Special Educator Roles

Teaching Play Skills toChildren With Autism Using

Visually Structured TasksPatricia K. Hampshire and Jack J. Hourcade

As an early childhood special educa-tor, Ms. Pool is proud of her elemen-tary school's commitment to providingspecial education programs to stu-dents with disabilities in inclusive set-tings. She is especially excited aboutMs. Carter's flrst grade classroom, inwhich Keith, a 7-year-old boy diag-nosed with autism spectrum disorder(ASD), has been placed for the past 2months.

However, the two teachers havebecome increasingly concerned aboutKeith's obvious social isolation in theclassroom. During relatively unstruc-tured free and playtime activiäes,Keith typically sits by himself in onespecific location, repetitively rockingback and forth while quietly hum-ming. Other students do not seem toenjoy this activity, so Keith is usuallyleft alone during these times. Ms.Carter and Ms. Pool are convinced ofthe benefits that enhanced socialinteractions could have for Keith.They also believe that if Keith coulddevelop more appropriate toy playbehaviors, other students would bemore likely to play with him. Thequestion they both pose is how dothey best teach Keith these skills?

Young students diagnosed with ASDincreasingly are receiving their educa-tional programs in inclusive settings,learning side by side with typicalpeers. These students often display

26 COUNCIL FOR EXCEPTIONAL CHILDREN

lower levels of social interaction(including appropriate play behaviors)than do other students (Bregman &Higdon, 2012; Smith, 2011). Therefore,any interventions implemented ininclusive settings must be tailored tothe individual child's needs. Giventhese potential challenges, providingstudents with ASD in inclusive schoolsettings with opportunities to interactwith students who have more estab-lished toy play and social skills can beespecially valuable.

One way teachers can help studentswith ASD develop these skills is tounderstand the progression of howyoung children learn to play. Generally,the accepted progression of play skillsis (Charlesworth, 2011):

• Solitary play (e.g., shaking objects,reaching out for toys, showing andpulling toys).

• Parallel play (i.e., playing nearanother child but not interacting).

• Associative play (i.e., sharing toyswith peers, but each child goes hisor her own way).

• Cooperative play (i.e., children worktogether toward a common goal orshare a fantasy theme).

In the earliest stages of play, teach-ers working with students like Keithneed to know that appropriate interac-tions with toys facilitate the develop-ment of later and more social levels of

play. As Weiss and Harris (2001)described, children first establish thefoundations of subsequent social inter-actions by learning basic toy manipula-tion skills. Once the child has estab-lished these skills in isolation, they canthen be expanded into the associativeand cooperative levels of play.

In this way, students with ASD, likeKeith, can gain more success in toyplay activities and then enjoy success-ful interactions with peers. This pro-gression of skills is especially criticiil inthat students with ASD often exhibitlower levels of play behaviors than dotheir typical peers (e.g.. Barton &Pavilanis, 2012; Barton & Wolery,2010). In addition, their play activitiesmay be idiosyncratic and/or unusual(e.g., stereotyped or inappropriatelyrepetitive; Barton & Pavilanis, 2012),further inhibiting the possibilities forsuccessful social interactions withclassmates. For too many students withASD, invaluable social interactionopportunities with classmates may belimited simply by their lack of develop-ment of appropriate play skills.

However, as teachers and parentswork with children with ASD at anearly age, these learners can besystematically taught appropriate playbehaviors that can then lead toenhanced social opportunities. In thisarticle, we share how teachers candevelop and implement systematicinstructional strategies incorporating

visual structuring to elicit more suc-cessful play behaviors for students likeKeith in inclusive settings.

Visual Processing andVisual SiTucluring

Although students with ASD often areseen primarily in terms of skill deficits,a more accurate and productive viewalso notes that these students may pos-sess unique skill sets relative to theirtypical peers. One such recognizedstrength for students with ASD may bein the area of visual processing. As

described by Temple Grandin (1995)taking in information visually enablesmany individuals with ASD to processnew content in a more concrete way,as mental images can be "stored" andlater accessed. Educators teaching playand social skills should remember thattraditional methods that are language-based have been found to be less effec-tive for many students with ASD whooften have difficulty understandingabstract concepts and words with dualmeanings (Mesibov, Shea, & Schopler,2004).

