ATYPICAL PLAYER AND. THE AUTISTIC CHILD. Gabrielle Eisele .... Rise/Option
Approach (Kaufman, 1994) and Intensive. Interaction (Nind & Hewlett, 1994).
THE HAND IN HAND PROJECT: NON-DIRECTIVE PLAY, THE ATYPICAL PLAYER AND THE AUTISTIC CHILD Gabrielle Eisele Windfall Therapy, Training and Consultancy
[email protected]
NOT A DISORDER, BUT A DIFFERENT WAY OF LOOKING AT THE WORLD
“Autistics may march to a different beat, but that beat can be meaningful.” Temple Grandin
WHAT DOES IT MEAN TO BE AUTISTIC?
GENERAL INFORMATION Autism is a lifelong complex condition that can affect all aspects of development, life and human perspective with no racial, cultural or socioeconomic boundaries. Typically ‘appears’ during the first three years of life Currently at 1:100 prevalence rate, or 1% of all populations Male to Female ratio is 4:1 5 times more common than Down’s Syndrome; 3 times more common than Juvenile Diabetes. Over 70% of individuals with ASC have learning difficulties. Common experiences of hyper/hypo- sensitivities, anxiety disorders, abnormalities of development, ‘challenging’ behaviour and social/emotional difficulties
WHAT DOES IT MEAN TO BE AUTISTIC? The triad of impairments
Social Interaction
Wing & Gould, 1979
Social Communication
Imagination
SOCIAL INTERACTION • • • • • • • • •
May prefer to be alone than to be with others May use others as objects Difficulty in reading social cues Behaving in odd or unsocial manner Appearing to lack empathy Avoidance of eye contact May relate better to objects May tolerate contact with only familiar people May have paradoxical emotional responses
SOCIAL COMMUNICATION Language development may be slow, disrupted or disordered – no verbal language at all/loss of language Echolalia Difficulties with pragmatics, semantics, prosody and non-verbal communication Literal interpretations of language Formal or ‘stilted’ use of language Difficulty with reciprocal exchange Argumentative/over-compliant Poor listening skills Honest to the extent of bluntness or rudeness
This is the lack of understanding that language is a means of sharing information and process abstract concepts such as feelings or ideas.
IMAGINATION Difficulty foreseeing consequences or to abstract future events or outcomes, therefore… Tendency to become anxious and controlling over changes or unexpected events Adherence to sameness and routine/resistance to change Atypical play Rarely consider ‘What if?’
BUT THERE ARE GREAT ASSETS AND STRENGTHS…. On the whole, autists are….
Honest
Brilliant researchers
Self-motivated
Relentless and determined
And have..
Strong visual thinking
Strong ability to concentrate and perserverate.
Powerful and unusual learning curves
Drive for the details
Giftedness – 10% approximately
New ways of thinking …. the movers and shakers of the modern technological world.
ADVERSITY FACED BY AUTISTIC CHILDREN Limited access to services Subject to myriad interventions Family stress Regular separation from family Inappropriate teaching styles – 1 in 5 children with autism/Asperger’s Syndrome are excluded from school at some point in their lives (NAS 2000). Overly controlled in play and leisure Secondary mental health difficulties – untreated/inappropriate treatment Vulnerability to abuse and neglect
MAKING PLAYFUL RELATIONSHIPS WITH AUTISTIC CHILDREN
PLAY IS A LEGAL RIGHT FOR ALL CHILDREN UNCRC
Article 31 Children Act 1989 and 2004 DDA 1995 and 2004 SENDA 2001 National Service Framework for Children, Young People and Maternity Services, 2005 WAG Seven Core Aims WAG Play Policy
DEFINITIONS OF PLAY… play
is pleasurable and enjoyable play has no goal imposed on it from the outside play is spontaneous and voluntary play involves some active engagement on the part of the player play has certain systematic relations to what is not play. It can be contrasted to non-play. (Garvey, 1997)
THE POWER OF PLAY •“Play is the source of development & culture” Vygotsky • Play is a universal language • Play is pleasurable & enjoyable • Play skills prepare us for the social and mechanical world, i.e survival. • Play allows children to experience different psychological states in themselves and others
THINKING ABOUT AUTISM & PLAY….. What
kind of play and behaviours do we associate with autism?
ATYPICAL PLAY IN AUTISM Unusual, repetitive or limited play is a core feature of autism Visually oriented play Local vs global Children with autism lack early play skills such as:
Social smiling Shared cooing/babbling Pointing Social eye gaze Joint referencing/attention Understanding of social gestures
POSSIBLE CAUSES OF PLAY DEFICITS IN AUTISM Difficulties
with early joint attention (Mundy et al, 2007; Whalen & Schreibman, 2003). Difficulties with Executive Function/Metarepresentational Theory (Leslie, 1987). Lack of Theory of Mind (Baron-Cohen, 1987). Weak Central Coherence (Frith, 1989).
PLAY IN AUTISM
Play in Autism found to be less versatile, of shorter duration, having fewer occurrences of functional play and lacking in displays of symbolic play using toys and play partners (Charman & BaronCohen, 1997; Wolfberg, 1999).
