Halloween is almost here, and if you’ve got a sensory sensitive kiddo, you might be dreading putting on that costume. Sensory sensitive kids are often overwhelmed by tags, seams, and things on their face and head. Which describes a lot of what a traditional Halloween costume entails. So what can you do to make sure your child can still enjoy the school party, trick or treating and other festivities? Read on to see some of my tips on how to find a fun, sensory friendly costume that will keep your child comfortable and happy.
Please note this post contains affiliate links, which means I earn a small percentage of the sales that come from the links.
Use a Sensory Friendly Item & Paint It/Attach Other Items To It
Stay with me…you can do a lot with your child wearing comfy clothes like t-shirts and leggings and you attach or paint the more “recognizable” features of the costume onto the clothes. Think M&Ms, all red outfit with Elmo’s face glued to the shirt, crayons, an emoji, bubble gum machine, the game “Operation.” Here are some puffy paint pumpkin sweatshirts. Here’s one mom’s version of a DIY cookie monster t-shirt costume. Here’s a super cute DIY gumball machine costume.
Sensory Friendly Ridable Costumes
This will probably depend a lot on your child, but I suspect a lot of kids who are sensitive to tags might do well with this set up. Especially because some of these costumes are so fun/exciting, some kids might be able to tolerate the drawstring waistband that holds most of them up. There are lots of options to choose from, but this safari/tiger riding was one of my favorites. This dragon is pretty impressive and there’s a unicorn if you’re going for mythical, yet delicate.
Which One Looks the Most Fun to You?
Remember that at the end of the day, you don’t have to impress anyone with a costume. It’s most meaningful that your child is relaxed and has fun. What is your child wanting to dress up as? Tell me below and I’ll share any tips I have to make it more sensory friendly!
By the time your child is 5 years old (if they’re pretty typically developing) I will give the overall advice that you should follow their lead/interests in developing hobbies and activities that meet their sensory and motor needs.
For instance, riding bikes, cooking, doing crafts, playing sports, exploring outdoors, [and doing chores 😉 ]etc. are all chock full of natural sensory and motor development. You don’t have to try very hard to curate a sensory or motor experience.
That being said, this lists has some activities that fit the bill of being everyday activities that could be matched to your child’s interests.
5-8 Years Old
Mini Toys/Games: I promise you there is nothing more inviting to a child than mini games and toys. (Maybe that’s a big promise. lol) But they are so, so enticing!! This is a great way to work on fine motor skills and muscle grading (how much force do I need to use to manipulate this item). As your child stabilizes their arm and hand, they work on focus and the muscles of the hand and arm.
Jenga: This is a classic, but for good reason. This game also requires focus, self control and muscle grading. Your child will strengthen up the muscles they need for writing, buttoning, tying shoes, etc. while having fun with the family. Nice thing is you could also use these blocks for building and more open ended play. Some people will even write questions, sight words etc. on the blocks. You could maybe even write words in another language if you’re trying to incorporate bilingual learning.
Small Pop Beads: These small beads are great for strengthening the arches of your hand as you have to push with a good amount of force to get them together. Bonus is as you clean up, pulling apart the beads can get a second round of strengthening in. Another highlight of this toy is the two hand coordination required for stabilizing and pushing the beads together.
Twister: This game targets so many good things sensory and motor. Listening skills, motor planning (how can I make a plan and move my body), problem solving, core strength, shoulder stability, and provides lots of movement sensory input that is often needed. A great option to keep around for cold weather and days when you need to stay inside.
Bean Bag Chair: Bean bag chairs give the comforting deep pressure input many kids crave. It’s kind of like a little hug. It will help your child to get the squish they’re seeking if they’re one who likes to roughhouse, seems clumsy, asks for big hugs, breaks crayons when coloring, etc. Nice feature is that they’re mobile. You can also use them for heavy work by tossing them or giving someone squishes.
Velcro Mitt & Ball: I love this toy. Aside from the obvious hand eye coordination benefit from a motor perspective, it’s great sensory input. Your child has to pull hard everytime they toss the ball back to you, getting some of that calming heavy work.