Taking advantage of this populationof students' preference for visual stim-uli, teachers structuring materials forlearners through this modality is anincreasingly common practice (Mesi-bov & Shea, 2010; National ResearchCouncil, 2001). Using visually struc-tured activities provides students withASD materials with cues to assist themin responding correctly. In effectivevisually structured activities, thematerials are organized and presentedin a planned, sequential, and logicalway. This planning may incorporateadditional visual cues to enhance thesubsequent acquisition of the skill. Byvisually structuring materials, teacherscan help students with ASD focus moreon essential information and cueswhile minimizing attention to irrele-vancies (Ganz, Earles-VoUrath, & Cook,2011).

Effective visual structuring providesstudents with ASD with stable cues

that can be repeatedly accessed overtime, thus reducing overreliance onadult prompting (Hodgdon, 1995). Thebenefits of visually structured materialsinclude (a) expansion of social skills(Laushey, Heflin, Shippen, Alberto, &Fredrick, 2009), (b) task accuracy andindependence (Hampshire, Butera, &Bellini, 2011), and (c) effective manage-ment of transitions (Banda, Grimmett,& Hart, 2009). These cues can then beused in a variety of settings includinghome, school, and community. Visualstructuring strategies also can help stu-dents with ASD master appropriate toyplay behaviors and subsequent socialinteractions. The following five-stepsequence to developing effective visu-ally structured activities explains howthis might be done for a child likeKeith to help increase his peer interac-tions and play behaviors.

Development andImplementorion ofVisually SIruclured Tasks

Step 1 : Identify ReinforcingPlay Materials

The first step for developing a visuallystructured play task is identifyingpotentially reinforcing play materials.Initially the teacher might spend sometime observing the child in a variety ofsettings, including home and school.As part of this initial information-gath-ering phase, the teacher might also askthe child's parents to observe the child,noting any favored toys or materials.

In some cases, the teacher and/orparent might observe that the childperhaps does not prefer any particularitems, but instead certain attributes ofseveral related items. For example, thechild may show a strong preference forthings with wheels, or for items withsmooth textures (e.g., plastic blocks).The goal is to identify items or itemattributes that the child has a prefer-ence for, but does not currently engagewith in a functional way. These itemsmay facilitate the progress into thenext stage of an imaginative sequenceof play.

LGHING EXCEPTIONAL CHILDREN JAN/FEB 2014 27

Based on observations in the schooland home setting, Keith appeared toprefer items that "fit together. " Forexample, Keith's mom reponed thatwhen playing with markers at home,he consistently put the cap back on themarker immediately after he was fin-ished with it. Similarly, whenever Keithsaw a cup or a cooking pot with anunattached lid, he typically quicklysought to attach the cover.

At school Keith's teacher saw simi-lar behaviors, and noted that he par-ticularly sought out such items as puz-zles. Tinker Toys, and other materialsin which items fit together. Given thisobserved preference for fitting itemstogether, it was determined that Legosmight be a good place to start teachingKeith toy play behaviors.

Step 2: Task Analyze aPlay Sequence

Next, the teacher should determinehow the student might play with thetargeted items in a way that would pro-mote later elaboration, imaginativeexploration, and associative and coop-erative levels of play. This processmight begin by the teacher thinkingabout what a student could do withthe materials. The teacher can observehow otber students in the classroomengage with similar materials.

Based on ohservations in

the school and home setting,

Keith appeared to prefer items

that "fit together."

Once the teacher has identified apossible play sequence, he or shemight then task analyze the sequenceto determine the specific steps thechild must go through to complete thatplay sequence. An additional consider-ation is to estimate how much support(prompts or cues) the learner withASD might require with each step ofplay. Once the individual steps in theplay sequence have been determined,the validity of this proposed sequenceshould be conflrmed by having anotheradult (e.g., a paraprofessional) or apeer already competent in the task go

Figure 1 . Keith's Task Analysis for Legos

Time to Play With Legos!

