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Through play, children with autism can hone thinking skills

by  /  31 May 2016
The Expert:

Raphael Bernier

Associate professor, University of Washington

At least 100 times a day, my toddler repeats this refrain: “Daddy, can you play with me?”

Strewn across my living room floor are the Lego pieces, action figures, toy cars and countless other random objects that serve as the roads, spaceships, food and everything else my toddler’s characters need in the course of his pretend play. All he wants is to have fun, but every time he sits down (or stands up) to play, I know that he is unconsciously practicing countless skills he will need as he develops.

Play provides some of a child’s first opportunities to rehearse social interactions, generate novel ideas, toy with symbolism and develop narratives — skills that serve us later in life, particularly in our highly social world. Indeed, children who engage in more complex play early in development show greater social competence at later ages1. Add the opportunity to invite another person to play, or to follow another’s lead, and the foundation for working with others is set.

For children with autism, however, these opportunities do not present themselves so easily. Yet play is still an important developmental tool for these children. For clinicians, it represents a key arena for delivering therapies that could improve a child’s social skills, language and certain cognitive capacities.

Particular play:

Many children with autism show unusual features in their play starting early in life2,3. These include reduced creativity and imagination, such as recreating scenarios from a television show verbatim. The play of children with autism also tends to have a persistent sensorimotor or ritualistic quality. For example, a child might repetitively arrange toys to mimic some observed play activity.

These play characteristics were part of the diagnostic criteria for autism for many years, but are not listed in the newest edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5). Still, the way children with autism play can provide clues to what skills they lack and highlight areas that warrant intervention.

In assessing children with autism, clinicians look at several different types of play. Symbolic play includes the use of objects or actions to represent other objects or actions. In autism, symbolic play is often delayed, and spontaneous play is less frequent, less complex and lacks the novelty that typically developing children demonstrate4,5,6.

Functional play involves actions such as throwing balls, pushing cars back and forth, and stacking and knocking over blocks. Sensorimotor play involves the body: A child might practice jumping, pat playdough or pour water.

Children with autism are often typical in their functional and sensorimotor play at age 3, but they show poorer pretend play skills than their typical peers do7. If we did not see the intact functional play, we might attribute the unusual pretend play in children with autism to cognitive challenges. But because functional and sensorimotor play require an array of learning and memory skills, we think that differences in pretend play do not result solely from cognitive problems.

Flexible thinking:

Cognitive abilities, language skills and executive functions such as self-control and mental flexibility all influence the development of play and its application to clinical settings. Autism affects all these domains.

In children without autism, pretend-play abilities are associated with performance on measures of self-control more than cognitive ability (learning and memory)8. For example, differences in the ability of typical preschoolers to pretend to do something and suspend reality relate to their performance on tests of self-control that require waiting or choosing a counterintuitive response9.

Play skills are also tied to language. Some researchers have proposed that the ability to talk to yourself draws from executive function, such as working memory, and allows typically developing preschoolers and young children to engage in pretend play.

Likewise, in children with autism, the nature of pretend play appears to correspond with language ability and intelligence, even in minimally verbal children, and preschool play skills can predict the later language development in these children10,11.

Earlier this year, my colleagues and I reported that individual differences in executive function — specifically, self-control and working (short-term) memory — predict pretend-play skills in children with autism both at the time of their assessment and later in life12. Interestingly, this pattern depends on language ability: For children with significant language difficulties, cognitive ability — not executive function — predicts later pretend-play skills.

Teaching with toys:

Together, these findings highlight pretend play as an important arena for clinical care. Many children with autism are missing out on the opportunities and benefits of pretend play.

Still, the relationship between executive function, language and pretend play provides new avenues for treatment. Developing therapies to improve executive function, for example, can help children with autism benefit from pretend play, which creates natural learning opportunities for a prepared mind.

Pretend play itself can be considered a form of treatment — one that costs nothing, requires no professional training and can happen anywhere. What’s more, by capitalizing on existing therapies designed to improve language abilities, clinicians can enhance a child’s executive function — thereby maximizing a child’s ability to engage in pretend play. Doing so should then feed back into a child’s cognitive and social skills and emotional well-being.

