Learning through play

One of the best ways for children with autism, Asperger's, and sensory processing disorders to learn is through play. Children improve their motor skills, language skills, and social skills by moving their bodies and interacting with their environment. Yet the biggest challenges parents, teachers, and loved ones face with children on the autism spectrum or with sensory processing disorders is how to successfully engage them in play.

Pediatric occupational therapist Tara Delaney provides the answer. In 101 Games and Activities for Children with Autism, Asperger's, and Sensory Processing Disorders, she shows you how to teach your children by moving their bodies through play. These interactive games are quick to learn but will provide hours of fun and learning for your child. And many of the games can be played indoors or outdoors, so your child can enjoy them at home, outside, or on field trips.

More than one hundred games that help your child:

• make eye-contact, stay focused, and strengthen his or her motor skills
• associate words with objects and improve language and numerical skills
• learn how to interact with others, how to take turns, and other social skills needed for attending preschool and school

Tara Delaney M.S., OTR, is the Executive Director of Steps Therapy Inc., specializing in sensory integration, autism, ADHD, learning disabilities, as well as social skills development.

101 Games and Activities for Children With Autism, Asperger's and Sensory Processing Disorders

The McGraw-Hill Companies, Inc.

Contents

Chapter One

It is often said that play is work for children with neurological difficulties, especially autism, Asperger's syndrome, and sensory processing disorder. This is understandable since many children with a neurological challenges struggle with expressive and receptive language skills, motor planning, as well as sensory processing. These struggles ultimately impact the ability of these children to initiate and engage in free play. The challenge is compounded because they have difficulty learning by watching others—another key element of play. Also, social interaction, in and of itself, is not highly motivating for many of these children, especially children with autism or Asperger's, so they are not naturally inclined to seek out other children to play with. However, reports from parents, educators, and therapists, as well as my own experience show that when these children are taught effective ways to engage with objects and people to expand their sensory, motor, language, and social skills, they have fun!

Assume a Connection

Increasing a child's engagement in the world around him or her is the main objective of the games and activities in this book. Getting and holding the interest of some children may seem futile at times. The challenge when playing with and teaching children with neurological difficulties is that we, caretakers and educators, judge a child's interest based on the feedback he or she gives us. However, children with autism, Asperger's, or sensory processing disorder may not give typical feedback, even as infants. We may find ourselves decreasing or changing our engagement level, ultimately giving the child less input or fewer experiences. Often our motivation is to protect our children or simply not to over-stimulate them, but instead we limit their opportunities to learn how to connect.

As a therapist, I see that children with neurological difficulties are exposed to fewer sensorimotor and language experiences compared to typically developing children, often because these children don't give feedback that shows they are interested in playing or being spoken to. Some may even give negative feedback to parenting input, such as arching away when we hold them, averting eye contact, not watching the caretaker with their eyes, as well as having adverse reactions to certain sensory stimulation, such as movement or touch. When a young child doesn't appear to register what we say or do, or appears to register it in a negative or fearful way, the natural reaction is to pull back and give less. We may not even realize we are doing this. It is simply a natural response that occurs during all human interactions.

When we smile at or talk to babies, they smile back or even laugh and coo; then we smile and coo back, responding to the baby's positive feedback. When that doesn't happen, we start doing it less because we are not getting the expected feedback. Interaction is reciprocal, so when someone talks less to us, we also tend to talk to that person less. When parents put their child on a swing at the playground and the child screams, most parents take the child off the swing—and it may be a while before the parents try to put the child back on the swing. If the parent gets the same reaction on the next attempt, that parent may never try the swing again. The same applies for other experiences, such as touching certain textures, listening to certain types of music, or eating different types of foods that your child may react to negatively. Soon the lack of response or the negative response changes our behavior as adults because we intuitively pull back on input that is not garnering positive responses from the child. In essence, we as caretakers become trained by the child to verbally interact less or even guard the child from sensorimotor input the child has reacted to adversely.

When we interact with any children, including children with neurological difficulties, we have to assume that they are connecting to us and that they are getting something from the interaction even if it doesn't seem as if they are. We cannot judge their level of interest strictly by the feedback they give; otherwise we are prone to give less. We need to be careful not to allow ourselves to give less, as these children need more, not less, input. As you participate with your child in the activities in this book, assume that the child's nervous system is enriched by the experience. Assume that you are connecting to your child and he or she is connecting to you, even if it doesn't seem like it. Remember, for children with neurological difficulties to store and access information, they need higher levels of input infused in many different ways. The key is ever-increasing engagement of your child.

Baby Steps

If an activity is perceived as too complicated or too long, many children will not engage. To be motivated, they need to perceive activities as being "fun" because the children who don't have a clear picture of where to begin and where the activity is heading will be reluctant to participate. This is true for neurologically typical children as well as for children with neurological difficulties. Therefore, one of the keys when teaching a child a new game or activity is to break the activity into smaller parts and demonstrate one part of the activity exclusive to the other parts. Once a child understands and has mastered one part, you can start adding more parts to the activity. You are stringing together mastered tasks that if done sequentially complete a whole activity or game. Keep this in mind as you go through the games and exercises in this book; if your child has difficulty understanding the entire "game," try breaking it down into smaller, more manageable tasks.