1. Place a long blue Lego block on the table.

2. Pick up a long green Lego block.

3. Place the long green Lego on top of the long blue Lego block, and pressdown until secure.

4. Pick up a small blue Lego block.

5. Place the small blue Lego block in the middle of the long green Lego block,and press down until secure.

6. Pick up a long red Lego block.

7. Place the long red Lego block in the middle of top of the blue Lego block,and press down until secure.

8. Pick up a small blue Lego block.

9. Place the small blue Lego block in the middle of the top of the long red Legoblock, and press down until secure.

10. Pick up a small red Lego block.

11. Put the small red Lego block on top of the smallblue Lego block, and press down until secure.

12. Pick up a long green Lego block.

13. Place the long green Lego block on top of thesmall red Lego in the middle, and press down until secure.

14. Finished!

through each step to identify anypotential unidentified issues (SeeFigure 1 for an example of a taskanalysis of Keith's Lego toy skills).

After completing the task analysis,the teacher should consider how thesequence of steps would be taught tothe student. Whereas many studentswith ASD struggle with written lan-guage, others are competent readers. Inthe latter case, the teacher might use awritten list of short instructional phras-es, one per step (as in Figure 1) or useimages on a mobile device or simpleimages to convey each step. If thechild is at an emergent reader level,alternative visual cues with wordsmight be added to the written instruc-tions.

Step 3: Visually Structure theMaterials

The next step for the teacher is toplan the visual structure of the materi-als. In doing so, the teacher shouldremember that in effective visualstructuring, the materials are inessence the instructions. The order inwhich the materials are presented

serves to cue the learner, giving theorder in which the task steps shouldbe done. Mesibov et al. (2004) sug-gested three key areas to considerwhen visually structuring any teach-ing materials: (a) visual organization,(b) visual clarity, and (c) visualinstructions.

Visual Organ-izatiora.Visual organi-zation refers to the way in which thematerials and physical space of tbetask are organized and presented bythe teacher to the learner. Especiallyearly on, materials should be presentedin a consistent and predictablesequence. This sequence may be espe-cially critical in teaching toy play skillsto students with ASD given their fre-quent strong preference for organiza-tion and "sameness." Good visualarrangements include presenting onlythose materials necessary to completethe activity, eliminating irrelevant andpotentially distracting materials. How-ever, as each step in the sequence ismastered, such distractors may be sys-tematically introduced to furtherenhance student independence andgenerahzation.

28 COUNCIL FOR EXCEPTIONAL CHILDREN

Figure 2 . Visual Organization: Key

1

V

y day on tin*

/ —Containers used to keepmaterials together.

Components for Visually

m\ mm

Only materials present arethose needed for the activity.

Organizing Toy Play

1

Materials

\ Consider the Stability of the\ materials—as unstable materials

\may prove to be a distraction.

An additional consideration is thestrength and stability of the materials.Especially early on, toy materials usedshould be especially sturdy to mini-mize student fixation on any instabilityof the materials (Mesibov et al, 2004).

In teaching Keith toy play skillswith the Lego blocks, instead of simplyputting a pile of blocks on the floor infront of the child, the teacher couldpresent the blocks in a series of bins,sorted by size and/or color. To mini-mize learning errors, the teachershould assure beforehand that the binsare not too small or too large for thenumber and sizes of the Lego blocks.This placement reduces the possibilitythat extraneous bin space will serve asa distractor for the students, who mayfixate on this irrelevant feature of thetask. (See Figure 2 for additional visualorganization strategies.)

Visual Clarity. Visual clarity refersto the visual cues the teacher incorpo-rates in the presentation of the materi-als that will best draw the student'sattention to critical features of the task.Examples include color coding, label-ing, highlighting, and exaggeration. Forexample, for Keith's Lego blocksinstruction, color cues were inherent inthe task, as both the completed modelLego assembly and the individual parts

Keith was to use were already color-coded. (See Figure 3 for an illustrationof how visual clarity was considered inKeith's structured materials).

