Autism and Play

Play is a recognised area of difference in autism, meaning autistic children may progress through the stages of social play and engage in restricted and repetitive play types in a manner which appears different from their neurotypical peers. By age 3-4 years most children are playing together, sharing toys or activities, and developing play through observation and imitation. These expectations can prove challenging for autistic children who may show a lack of interest in or ability to engage with other children, and as play becomes more socially complex it is common for autistic children to remain in the solitary play stage. This can be due to a range of factors which make it more difficult for autistic children to interact with their peers, including differences in joint attention, flexibility of thinking, social communication, sensory processing, motor skills, and imaginative ability. 

• Areas of difference relating to play

Autism is a spectrum condition which affects different people in different ways. There are a number of key differences which may be shared by children on the autism spectrum that can impact the child’s ability to engage in play and develop social skills and relationships. 

Joint attention

Joint attention (or ‘shared attention’) involves sharing a focus with another person for the purpose of social interaction. In play, this can involve taking part in a game, or focusing on a toy or puzzle together. The ability to establish joint attention is essential to developing social and communication skills, and without joint attention skills children may struggle to interact and build relationships with their peers. Joint attention is established using eye contact, gestures, words and sounds, and requires the ability to gain, maintain, and shift attention. This can prove difficult for autistic children, who might struggle to pay attention to another person and object at the same time, and may result in missed opportunities for social interaction. 

Inflexible thinking/Cognitive rigidity

Many autistic children struggle to adapt to new demands or changes in routine. The spontaneous nature of play can therefore cause anxiety, as the child may not be able to cope with sudden changes to the rules of the game, the number of players, etc. This is often due to cognitive rigidity, which is characterised by inflexible thinking and beliefs, inability to see things from another’s perspective, difficulties sharing toys and games, and a desire for predictability. Autistic children may therefore seek out play which is solitary and comforting, for example, playing with the same toys repeatedly or lining up objects in the same order. 

Social communication

The social communication differences characteristic of Autism Spectrum Conditions can create challenges for children in initiating and maintaining play. These challenges may include difficulty recognising social cues, understanding and responding to others, communicating wants and needs, using eye contact and nonverbal gestures and relating to other children, which can inadvertently lead to isolation from peers and reduced opportunity to build social and communication skills through play. Social interaction is important for our wellbeing, and many children on the autism spectrum seek and value friendships with others. Simple communication supports and social narratives can be used to support the social interaction and inclusion of autistic children in play environments if they feel they need it. 

Sensory processing 

It is common for autistic children to be over or under sensitive to sensory input such as sight, sound, smell, taste, touch, balance, and body awareness, causing them to either seek or avoid particular sensory experiences. Certain environments can therefore be overwhelming for children who find it difficult to process sensory information, and sensory overload can limit the child’s ability to engage in play unless suitable supports are in place within the environment. The enriching nature of the outdoors makes it the ideal space to deliver play which stimulates all of the senses and regulates the child’s sensory needs. More information on the sensory function of play and how it can be supported in the outdoors can be found here.

Motor skills

Most autistic people have some form of motor difficulty (Bhat, 2020) which can range from mild to severe and impact the development of skills which rely on balance, bodily awareness, and motor control. Issues relating to gait, posture, hand-eye coordination and low muscle tone can create barriers to play as children may be unable to perform tasks such as running, jumping, catching, throwing or kicking. Play environments designed to cater to and challenge all abilities provide an optimal space for children to practice and develop motor skills in a safe space through playful interactions with peers. 

Imaginative ability

Autistic children typically do not engage in pretend play as often as other children, and when they do, their play tends to be less complex. It is rare for these behaviours to develop on their own without help and encouragement. Research shows a connection between underdeveloped Theory of Mind – which allows children to understand the perspectives of others – and lack of pretend play in autistic children (Chan et al, 2016). Autistic children may therefore struggle to engage in imaginative scenarios, instead relying on memory to copy situations which they have seen, e.g. on TV or enacted by other children. 

• Play, disability and children’s rights

Many schools now identify as Rights Respecting Schools, which aim to actively uphold the rights of the child. 

