Teaching Play and Social Skills to Children with Autism

Transcript for Podcast Episode: 079
Teaching Play and Social Skills to Children with Autism
Hosted by: Dr. Mary Barbera

You're listening to The Turn Autism Around podcast, episode number 79. I'm your host, Dr. Mary Barbera, and I am thrilled that you are listening. This episode is a solo show talking all about autism and play skills, and how play skills are so connected to social skills and language skills and how everything is connected. So let's get to this topic, which is so important to many of our children and clients.

So today's session is all about autism and play skills. And when we think about autism and play skills, we're talking there's two types of play. There's independent play. And those are your leisure activities. And then there's social play and that is play involving other people. Today, I'm going to focus mostly on that social/play component because we do tend to teach these things separately and we want our children to be as social as possible and we want them to use language and we want to pair this all up together. So today we are covering mostly that social/play component. It's really hard to separate out play versus social versus language. And many of my free and paid resources all focused heavily on language because what I have found is it's really hard to build adequate social and play skills without the language to support it. And it's easier for me to teach parents and professionals how to teach language. And then the social and play skills will be taught in sync with that.

So as we all know, autism is characteristically diagnosed with a failure to socially communicate. Social communication skills, rote, repetitive interests are also usually part of the diagnosis. So that play and social piece is largely missing from kids who are diagnosed or showing signs of autism. I am also going to talk about this book that I got. It's published in 1997. I bought it at a conference. I saw the authors present on this book. I think it was two thousand. And I bought the book for like 40 bucks. The good news is you can download this book for free and my staff will post the link for that in the comments or in the show notes. So stay with me here, because this link isn't going anywhere. You're going to be able to download this and I'm going to cover the pieces of this book that I would highly recommend.

But most of you listening actually probably have kids or clients that are not ready for this kind of explicit instruction on play and social skills. So I'm also going to cover some of the pre-requisite skills to get us going. So as you know or just found out, I fell into the autism world in 1990 when my son was diagnosed with autism one day before his third birthday. His name is Lucas. He's now 23 years old. And when Lucas was two years old, when he was 21 months, my husband first mentioned the possibility of autism and I shut him down. I told him I never wanted to hear the word again. And we had a second baby right away.

So when Lucas was 18 months old, we had Spencer. And so Lucas was warm and cuddly with me. He had some language. But at the time, I knew nothing about how to teach language. I had enough, knew nothing about how to teach play skills. And so we thought maybe Lucas would perk up and start really playing with kids better and start talking more if we enrolled him in a toddler preschool or class, which was a two year old preschool class in our neighborhood. And Lucas just turned two in July. So the class started in September.

So there were, you know, newly turned two year olds like Lucas. And then there were two- and three-quarter year olds, almost three years old. There were some kids in there that turned three right in October. So there was a wide range of abilities am going from a two year old to a three year old, that is an explosive age in terms of play and language. So Lucas had very few words. Like I said, I didn't know how to teach new words. And I know now. He was not diagnosed with autism. And besides, my husband mentioned the possibility of autism. No one was thinking or talking about autism for Lucas. So he would go to this little toddler class and, you know, he wouldn't have a problem separating. Some of the other kids had major separation anxiety. Some of the other kids had major aggression when other kids took their toys.

Lucas wouldn't really care if somebody took a toy out of his hand. He would just kind of go to the next toy. He would enjoy the little singsongy, you know, circle time. But if it got too heavy with language, he was not attentive. He wasn't rolling around on the floor or running out of the classroom. But it became clear midyear that Lucas was falling behind. And that's when the teacher and the preschool director brought us in, my husband and I. And they basically said Lucas was, they used words like "in his own world", and he wasn't really participating much. He did like to paint and he did like to do the instruments with the shaking, with the songs that he was familiar with. But there was no understanding of a lot of the language.

And they were worried that it was time for enrollment for the three-year-old class. And they were worried about him moving up there that, you know, it was a worse staff to student ratio and the toddler course. You know, they didn't have to be potty trained and in three-year-old course classroom they did. The staff, you know, there there's only one teacher. So there was no way that teacher could leave to change a diaper or anything. So potty training is one of the barriers. And so Lucas stayed back in two year old preschool. And in that year, he was diagnosed right before he turned three. So he repeated the two year old preschool and he went with an ABA therapist who shadowed him.

And, you know, a lot of people that I see with little kids with autism or signs of autism. Some of them don't have a choice like they work and they need childcare. And the child is in daycare all day. But studies have shown, lots of studies have shown, for many decades that kids with autism really need intensive one on one ABA and just having a one to one person shadow you around and prompt you and make sure you don't hit anybody and make sure you don't roll around on the floor. That's not the kind of instruction kids need. Kids need very systematic instruction on language and play skills and imitation and all those sorts of things.

So Lucas did get 40 hours a week of ABA, including these two mornings a week where he continued to go to preschool. And for him, that was a good thing because he already knew the routine. He was comfortable with the teacher and he had maybe a therapist there who would make sure that he, you know, was fairly focused and didn't make a mess with the paint and didn't get into any trouble. He continued to progress to the three-year-old preschool and the four year old preschool, and he went to typically developing preschool.