7. Magnatiles: I’ve seen these become super popular, and I think with great reason. This is an open ended toy (one that allows your child’s imagination to make the fun) and it provides more of that calming heavy work as your child pulls magnets apart while building. This also provides an opportunity for strengthening hands.
8. Beados: I loved discovering this toy as an OT. Especially if you have a kiddo who struggles to hold a pencil, this toy is great for practicing that. Lots of fine motor practice to push the tiny beads into the bulb, release one bead at a time using the pen, squirt water to make them stick together. Your child also develops visual scanning, visual perceptual and discrimination skills as they use their eyes to discern how many beads of each color they need and where they go.
9. Bop it: The package says 8 and up, so maybe reserve this for 7-8 year olds. If you have a child who doesn’t get frustrated easily and likes a challenge, I’d say this could still be fun for them. I had this growing up, and I did seriously love it. Writing about it makes me want to play again, haha. It’s a really fun motor challenge. Bop it is another awesome way to get your child moving and working on lots of the same skills I mentioned above for Twister.
10. Card Games: Card games are a great activity to play with your whole family, and manipulating the cards strengthens your child’s grasp as well as midline crossing skills, which are important for higher level problem solving and motor planning. Spot it is particular favorite of mine because kids enjoy it but it’s also actually fun and challenging for adults too. Another classic is Uno and Go Fish for the kids on the younger end of this range.
11. Lite Brite: Lastly, another nostalgia provoking classic. Lite Brites are an excellent way to continue to strengthen the arch of the hand. They also provide lots of practice for developing some of the visual skills similar to those I mentioned for Beados. The bright colors and lights can also be very satisfying visual sensory input for some kids.
There you have it!
A full list loaded with toys that will not only (and most importantly) fill your house with more fun and joy, but also strengthen your child’s sensory and motor skills. These toys are mostly classics, and that’s with good reason. Multiple generations have realized how fun they are, and so worth having in your home.
Have Other Kids?
Don’t forget to check out my guide for your other little ones too! I have toys to foster sensory and motor development for kids ages birth through 8 years old. You can find the main post with the separate posts broken down into age groups here.
At this age, your little one is really mastering and exploring movement with their body! They still love big, gross motor movements, but are starting to develop and refine their fine motor skills too! Many of these recommendations support important skills your child needs, like using two hands together in a coordinated movement, strengthening their shoulders, arms, hands and fingers and maneuvering and controlling a tool to get a job done (like in drawing, cutting, eating, etc.)
Lest we forget…kids of this age continue to need LOTS of quality sensory input. Many of the toys encourage those big gross motor movements, because movement sensory input is strong and can be really helpful in regulating your child’s big feelings.
In that same vein, I included some toys that can double up as tools to help manage big feelings.
2-3 Year Olds
Wooden Lacing Beads: A classic activity that sets the scene for lots of other skills as your child gets older. Lacing beads helps your child use two hands together, work on muscle grading [aka how much force do I need to maneuver this object] and visual motor skills. These beads are extra cool because they come with a variety of textures, which is pleasing to the touch and visual systems. You can also experiment with stacking/building with these beads due to the flat surfaces.
Felt Busy Book: These are just too fun and whimsical to me. These felt busy books are often chock full of super intriguing fine motor activities that are oftentimes very calming for your little one’s sensory system as well. A high interest, screen-free way to regulate those big feelings.
Play Dough: Maybe one of the original “sensory” play items. Play dough is awesome because you get lots of tactile input from the texture of playdough plus a bonus of some calming heavy work as your child uses their fingers and hands to push, smoosh and pull. Use the code CLARE10 to get 10% off when you support fellow mompreneur Teresa’s Etsy shop.
Ride on Toy/Scooter: I think it’s important to include gross motor toys when considering your child’s sensory development. Sensory has strong foundations in our movement systems, so feeding those is great for sensory development. Your child will strengthen and coordinate their arms and legs while getting lots of calming input to their joints and muscles. This ride on toy is cool because it converts to a scooter when your child is ready! Score for some 2 in 1 toy efficiency.