Autistic children may also vary considerably in their play ability and can demonstrate very sophisticated play skills (Mastroangelo, 2009).
AUTISTIC CHILDREN MAY ENGAGE IN AS MANY VARIED TYPES OF PLAY AS ANY CHILD. THESE WILL INCLUDE:
Sensory play which focuses on how something feels, tastes, smell, or sounds or may be visually oriented, such as looking at something from different angles or seeing how light reflects off shiny material. Relational play is the relating of objects to each other independent of their function or their representation of something else. Functional play is the ability to use an object as its design intends. Symbolic play, which involves treating an object or partner as if it or they are something other than what or who they are. (Both functional and symbolic are sometimes considered together as ‘pretend play’). (Libby et al, 1998)
REPETITIVE BEHAVIOURS Repetitive activities are not ‘bad’. May be a form of self-regulation the child uses to stay in their ‘comfort zone’. Help child manage a chaotic world. Joining in repetitive activity can support engagement. May become habits & keep the child isolated. May evolve into or include self harming behaviour May prevent alternate play styles Research has shown that as the child’s play repetitoire enlarges rrb will diminish naturally. May be a type of play!!??
REPETITIVE AND RITUAL BEHAVIOURS
hand flapping rocking spinning objects tracing running back and forth look at shiny features such as electrical outlets excessive smelling or touching Pica Manipulation of certain objects such as twigs or rubber bands or flicking switches
Obsessive interests may concern preoccupations with parts of objects rather than the whole or a fascination with patterns, collections, or specific topics.
Although stereotyped repetitive behaviours are a defining feature of autism, they are not exclusive to the condition.
ACCESS ISN’T EVERYTHING. BARRIERS TO PLAY FOR AUTISTIC CHILDREN
Attitudes of parents and play staff Focus on care Lack of confidence and skills Gatekeepers and restriction of risk Communication impairment Behaviour which gets in the way of play Inflexible and inaccurate definitions of play
THE BEHAVIOURAL APPROACH TO TEACHING PLAY
Includes Discrete Trail Training, Video Modelling, Pivotal Response Training & Applied Behavioural Analysis.
Teaching play is the same as teaching any skill
Breaks play into discrete components, taught and chained together.
External reinforcement following appropriate imitation/successes
Uses judgement and coercion.
Doesn’t lead to novel, spontaneous play
Goes “against” basic premise of play: self-reinforcing
Findings of Luckett et al, 2007 – cannot really teach autistic children to play, only comply.
THE FOUNDATION STONE OF THERAPEUTIC PLAY FOR AUTISTIC CHILDREN…
Numerous studies highlighting the beneficial power of the synchronized and contingent play of caregivers with autistic children (Siller and Sigman, 2002). Many case studies of successful play therapy relationships with autistic children (for example, Josephi and Ryan, 2004). Anecdotal positive report on programmes such as SonRise/Option Approach (Kaufman, 1994) and Intensive Interaction (Nind & Hewlett, 1994). Studies of play-based, caregiver led interventions such as Floortime (Greenspan & Weider, 1998); P.L.A.Y (Solomon, 2007 ) and Watch, Wait and Wonder (Wesner, Johnson & Dowling, 1962)
BORN FROM THESE …. THE HAND IN HAND APPROACH
Caregiver mediated approach for early intervention Uses non-directive play ethos of Play Therapy and DAPT so…. Follows child’s lead Builds on natural interests Broadens child’s experience in play (Zone Proximal. Development) Extends circles of communication Use of imitation Tailors communication to child’s style
PARENT/CARER AS A CONTINGENT PLAY PARTNER Engages
with the child in a non-coercive, playful & encouraging manner Doesn’t turn a play session into a teaching session Reads the child’s cues (language, gestures, affect & rhythms) Knows when to talk and when to be quiet Is sensitive to the emotional needs of the child Treats what the child is doing as purposeful and valid Is both extremely interested and interesting Enjoys playing with their child & shows it!
ATYPICAL PLAY - IF WE ARE THE MORE ‘ABLE’ ONES, WHY AREN’T WE ADAPTING FIRST?
Prove that interacting with others is not only possible but enjoyable and meaningful. Do not adulterate atypical play – rather tune in and join in. Some play may feel uncomfortable but that is our stuff. We need to start by just being with and build on this when it feels right. Be flexible, creative, patient, and don’t take anything personally! “Best practice for autistic children is best practice for everyone” Prof. Rita Jordan
DOGS AND CATS OR THE PLAY WARS Donna Williams, a famous and influential Autist, suggests that… Autistic people are like cats, and ‘Neurotypicals’ are like dogs. Highlights how adversarial the relationship can be without tolerance and acceptance. It is especially dangerous for autistic children being a cat, with the inclination for solitary play and self-focus, to grow up in opposition to the prevailing image of the successful, social ‘dog pack’ personality in today’s world
References Bates, D.G. & Phlog, F. (1991). Human Adaptive Strategies. New York: McGrawHill. Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and loneliness in high-functioning children with autism. Journal of Autism and Developmental Disorders, 33, 489-508. Blume H (1997). "Autistics, freed from face-to-face encounters, are communicating in cyberspace". The New York Times. http://query.nytimes.com/gst/fullpage.html?res=9803E7DC1F31F933A05755C0A961 958260. Retrieved on 2007-11-08. Buron, K.D. & Curtis, M. (2003). The Incredible 5-Point Scale. Kansas: Autism Asperger Publishing Co. Crissey, P. (2005). I Have Autism: A Child’s First Look at Autism. Super Duper Publications Hart, K. I., Fujiki, M., Brinton, B., & Hart, C. H. (2004). The relationship between social behavior and severity of language impairment. Journal of Speech, Language, & Hearing Research, 47, 647-663.
