Success of "Integrated Play Groups" for children with autism

This article explains how "Integrated Play Groups" where children interact with each other instead of with adults helps children with autism.

It's an often agonizing challenge facing any parent of a child with autism: How can I help my son or daughter socialize with his or her typically developing peers? The solution, SF State's Pamela Wolfberg found, may lie in a different type of playgroup that focuses on collaborative rather than adult-directed activities.

A new study shows that "Integrated Play Groups," or IPGs, developed by Wolfberg over several years, are effective in teaching children with autism the skills they need to interact with their peers and engage in symbolic play such as pretending. In IPGs, adults help children with autism and their typically developing peers engage in playful activities of mutual interest, but do not direct the play themselves. That sets them apart from more traditional interventions, according to Wolfberg, a professor of special education and communicative disorders.

"Children learn much better how to play through interactions with peers than they do from adults, because adults are not like children anymore," she said. "We can definitely have wonderful interactions with kids through play, and we should. But this is qualitatively different."

Wolfberg and her colleagues studied 48 children with autism during free-play activities, in which they did not know the other children, twice before and once after those same children participated in an Integrated Play Groups program with familiar peers. They found that, following the IPG intervention, the children's ability to interact with kids they did not know and to engage in pretend play had risen dramatically, indicating the IPGs were successful in providing them with transferable social and symbolic play skills.

Children with autism, according to Wolfberg, tend to have a "very restrictive play repertoire," in which they may have unusual interests and repeat the same activity, most often by themselves. The goal of Integrated Play Groups is to move children from engaging in lower levels of play, such as simply banging something, to engaging in more symbolic play that involves reciprocal interaction with peers.

"The earthquake-rescue theme is the most popular in San Francisco, and we had a little boy just like that, who had an affinity to bang things," she said. "So the kids came up with this idea of building cardboard blocks and having an earthquake, and he was the construction worker. He was able to participate in other kids' interest, build something more elaborate and have a whole fantasy about it."

The success of IPGs is an opportunity for parents, educators and therapists seeking to help children with autism in socializing with their peers. In addition, the IPG model also teaches typically developing children about autism and lets them learn how to form friendships with kids who might play, communicate or relate differently.

"This is what families want for their kids," added Wolfberg. "This flips around the idea that kids with autism are incapable of socializing or incapable of pretending. They have the same innate drive to participate with peers and to engage in playful experiences, but what has been happening is we have not been able to tap into their potential."

Future research will involve collaboration with assistant professor Betty Yu and graduate students to look more closely at how Integrated Play Groups can help children with autism better communicate with their typically developing peers, another challenge they face. Wolfberg also has been adapting the IPG model to be used in other countries, including Saudi Arabia, where she traveled this fall.

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Children with autism prefer play with sensory aspects

A study shows that autistic children prefer sensory play, such as pushing a windmill and watching it spin, to other types of play.

Play is critical to children's development, including children with autism spectrum disorders (ASD). Kathy Ralabate Doody, assistant professor of exceptional education at SUNY Buffalo State, observed different play options to determine those most likely to appeal to children with ASD.The findings were published in the North American Journal of Medicine and Science.

"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 ADS preferred activities that involved the vestibular and proprioceptive senses as well as other senses.

"Children with ADS 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 ADS 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."

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Play-Focused Therapy Helps Kids With Autism

This article discusses how therapy focused on play and fun is beneficial for children with autism.

Laughing, giggling and making silly faces. Building a tower of blocks together and then crashing it down. Engaging young children with autism in a program that involves such fun, interactive play can affect their brain activity, making it resemble that of children without the disorder, a new study shows.

The research is the first trial to demonstrate that early behavioral intervention may be associated with normal patterns of brain activity and improved social behavior in young children with autism.

Researchers used a tested behavioral program that has been shown to raise intelligence, language and adaptive behavior in children with autism to evaluate whether such therapy might be associated with measurable improvements in their brain activity.

The investigators found that interventions designed to enhance the ability of children with autism to attend to social cues -- like human faces -- and engage with others may help their brains develop more normally.

"After the treatment, the EEGs [brain activity tests] of the children with autism looked like those of children who were developing normally," said Sally Rogers, a study author and professor of psychiatric and behavioral sciences at the MIND Institute at the University of California, Davis, in Sacramento, Calif.

"This study should make parents optimistic and hopeful, and motivate decision makers to provide more intensive interventions for young children," Rogers added. "Results of this study underscore the importance of early detection of and intervention in autism."

The research was published online Oct. 26 in the Journal of the American Academy of Child & Adolescent Psychiatry.

The behavioral program, called the Early Start Denver Model (ESDM), was first shown in 2010 to have a measurable positive impact on children with autism spectrum disorder. The therapy involves interactive play-based, developmental activities.

Autism is a developmental disorder that appears in the first three years of life, and affects the brain's normal development of social and communication skills, according to the U.S. National Library of Medicine.

ESDM is thought to stimulate the kind of brain activity associated with the ability to recognize and perceive social information and language.

While babies and young children without autism are drawn to view such social stimuli as faces, those with autism tend to focus on objects instead.

The research involved 48 male and female children diagnosed with autism between 18 and 30 months of age. The children were randomly assigned to receive either ESDM therapy or other community intervention for two years.

Those in the ESDM group received about 20 hours a week of therapy from trained clinicians plus five hours of intervention directly from their parents, who were specially trained. The other group of children received a similar number of hours of therapy from a variety of community-based programs that did not use the ESDM approach.

After two years, all of the children were given EEGs while looking at both faces and objects. Their EEGs were compared with those of children of comparable age without autism.

"Children with autism who received ESDM had greater brain activity when looking at faces than did those who did not get ESDM therapy," Rogers said.

Twice as many of the children who received ESDM therapy showed greater brain activation when looking at faces rather than objects, such as toys, which is considered more typical of a child without autism. But the majority of those in the community therapy groups showed the reverse, or autistic pattern, responding more to objects than faces.

One expert reacted to the study with guarded enthusiasm.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children's Medical Center of New York, in New Hyde Park, was concerned that the researchers had not performed baseline EEGs on the children before starting the therapy. He also noted that valid EEGs were obtained from only a little more than half of those who received the treatment.

Despite such issues, Adesman did say the results of the study were encouraging. "It suggests that clinical improvement is associated with neurophysiological improvement, in terms of EEG," he noted.

Rogers said that it was critical that parents of children with autism understand the importance of playing with their children. "Some children with autism don't know how to communicate 'Come play with me' to their parents or they don't respond to the parents as enthusiastically as other children would," she explained.

"Parents have to take the initiative that most other children would take on their own," said Rogers.

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