Sand and Gel Timers: These are a little less “toy” but I wanted to include them because as those 2 year old feelings ramp up…it’s a good time to slowly introduce some toys that can be used to help process feelings. The sand timer kit here has different colors for different times.
Teepee Tent: I had a little tent as a child and I truly treasured that thing. It was very simple, but felt so fun and like I had my own little space. I think that’s important for kids as they start to get older, especially as a means to process their sensory needs.
Chef’s Apron: I am also plugging how cooking is the best sensory and motor experience. Engaging with food provides touch, smell, sights, sounds and taste as well as heavy work when your child is getting involved in smooshing, tearing, pulling etc. This also develops their motor skills of using two hands and improving finger strength and coordination. And the best of all? Exposure to foods is a helpful tool to prevent and address picky eating.
Massager: Another item you can introduce in a low key way that can eventually serve as a self calming tool. These massagers are fun and provide buzzing input. I usually recommend showing it to your child and then handing it to them while turned off to give them control over trying it out.
3-4 Year Olds
Water Wow Books: When I discovered these, it felt like a jackpot find. These are great way to slow down kids who are typically interested in fast paced activities. The magical cause/effect of colors showing up when you color the page with water is very enticing. This is a great way to also work on pencil grasp as your child has to hold a developmentally appropriate chunky water marker to color.
Sneaky Snacky Squirrel: These games are great first “group” games for your little one. I think having to pass the cute squirrel tong back and forth is very helpful to learning to take turns. Your child gets great hand strengthening by squeezing the tongs to pick up and place fun, colorful acorns in the corresponding spot on the tree.
Rubber Ink Stampers: This is another throwback to my childhood. Rubber ink stampers are a great way to strengthen up the arches of your little one’s hands while also getting some satisfying feedback to their hands with every push to ink the stamper and stamp on the page.
Wooden Magnetic Fishing Game: I LOVE this game. haha Capslock always comes across so strong. But I do really love this game! Super fun and helps to develop hand eye coordination and muscle grading.
Sit and Spin: Vestibular input (the sense that is activated when our head moves) is a powerhouse of sensory input. The first system to develop in utero as baby is floating around in the amniotic fluid, this system can be very calming, but also of course…very alerting. A sit and spin is a great toy to get strong vestibular input for kiddos who seek that out. It also addresses crossing midline and using two hands together, both of which are very important skills.
Bowling: Bowling is a great way to get your little one up and moving to develop motor skills and get the sensory input they need. Simply walking, bending and throwing the ball and setting up pins will get lots of that vestibular input kids often crave and need. Bowling also develops hand eye coordination in a very fun way.
Hippity Hop Ball: This bouncing ball equipped with a handle to hold onto challenges your child’s balance, core strength and coordination, while getting that movement input they’re seeking.
Time to get your little one on the move and start refining those movements that will help them to continue to grow in the independence they so desperately want 😉
If you have other big kids or babies (0-24 months and 4-8 years old!) don’t forget to check out my suggestions for them too! You can find each post broken down by age here.
Your baby may be feeling much less like the snuggly newborn from days of yore and looking much more like a little “big kid.” As baby continues to grow, he or she will love to explore and maybe sometimes get into trouble with all of the new motor skills they’re learning.
The toys I included for your 12-24 month old focus on the fact that baby is learning to refine the control and coordination of his or her limbs and body. These toys offer opportunities for important developmental skills such as using two hands together, learning how much force to use to maneuver items and using their joints and muscles to push, pull and smoosh as they develop their body awareness (aka where is my body is space).
12-18 Months
Knob puzzles: These are a great starting point for your baby who is learning how to use more and more precise movements with their arm and wrist. Also develops sensory skills as baby learns how much force to use to place pieces inside the frame.