Every child’s right to play is protected under Article 31 of the United Nations Convention on the Rights of the Child (UNCRC) which states that:

Article 31 (Leisure, Play and Cultural)

1. States Parties recognize the right of the child to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts. 

2. States Parties shall respect and promote the right of the child to participate fully in cultural and artistic life and shall encourage the provision of appropriate and equal opportunities for cultural, artistic, recreational and leisure activity.

This is equally valid for children with disabilities, who derive just as much benefit from playing outdoors as their peers, but experience significantly more barriers to accessing suitable play spaces and opportunities. Lack of consideration for disability often negatively impacts the child’s right to play, and additional support should be provided to ensure that all children are empowered to engage in outdoor play both at school and in the community. 

The UNCRC also notes: 

Article 23 (Children with a Disability)

States Parties recognize that a mentally or physically disabled child should enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child’s active participation in the community. States Parties recognize the right of the disabled child to special care. 

and

General Comment 9

Play has been recognized as the best source of learning various skills, including social skills. The attainment of full inclusion of children with disabilities in the society is realized when children are given the opportunity, places, and time to play with each other (children with disabilities and no disabilities). Training for recreation, leisure and play should be included for school-aged children with disabilities.

The right to inclusive play for all children is further supported by The Convention on the Rights of Persons with Disabilities (2006):

Article 30  (Participation in Cultural Life, Recreation, Leisure and Sport) 

States Parties shall take appropriate measures:

To ensure that children with disabilities have equal access with other children to participation in play, recreation and leisure and sporting activities, including those activities in the school system.

“My child struggles to stand up and take her place where she is just as entitled to play”.

Parent, MCA Outdoor Play Survey

In order for children with disabilities to have equal access to and participation in play and leisure along with other children, barriers must be removed and play spaces and experiences designed with the needs of all children in mind. The key elements outlined in the above Articles point to a need for play spaces which are fully accessible and inclusive of all children. Guidance for designing outdoor play spaces can be found here, along with this template for consulting with children.

• Benefits of outdoor play for autistic children and young people

Children are happier and healthier when they are given the freedom to engage in physical activity, stimulate their senses and connect with nature through outdoor play. For autistic children in particular, the outdoor environment teaches essential life skills, regulates the mind and body and improves readiness for learning. 

It is therefore important that play spaces are designed to include, challenge and engage children of all abilities, allowing them to enjoy the many proven benefits of being outdoors through physical, nature, and sensory play.

Physical

• Autistic children and adolescents are at a higher risk of obesity and higher body mass index (BMI) due to inactivity and sensory avoiding behaviours (Healy et al 2017; Lawson and Foster, 2016; Liang et al, 2020; McCoy and Morgan, 2020).
• They are more likely to present with poor fitness levels and underdeveloped motor skills (McAllister and Sloan, 2016).
• A sedentary lifestyle increases the risk of heart disease and diabetes (WHO, 2002). 
• Studies show autistic children to be a high risk group for Vitamin D deficiency from not spending enough time outdoors (Healy et al 2017; Lawson and Foster, 2016; Liang et al, 2020; McCoy and Morgan, 2020; Sengenc et al, 2020).
• It is recommended that autistic children participate in sports training and structured physical activities with their peers. 
• Playing outdoors can improve motor skills by motivating children to engage in more frequent and varied types of activities, at their own pace, alongside peers (Niemistö et al, 2019). 
• Circuit exercises can lead to significant improvements in areas including running speed, agility, balance, reaction times, handgrip strength and flexibility (Arslan, 2020).

Sensory

• The outdoor environment engages all of the senses through its dynamic range of sights, sounds, smells, tastes and textures.
• Outdoor play promotes proprioceptive, vestibular and tactile input, engaging and strengthening these power systems.  
• Taking part in sensory activities in the outdoors can help keep children in a calm and regulated state, improving focus, mental alertness, and ability to learn. 
• Regular outdoor breaks are especially important for autistic children who can become distressed and agitated by loud environments, artificial lighting and sitting still for long periods of time.
• The outdoors provides an environment that is both calming and alerting to the senses.