Visual Instructions. Visual instruc-tions refers to how the teacher commu-nicates to the student the expectationsfor engaging in the activity. This stepof the play process can be given to stu-dents through a variety of visual cues.A particularly valuable strategy is toteach the student simple and typicalusage patterns employed in many envi-ronments (e.g., left to right and top tobottom). To teach the typical left-to-right sequence used in so many dailytasks (e.g., reading and writing), theteacher might consistently lay out theplay materials left to right in the orderin which they will be used.

Effective visual presentation ofinstructional materials might initiallyadditionally contain supplemental cuesfor the learner to enhance the under-standing of as well as independence ofthe task in the early stages of learning(Mesibov et al, 2004). For example,with students who have mastered basicnumber skills, number signs might beadded to each of the physical objectsthemselves, with the first object to bemanipulated identified as "1 ," the nextobject as "2," and so on. For students

with ASD who are not yet reading, theteacher might prepare a series of pic-ture prompts that illustrate each of theindividual steps of the play sequence.These picture cues might include pho-tographs of the learner or another childexhibiting the correct response, and/orpictures of what the completed steplooks like. These picture prompts mightbe paired with appropriate verbalprompts. As the student comes todemonstrate greater learning and inde-pendence in the skill, these promptscan be gradually reduced.

In the case of Keith learning to playwith Legos, if the inherent color cuesof the Lego pieces had been insuffi-cient for him to complete the task, theymight have been supplemented withnumbers attached to each piece in theorder that it was to be handled. Inaddition, these numbers could bematched with the same number on theLego piece in the model.

Other ways to present visualinstructions include using visual"mini-schedules," and providing amodel of a completed play sequence.Mini-schedules typically consist ofthe task-analyzed steps of the routinepresented in a visual format (usuallywritten with accompanying pictures).When using a mini-schedule, as

TEACHING EXCEPTIONAL CHILDREN JAN/FEB 2014 29

Figure 3 . Visual Ciarity: Colors Can Be Used to Increase Visual Clarity in Structured Toy Play Materials

Instead of using all the samecolor Legos, different colorswere used to highlight thedifferences between blocksand the order of the sequenceshown in the model.

students complete each step of theactivity they cross off that step andproceed to the next. For learners whoalready use a visual schedule in dailyroutines, a mini-schedule to teach atargeted toy skill sequence may be anespecially promising strategy, as thestudents will already be familiar withthe basic strategy.

For Keith, including a flnal picturemodel of the Lego structure was deter-mined to be an effective way to clarifythe targeted play skill outcome. (SeeFigure 2 for an example of a picturemodel. Figure 4 illustrates a mini-schedule as well as a left-to-rightsequence cue.)

Step 4: Teach With Prompting

Once the teacher has selected andstructured the play materials, the next

step is to teach the child how toengage with the materials. Using astructured system such as leastprompts has been found to be highlyeffective with individuals with ASD(Neitzel & Wolery, 2009). The research-based system of least prompts uses aprompt hierarchy ranging from least tomost intrusive (e.g., visual prompt,verbal prompt, hand-over-hand, partialphysical, full physical). For example,when teaching a new skill, the teacherwill provide a visual cue (perhapspointing), indicating to the child thenext step in the activity. If the child isnot able to complete the step with thatlevel of prompting, the teacher willprovide the next level of prompt on thehierarchy and so on until the child isable to complete the step. Such anapproach assures that students receive

the minimal amount of help necessaryto complete the task, simultaneouslyenhancing both ultimate task inde-pendence and instructional efflciency.

Initially, Keith required a mix of ver-bal and gestural prompts paired withthe aforementioned color cues. Thesesupplemental cues were quickly fadedas Keith learned the task. Anotheroption for Keith would have been touse a visual mini-schedule that wouldhave served as a consistent source ofinformation as Keith worked towardindependence in a toy play activity.

