LEGO® Therapy: How to Build Connections with Autism – One Brick at a Time

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 19581.  LEGO® combines two Danish words. “leg godt,” which means play well1The fundamental premise of LEGO® Therapy is to do just that. So, let’s get our bricks on and talk about LEGO® Therapy through the lens of occupational therapy.

autism-lego-therapy

Fundamentals

The ability to form meaningful and self-fulfilling interpersonal relationships is closely aligned 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 includes 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 lead to generalizable outcomes. What is learned in a structured social skills program often cannot be applied in the ‘real world.’ Enter LEGO® Therapy; a naturalistic intervention, that for many with ASD is a satisfying means to address social communication skills, and so much more. LEGO® Therapy captures a child’s intrinsic interests and builds (no pun intended) on a foundation of motivation and behavior change.

Using LEGO® as a therapeutic medium was first reported in the research literature by Dr. Daniel LeGoff in 2004.  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 programs.

Process

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 LEGOs® (have you seen entire cities constructed in miniature from LEGOs®?) 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.

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 play3.  LEGO® Therapy is a successful intermediary to address social communication skills. In fact, 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® Therapy2,4.

LEGO® Therapy provides natural reinforcement, as building is a highly desirable activity. The LEGO® Therapy process requires a division of labor, communication, rule setting, social engagement, and oh yes, 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 builder2. 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. In order for the project to go from bricks to 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; whomever 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 shouting2. 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.

Connections

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 occupations-based and projects can easily be individualized and graded to be easier or harder in order 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:

       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 over sized 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
  • With eyes closed, identify the shape of a brick

       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
  • Correctly sort bricks 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 (e.g. crayon, key, coins) 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 table top or vertically along a wall

       Self-efficacy Skills

  • Express pleasure at engaging in and completing task
  • Initiate 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 (call it a club!) to build with LEGO® for an hour or so on a regularly scheduled basis. 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. 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

  1. The LEGO® Group. (n.d.). The LEGO® Group History. Retrieved from: http://www.lego.com/en-us/aboutus/lego-group/the_lego_history
  2. LeGoff, D.B. (2004). Using LEGO® as a therapeutic medium for improving social competence. Journal of Autism and Developmental Disorders, 34 (5), 557-571.
  3. 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.
  4. LeGoff, D.B. & Sherman, M. (2006). Long-term outcome of social skills intervention based on interactive LEGO® play. Autism, 10(4), 317-329.

Amy WagenfieldAmy Wagenfeld, PhD, OTR/L, SCEM is the Research Coordinator at the Els Center of Excellence in Jupiter, FL and Assistant Professor in the Department of Occupational Therapy at Rush University. She received her BS in occupational therapy from Western Michigan University, an MA in human development from Loyola University Chicago, and a PhD in education from Walden University. Amy presents on and publishes widely in peer-reviewed and popular press journals, magazines, and books, on topics relating to occupational therapy, interprofessional collaboration with designers, and access to nature. She is co-author of Therapeutic Gardens: Design for Healing Spaces, published by Timber Press.

The Els for Autism Foundation was established in 2009 by Liezl & Ernie Els shortly after their son Ben was diagnosed with autism. Els for Autism is committed to helping people on the autism spectrum fulfill their potential to lead positive, productive and rewarding lives. http://www.elsforautism.com/site/PageServer?pagename=Center_Excellence

This article was featured in Issue 39 – Working Together to Communicate Better

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