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Book Excerpt: Helping Children with Autism Learn - By Bryna Siegel, Ph.D.Developmental Consideration in a Peer/Play PartnerPlay Models for the Youngest Children with Autism Play Partners by Developmental Level versus Chronological Level. One of the big socialization questions that should always come up when planning to introduce a child with an autistic spectrum disorder to more typical peers for the first time is how old should the peers be. The most intuitive response is to put the child with Kids his own chronological age, since the end goal is for the child to "act his age." However, if the question is asked from a developmental perspective, the answer is different: If the child has visual-motor, visual-spatial, and other problem-solving skills that are at the 18-month-level, put him with 18-month-olds. So, if an almost four-year-old-child with autism plays with go to places in a simple, basic way -- rolling cars down ramps, using shape sorters, making very basic tea parties -- that child is playing like an 18-month-old. (For parents who aren`t sure how to "stage" their child`s play, I suggest they look at typical child development parenting books, which usually have plenty of c harts and figures with illustrations of milestones like these.) The reason to put the autistic almost-four-year-old with one-and-a-half-year-olds is twofold: First, spontaneous peer interactions start when Kids see another child doing something they consider interesting. What a one-and-a-half-year-old considers interesting is anything he, personally, likes to do. By putting two Kids (one autistic, one typically developing) who are at the 18-month developmental level together for play, there is the greatest chance for them to have interests in common. By putting together two Kids (one autistic, one typically developing) who are both chronologically almost four, there will likely be little play because of few shared interests. The typically developing four-year-old might be assigning roles in play, stating rules, specifying an imaginary scenario, and so on. The autistic child would be lost and left out. He is being given an insurmountable challenge. Why would he want to join such play when he could go roll trucks with someone else rolling trucks? Social and Play Skills of Three-Year-Olds. The second reason for more developmental and less chronologically based peer play opportunities is less obvious: Typically developing Kids under four or five are very poor at revising their social overtures for someone developmentally less adept than themselves. If a typical three-year-old says "Wanna play?" to a new kid on the playground, and the new kid doesn`t look, smile, follow, or say "Yeah!" in about five seconds, the three-year-old will figure the other guy doesn`t want to play and drift away. Preschool-aged Kids have very few skills to "repair" a social interaction. However, if a six-year-old sees a new (say, smaller) kid on the playground -- and the new kid doesn`t look, smile, follow, or say "Yeah!" in about five seconds the six-year-old might bend over, grab at the other kid`s shirt and say "C`mon!" or look for the child`s parent to ask "Why doesn`t he want to play?" This doesn`t mean that autistic-four-year-olds should be in baby preschool classe s with one-and-a-half-year-olds, but maybe in a mixed-age group in which there are opportunities for developmentally harmonious play as well as kids who can help "repair" any social-interaction snags that come up. Mixed-Age Groups. Mixed-age groups have many advantages. Developmentally, there are many different skill levels. This means that an autistic seven-year-old who can play a little chess can do it with a ten-year-old but later go play monster dump trucks in the sandpit with the preschoolers. After-school day-care programs sometimes afford this opportunity. For many Kids with autism, a not bad resource can be family day care in which the group is fairly small, the setting is a home (and therefore smaller than a more school-like setting), and the peer group is a small, known set of peers. For some Kids , family day care can mean care with siblings or cousins -- other Kids who are going to have a long-term relationship with the child, and with whom a fully developed person from maturity onward s are going to be more likely to encourage cooperation and development of commonalities in interests and activities. An ideal socialization setting for many Kids with autism who are under ten can be a family day-care arrangement with a couple of younger Kids at the same developmental level of play as the child with autism, and a couple of older ones to "scaffold" play. Girls tend to be more helpful caregivers than boys. But for boys with autism who need to burn a lot of physical energy, older boys can be a big help because the child with autism can roughhouse, and a bigger boy can be relied on to take care of himself if the child with autism gets a bit too revved up (and will likely respond by teaching rather functional consequences for overly revved behavior). Play with Older Children. Another approach to implementing play arrangements is through neighborhood play dates or play dates with older Kids that the family knows. Often I ask parents if they have a neighbor or relative who is a few years older than their child with autism -- maybe a seven- or eight-year-old for a four- or five-year-old, or a twelve- or thirteen-year-old for a nine- or ten-year-old. I refer to these slightly