Step 5: Expand and Generalize

Once the child has learned to completethe play sequence independently, theteacher should move toward expansionand generalization of the new skills. Aspreviously noted, a powerful rationale

Figure 4 . Visual Instructions: Use of a Left-to-Right Sequence and a Mini-Schedule for Providing VisualInstructions

1JE

Materials —«—-laid out in a m ^ ^ ^left-to-right ^ ^ |sequence. ^ ^ ^ |

' ^ ^ H Use a mini-schedule^^^H to show the student

^ ^ ^ ^ ^ B the individual steps^ ^ ^ ^ ^ 1 for engaging with theH H ^ H materials.•

30 COUNCIL FOR EXCEPTIONAL CHILDREN

in the decision to teach toy play skillsto a student with ASD is to facilitatesubsequent, easier, and more success-ful social interactions with peers. If ateacher stops after simply teaching thestudent with ASD to engage appropri-ately with the structured play materials

greater interactions between Keith andhis classmates. Following the steps list-ed here, the teachers were able to moveKeith along to the point where he wasindependently combining the Legosinto interesting shapes. They graduallymoved two of his more socially skilled

Other ways to present visual instructions

include using visual "mini schedules," and

providing a model oí a completed play sequence.

without involving peers, the instructionremains incomplete.

Generalization of the newlyacquired toy play skills includes usingsimilar though different materials, indifferent places, and at different timesand includes playing with others withthese materials. Teachers can use avariety of ways for a student to expandand generalize new play skill reper-toire. These changes might include (a)adding in new materials, (b) fad-ing/reducing the visual structure, (c)modeling new behaviors with thematerials, and especially (d) bringingin a peer.

When seeking to develop greatergeneralization of the student's new toyplay skills, as always the teacher mustbegin by considering the unique char-acteristics of the learner. Given that somany students with ASD find changechallenging, the teacher might initiallyprovide additional supports when newelements are introduced. For studentswith established imitative tendencies,the teacher might use modeling tohelp the child better generalize his orher new skills with the toy play mate-rials. Finally, moving the play materi-als to a more inclusive setting wheresocial bids from peers are possible canset the stage for expansion into moresophisticated and advanced levels ofplay.

After observing Keith's typical class-mates playing with Legos and notingsome interest on his part in thesematerials, Ms. Pool and Ms. Cartersaw this activity as a potential path to

classmates to play alongside him withthe Legos, helping them to shapeKeith's social behaviors as they playedtogether. This included sharing thematerials and positively commentingon the completed pieces each construct-ed. The teachers also are observinggreater social interactions betweenKeith and these classmates in othersettings, including the playground.

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Laushey, K. M., Heflin, L. J., Shippen, M.,Alberto, P. A., & Fredrick, L. (2009).Concept mastery routines to teach socialskills to elementary children with highfunctioning autism. Journal of Autismand Other Developmental Disorders, 39,1435-1448. doi:10.1007/sl0803-009-0757-9

Mesibov, G. B., & Shea, V. (2010). TheTEACCH program in an era of evidence-based practice. Journal of Autism andOther Developmental Disorders, 40,570-579. doi: 10.1007/sl0803-009-0901-6.

Mesibov, G. B., Shea, V., & Schopler, E.(2004). The TEACCH approach to autismspectrum disorders. New York, NY:Springer.

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Neitzel, J., & Wolery, M. (2009). Steps forimplementation: Least-to-most prompts.Chapel Hill, NC: National ProfessionalDevelopment Center on Autism SpectrumDisorders, Frank Porter Graham ChildDevelopment Institute, The University ofNorth Carolina.

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Patricia K. Hampshire, Assistant Professor:and Jack J. Hourcade, Professor, Depart-ment of Special Education and EarlyChildhood Studies, Boise State University,Idaho.

Address correspondence concerning this arti-cle to Patricia K. Hampshire, AssistantProfessor, Department of Special Educationand Early Childhood Studies, MS 1725, BoiseState University, Boise, ID 83725 (e-mail:patriciahampshire@boisestate.edu).

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