Finger paints: I know mess can be triggering…but letting kids get messy really is great for them!! And painting is a fun way for them to start to express themselves. If your child is hesitant, you can start by rolling a toy car or a ball through the paint and always having a cloth nearby to wipe hands when they feel overstimulated. This also helps your little one develop the muscles or their hands and using two hands together.
Poke a Dot Book: These books by Melissa & Doug are a great way to get that pointer finger poking. They also provide some satisfactory sound input as well as heavy work for fingers for your little ones who are getting used to being gentle with how much force they use.
Musical Instruments: This age is an awesome time to encourage your little one to make some music. Instruments help to develop and strengthen shoulder, arm and wrist muscles as well as provide opportunities for two hands working together. Obviously sensory input is sound, but it’s also good for them to use their muscles and joints to get some input there as they shake, rattle and bang away.
Wooden Blocks: Simple cube wooden blocks are a classic for a reason. Your little one will continue to strengthen shoulder, arm, and hands with picking up, dropping and stacking. This also helps develop muscle grading, which is our ability to know how much force to use to maneuver items. This particular set is dyed using vegetable and spice food dyes!! Super cool.
18-24 Months
Height Adjustable Easel: An easel is an awesome way to increase your child’s shoulder and wrist stability. Scribbling and painting on a slanted surface encourages lots of strengthening that will come in handy when it’s time for drawing and writing down the road. I picked this one because it looks like the height can be adjusted for little ones.
Bingo Dot Markers: These are great first tools for drawing and “writing” for your little guy or gal. Your child will have fun learning the cause and effect of making dots and drawing. These also provide some satisfying heavy work feed back as you have to push a little harder to get the ink moving.
Velcro Fruits & Veggies: This is a toy that packs a punch because you get hand strengthening, two hand coordination, imaginative play and some heavy work as your kiddo has to pull velcro fruit apart.
Suiggs: Have you seen these guys yet? I feel like they’ve gotten fairly mainstream. But, they are super awesome. Pulling and pushing these whimsical looking suction cup/alien antennae looking suction cups works on hand and arm strength, two hand coordination and gives lots of heavy work for your little one who likes to roughhouse, asks for tight hugs or has lots of energy.
Shopping Cart: I was between this and a ride on toy. Both are great for getting big movement (especially when you need to move play indoors.) Your child gets heavy work as they get lots of input to their joints and muscles with pushing, pulling and loading up the cart. For some extra oomph add some bags of rice, beans, ankle weights etc. to the lower compartment to really tire them out 😉
So now you’re ready to select the toys that you think look the most fun for your baby, knowing what sensory and motor benefits they’ll be getting as a bonus as they play.
Which toy do you think your baby will be most excited to break in?
Got big kids too? Check out the main page of the gift guide for my recommendations for kids 0-12 months and 2-8 years old!
For young babies, their whole life is an abundant sensory and motor experience! They’ve exited the womb and entered the world, and often times they’re super excited for all of things that have become mundane to us.
So as far as toys go, I keep it very simple. I look for toys that are not over-stimulating, and that promote babies’ interest in moving, cause and effect, engagement, joy and exploration.
0-4 Months
Yoga ball: When babies are not so mobile on their own, a yoga ball is a great way to introduce them to movement. You can sit and bounce while holding your baby, you can lay baby on his or her back and belly and do gentle rocking movements in all directions. Best part is this item can grow with your child. You can roll it, bounce it, etc. as they get older and bigger.
Tiny Love Black and White Activity Mat: I thought I didn’t want an activity mat, but I’m super grateful we have this one. The black and white is great for when that’s about all baby notices. This mat comes with a nice little accordion set of black and white pictures which was great for our early tummy time days. The items that hang off of the hooks are simple and not overstimulating, and most importantly, I enjoy the little songs the hedgehog plays. That’s important for a toy that makes noise.
Usborne Tummy Time Book: I am VERY excited for my mom and dad to bring this for my baby! I love it because it has a mirror, which is an awesome and perfect tummy time tool. It “grows” with your child as there are multiple sides to the book, which evolve into a cloth book with pages to flip, etc.
