Play skills are directly related to communication abilities.
One of the first things that our first ST told me was that developing play skills is crucial for early communication. I would like to understand the hows and whys better, but I have seen that as R.’s play skills increase so does her ability to communicate.
In the beginning I felt like I should always be working on something with her. I’d talk to her constantly, follow her around reading books, doing all kinds of things that did not hold her interest. One afternoon I just started with what she would like to do – I chased her, and she loved it, she engaged with me and was smiling and laughing. I realized that although it did not seem to have anything to do with encouraging her to talk, our play was a step in the right direction.
R. like many children on the spectrum only engaged in exploratory play. She would shake, hit, throw, mouth and examine toys. Sometimes she would line them up. I hosted a playgroup for a typical Mom’s group before R. turned two. I did not know about the autism yet, but I knew R. did not play like other kids. A baby who wasn’t even walking yet crawled over to the toy box, found a car and proceeded to drive it across the carpet. His older sister put a doll in a play stroller, flung a play purse over her arm and said she was going out. R. spent most of the time rolling around under the dining room table.
It is hard to figure out how to play with someone who doesn’t seem to want to play with you. When that person is your child, it can be even harder. I had to realize that any kind of interaction was the goal, and any activity that she found enjoyable was worth pursuing. I did not need to worry about if the activity was educational or appropriate or anything else.
Activities that require me or another adult’s participation were (and are) the easiest to engage R. We still play “baby games” like peek-a-boo, chasing, tickles and raspberries. In the beginning one of the few sure fire ways to engage her was to let her knock over a tower of blocks that I stacked, she would do this over and over. Bubbles, wind up toys, even a whoopie cushion all got her attention and made her want more of the activity. The ABA therapists are really good at coming up with their own silly games.
A couple of silly games we are playing now- R. will lead me to a computer chair with wheels , I’ll prompt her to say come, and when she wants me to sit, I’ll verbally prompt her to say sit. She will then climb in my lap, say ready, set go and then I have to give her a chair ride. A variation of this is that she will lead me up the stairs, I’ll prompt her to say come and then up. She then pulls me to sit down on the top step, and I’ll prompt sit. She’ll climb in my lap and say down- again she wants a ride. I’ll make her say down for every step. With games like this that are consistent, she seems to be able to say a spontaneous word for the start of a desired activity (ABA calls this manding) more consistently. So she will say ready set go, or down with no prompt most of the time, but the lead in words -come, sit, still require verbal prompting the majority of the time.
I keep some toys out of reach, and some are in boxes or bags that she can’t always open, so she has to ask for them. During EI, R. had a program that was just the therapists demonstrating different things to do with toys and taking data on her interest level and attention span. I try to come up with interesting and different things to do with her toys, so she will ask me to repeat the activity.
Floortime talks about joining in a child’s play, and this is a good way to engage R. when she is perseverating or just on her own agenda. When we started, one of her favorite activities was to carry all of something, like blocks or stuffed animals one or two at a time from one side of the house to another. I would get in the way and hand her the animal or whatever, and just insert myself into her game. I would also mess up her pile, which sometimes annoyed her, but hey I got her attention.
I think the reason that children on the spectrum are limited in their play is because they literally have difficulties imagining anything else to do. It seems to me that the repetitive nature of her play was (and is) comforting to her. Most people have an easier time in most situations if they have some idea about what is going to happen. Perhaps for R. it is that she can not even conceive of a unique situation until she has seen it, and often she might need to see it several times. If I pick up R. in the kitchen and run or spin her or do something fun, she will hand lead me back to the exact same spot to repeat the activity. It doesn’t occur to her that I could do this anywhere, until I show her.
Thinking about pretend/symbolic play it makes sense that children on the spectrum would have difficulties in this area. Why is symbolic play so significant? I wondered this after our diagnosis, and I’m probably not the only one. Symbolic play is essentially how she is perceiving and reenacting her experiences. I think that when R. did not have any symbolic play skills, she also did not have much knowledge about or ability to manipulate her environment. As R.’s symbolic play increases so does her expressive and receptive language abilities. I think in the wait for spoken words, I kind of forget about receptive language. It is so amazing to get responses to things I say, that tells me that not only is she understanding me, she can imagine and conceive of a familiar situation she is not experiencing at that moment.
As an example, We went to Home Depot recently, and as soon as we pulled into the parking lot R. started to cry. It was clear she did not want to go. A year ago she would not have even noticed where we were until we were in the store. She could see the store and imagine (I’m guessing here) the last time we went. She did not cry the last time, but we had been there the day before, so I’m sure she was tired of it. I told her that Daddy would go to Home Depot and she and I would go get a cookie at the bakery. I repeated this a few times and she stopped crying and she even said cookie a couple of times as she climbed into the stroller.
I think it has been the most difficult to encourage pretend play as opposed to other kinds of play. Probably because I have a tendency to over think it. R. really liked to set up toys on the dining room table, so it seems like a natural thing to encourage her to set the table with play dishes and food and have her dolls eat and drink. She will set the table, feed and give drinks to her dolls (mostly Elmo and company). She will try hats on Elmo or Ernie and she is starting to try out things that aren’t actually hats. This is a great improvement over a year ago when this kind of play was non-existent. But her symbolic play skills are still very much in the beginning stages. She’ll brush Ernie’s hair for a few minutes and then go on to something else. I’m not seeing many complex scenes acted out. It is not always easy to interpret what she means by what she is doing. When we are out she’ll have Elmo and Ernie try out things, she’ll dangle them over the side of the shopping cart and she will be babbling in a conversational tone the entire time.
I set up different play scenarios and I try to mix up the locations and how they are set up, so she doesn’t become too fixed on one way. I also try to jump in and make her play sessions a little longer. She will put a doll to sleep and I’ll pick her up and make her tell R. that she doesn’t want to go to sleep. Or when she removes the doll’s clothes I’ll have the doll complain that she is cold. R. is becoming very receptive to me playing like this. She smiles and is very engaged and will give me items to use to play.