Some kids with autism that when they're young, they go to special needs preschool, which was an option for Lucas. But we chose to do home ABA, and this typical preschool opportunity. But, you know, I had some clients who went into special needs preschool. And what I found was sometimes the one, you know, environment wasn't good. There was, you know, eight kids and two teachers or three or four teachers and aides. But that's still not a one to one ratio. And so there was very little pullout time.

I had one mom of a boy, I'll call him Adam, and he went to special needs preschool. But he was off every Friday. So Mom thought, just expose him into a typical day care on Fridays was gonna be a good thing. But when I started with Adam, I observed him at home and then the special needs preschool. And I went to daycare on a Friday and he was in his own world. The kids around him were just running around, negotiating play. He was in his own world. And at one point he even he didn't have a one to one when I was there. And even at one point he started licking the wall and I had to, of course, get up and stop that. But, you know, little Adam didn't make any progress for a whole year in this, and he went from age three to age four making no progress.

And so one of the very common mistakes I see both parents and professionals making is, is they think that just exposing kids to other typically developing kids is going to make social and play skills come naturally. And it involves a lot of work and it usually involves a lot of work with teaching language. So I have done several other video blogs and podcasts. I did podcast number 17 on Social Skills. Podcast number 18. I had a guest, Ashley Rose, who teaches social skills instruction to older kids usually. And I also did a couple of video blogs on mistakes people make with social skills and also how to teach both independent and social play skills, which you may want to check out.

So in addition to thinking exposure's, the answer exposure to other kids and thinking that social skills will come naturally. Those are the two big mistakes and as well as programming too high for social skills. Working on things like manners and turn taking and greetings and sharing and saying I'm sorry before a child has these prerequisites which are really baby infant type of social and play skills. So let's talk about how typically developing babies, what kind of play and social skills they have. So babies and typically developing toddlers, and I am saying this because if you have a two, a three, a 12 year old that doesn't have these baby skills of being social and playing, it's gonna be really hard to get to the good stuff in this play time social time book, which I'm going to talk about in a few minutes.

So babies: eye contact cooing, smiling at a caregiver space. When you point, the infant or toddler should be following your point. They should start pointing between 12 months and by at the very latest by 18 months. And this isn't just like a point here or there. This is a point a lot. Every day you see pointing. In a 12-month-old to 18-month-old. You have to see pointing, reaching, gesturing. If a baby or a toddler takes your hand and puts it on an item that's called hand leading, and that's actually a red flag for autism. So lack of pointing, hand leading are red flags by 18 months of age. But young, typically developing 12-month-old, 15-month-old, 18-month-old, also bring you things to show you to get your attention.

OK. If you are familiar with the VB map assessment, which I talk about a lot in my verbal behavior bundle courses, the play skills in the zero to 18 month level include putting items in, stacking blocks, sitting on the floor or at a table and attending to, you know, being aware when people walk in the room being where when people call their names. I did a video blog on response to name, which tends to be another red flag for autism. Looking at faces, not just eye contact, but at your face being aware.

So when typically developing baby, you know, spills milk or whatever, they would, you know, say an 18 month old spills milk or spills water. They would look at their parent, look down at the mess like, oh, gosh, what are we gonna do kind of thing to negotiate that where a child with autism might just start playing in the water. Just more about cause and effect kind of thing. Also, when tested with bubbles, for instance, when you blow bubbles and you put it back in and OK, your turn, a typically developing child would be looking at you like, come on, you know, even if they're not talking, they would be looking at you reaching, giving you the bubbles, looking at your eyes to see if it was OK, if you were going to do it.

Where a child with signs of autism will just hand the bubbles back to you, to your hand and kind of require the hand to do all the movement to get the bubbles going again. OK. So those are kind of those. One of the things that people don't realize is that you really need to have some attention. The child needs to be sitting and attending. I am a big fan of bringing very little kids once they can sit safely out of the highchair, out of a strapped booster seat. If you have to do that for a young child or even a child with physical disabilities to keep them in the highchair and are strapped in chair for safety, that's great. That's fine. But once they can freely walk and run and sit and have balance to sit at a small child sized table, I do find that my approach revolves around paring that table time up to be so much fun.

And we are teaching language. We're teaching cooperation. We're teaching sitting skills, attending. We're teaching beginning language skills. What I find is that some early intervention professionals, me included, when I was an early intervention professional, I would often go in and if the parents didn't have a table or didn't want to use a table, I would spend a lot of my time just chasing the child around the house, trying to, you know, hold up a picture of a cat or a little toy figurine of a cat and saying cat once or looking out the window and trying to get the child's attention and look at the tree. There simply just wasn't enough time of focused attention to really improve language so much.