Motor Learning

While you are watching another person perform a physical activity, motor neurons in the brain called mirror neurons fire as if you were performing the activity yourself. For example, when you watch somebody throw a baseball, the same motor neurons that fire in that person's body when throwing the ball fire in your body when you watch him. Studies have shown that individuals with autism do not have the same mirror neuron responses as people who are considered neurotypical. Since many children with neurological difficulties have a difficult time processing movement information or replicating motor actions, having them watch somebody do something may not be enough—you may have to physically guide your child through a new motor action several times before his or her body "gets it."

If your child appears not to know how to make his or her body do what you are asking, then your child's brain may not be able to learn motor tasks by observation only. Physically teach your child by moving his or her body through the new activity while verbally saying what the child's body is doing. For example, if you are showing a child how to pull himself across the floor on a scooter board, move his arms in an alternating pattern in front of him so his body can feel the motor movement. Coach him the entire time, telling him to pull with his right arm and then with his left arm. Once the child's body understands how to move to accomplish the action, the child will be able to perform the action independently.

Reinforcers

Some children are motivated to engage in a new activity simply because it is novel, while other children will shy away from anything new, or even familiar, unless a tangible reinforcer is present. Simply said, some activities are internally motivating (naturally reinforced) for some children, while other activities will require external reinforcers to motivate a child to attempt or engage in the activity. This does not mean that the activity is not fun for the child. It simply means that your child has difficulty perceiving the activity as fun or something the child is capable of doing. Once the child is engaged or has some mastery over the activity, the child's understanding of the activity increases, as does the child's enjoyment. So the cycle begins: with increased enjoyment comes increased engagement, which begets increased enjoyment.

A reinforcer can be tangible such as a food item or a sensory toy, or it can even be embedded in the activity or game. For example, if the game involves a scooter board, the reinforcement might be getting to crash the scooter board into a large pillow. Since many children with neurological difficulties have fear reactions to certain stimuli, it is important to understand this and pair possibly frightening new stimuli with external reinforcers that you know the child likes.

Social reinforcement is the obvious display of pleasure from another because of our actions or words. It ranges from a big bear hug or clapping to a wink or simple acceptance into a group. Social reinforcement is one of the fundamental drivers of human behavior. As parents we want our children to be motivated by the positive reinforcement of ourselves and others. So every time they complete a portion of the activity, smile and cheer for them. It is important to remember many children on the spectrum do not appear to be motivated by social reinforcers, and that is why using tangible reinforcers along with the normal social reinforcement may be required. By linking a social reinforcer with a tangible reinforcer, you are helping the child understand that the social component is positive, and the child will start to seek the social reinforcer because he or she will understand it as a reward.

When using reinforcers, it is important to understand certain things about behavior related to reinforcers. First, if anyone is exposed to the same reinforcer over and over again, that person eventually reaches a saturation point known as satiation. Exposure to a certain reinforcer over and over again results in decrease in interest of the item. For example, if you love chocolate and someone gave you a chocolate bar every hour, you would relish it. But after several bars, you would not be motivated by the chocolate any longer, because you would have reached a satiation point. The same thing happens to children when you give them the same thing over and over—the encouragement or external reward you give them loses its effectiveness. The way around this is to offer different reinforcers or random reinforcers.

Differentiating reinforcers can be very effective when teaching a complex activity because you use reinforcers that are considered "pretty good" or "fairly desirable" for parts of the activity and you offer the "most desirable" reinforcer when the child completes the whole activity. Note that social reinforcement can also be differentiated. For example, smile and say, "That was a good something," when the child gets part of the activity, and then say, "Wow, amazing!" and jump up and down when the child completes the whole activity. Let the child know that different tasks or efforts result in different rewards. It is difficult for a child to judge good, better, and best when we give the same reinforcer each time.

Keeping several things in mind when using reinforcers will help increase the success of engagement. First, make sure the reinforcer you are using is something that your child really wants—whether it be a small, sweet treat; a particular toy; or a tickling. Also, remember that what a child likes changes continuously. Something that was reinforcing last week may be boring or even undesirable next week. Finally, the reinforcers should be offered only after the child follows through with the desired action or behavior. For example, if you are trying to teach a child to "wait" between her turn and yours and she does, reward her instantly. If she doesn't, make sure not to give her the reward, or you diminish the power of using reinforcers.

When you use outside reinforcers, meaning reinforcers that are not part of the activity or game, make sure you label the behavior you are rewarding. Say, "That was good waiting," as you give the child a big hug or a small piece of cookie. Using a particular character who already is a strong fixture in your child's life, such as Thomas the Tank Engine, Lightning McQueen, or Dora, to motivate the child to do something is simultaneously reinforcing and motivating for your child. For example, my four-year-old son does not readily switch from one activity to the next. So if he is in the midst of playing, the idea of leaving and going to the store is not acceptable. However, if Thomas is going along to be Mommy's helper by watching where Mommy drives and finding apples at the store for Mommy, my son will go because Thomas is going!