Play is critical for every child, providing opportunities to practice the skills that we employ as adults during social interactions, academic pursuits and professional responsibilities. As I consider the mess of toys in my living room, I hope every parent has the opportunity to see their child take advantage of the therapeutic richness provided simply by playing.

  1. Howes C. and C.C. Matheson Dev. Psych. 28, 961-974 (1992) Abstract
  2. Hobson R.P. et al. J. Autism Dev. Disord. 39, 12-22 (2009) PubMed
  3. Jordan R. Autism 7, 347-360 (2003) PubMed
  4. Ungerer J.A. and M. Sigman J. Am. Acad. Child Psychiatry 20, 318-337 (1981) PubMed
  5. Jarrold C. et al. Br. J. Dev. Psych. 14, 275-300 (2001) Abstract
  6. Charman T. and S. Baron-Cohen J. Autism Dev. Disord. 27, 325-332 (1997) PubMed
  7. Rutherford M.D. et al. J. Autism Dev. Disord. 37, 1024-1039 (2007) PubMed
  8. Kelly R. et al. Australas. J. Early Child. 36, 21-27 (2011) Full text
  9. Carlson S.M. et al. Cogn. Dev. 29, doi: 10.1016 (2014) PubMed
  10. Thiemann-Bourque K.S. et al. J. Autism Dev. Disord. 42, 863-873 (2012) PubMed
  11. Kasari C. et al. J. Am. Acad. Child Adolesc. Psychiatry 51, 487-495 (2012) PubMed
  12. Faja S. et al. Autism Res. Epub ahead of print (2016) PubMed

2 responses to “Through play, children with autism can hone thinking skills”

  1. Ethyl says:

    I in no way mean to be disrespectful. I am a simple woman…not a scientist in any respect, my only background is a little in Special Ed. BUT…I think that background made me a little more alert to some things.And I don’t have any answers—but maybe I might stimulate some memories or information in others. We have to come up with answers that build up the minds and personalities of children as they are. When adults “teach”, sometimes children learn, but is it actually self-rewarding, as typical play is?

    My son had a label of PDD-NOS at age 3. What broke my heart most, in the list of three awful pages of what he couldn’t do that came from the OT, was that he could not do the “work” of childhood. I was told he would have little to no imagination, no pretend play. I used to sit with him and attempt the “give and take” of play of typical kids, but there was no interaction, to speak of. And I mean that literally. Typically, children build on each other’s stories. They get wilder and wilder as each tries to outdo each other. But my son had no language other than echolalia. He could not have a conversation.

    Thankfully, I was blessed with courageous teachers in the regular classroom who loved my son, and did their best to encourage him. I’d send him outside with the neighbor kids, and, in a way, he was forced to stick up for himself. His friends were always non-neurotypical…ADHD, mostly, and got kicked out of everybody else’s home. One day I heard him in the bathroom,water running and splashing.
    “What are you doing?” I asked
    “I’m the captain of the Titanic. I’m going up and down the Easter seaboard.”
    “You can see it all?”

    I tell this story a lot, because that is where I woke up to the imagination my son was not supposed to have. It was visual. Dr. Tom West, Dyslexic himself, wrote In the Minds Eye. He feels Dyslexics and Autistics often times have the commonality of visual thinking, of being able to see “movies in their head” instead of words. Visual thinking is primary, auditory thinking is secondary. Language is a second language to them. Their first language, for many, is pictures. I have an artist friend, outstandingly talented, who finds speech difficult, and is very Dyslexic.

    My son now works as a machinist. He also has a 1973 Lincoln Continental he drives (and repairs) daily. He is drop dead funny…a very intellectual sense of humor, very quick witted. His language skills are near that of a genius. We have to quit trying to make kids be more like their peers, when they were never born to be like them. We have to find them where they are, we have to see things from their eyes.

    I’m sorry…I have no idea how to even go about doing this. But a Dyslexic teacher, when my son was 10 years old, taught me to support him as he is, rather than to try to change him, which is a fruitless endeavor for any of us to do to another human being. Ask my husband, he has tried….

    What my point is, is that play will be different for a child who thinks in pictures, rather than words. More action, less talk. One thing I have NEVER figured out is why kids line things up. I think I’ll ask my son if he remembers. .

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