the behaviour occurring again. The ABA approach recognises that some children will need tangible rewards (favourite toys, music, food, drink) but that the child should always be praised as well as given a reward. The child subsequently learns that praise is pleasurable.

Teaching step by step

A complex skill is broken down into small steps and each step is taught discreetly. Skills can be analysed in different ways. Firstly, it is important to find out what bit of the task the child can do already - this is referred to as the baseline. Then define exactly what you want the child to be able to do, using adjectives such as 'point', 'match' and 'say', so it is very clear when the child has learnt the skill.

Forward chaining

If steps are sequenced and taught in their natural order, this is known as forward chaining. For instance, if a child is being taught to drink from a cup, forward chaining will usually be taught. The first step might be to pick up the cup and then hand over hand can be used to prompt the child to guide the cup to his mouth and tip the cup.

Backward chaining

Steps are taught in the reverse order, with the child completing the last step of the task. For example, if you are teaching a child to dress himself, the adult will start the task but prompt the child to do the last step, eg pulling up of socks or trousers. Gradually the adult encourages the child do a little more and the child eventually learns to dress himself.

Shaping

Some skills, such as talking, cannot be broken down into separate steps and need a different approach. Shaping is also used for tasks that cannot be prompted, such as toileting. For this type of skill the child is rewarded at the beginning for making any attempt at the task. Gradually, the child can be guided to make more accurate attempts. An example of this approach can be seen when a child starts to use his voice to ask for something. In the beginning, the child is given what the adult thinks he wants, and the adult says the word as the object is given. Gradually, the object can be withheld until the child repeats the sound. The first attempt might be a sound, but gradually the child can be encouraged to keep trying to make a closer attempt at the word.

Modelling/prompting

Modelling and prompts are used to show the child what to do; these are used instead of telling the child what to do. This can include:

• Physical guidance (hand over hand)
• Demonstrating what to do (Modelling)
• Using a gesture such as pointing

Giving a verbal prompt

It is good practice to prompt the child as little as possible, but just enough so that she does the task correctly. Prompts should be withdrawn as quickly as possible so that the child can carry out the skill independently.

Success criteria

ABA approaches teach a child until they have full mastery of the skill. Targets will include details of the level of mastery, eg match two shapes correctly nine out of ten times on three successive days. This may appear quite rigid but it ensures that the child has fully learnt the skill, rather than partially mastered it.

When the child has mastered the skill, opportunities to regularly practise it should be provided so that it is not forgotten.

Teaching sequences

When a new activity is introduced, it should be set up to give the child maximum opportunity to succeed. The child can be physically guided to do what is required and then the prompting can be gradually reduced. When teaching the child to recognise an object or picture, have only one in view then another object that he knows can be introduced and the two practised together. The aim is to teach new items separately and then practise them with the other items that have been mastered.

Developing a support plan

Finding a suitable place to work with the child is very important. A quieter area of the setting with reduced visual distraction will help the child maintain focus. Creating a workstation with a low table and chairs placed between the adult and child, will further support focus and attention. The adult could sit with her back to a blank wall so all the child sees is the adult against a plain background.

It is important to find out what skills the child already has (baseline) so that next steps that she needs to learn can be planned. Objectives will probably need analysing into even smaller steps so that the child can master the skill more easily. Toys and equipment will need to be set up within easy reach of where the practitioner is working.

Generalisation

When the child has mastered a skill, consideration should be given to teaching her to generalise and apply the skill in everyday life. For example, if objects or pictures have been used to teach a skill, generalise by using different examples of the same objects or by providing opportunities to discriminate during play, such as picking out her boots when going outdoors. The sequence chosen to generalise skills will depend on the task, child and setting situation.

The following sequence can be used to teach a child to generalise and apply skills:

• Can do the task in one situation with one adult
• Can do the task in a different situation, for example, sitting on the floor, or in a different room
• Can do the task with other adults in a structured setting
• Can do the task in several situations in the setting where it naturally applies
• Is able to complete the task with other children when prompted by an adult
• Is able to complete the task with other children, with no adult prompt