As your child learns the basics of participating in an activity or game such as waiting, following directions, and requesting help, you will be able to move away from the more tangible reinforcers and move toward more natural reinforcers. Natural reinforcers are considered internally driven reinforcers, such as the good feeling that comes from success at an activity or in a social situation. When you see that a child is becoming internally motivated by the activity itself, start to gradually decrease the tangible reinforcers and opt for the more natural reinforcers.

Visual Cues

One of the most powerful tools to use when teaching anything, new or familiar, with all children is a visual schedule. It has been well documented that children on the spectrum rely heavily on their visual systems to understand their environment. Visual cues are powerful tools to aid any child and increase the understanding of what to expect from a situation or "what is expected" of him or her. The use of pictures makes instructions clear and decreases frustration for both the child and the person giving instruction.

Visual cues offer more permanent information for children than does telling the child what he or she is expected to do. Although the use of visuals is promoted for teaching children with autism, I find that they are effective teaching tools for all children—especially those with neurological difficulties, such as sensory processing disorder, Asperger's syndrome, or attention deficit/hyperactivity disorder (ADHD).

When verbal or physical directions are accompanied by visuals, a child has something to refer to if he or she is not able to retain the auditory information. Pictures can be used to show the sequence of an activity or even the rules of a game. For example, you can have a child hold a picture of another child sitting to indicate waiting. The visual doesn't necessarily need to be a picture; it can be something like a medallion that is passed between two children to indicate whose turn it is to "jump into the mound of pillows."

A visual strategy that Hilary Baldi, a play-based behaviorist, employs when teaching games involving peers is a long necklace (Mardi Gras style) with a small card hanging at the end that says, "My turn." Children put it on when it is their turn; then they take it off and offer the next child the "My turn" necklace for their turn. This is an effective way to teach children how to take turns because they have to wait to exchange the necklace and the necklace physically reminds the waiting children that it is someone else's turn.

Besides using pictures or schematic drawings of directions, another excellent visual cue to help children understand the time component of an activity is the use of a timer. The Time Timer is especially effective. This visual timer shows the time remaining in red, with the red decreasing with the passage of time. Using the Time Timer in combination with a picture that shows what is happening during the time helps decrease anxiety.

Social Story

An expanded and personalized version of visual cueing is the social story. This involves stringing together pictures and simple words to tell a story of something that has happened or will happen. It provides a way to give the child visual cues along with words to guide the child through a particular scenario and his or her role in the story. In addition, it gives the child a framework of how to act in a given situation. When peers are introduced into the activities and games, a social story detailing how to "play" a particular game with a peer and some possible scenarios of interaction may be helpful. This prepares your child ahead of time and increases his or her chance of success with peers in game situations.

Social stories are a tool used to explain potential situations, new places, or new people to children who have difficulty projecting themselves into novel situations and therefore have difficulty knowing how to act in such situations. Usually, social stories are a set of pictures accompanied by short and concise sentences, creating a book that provides children with a framework of what to expect and how to act in a given situation. You can purchase prepared social stories and even social sensory stories. However, many parents and educators become masters at creating personalized social stories. I find that the social stories that include pictures of the child are the most effective for young or nonverbal children.

Infusing Language

You will find that the games and activities in this book are what I call language-rich activities. In my experience working with children and cotreating with speech pathologists, the best way for a child to learn language is in the midst of activity. Research shows that in early life more than 90 percent of verbs are learned while the action is taking place.

When children learn while engaging in the action, they are more likely to have developed motor memory of the action linked to the verb. For example, they will understand the word jump better if they are jumping while they learn it. Furthermore, the best way to learn descriptors for the physical qualities of objects is by interacting with those objects: having the child hold a pillow while you are teaching the word soft, for example, is the best way to go. Additionally, spatial concepts are best understood in a three-dimensional world (big, small, on top of, etc.); children learn these kinds of words best when they are appropriately interacting with the words.

Always talk, talk, and talk some more when playing with your child. The key for children with neurological difficulties is to keep the language clear and concise and, when necessary, to link words to pictures. Make sure that what you are saying is related to the activity that is taking place, which means you have to stay on task, too. If you are playing with a child and talking to someone else about something completely unrelated, the child may become very confused. Always interject as much purposeful language as possible!

The main purpose of many of the activities and games in this book is to teach certain language concepts. To increase a child's language acquisition, as well as enrich the child's vocabulary, remember to keep the language simple and concise when giving directions or the child may become confused.

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Excerpted from 101 Games and Activities for Children With Autism, Asperger's and Sensory Processing Disordersby TARA DELANEY Copyright © 2009 by Tara Delaney. Excerpted by permission of The McGraw-Hill Companies, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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