OK, once you have those beginning language skills which are covered more in-depth in the toddler course, as well as the early learner course, which is part of my verbal behavior bundle of courses, then we get to teach you are we? The child naturally develops skills such as sharing, turn, taking greetings, pretend, play, understanding rules of games, negotiating, cooperative play with others, imitating others, playing games like Simon says, then playing board games and those sorts of things. Also, an advanced social play skill is using manners, saying please and thank you. That comes much later. Saying sorry. I see that often. I did a video blog on saying sorry, where a child with very little language, with little to no language hits someone and then they're being explained to why hitting is bad and say, I'm sorry. They have, you know, hardly any words. And now they're being prompted to say, I'm sorry. They just don't understand the whole thing.

So we not only have to look at delays in expressive language, but also what they're comprehending, their receptive language. And some families have no choice. Their kids are in day care all day long or they are in preschool or at a caregiver's house all day long. But if you really do want to catch the child up and and get them to their fullest potential, they're going to need most likely some serious one to one instruction. Most research shows that kids with a diagnosis of autism need at least twenty-five hours per week of intensive one to one ABA instruction. And that's a lot of time. Lucas had 40 hours a week, and I don't see...

My approach trains the parents first and foremost and always keeps them in the captain's seat. And then they know how much therapy. It's basically we want to engage the child for all of their waking hours as many of their waking hours as possible. Their waking hours is something like one hundred hours per week. And even for older kids, we want to keep them as engaged as possible. We are in the middle at the time where I'm recording this in the middle of the COVID shutdown where parents are, you know, really struggling to keep their kids with autism, especially their older kids, engaged for long periods of time. There's a lot of free access to screen time. And that is leading to lots of stimming, lots of regression in some cases, which is so tough for parents.

So to get to those higher skills of using manners and being flexible and using language in the natural environment, we have to make sure we have those prerequisite skills, the ability to sit and learn, the wanting to be with you. We can't teach kids how to be social and play if they're trying to get away from us, trying to get back to their iPad. And so we have to do it very systematically. Make table time super fun, make it so reinforcing that the child is literally running to the table. I used to have clients where I would show up and they would go to the table and drop, try to drag the table out. That's how excited they were to see me and to get to the materials which we go over in my courses. But now let's get to this play time social time book.

As I said in the beginning of this session, this Play Time Social Time book was written in 1997. I paid about forty dollars for it. I saw the authors present at a conference. And what it does is it lays out the importance of teaching play skills and starting on page 92. We start with 20 different activities in this play book, such as a bean table, and it lists all the materials you would need, like a bean table, or two or three large tubs or bowls of beans, large spoons, different colors, cups, funnels, toy cars and trucks, small baskets and other toys and containers. Then it goes down the list and you could prompt sharing such as, "Tommy hand Suzy the big scoop or the funnel" or those sorts of things.

As you can see, these are pretty advanced language ability. So we need to know what big and small are. We need to know colors, which surprisingly gets taught much later than most kids get exposed to colors if they're not picking it up on their own. The next activity is a birthday party where we would gather table chairs, plates, spoons, play dough that you can use to make pretend cakes, teapot or picture 10 pegs for use of candles. Or you could use real candles. So what I have recommended to both teachers, these are preschool teachers or autism support classroom teachers, is to make a couple of these boxes so you have the materials altogether. So I would have in this birthday party box, I might have the script on top. And it's really important, too, that you don't use the script rotely every time the same.

And it's not to say that if the child doesn't know big and small, you could just omit that, that these are just ideas. One of the problems with kids with autism, they get very rude. So I would have a bean table box and then I would have a birthday party box of the materials already gathered. And that way we can kind of go through some natural environment teaching, whether that's at the table or on the floor, whether that's in the classroom or at home. I just find that this book starting on page ninety-two, there's twenty activities and you might even have other activities that you could just page through these and get some ideas. OK. Another great part of the book, I like two major parts of this book, the Play Time Social Time book page 136. We have scripts that systematically teach social skills to small groups of children.

So I have recommended these social skills groups. They're scripts such as language for learning, direct instruction scripts. So we would have a small group of children. You could do this if you have multiple siblings at home or you're in preschool or an ASD classroom, you could run this. Today, we're going to talk about sharing. Sharing is, you know, what are we going to talk about today? And then the class would say sharing. If you have a child who's not talking, they are not ready for this. You have a child who doesn't understand any, you know, isn't able to label, to request items.

That's really where you want to start back and teach them some beginning language before we get into this book. But I do know that there are many children who get up to this book or the play and social skill needs that this book covers. And I find it to be a great resource, especially since it's free. We are going to link that in the right below, wherever you're watching or listening.

So in summary, and then play skills, independent play skills. Also are a whole different thing to teach them. Maybe we'll do another session on that some time. But these social skill play skills for kids with autism are super important to teach. Hopefully I gave you some good ideas on where to get started and to really look at the language ability of the child and the play and social abilities before we program way too high, before we expect things to come in naturally, and before we expect that just exposure to typically developing kids is going to is going to work out well.

I have found that if the adult really teaches a child how to play, we can often transfer these skills to playing with other kids, other typically developing kids or kids with delays or disabilities. So I hope you enjoyed that short presentation on autism and play skills. And for more information about my courses and how you can get started with some of those major prerequisite skills, you can go and take the quiz at MaryBarbera.com/quiz.