It All Comes Down to Play: Autism Play Therapy
Play is an important activity of childhood and is understood to contribute to healthy development1. It is so important that the United Nations High Commission for Human Rights has identified play as the right of every child2. Through play, children have opportunities to move, be curious and creative, learn to share, problem solve, negotiate, cooperate, communicate, and have fun.
Typically developing children often engage in spontaneous play with little or no initiation from adults. children with autism spectrum disorder (ASD) also engage in play, but it tends to be more solitary and rigid and repetitive in nature.
How Lego Therapy Can Help Children with Autism
While children with ASD play differently than their neurotypical peers, opportunities to play are equally if not more important for children on the autism spectrum. Children with ASD may benefit from play therapy.
Play therapy for children with ASD is not about taking away rigid and repetitious behaviors, but to use it as the basis for helping to develop creativity, problem-solving, and spontaneity. Here is an example. Let’s say a child with ASD likes to sort and stack coins by size or denomination on a table top.
A therapist may introduce a floor mat that has circles the size of various coins drawn on it. These circles may be randomly placed on the mat or arranged in patterns. In order to engage in this new coin activity, the child needs to communicate a desire to be given a coin, to place it on a corresponding circle, and ask for more.
Working on the floor versus at a table changes up the activity as well. The key takeaway is that in play therapy for children with ASD, a skilled therapist will understand what the child identifies as valued play and gently adds in variations to the activity to develop a broader range of prosocial play skills.
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Building Social Skills
The ability to form meaningful and self-fulfilling interpersonal relationships aligns with social communication skills. Social communication skills help people function successfully in their daily lives. Individuals with ASD, at varying degrees, lack effective social communication skills. This also includes the theory of mind; recognition that there are other ways of looking at the world than through one’s own lens, poor eye contact, and reciprocal communication.
And, while there are many social skills interventions that are available for individuals with ASD, few of the interventions lead to generalizable and practical outcomes. What is learned in a structured social skills program often cannot be applied in the ‘real world.’
How LEGO Therapy Can Help Children with Autism: Teaching Your Child Social Skills
Are you aware of the many LEGO social skills activities available for kids on the autism spectrum? Enter LEGO Therapy—a naturalistic intervention. For many with ASD, LEGO Therapy provides a satisfying means to address social communication skills, and so much more. It captures a child’s intrinsic interests and builds (no pun intended) on a foundation of motivation and behavior change. Invented by Ole Kirk Kristiansen, the family-owned LEGO Group was founded in 1932, much to the delight of millions of children and adults throughout the world. What we recognize as the modern-day LEGO brick was introduced in 19583.
LEGO combines two Danish words. “leg godt,” which means play well3. The fundamental premise of LEGO Therapy is to do just that. So, let’s get our bricks on and talk about LEGO Therapy for children with ASD through the lens of occupational therapy.
Using LEGO as a therapeutic medium was first reported in the research literature by Dr. Daniel LeGoff in 20044. He was trying to provide effective social skills intervention for children with ASD with few positive outcomes. Many of the available programs were, in Dr. LeGoff’s words, uninteresting and lacking in intrinsic value for children.
Equally as important, he felt the results of most social skills programs were not generalizable from one setting to another, that is, enabling the skills to transfer from classroom or clinic to the playground. Dr. LeGoff developed an intervention he called LEGO Therapy to fill the void in effective social skills programs4.
Is LEGO Therapy Effective?
As to the effectiveness of LEGO Therapy and LEGO interventions for children with ASD, results are promising. Findings of a study of a community-based LEGO social skills intervention involving children with ASD, their siblings, and peers showed improvement in play and social skills for the children with ASD5.
A review of 15 studies that involved using LEGO Therapy or LEGO interventions for children with ASD found that in 14 of the 15 studies, improvement in social and communication skills such as desire to play with others, improved social interactions, better coping, and engagement with family was noted after participating in LEGO Therapy or LEGO interventions 6. The results are promising. The best way to know if LEGO Therapy is right for your child is to give it a go.
Is LEGO Therapy Good for Autism?