Nature

• The therapeutic qualities of the outdoors have been studied in relation to children with Special Educational Needs, and a clear argument has been made for autistic and neurodiverse children spending more time in nature (Barakat et al, 2018; Li et al, 2019; Ramshini et al, 2018). 
• Playing outdoors in nature activates the senses and offers a variety of sensory input which supports regulation.
• Play in natural environments gives children the opportunity to practise motor planning skills which can translate to more independence in daily life.
• Being outside in nature can lead to improved concentration and help reduce symptoms of ADHD.
• Exposure to nature is calming and reduces stress and anxiety. Time spent outdoors decreases the stress hormone cortisol and studies show that even small amounts of time in nature (10-20 minutes) can improve mood (Meredith et al, 2020).
• Nature play is creative, imaginative, open-ended and unstructured. Interacting with natural resources (e.g. leaves, sticks, rocks) requires a child to think and expand their play repertoire.
• Natural environments stimulate social interaction between children. There are many opportunities to work together to engage in play which in turn promotes language and communication. 
• Play which uses natural rather than manufactured equipment is more equitable and reduces hierarchies based on physical capabilities or popularity.
• Playing in nature supports children to experiment and take healthy risks, which boosts confidence and independence.
• Regular contact with nature promotes a deeper understanding of the world and strengthens the bonds between the child and nature. It creates empathy and teaches responsibility for and connection to the environment. 

Ideas for physical, sensory and nature outdoor play can be found here.

• Barriers to outdoor play 

Outdoor play provides exciting and open-ended opportunities for learning and development, yet autistic children face a range of challenges which can prevent them from playing outside as often as they should. The barriers which they face can be attitudinal, environmental and institutional, limiting their access to play spaces and opportunities and the many benefits that regular outdoor play in an inclusive environment affords. 

Barriers identified by playground users in Middletown’s Outdoor Play Survey related to:

• Appropriate equipment to support play for children with additional needs.
• Availability of suitable outdoor play facilities near the home.
• Community attitudes and understanding of autism.
• Safety and supervision.
• Social skills and the presence of other children.
• The sensory experience (e.g. noise and crowding)

We can take steps to remove the barriers faced by autistic children at school and in the community by encouraging:

• Autism friendly hours.
• Consultation with autistic children and their families in the design of parks and playgrounds.
• Community awareness of different needs.
• Specialist equipment for older and physically larger children.
• Secure and well-maintained play spaces.
• Provision of sensory play.

• Supporting outdoor play for autistic children and young people

It is common for autistic children and young people to present with differences in play behaviours compared to neurotypical children, and while playing outdoors has many important benefits the unstructured and often unpredictable nature of the outdoor environment can lead to anxiety and disengagement from play.

Some of the following strategies may be helpful to the autistic child when engaging in outdoor play.

• Pre-teaching the behaviours required for outdoor play.

The rules of simple games and behaviours such as turn-taking can be modelled in the home or classroom before transferring to the outdoors.

• Following a schedule.

A daily visual timetable creates predictability and can help with the transition to outdoor play.

• Offering choices.

A choice board incorporating the child or young person’s interests gives them greater autonomy over their play time while still retaining a sense of structure. 

• Visual aids.

Helpful visuals may include photos of the equipment available today, communication boards and symbols, playground rules and visual play cues, which can be displayed around the play space or worn by adults on a lanyard.

• Providing structured activities and zones.

Organised games led by a supporting adult can help encourage children to engage in play, while designated activity zones provide direction and cater to a variety of interests and abilities. 

• Observing play.

Observation is an important part of planning for play and adapting the environment to meet the children’s interests and needs. 

• Make use of sensory materials.

Play involving natural elements and loose parts materials is a cost-effective way to engage children in open-ended play which stimulates the senses and promotes physical development and emotional regulation. 

• Buddy systems.

Buddy benches and peer mentors encourage inclusion and support children who may struggle to initiate play. Outside of the school, setting up play dates can be helpful for children who seek peer interaction. 

Our case studies highlight a range of techniques Middletown staff have used to engage children and young people with outdoor play. 

It is important to note that while play behaviours can be developed in autistic children, all children have a right to play freely, and this includes non-normative forms of play. Any supports used should be acceptable to the child and appropriate to their play needs and goals.