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A Paediatric OT Guide to Autistic Play




I was recently writing a reply to a question in one of my OT Facebook groups about play, and it struck me that this was too important a topic not to explore more deeply. The question was about which treatment models and approaches we, as therapists, should use that are neurodiversity-affirming when building play skills for kiddos on the spectrum, especially considering the perspectives of the adult autistic community.


Language Matters

First, a quick note on language. I work with autistic children and their families daily. Typing "autistic children" feels a bit strange because I was trained to use person-first language, such as "a person with autism." However, many in the autistic community are now letting us know they prefer identity-first language, like "autistic person." Some still prefer person-first language, including clients I work with, so I want to respect both perspectives. Given language preferences are deeply individual, in this post, I will use both terms: "child with autism" and "autistic child." I'm not autistic, so I'm guided by the preferences of those I work with first and foremost, and as best I can with the broader autistic community.


The Role of the Therapist in Autistic Play

Back to the main topic: autistic play. What is our role as therapists? Where is the evidence base, and does it consider the perspectives of autistic adults who experienced various interventions as children? This is a vital question and one that therapists must wrestle with.


Every child is unique, whether they are autistic or not. Families often come to me for support in their child's development, including how their child plays. I don't believe it's my job to "fix" anything about the children I work with, including their preferred play styles.


That said, families I work with often face challenges, such as sibling dynamics where one child's play style or need for regulation can negatively affect their siblings. These situations are complex, and there’s no one-size-fits-all solution.


The Importance of Play

Play is a major occupation of childhood and a powerful way for children to make sense of and master their world. As therapists, meeting children in their preferred ways of playing is crucial for supporting their development. This doesn’t mean however we are ‘just playing’.


In a recent discussion on the Spirited Conversations podcast with Tracy and Michelle, we talked about following a child's lead. This principle is embedded in both sensory integrative and DIR treatment frameworks and is essential for attuned therapy (see the references at the end for information about these approaches).


Attuned and Flexible Approaches

Attunement and understanding the unique ways development occurs are where I feel I can best support autistic children. This doesn't mean rigidly focusing on a specific skill based on age expectations. Instead, it's about observing and understanding the skills a child is currently mastering and offering the "just right" challenge to facilitate neuroplasticity.


If you’re lucky everyday experiences will support development, but for neurodivergent children, enhancing or dampening specific sensory aspects might be necessary. Repeating activities to attain mastery or respecting a child's need for less intense social cues and eye contact can be crucial. Therapists must pair their scientific knowledge with deep attunement to each child's responses, and this is where we find the most meaningful treatment.


No One Right Way to Play

In my opinion there is no one "right" way to play. Play is a state of being, not just a set of actions. Peter Gray's thoughts on play illustrates this well with the example of two people typing at a computer—one is playing, the other is not. It's the individual's experience and state that matter.


For my autistic kiddos, I look for all the ways they already engage in playful, joyous, and regulating activities. Attuned play, allows me to offer experiences that support their development and therapeutic needs. Sometimes I need to take a stronger lead and structure the play as it’s where the child feels most comfortable, while other times, open-ended play is best.


The challenge for clinicians is to flexibly co-construct meaningful experiences across such an array of developmental domains—social, cognitive, motor skills, postural functions, and sensory processing capabilities.


Continuous Learning and Engagement

No doubt my thoughts will continue to evolve as more science and information emerge from the autistic community. At this point, my approach to supporting autistic play, and all neurodivergent children, is to focus on intentional attunement and a deep understanding of development and integrative processing.


Given this, feedback and experiences of autistic people are invaluable. Feel free to reach out and share your thoughts! ❤️


More information:

DIR Framework

The Developmental, Individual-differences, and Relationship-based (DIR) model, commonly known as DIRFloortime, is a comprehensive approach focusing on promoting healthy development through emotional and relational engagement. It emphasizes understanding each child's unique developmental profile and creating tailored interventions to support their growth. For more detailed information, you can visit the official [DIRFloortime page](https://www.icdl.com/what-is-dir) and [DIR Courses](https://www.icdl.com/dir-courses) page on the ICDL website [oai_citation:1,Home of DIRFloortime® (Floortime) - What is DIR®?](https://www.icdl.com/dir) [oai_citation:2,Home of DIRFloortime® (Floortime) - DIR® Courses](https://www.icdl.com/courses).


Sensory Integration Framework

Sensory Integration (SI) focuses on how the brain processes sensory information and how this processing affects behavior and learning. This approach is particularly beneficial for children who experience sensory processing difficulties, such as those on the autism spectrum. For more detailed information about sensory integration therapy, you can refer to resources such as the American Occupational Therapy Association (AOTA) or specialized therapy sites like [Occupational Therapy Helping Children](https://www.occupationaltherapy.com.au) and the [Sensory Processing Disorder Foundation](https://www.spdfoundation.net) [oai_citation:3,The DIR Model and Floortime Method](https://connecticutoccupationaltherapist.com/the-dir-model-and-floortime-method/).


If you are looking to listen to the specific podcast episode I referred to, you can find it on the website here www.spiritedconversationspodcast.com


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