* appropriate behavior
* task completion
* imagination
* turn taking
* building relationships
* joint attention
* imitation
* appropriate language
* tolerance to a variety of ways to play with toys
* reciprocal interaction

and most of all to have fun. Play, essentially, is an important skill that compliments ABA and generalizes skills taught formally.

Below are brief summaries of clients that I have worked with who, after years of dedication, learned to have fun with toys.

One child I worked with started with no play skills and did not enjoy formal teaching of play. After three years of rigorously playing with a variety of toys, he now has favorite toys and will spend time independently playing.

Although there are kids who must be taught formally on how to play by putting play tasks in an ABA program, this particular child was not having fun. The team worked especially hard to motivate this child to play. This particular play program was taught informally and had to be fun. Attention to a task was also difficult for this child, as he would not sit for more than a few seconds at a time.

During countless sessions, I did everything possible to make this child ENJOY play and not just go through a rote script that was taught to him. I used a lot of social reinforcement, as this was something he liked. As an example, the child and I would build blocks and then crash them. When the blocks crashed, I fell back and pretended that I was dead. This sparked laughter, so we did it again and again. Another instance that I can recall is playing a bead maze. As a way to prolong sitting and playing, I would make funny noises or change the tone of my voice when talking. This child enjoyed this tremendously. I was able, through social interaction, to pair this enjoyment with playing.

Sitting down to play with a toy has also gradually increased and he now sits for up to 15 minutes playing with a variety of toys.

This child is now 5 years old. Through years of dedication, our team was able to drop our SD voice and formal teaching style and have fun with play. In turn, this child learned that playing IS fun and it is not a chore that must be completed.

Now, when I do therapy, this little boy will sit happily playing with one of his favorite toys while I set up a program. Every time I see this, I smile and always treasure these precious moments.

Since each child with autism is unique and possess different strengths and weaknesses, I have had other clients in which there was a formal toy play program. Play was geared towards appropriate usage of certain toys. For example, when teaching play-dough, certain tasks were targeted such as rolling play-dough with a rolling pin, cutting play-dough and making shapes from cookie-cutters. For these children, SD voices were used, but in a natural tone of voice.

After targeting task in play, this child will now naturally roll play-dough with a rolling pin and enjoys making countless shapes from cookie-cutters. As well, therapists have also taught numerous other play tasks for play-dough in a natural manner such as making snakes, balls, or spaghetti from the play-dough machine.

For other children, certain rigidity patterns were targeted in a toy play program. For instance, a child may string beads in a certain order, or must complete the whole task of beading and cleaning up with no interruptions. For children that have rigidity behaviors, therapists work at breaking these patterns by interrupting a child’s play sequence, or changing it up. As an example, to disrupt a ritualistic behavior I often play “dumb” and do other things with the toy. For example, if a child always has to put the basket ball through the hoop, I put a block through the hoop or bounce the basket ball around. In the beginning, children with autism will resist any change in their play, and therefore will try anything to make a therapist stop. It is the therapist’s job, however, that once a goal has been set, to go through with whatever you are doing. It is important, however, to follow the program supervisors suggestion on the amount of disrupting rigidity behavior as to not overwhelm the child. Children with autism will soon learn to tolerate other ways to play with a toy and may even find it entertaining and fun along the way.

It is true, as in Maurice’s (1993) case, that in approximately 20% of children, development is normal in the first 2 years of life (DSM IV, 1994). Between the second and third year of life, however, parents report a regression of language and then finally an abrupt stop in development (DSM IV, 1994). According to the DSM IV (1994), there are core deficits and excesses in autism that must occur before the age of 3 for a proper diagnosis.

Main deficits in children with autism can affect communication, play and social interaction (DSM IV, 1994). Impairments in communication are primarily associated with expressive and receptive language. Language can be delayed (DSM IV, 1994), or non-existent in which other forms of communication such as Picture Exchange Communication (PEC) might be used (Bohdanna Popowycz Kvam, personal communication, November 1, 2002). Language can also be impaired in the form of a lack of spontaneity (i.e. “I see a car”) or reciprocal statements (i.e. “Tickle my tummy”), pronoun reversal (i.e. “This is your [instead of my] bedroom”), echolalia in which children repeat words said to them and in, “pitch intonation, rate, rhythm [and] stress” (DSM IV, 1994; Schopler, Riechler, DeVellis & Daly, 1980). When children do acquire some language, it can be extremely limited and can largely encompass an array of unique idiosyncrasies such as phrases from books, movies, songs or funny sounding words like “gasoline” which can be spoken during inappropriate times (DSM IV, 1994). Not only is expressive language affected, but so is receptive understanding of spoken language. An impairment of receptive understanding may cause enormous frustration for children trying to understand language and for parents who ask children to do simple commands such as, “go get your shoes and coat” (DSM IV, 1994). Parents often complain that the first sign of something wrong was that their child did not respond to their own name (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).

The areas of parallel, associative, cooperative, imaginary and interactive play can also be impaired in children with autism (DSM IV, 1994). Some children with autism unfortunately do not know how to play since they may lack imitation skills. When they do play they usually engage in perseverative play of doing the same actions over and over again. They can also form ritualistic patterns during play in which play sequences must be exactly the same each and every time (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).

As well, social interaction can be severely affected since autism means to be isolated from others (Maurice, 1993). Deficits in social interaction can take the form of a lack of sustained eye contact, asking questions, nonverbal cues such as tapping a person’s shoulder to get their attention and including other people in their play (DSM IV, 1994). Children with autism also may not recognize other people as sources of social enjoyment and might prefer to be isolated from others since it is more reinforcing to be alone and comfortable than to be forced to engage with other people (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).

Autism can also be characterized by a series of marked excesses. Besides perseverative and ritualistic behaviors, self-stimulatory behaviors can also exist in children with autism (Bohdanna Popowycz Kvam, personal communication, November 1, 2002; Lovaas, 1987). These behaviors appear to look odd to others since they do not represent normal development in children. Examples of self “stims” include verbal (i.e. repeating a word), visual (i.e. using your peripheral vision to look at everything) or tactile (i.e. licking books) (Bohdanna Popowycz Kvam, personal communication, November 1, 2002). Children with autism can also exhibit self-injurious behaviors or severe aggression and tantrums (DSM IV, 1994). As well, some children can be hypersensitive or hyposensitive to any of our five senses (DSM IV, 1994).