Wooden Rattle with Bell: A friend bought this for my baby and it’s awesome. I like using wood/more natural and simple toys when possible. I like this one because baby can grasp it in the holes of the rattle, which encourages development of the muscles of the arch of the hand. And the bell is a more charming noise than plastic beads. Though, we have one of those rattles too. 😉
4-6 months
Colorful scarves: I was with a mom friend the other day, and she brought these out for her 4 month old son, and I thought–brilliant. Colorful so baby’s interested, and scarves are a lovely form/texture for babies who are just learning how to grasp things. Basically they are pretty likely to be successful as opposed to when they are trying to grasp a more formed toy. Bonus is you can throw these in the dress up bin someday.
O-ball teether: If you don’t know by now, OT’s love the O-ball. 2 for one. Teether and a ball. Also, the open web-like design allows for a little bit of help for little hands that are learning to grasp and use their fingers.
Suction Cup Zebra Activity Toy: This guy is awesome. It’s one part teether, one part rattle, one part something to swat at. Bonus is that it has a suction cup, so you can attach it to a high chair, grandma’s table, the table at the restaurant etc. And there is a little rotating compartment with mini plastic beads that gives lots of cool visual sensory input.
Touch and Feel & Crinkle Books: These books are lovely. I always have to touch every texture myself, lol. As baby starts swatting at things, they’ll be (hopefully) delightfully surprised to explore interesting textures. Bonus is that baby can help turn the pages with chunky board books.
6-9 Months
Roly Poly Musical Toy: This toy is great to encourage more controlled/directed swatting from baby during tummy time as well as crawling. Light bells or chimes is the old school way to teach baby cause and effect with auditory sensory input (pre push a button, toy plays music)
Melissa & Dough Stackable Animal Wooden Cars: Someone gifted us these, and I already use them with baby during tummy time. They’re fun because you can stack them. So I often will roll it across the mat to work on his visual tracking and then stack them up and knock them down to address his attention and cause/effect play. As he gets older, he’ll be able to roll them, knock down other things with them, etc.
Hand Drum: Another great way to introduce music for natural sensory input along with an opportunity for baby to play at midline while using both hands together to bang away as they improve their aim with their hands.
Activity Cube: I like this for (at least) two fold reasons. One is that as your baby is getting more sturdy during tummy time, they can use a cube like this to challenge their shoulder stability as they reach up off the floor. It’s also a great toy for your baby as they look for something to play with while sitting up. This particular cube allows you to take off the twisty-twirly maze, which makes this a great activity to practice dropping items into a container.
9-12 Months
Large Pop Beads: Being that baby is sitting or on their way to being a more sturdy sitter, using two hands to do something a little more challenging will work on their core, shoulder and hand strength.
Fisher Price Stack & Roll: This is seriously one of my all time favorite toys as a pediatric therapist. I use it with kids of so many different ages. It’s awesome because the “cups” that nest together also push together to form balls of varying sizes. So you can work on rolling the ball to each other, rolling to knock things over, etc. The stacking is nice because they “click” so they’re more sturdy than other stacking toys. They are a little challenging to push and pull apart to make the balls, so mom or dad will have to help with that for now.
Fisher Price Gumball Drop Toy: Dang, I really like Fisher Price’s toys for 9-12 month olds, lol. This one (though it has lights and music…you could choose to not put in batteries. Baby won’t know the difference) is super fun because baby will work on refining their ability to release items into a large opening as well as pushing down a lever to release the ball down the ramp. The balls are all very cute with captivating sound or visual input.
Phew!
There you have it. Those are my recommendations for toys that are unique/worth keeping around the house that will also bring baby joy as they develop their sensory and motor skills. Share this post with a new mama who is also looking for toys she won’t regret buying!
If you have other big kids (12 months to 8 years old!) don’t forget to check out my suggestions for them too! You can find each post broken down by age here.
If you want ideas for toys that will support your child’s sensory and motor development and like to be intentional with your purchases, this guide is for you.
