Preferred play for children with autism

"Children with ASD chose to engage in play that provided strong sensory feedback, cause-and-effect results, and repetitive motions," said Doody.

One novel aspect of the research, conducted by Doody with Jana Mertz, program coordinator at the Autism Spectrum Disorder Center at the Women & Children's Hospital of Buffalo, was that the children with ASD could freely select their preferred activities. The research was conducted at a monthly event, "Au-some Evening," at Explore & More, a children's museum with exhibits that are designed to engage children through play. The event is open to children with ASD, their families, and their guests.

The most popular activity among children with ASD was the exhibit "Climbing Stairs." Children who climbed a short staircase could then drop a ball and watch it descend. Another popular activity involved a windmill. Children can push its arms, causing it to spin. A table filled with rice completed the top three exhibits among children with ASD.

In addition to the well-known senses of sight, smell, touch, taste, and hearing, Doody described others, including the vestibular and proprioceptive senses. The vestibular sense helps us keep our balance and know where we are in space; proprioception has to do with the way our joints respond to movement and pressure. "It's the sense that makes deep-tissue massage pleasurable," she said. Children with ASD preferred activities that involved the vestibular and proprioceptive senses as well as other senses.

"Children with ASD sometimes tend to crave motion, and if they can't be moving, they like to look at moving objects," said Doody, noting that motion engages the vestibular, proprioceptive, and visual senses. "So just watching the windmill engaged them. When the windmill turned in response to their push, it also provided cause-and-effect play. And the repetition of the spinning movement provided a third level of satisfaction." Climbing the stairs also satisfied multiple senses. Playing with rice provided both tactile and visual stimulation as children felt and watched the rice pour through their fingers.

By knowing the kind of play that children with ASD prefer, educators and clinicians can use such play as positive reinforcement in educational and treatment settings. "This information is especially helpful for children with ASD who have difficulty communicating their preferences," said Doody.

Parents can also benefit from the information. "A child who is playing alone is developing a degree of independence," said Doody, "and that can enable the parent or caregiver to engage in other activities, like making dinner or attending to another child. Parents might use a snow globe so the child can observe movement. Aquariums or water sculptures provide movement, too."

Some of the behaviors exhibited by people with autism -- hand-flapping, for example -- may reflect a need for sensory stimulation. "Sometimes just giving a child a string of Mardi Gras beads to swing and watch will help the child sit still," said Doody. Toys that provide sensory stimulation -- sounds, movement, or lights -- in response to an act such as pushing a button also may be well-received. However, Doody noted, the need for, and tolerance of, sensory stimulation varies by individual.

At Explore & More, children with ASD tended to avoid the exhibits that required pretending, such as imagining oneself as a butterfly or as a cook in a play kitchen. Doody explained that pretending requires a phenomenon called Theory of Mind, which is the ability to imagine oneself in the place of another. "That develops much earlier in children with typical development than in children with autism, if they develop it at all," said Doody.

Doody hopes that options for children with ASD will be built into a variety of recreational facilities, after-school programs, and playgrounds. The benefit is not only inclusion. "It also encourages social interaction between children with ASD and their peers," said Doody. "Some children with ASD are academically successful, but they struggle in social situations. So opportunities to play with their peers are really valuable."