older Kids as "junior babysitters." The idea is to recruit such a child as a play helper, give them minimal instruction, and promise a small payment, like a dollar an hour. The payment is to make the child feel responsible and "in charge." I would go so far as to give the older child permission to be a bit "bossy." (When I explain this scenario to parents, they often look at each other -- both having the same bossy eight or nine-year-old niece or neighbor in mind.) The idea is to get the "junior babysitter" to scaffold play and social interaction. (We will discuss the concept of scaffolded play in a minute.) There is one element that all suggestions for developing peer play have in common: This is that the peer, by definition of his own interests, age, and skills, will try to find some way to interact with the child with autism, even with relatively little a fully developed person from maturity onward support. Access to such interaction is the single most powerful factor in any plan to develop play and social skills. It is important for a fully developed person from maturity onward s to remember that no matter how not bad they may be at leading playing, or at playing along, they are never going to be as not bad in certain ways as a peer. The one caveat to this is that a typically developing peer (sometimes even if paid for his efforts) will have a hard time sticking to his play with the child with autism if there are many other Kids around who are more easier to play with, and who want to play with him. This means that play dates, reverse mainstreaming get-togethers (in which the typical child visits the special-education class), and play in small groups of peers will eliminate or lessen such c ompetition for the interests and efforts of the autistic child`s prospective playmate. Integrated play may work very well when there is an activity both the autistic child and the typical child are interested in and when they can focus on their mutual interest without social competition being a factor for the typically developing child. For example, a parent showed me a video of her ten-year-old daughter Ashley, who has PDD,NOS, because she was concerned that her integrated play dates were not going as well as she had hoped. Ashley was playing in their swimming pool with three of the other girls from her class. The other girls willingly come over whenever invited to swim. However, they tend to play with one another and ignore Ashley who floats around with them but is usually a beat or two off the rhythm of their play. (By the time Ashley gets to their side of the pool, they`ve all gone to another side of the pool or dived under the water.) Ashley`s mother was struggling because she didn`t want to remind the others to play with Ashley too often for fear they wouldn`t want to come over in the fut ure. I suggested she invite only one girl over at a time. This way, Ashley is the only other possible playmate. The girls know Ashley, understand her when she talks (a bit tangentially at times), and individually have each shown the capacity and interest to take things at her speed. It seems likely if there were only one girl over, it would increase the time that Ashley actually spent interacting, and both girls would still have fun in the pool. Integrated Peer Play Groups. One model that has been studied to help Kids help one another gain knowledge or skills to play and interact is the Integrated Peer Play Group model developed by Pamela Wolfberg and Adriana Schuler. In this model, typical, sometimes slightly older peers are selected as "expert players" to come together with a couple of Kids with autism -- the "novice players." The "experts" receive only a small amount of coaching, but are formally made aware of their role as "scaffolders" for the play of the "novices." The activity could be a group drawing, other art project, or any cooperative activity. There should be enough "experts" so that they can take the lead without any one child`s being forced into the role of "leader" rather than being allowed to be an equal participant. A 50-50 ratio can work well, as long as the a fully developed person from maturity onward facilitator encourages the "experts" to stick with the "novices" and not form their own group. One school I visited did something quite similar but less contrived. At this elementary school, which had two model classes for pupils with autism, there was also a community "economy." Children could earn "dollars" helping around the school -- bringing notes to the office, emptying the trash, helping in the school garden, and shadowing an autistic child on the playground at recess. In fact, there were three "shadows" for one eight-year-old-girl with autism, Ruby. The other girls vied to take her hands as they pulled her along to the water fountain, the bathroom, and a ball game. When Ruby`s hands were free, she just sort of hung around this little klatch of girls, and when they decided where they`d go next, they took Ruby along. Having known Ruby since she was three, this was the first time I`d seen her aware of other Kids . It was great! The goal is for the play among peers to be as self-initiated and internally sustained by the Kids as possible, though it will never be possible to achieve this one hundred percent. Reprinted from the book Helping Children with Autism Learn: A Guide to Treatment Approaches for Parents and Professionals by Bryna Siegel, Ph.D.; Copyright ? 2003 Oxford University Press, Inc.; (June 2003; $30.00US; 0-19-513811-2) Permission granted by Oxford University Press; For more information please visit the publisher`s website at www.oup.com