By and large I am ever striving for a minimalist lifestyle. I have anxiety and lots of extra stuff makes that worse. However, I also am a sucker for a great toy that I think will get a lot of mileage and/or uniquely suites a child’s needs or interests.
Overall, I stay far away from toys with lights and music because I truly believe kids need opportunities to create their own magic in play. (I have exceptions. Such as for kids with significant motor delays I think technology, lights and music [barring those susceptible to seizures!] give kids lots of bang for their buck when they have to work so hard to get their bodies moving!
Benefits to Being Intentional with Toys
Play is slowly making a comeback, and everyone will benefit from that! In play, children develop….
Attention skills
Self regulation and emotional regulation
Executive functioning
Language
Relationships
Imagination
Problem solving
You get it. Play is awesome. But being intentional about which toys you select helps you set the stage to promote your child’s sensory and motor development and lots of fun without tons of unused things gathering dust.
Below you’ll find my recommendations by age. For ease I created separate links for 0-12 months, 12 months through 2 years, 2-4 years old and 5-8 year olds. Click on the image for the list you want to be brought to that post. When possible, I included links for items that I recommended that I found on Etsy, in an effort to support small businesses. I cannot attest to the experience you’ll have with sellers or stores. I’m just showing you what toys I think will be awesome for your kids! There are also affiliate links from which I will receive a portion of sales.
Sensory processing is so central to what peds OT’s do these days, but there remains a lot of difference in opinions. From “whether it exists,” to what’s the most effective way to treat it. One often leaves OT school feeling like there’s still a lot of new learning to be done.
Learning curves for new grads can be steep. I will say that I personally have shifted my thinking dramatically as an OT since the time I graduated. I have gone from being verydetail oriented, goal focused, everything must look like typical to much more practical, holistic and functional.
This journey has led me to be interested in developmental approaches like the DIR/Floortime model. From what I’ve read, it is a collaborative approach between parents and professionals, in which parents are key players. It also emphasizes emotional development and engagement. These are also two elements that have become largely more important to me as I’ve learned to see the forest instead of focusing only on the trees.
I plan to research more into DIR and similar approaches, but this was a basic starting point on an article that reviewed DIR’s impact on communication and self-regulation.
Journal Journal of Occupational Therapy, Schools, & Early Intervention (SNIP 0.535)
Article Title Intervention effects on communication skills and sensory regulation on children with ASD
4 Case series (and low-quality cohort and case control study)
5 Expert opinion without explicit critical appraisal
Methods Professionals recruited 25 children aged 3-6 years old with ASD and their families to participate in this study.
Intervention
A multi-disciplinary team developed focused individualized intervention plans for each child that were completed for a 10 month period. The programs included 1-2 elements that were included in the approach: Floortime, sensory integration and speech therapy (Helena I. S. Reis, Ana P. S. Pereira & Leandro S. Almeida p. 349, 2018). Important aspects of the intervention process included:
A team of multi-disciplinary professionals who worked as a team with families
Identifying children’s strengths, preferences and interests
Focusing on developmental areas that emphasis connection, engagement and social skills to promote learning in a child’s natural environments
Every member of the team of professionals was trained in DIR/Floortime and OT’s additionally were trained in Ayres Sensory Integration (Helena I. S. Reis, Ana P. S. Pereira & Leandro S. Almeida p. 350, 2018). All team members had also worked for more than 5 years in the Early Intervention System with children with ASD.
Sessions were as follows…
Floortime A psychologist led parents in 30 minute Floortime sessions, in which psychologists coached parents in promoting joint attention from their child. The psychologist also observed and provided feedback to the parent utilizing these skills following the time spent working together.
Sensory Integration OT’s led sessions for 30 minutes if the child participated in multiple therapies from the three options (SI, Floortime and Speech therapy). The children who only participated in SI therapy participated in 45 minute sessions. OT sessions aimed to promote joint attention, social skills, perceptual skills and motor planning through eliciting increased integration of sensory input.
OT’s also provided education to parents as to the connection between sensory integration abilities and difficult behaviors children sometimes display. In this education, OT’s included information on how to adapt the child’s every day routine with modifications to promote regulation.