There is a reason to believe that LEGO Therapy can be good for children with ASD, particularly if they have an affinity or interest in the building. For instance, results of an observational study of a preschooler with ASD found that after participating in three sessions of LEGO interventions with typically developing peers in his preschool classroom, the young boy demonstrated improved social interactions, eye contact, verbal skills, a desire to play with others, and willingness to share7.
Another small study found that prosocial playground behaviors of children with autism improved after participating in a ten-week LEGO therapy program and these results were long lasting8. Knowing that there are research findings that support the effectiveness of LEGO therapy and that it may be good for children with ASD, let’s take a look at how LEGO therapy works.
How The Therapy Works
LEGO Therapy is far more than transforming a pile of LEGO bricks into a completed project. It is a form of group play therapy with specific guidelines. For many reasons, LEGO Therapy is a successful social skills intervention for children and youth with ASD. While the sky is the limit in terms of what can be constructed from LEGO blocks (have you seen entire cities constructed in miniature from LEGO blocks?) they are a highly-structured and systematic toy.
Structure and systematic materials appeal to many individuals with ASD. Because of the highly-structured and predictable nature of LEGO, it is a desirable medium for children with ASD, particularly those who are more high functioning. So far, so good.
Benefits
Engagement in construction activities, like LEGO, is second only to rule-governed games in terms of effectively facilitating social interaction as compared to dramatic and functional play9. LEGO Therapy is a successful intermediary to address social communication skills. In fact, as we explored above, research has found significant benefits associated with LEGO Therapy.
They include improved sustained initiation of social contact, improved length of social interaction, and reduced rigidity for children participating in LEGO Therapy pre-treatment and compared to those who were on a waiting list to participate in LEGO Therapy4,10.
LEGO Therapy Training
LEGO Therapy provides natural reinforcement, as the building is a highly desirable activity. The LEGO Therapy process requires a division of labor, communication, rule setting, social engagement, and oh yes, it is fun. LEGO Therapy involves several roles for a group of three children to fulfill, which ideally shift within the course of a 60-minute session. The roles are engineer, supplier, and builder4. The engineer directs and describes the instructions for the project.
The supplier locates the correct pieces and passes them on to the builder. The builder puts the bricks together. For the project to go from bricks to the final product, the three players must be able to communicate with each other, verbally or non-verbally, and to engage in joint attention, creativity, and problem-solving. Rules also have to be established between the ‘players.’
They typically include construction rules; whoever breaks the project must fix it and put pieces back from where you got them; conduct rules; no stepping on the LEGO, furniture, or each other; and social rules; do not take LEGO away from each other, do not tease, and no shouting4.
Typically, parents are not involved in LEGO Therapy, as they may disrupt (unintentionally!) the flow of the building process. Instead, parents may use LEGO Therapy time to have their own informal support group.
What are the Benefits of Lego Therapy?
As an occupational therapist, I recognize an even more expanded value of LEGO Therapy beyond its demonstrated capacity to help children improve social communication skills. Here is why. The basic premise of occupational therapy is the therapeutic use of everyday activities (occupations) with our clients.
Occupational therapy is also all about client-centered and individualized practice; identifying what is meaningful and important to those we work with and incorporating it into an intervention plan. The primary occupation of childhood is play. LEGO is one form of play.
Using LEGO is clearly occupation-based and projects can easily be individualized and graded to be easier or harder to meet every child’s needs. Using LEGO as an activity is enjoyable and meaningful for many children and youth!
While working on building projects or simply using the bricks as a base therapy tool, LEGO as a therapeutic medium also offers the following therapeutic benefits through the lens of occupational therapy:
Therapy Ideas
Social Skills
- Take turns connecting the bricks
- Learn to ask for help
- Be courteous to each other
- Make eye contact: look at the therapist and each other
- Stay in the building circle
Fine Motor Skills
- Reach for, grasp, and release bricks located below, at, and above waist level
- Practice various prehension (grasp) patterns, such as picking up a LEGO with thumb and index finger, thumb and ring finger, etc.