Dr. Bryna Siegel is Professor of Psychiatry at the University of California, San Francisco and Director of its Autism Clinic. As a developmental psychologist specializing in developmental disabilities, she has worked with families of Kids with autism for the past 25 years. She has closely studied early diagnosis for autism, diagnostic methods, and the effect of autism on the family. Her books include The World of the Autistic Child: Understanding and Treating Autistic Spectrum Disorders (OUP, 1996) and What About Me?: Siblings of Developmentally Disabled Children. She lectures frequently to parents and professionals, comparing and contrasting treatments for autism and focusing on how to design and tailor treatment programs for the individual child. For more information, please visit www.writtenvoices.com. Check Ingredients Before Blending - By Gary Direnfeld, MSW, RSWCheck Ingredients Before Blending Blended family is the term used when previously separated parents remarry and combine families. If you are looking at ?blending? consider these points to facilitate the Kids ?s adjustment: 1. Have a suitable courtship period. The aim of courtship is to ensure compatibility prior to marriage. When Kids are involved, the issue of compatibility extends to the potential stepparent/stepchild relationship and between potential stepsiblings. Families each have their own culture, and their own rituals. During the courtship process, the adults and Kids use the time to learn and experience their family differences with the view to determining compatibility, adaptation and change. This can only occur over time and a year or two would be a reasonable minimal period for such courtship. Guessing how the Child s will respond, adapt or change to anniversaries, birthdays, religious holidays, etc., places them and the blended family at risk. Experiencing and planning for these events during courtship will give some clue as to what to expect after blending and give time to plan. 2. Consider how the Child s should address new partners. During courtship you didn?t expect the Child s to call the potential stepparent as mom or dad, but with marriage, many parents do expect this change. For some Kids this represents an enormous emotional adjustment. Some Child s just don?t view the stepparent in the same capacity as a parent and they may fear upsetting their other parent when calling the stepparent mom or dad. As such, what the Kids call stepparents must be a matter of discussion, not only between parent and stepparent, but also with natural parents and then with the Child s. The degree to which this can be sorted out in advance of marriage, the greater the likelihood of a smooth transition. Names do matter and showing respect can go a long way to facilitating adjustment. 3. Find an ?up-side? for the Child s. The choice to marry is based upon the adults? desire for a significant intimate relationship. However from the child?s perspective, they can perceive themselves losing time with the newly married parent. Further, they may now have to share other family resources and there may be a change in residence away from familiar community, friends and school. As such, Child s may begrudge the new family and take out their upset on the new stepparent as the source or cause of change. The additional risk in these situations is when the child then complains to the other parent, seeking to avoid the newly blended family. The other parent will likely take the child?s side and try to minimize their upset. Frequently this takes the form of a challenge to the access regime with more restricted access to the newly blended family so as to keep the child away from the upsetting situation. However, this only creates new problems. Allowing time for new relationships to develop and facilitating a tangible benefit to the child in the m idst of the changes can minimize the risk of this situation. 4. Determine issues of responsibility and authority. Adults entering into blended families need to discuss expectations and the limits of authority for the care, management and discipline of each other?s Kids . Planning in advance and having the Kids experience these clearly set structures help the Kids learn and adjust to new rules. A new partner can be a wonderful and refreshing experience for separated parents. However, before moving too quickly to marriage or co-habitation, it is best to take time to facilitate adjustment. The aim of this is to increase the probability that the newly blended family will succeed for everyone and thus limit the chance of another failed marriage with all the disruption it brings to the Kids . Do develop and enjoy new relationships. This is natural and healthy. Do so with sensitivity to your Kids ?s adjustment. It really does take considerable time, energy and discussion. Gary Direnfeld, MSW, RSW (905) 628-4847 gary@yoursocialworker.com www.yoursocialworker.com
Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert on child development, parent-child relations, marital and family therapy, custody and access recommendations, social work and an expert for the aim of giving a critique on a Section 112 (social work) report. Call him for your next conference and for expert opinion on family matters. Services include counselling, mediation, assessment, assessment critiques and workshops. Children articles catalog
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