REFERENCES Myles, B.S., Trautman, M.L. & Schelvan, R.L. (2004). The Hidden
Curriculum: Practical Solutions for Understanding Unstated Rules in Social Situations. Kansas: Autism Asperger Publishing Co.
Ormond, G. I., Krauss, M. W., & Seltzer, M. M. (2004). Peer relationships and social and recreational activities among adolescents and adults with autism. Journal of Autism and Developmental Disorders, Vol. 34, pp. 245-256. Wikipedia/Psychology. Autistic Culture. Retrieved May 3, 2009. http://psychology.wikia.com/wiki/Autistic_culture. Wing, L. & Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: Epidemiology and Classification. Journal of Autism and Developmental Disorders, Vol. 9, pp.11-30.
REFERENCES CON’T Happe´, F. (1994). Autism: an introduction to psychological theory. East Sussex: Psychology Press. Morris, J. (1998) Don't leave us out. York: Joseph Rowntree Foundation. Baron-Cohen, S.(1987). Autism and symbolic play. British Journal of Developmental Psychology, Vol. 5, pp. 139-148. Baron-Cohen, S. (1989) The autistic child’s theory of mind- a case of specific developmental delay. Journal of Child Psychology and Psychiatry, Vol. 30, pp. 285-297. Baron-Cohen, S. & Goodhart, F. (1994). The ‘seeing leadst to knowing’ deficit in autism. British Journal of Developmental Developmental Psychology. Vol 12, pp. 397-401. Abstract. Baron-Cohen, S., Leslie, A & Frith, U. (1985). Does the autistic child have a theory of mind? Cognition, Vol. 21., pp. 37-46 Leslie, A. & Frith, U. (1988). The autistic child’s understanding of seeing, knowing and believing. The British Journal of Developmental Psychology, Vol. 6, pp. 315-324.
REFERENCES CON’T Baron-Cohen, S, (1991) The development of a theory of mind in autism: deviance and delay? Psychiatric Clinics of North America, Vol. 14, pp. 3351. Baron-Cohen, S, & Cross, P, (1992) Reading the eyes: Evidence for the role of perception in the development of a theory of mind. Mind and Language, Vol. 6, pp.173-186 Matson, J.L. & LoVullo, S.V. (2009). Trends and topics in autism spectrum disorders research. Research in Autism Spectrum Disorders, Vol. 3, pp.252-257. Luckett, T., Bundy, A., & Roberts, J. (2007). Do behavioural approaches teach children with autism to play or are they pretending? Autism, Vol. 11, pp. 365-388. Prior, M.R., Dahlstrom, B. & Squires, T. (1990). Autistic Children’s knowledge of thinking and feeling states in other people. Journal of Child Psychology and Psychiatry, Vol. 31, pp. 587-601.
REFERENCES CON’T Frith, U. (1989). Autism: Explaining the Enigma. Oxford: Blackwell. Happe, F. (1995). The role of age and verbal ability in theory of mind task performance of subjects with autism. Child Development, Vol. 66, pp. 843-855.
Happé, F. (1996). Studying Weak Central Coherence at Low Levels: Children with Autism do not Succumb to Visual Illusions. A Research Note. Journal of Child Psychology and Psychiatry, Vol. 37, pp. 873-877 O'Hearn, K., Asato, M., Ordaz, S. & Luna. (2008). Neurodevelopment and executive function in autism. Development and Psychopathology, Vol. 20, pp.1103-1132 Leekam, SR. and Perner, J.. 1991. Does the autistic child have a metarepresentational deficit? Cognition, Vol. 10, pp. 203-218.
REFERENCES Solomon, R., J. Necheles, C. Ferch, and D. Bruckman. (2007). Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program. Autism Vol.11, pp. 205-224. Kaufman, B.N. (1994). Son Rise: The Miracle Continues. Tiburon, CA: H.J.Kramer. Inc. Greenspan, S. & Wielder, S. (1998). The Child with Special Needs. USA: Da Capo Press. Nind, M. & Hewett, D. (1994). Access to Communication: Developing the Basics of Communication with People with Severe Learning Difficulties through Intensive Interaction. London: David Fulton.
Wesner, D., Johnson F., & Dowling, J. (1962). What is maternal–infant intervention? The role of infant. Psychotherapy. Psychiatry, Vol.45, pp. 307–315.
