As OTs, we have an incredible opportunity to help our clients on the autism spectrum improve their play and leisure skills. We know how important play is for all kids, and many of us feel the immense responsibility of teaching play to our autistic clients when play just doesn’t come easily for them.
That pressure only intensified recently with the American Academy of Pediatrics’ new statement that highlighted the endless importance of play for the development of kids. The authors highlighted that even though play is incredibly relaxing and balancing for almost all children, kids on the spectrum actually experience a spike in their stress hormones when it’s time to play. Yikes.
The problem is, knowing how important teaching play is for our clients on the autistic spectrum doesn’t mean we feel competent and confident when we sit down to try to write our goals, plan our treatments, and actually teach new play skills to our young autistic clients.
Feeling Stuck on Teaching Play? I’ve So Been There
When I started out as an OT in early intervention, I remember getting my first autistic client. He was an adorable two-year-old boy with a very involved mother. I’d worked with tons of two year olds in my career before becoming an OT, so I was feeling pretty excited. Mom wanted me to help her child learn some new play skills, and I confidently dove right in.
And then I quickly hit a wall. I realized that the child did not imitate, and that the only way I knew how to teach play (or really anything) was through modeling and imitation. I dug deep into the tool box in my head. There was nothing there that didn’t involve imitation. I was stumped. And mortified.
This wasn’t my only struggle with teaching play, but it was the first one. And it stuck with me.
I’ve since learned that many OTs struggle to teach our clients on the autism spectrum how to play. The lectures from grad school are hard to apply, and their content quickly fades from our memories. We try to piece together continuing education trainings, but we often feel like we are missing an important piece (or two, or five) of the picture.
We dive in and teach the things we know, but we still have this slightly icky feeling that we could be doing something more relevant, more meaningful, and more effective for our autistic clients.
The thing is, so many OTs feel this way. Kids on the spectrum think and learn differently, and we need a truly robust and specific set of tools in our OT tool box to really be able to teach our young autistic clients how to fill their play time without spiking their stress levels.
It’s totally possible to become effective at teaching kids on the autism spectrum how to play. Keep reading for the three most important strategies you need to know to start saying “yes” with confidence to teaching your autistic clients how to play in a way that will be meaningful, stress-free, and effective.
Why You Should Learn to Teach Play
As I learned the hard way, trying to teach kids on the autism spectrum how to play without really good training can leave you feeling so discouraged. You might consider switching settings to avoid the challenge and hope that a more qualified therapist comes along to help your former clients learn to play. Or you might keep trucking along, nursing that icky feeling that you really aren’t equipped to teach this skill even though you know how important playing is for your young autistic clients.
You may find yourself focusing on the things you are good at teaching like fine motor skills and simply calling it “play” while hoping no one notices. Deep down you know that there is more to play than stacking and coloring, but it’s so hard to sort out where to start with writing a play goal and impossible to figure out what to do to teach play effectively. There seems to be no guidebook, so you simply turn away from being the one to teach your autistic clients to play.
Although many OTs fall into the routine of doing what they are good at and finding reasons not to do the rest, you can become excited about teaching play again by learning concrete, effective, autism-specific strategies.
For me, this took months (even years) of training and mentorship. But now when I write play goals, I write them with clarity and confidence. I teach parents the strategies they need to learn without hesitation. I teach therapists in my course, The Learn Play Thrive Approach to Autism, how they can obtain this confidence in teaching play. And I coach therapists one-on-one about how to overcome their play skills roadblocks.
In my own practice, I’ve come a long way since that awkward day in early intervention. Now, I teach play to kids who imitate and to kids who don’t. I teach pretend play and toy play, acting out play scenarios, symbolic play, and, for my older clients, leisure skills. I teach play at home and at school and at the park.
Now that I have relevant strategies in my toolbox, I absolutely love teaching kids on the autism spectrum how to play.
Tip #1: Select the Right Play Goal
One reason therapists often feel unsuccessful teaching play is that their goal is way off target. Many therapists fall into the trap of teaching too many things at once or of making too big of a leap.
Imagine that you were learning a new language, but you weren’t very good at it yet. Now imagine that a teacher came along with the brilliant idea to teach you a new skill like playing an instrument or doing advanced calculus in that language you’re learning! Terrible idea, right? Recipe for stress and failure.
That’s exactly what we often do to our kids on the autism spectrum when we write our play goals. I’ll explain. Writing the right goal is three-fold:
1) If you are teaching a new play skill, teach it using a mastered social play skill. That means that if you are teaching a child to use a simple toy (that's the play skill), you should not also be teaching turn taking (that’s the social play skill). Asking a child to learn a new play skill while using a social skill they haven't mastered is the equivalent of asking you to learn calculus in French!
If that child’s level of mastery for social play is playing side-by-side but not sharing materials, that’s where you want to be when you teach the new play skill.
If you don’t know the levels of play skills and social play skill, take some time to learn them. (If you get stuck, I teach them in The Learn Play Thrive Approach to Autism and to my one-on-one consultation clients.)