- Move small bricks from one place to another within one hand while the other rests on a table or in the child’s lap
- Pick up and store bricks one at a time with and in one hand and then release them, one by one using only that same hand
- Lock the bricks together and take the project apart, one brick at a time
- Place bricks in containers using oversized tweezers, tongs, or hinged chopsticks
Visual Perceptual Motor Skills
- Follow a diagram to build a project
- Correctly align the bricks, so all pieces fit together
- Match bricks by size or shape
- Create symmetrical projects
- Find specific bricks when mixed in with others of varying colors, size, and shape
- Trace around bricks with fingers and pencils
- Identify the shape of a brick with eyes closed
Cognitive Skills
- Identify bricks by color, size, and shape
- Create towers with largest bricks on the bottom (base) and smallest on top
- Match bricks to pictures of a specific brick
- Count total number of bricks or bricks by color
- Find other objects in the clinic that are the same color or shape as a particular brick
- Sort bricks correctly into containers identified by size or color
- Follow directions to place bricks over, under, between, on top, on the right, left of a line, doll, or body part
Sensorimotor Skills
- Lock bricks together
- Find objects such as crayons, keys, coins), and marbles hidden in a bucket filled with bricks
- Stand on and walk barefooted over a 12” wide LEGO ‘road’ without falling off
- Pick up and drop bricks into a bucket when laying on belly in a net swing
- Dip bricks into a shallow tray of paint (bumpy side down) and stamp onto heavy paper secured to a tabletop or vertically along a wall
Self-efficacy Skills
- Express pleasure at engaging in and completing the task
- Initiate a desire to use LEGO at subsequent therapy sessions
LEGO Therapy at Home
While it is not LEGO Therapy without formally being implemented by a therapist, there is good reason for two or three ‘LEGO-heads’ to informally work together to build with LEGO for an hour or so on a regularly scheduled basis. This gathering of children can be called a club, which by definition implies connection and socialization.
It could be mutually beneficial on many levels, socially, cognitively, and motorically for children and a built-in time for parents to gather and socialize while their children build. A LEGO club connects children with ASD while connecting the bricks. While not formal therapy, LEGO clubs can happen on a rotating basis at children’s homes or perhaps as part of an afterschool program or at a community center.
Let’s Build
The holistic nature of LEGO Therapy makes it an applicable intervention for therapists across disciplines. It can also be informally implemented in afterschool clubhouse programs, homes, and at camp. LEGO is therapy, but most importantly, LEGO is fun. Build on!
Resources
Recommended Reading
Thomsen, A; (2018). Thera-build with LEGO®. London: Jessica Kingsley Publishers
Resources:
- American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.682006
- United Nations High Commission for Human Rights. (1995). Fact sheet No.10 (Rev.1), The rights of the child. Retrieved from https://www.ohchr.org/en/professionalinterest/pages/crc.aspx
- The LEGO Group. (n.d.). The LEGO Group History. Retrieved from: http://www.lego.com/en-us/aboutus/lego-group/the_lego_history
- LeGoff, D.B. (2004). Using LEGO as a therapeutic medium for improving social competence. Journal of Autism and Developmental Disorders, 34 (5), 557-571.
- MacCormack, J.W.H., Matheson, I.A., & Hutchison, N.L. (2015). An exploration of a community-based LEGO social-skills program for youth with autism spectrum disorder. Exceptionality Education International, 25(3), 13-32. http://hdl.handle.net/10133/5135
- Lindsay, S., Hounsell, K.G., & Cassiani, C. (2017). A scoping review of the role of LEGO therapy for improving inclusion and social skills among children and youth with autism. Disability and Health Journal, 10 (2), 173-182. https://doi.org/10.1016/j.dhjo.2016.10.010
- Pang, Y. (2010). LEGO games help young children with autism. International Journal of Education, 2(2), 1-9. https://doi.org/10.5296/ije.v2i2.538
- Andras, M. (2012). The value of LEGO therapy in promoting social interaction in primary-aged children with autism. Good Autism Practice, 13(2), 18-25.
- Owens, G., Granader, Y., Humphrey, A., & Baron-Cohen, S. (2008). LEGO therapy and the social use of language programme: An evaluation of two social skills interventions for children with high functioning autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 38, 1944-1957.
- LeGoff, D.B. & Sherman, M. (2006). Long-term outcome of social skills intervention based on interactive LEGO play. Autism, 10(4), 317-329.
This article was featured in Issue 39 – Working Together to Communicate Better