Speech Therapy Speech therapists used augmentative and alternative communication systems in sessions to promote natural gestures and symbolic communicative forms during their 30 minute sessions (Helena I. S. Reis, Ana P. S. Pereira & Leandro S. Almeida p. 352, 2018).
Measures Parents completed the Assessment Scale of Children with ASD, which gathers information on Social Communication, Repetitive Behaviors and Restricted Interests, and Sensory Processing.
Findings
Children demonstrated statistically significant improved scores for the areas of Social Communication and Sensory Processing. The area of Repetitive Behaviors and Restricted Interests did not yield a statistically significant in the change in parents’ ratings.
Things to Consider
The authors note that the study had no control group, so the results cannot be compared to a lack of treatment, alternative treatment, nor control for development by maturation alone. They also noted that they did not compare or categorize children based upon the severity of their symptoms of each area included.
A limiting element in applying this study to a wide array of OT’s is that the OT’s in this study were trained in both Ayres Sensory Integration and Floortime. I definitely believe I do Sensory Integration Therapy based on the principles in the infographic above, but I’m not officially trained. What I do take away from this article is evidence that developmental models such as DIR/Floortime are a valuable tool to enhance the occupational therapy one is already providing.
References
Helena I. S. Reis, Ana P. S. Pereira & Leandro S. Almeida (2018). Intervention effects on communication skills and sensory regulation on children with ASD, Journal of Occupational Therapy, Schools, & Early Intervention, 11:3, 346-359, DOI: 10.1080/19411243.2018.1455552
Watling, R., & Hauer, S. (2015). Effectiveness of Ayres Sensory Integration® and sensory-based interventions for people with autism spectrum disorder: A systematic review. American Journal of Occupational Therapy, 69, 6905180030.
Case series (and low-quality cohort and case control study)
Expert opinion without explicit critical appraisal
Play as Occupation
Play is the quintessential occupation of all children. It impacts self-regulation, problem solving, confidence, emotional well being, creativity and more. In our ridiculously overscheduled culture, play is losing its footing and child development specialists are strongly advocating for people to comprehend and believe its worth. Play is fundamentally crucial right now as children live in a season of history with significant change to routines and dynamics. We are addressing important social issues, and throughout this children need time to play to help their emotional and mental health.
Uncovering the Skills That are Already There
Children with an Autism Spectrum Disorder have a different approach to many domains of life, including play. I personally believe that there is great value in children playing in a way that is naturally motivating, interesting and rewarding to them. However, I also believe that scaffolding and expanding the play skills of children with ASD is extremely beneficial. Improving play skills can lead to improved problem solving, perspective taking, relationships, communication skills and more. Meeting the child at their interests and style of play while emphasizing connection and relationship building both respects who they are while also seeking to provide them with an increased range of life skills.
More Play is Better for Everyone!
Also, let’s not forget how important it is for parents, siblings and friends to be able to meaningfully connect with their loved ones who have ASD. The child who expands his or her play skills is not the only person who benefits from their increased engagement in the world around them.
So how do we go about promoting an increase in play skills for kids with an ASD?
Many children on the Autism Spectrum often seek out play that is driven by the enjoyment derived by sensory stimulation. In the clinic I have loved seeing my kids with ASD grow their play skills. What most especially brings me joy is seeing them look at me in anticipation of me doing something silly or animated and then their laughter and joy that explodes when I deliver. I also love seeing what ideas they come up with and how they try to engage me in their play scheme. I have had a lot of success in using cause and effect play with balls, blocks, cars, and figurines. We often hit a stumbling block when it comes to symbolic play.
It’s Not “Just Play.”
I took the course, Play with a Purpose: Effective Play-Based Therapy & Early Child Development by Cari Ebert, and it was a game changer for me. It totally changed how I thought about therapy. I am purposeful, intentional and focused when it comes to getting things done in therapy. Sometimes I miss the forest for the trees. Learning about the development of play and how it impacts everything in a child’s development helped me to take a step back and fall in love with play. Parents often come to us wanting to address handwriting, shoe tying and meltdowns. All of those are occupations that I love. However, I came to see that if we neglect play, we are seriously limiting the progress we can help our kids to make in all other areas.