2) If you are teaching a new social play skill (like imitation, sharing materials, turn taking), use a mastered play skill. That child who's learning imitation? Make sure you are teaching him using a play skill he already has, like cause and effect toys or sensory exploration.
The child who is learning to take turns? Use a simple activity he already knows how to do; don’t teach turn taking right along side a new complicated game. Again, that’s teaching your piano lesson in Arabic.
3) Choose an emerging skill to work on and avoid trying to make big leaps. It’s so tempting to teach every child turn taking because….well, it’s something we feel like we know how to teach. But if a child isn’t already sharing their materials, they aren’t ready to learn turn taking. I teach therapists five concrete mini-goals (with specific teaching strategies) they can work on to slowly travel from solitary play to sharing materials and eventually working on turn taking.
Similarly, for play skills, if your child isn't yet using toys functionally they are probably not ready for pretend play or games with rules. It's best to shoot for very small leaps to make sure you are working at a level that is developmentally appropriate and meaningful for your client.
Tip #2: Use Structure
One thing we know about the learning style of kids on the autism spectrum is that they learn better from what they see than from what they hear. If you’ve read my ebook, 5 Essential Autism Strategies, you know that it’s important to use visual instructions at a level that the child can understand. Sometimes this means that our play activities need to contain object-level instructions for our kids who don’t understand pictures. Some kids understand pictures and benefit from picture instructions (photographs or symbolic pictures, depending on the child) in their play activities. And some kids can use written instructions.
Beyond how we embed visual instructions in our play activities, we can also structure the activities so that our kids can focus on the play goal. For a child who gets distracted by the materials, we may need to segment out each piece so that they are only picking up one at a time. Or maybe at the end-point in the activity, the materials need to disappear into the structure of the activity.
Let’s say I’m teaching symbolic pretend play to a child. She feeds a puppet little craft balls pretending they are cookies, but then she pulls the craft balls back out and gets distracted by playing with them. Cutting a hole in the puppet's mouth so the craft balls disappear can eliminate this problem and help the child focus on the play activity. The same can be done using a container with a hole in it for a variety of play activities.
There are lots of other ways to use structure. In The Learn Play Thrive Approach to Autism I teach therapists how to use informal assessment to think through exactly what structure they need in a play activity, and I give concrete examples of all of the different specific ways you can structure an activity.
Tip #3: Use Naturalistic Strategies
Let’s go back to that two year old who didn’t imitate. What I didn’t know then was that I had two options for how to teach him new play skills: 1) Embed visual instructions and structure in the play activities, and 2) Teach him how to imitate.
Since we teach new play skills using mastered social skills, this child needed to learn the social play skill of imitation before I could really dive into teaching new play skills.
Fortunately, folks wayyyyyy more clever than me have already figured out how to teach autistic kids to imitate using what’s called naturalistic strategies. If you already have training in an approach like Floortime, naturalistic strategies will be familiar to you. I learned how to do this from an autism specialist trained in the Early Start Denver Model.
Playing using naturalistic strategies comes naturally to basically no one, but we all need to know it to teach play to kids on the autism spectrum with greater success.
If you aren’t familiar with naturalistic play, I lay out the steps for you in this blog post. (If you’re reading in the Facebook app, links in this post may not work so head over to a new browser!)
The short version is, start by imitating the child and narrating what they are doing. When that gets their attention, try something new with the toy without telling them to copy you. You can use words or sound effects to describe what you are doing and capture their attention. Then go back to imitating them. It’s a bit of a back and forth dance. But the challenge is to try not to ask questions or tell them what to do.
This sounds so simple, but it’s a huge change from how we usually play. When I teach therapists and OT students how to do this, we work together over the course of many sessions (or videos for those in the course) to nail down these skills.
And it’s amazing because this way of playing really truly works. I’ve taught dozens of autistic kids to imitate using naturalistic strategies.
Naturalistic strategies aren't only useful for teaching kids how to imitate, they are also important for teaching new play skills to kids who already to imitate. I’ve used these same strategies to teach dozens of kids how to do all kinds of play without ever having to give them instructions like “do this!” or “make the plane fly!” They simply watch me and copy.
Teaching play skills using naturalistic strategies allows our kids to learn to play in new ways without requiring someone to prompt them verbally. Since our kids learn routines quickly, we want to be careful not to teach them the routine of getting a prompt before imitating. Teaching play in this way will go so much farther in helping them play in their real daily routines.
You Can Teach Play with Confidence
It’s so tempting to take the easy road and simply skip getting good at teaching play. But the research and our own experience tells us that learning to effectively teach our young clients on the autism spectrum to play could not be more important.
When you learn autism-specific strategies for teaching play, you can feel confident that you are making the greatest impact on your autistic clients .
To gain the skills you need to help your clients thrive during down time, check out my online self-study course, The Learn Play Thrive Approach to Autism.