Methods
Participants
Researchers recruited caregivers and 86 children with an Autism Spectrum Disorder aged 22-36 months who attended an early intervention program. The children attended the program for 30 hours per week, during which they received behavioral, speech and occupational therapy. The researchers randomly assigned children and their caregiver to receive 10 weeks of either hands-on parent training in the JASPER program or a psychoeducational intervention (PEI).
JASPER promotes joint attention, symbolic play, engagement and regulation through a naturalistic approach. The PEI provides parents individual education and support on having children with an Autism Spectrum Disorder.
Intervention
Parents in the PEI group spent 1 hour with an interventionist per week. They learned about Autism, details of specific behavioral impairments, principles of managing behavior, strategies for teaching new skills, improving social interaction and communication, service availability, managing parent stress, and sibling/family and community responses to Autism.
A trained interventionist instructed parents in the JASPER group in 2 thirty minute sessions per week. Parents learned through a hands on approach the strategies of the JASPER method. Parents learned to identify their child’s developmental level of play as well as the child’s demonstration of social communication gestures. Interventionists taught parents to use strategies in a structured sequence in order to promote opportunities for their child to initiate interest in an activity or a toy. Parents also used these skills to promote joint attention in their play interactions with their children.
Measures
Play & Joint Attention with Parents
Examiners who were blind to the interventions coded interactions between children and parents by watching 10 minute video recordings of play sessions. This occurred pretreatment, posttreatment and 6 months after the study ended. During the sessions, researchers gave parents a standard set of toys (dolls, dishes, puzzles, trucks, shape sorter and blocks) (Kasari, Gulsrud, Paparella, Hellemann, & Berry, 2015, p. 556). Parents engaged in free play with their child using these toys. Raters qualified engagement as joint engagement if the child was aware of the parent’s participation, acknowledged their parent with non-verbal language and/or used language or demonstrated following their parent’s language in play (Kasari, Gulsrud, Paparella, Hellemann, & Berry, 2015, p. 556).
Evaluators also coded observed instances of children’s play levels, diversity of their play and instances of initiating joint attention.
Parent Stress, Language Assessment & Joint Attention with Teacher
In addition, researchers coded play interactions between children and their teacher playing together in the classroom, assessing for time spent in joint engagement. This occurred pretreatment and at the end of treatment.
Examiners used the Mullen Scales of Early Learning and Reynell Developmental Language Scales to assess receptive and expressive language skills. These items were completed pretreatment and at the follow up 6 months after intervention ended.
Parents completed the Parenting Stress Index pre-treatment, post-treatment and at the 6 month follow up, providing information about parent stress levels.
Meat and Potatoes
Duration of Joint Attention
The data analysis demonstrated a significant increase in time spent in joint engagement for the children in the JASPER group compared to the PEI group. The children in the JASPER group’s length of time jointly engaging increased by more than double. At the six month follow up, children in the JASPER group continued to have significantly higher amounts of time spent in joint engagement than peers in the PEI group (Kasari, Gulsrud, Paparella, Hellemann, & Berry 2015, p. 558).
Initiating Joint Attention
No difference by treatment group existed in impacting the rate at which children initiated joint attention. So many children demonstrated such low incidences of initiation of joint attention that they did not fall within the measurable range at baseline. Taking data from the entire sample of study participants, the mean number of children initiating joint attention increased and the total number of children demonstrating initiation of joint attention increased significantly over the six months. It did not differ by group.
Functional Play Types
Children in the JASPER group demonstrated statistically significant higher types of functional play than the children in the PEI group. At the time of the 6 month follow up, the difference between the incidences of functional play between groups was not significant.
Symbolic Play Types
The group to which children belonged had no statistically significant impact on the occurrences of symbolic play or the rate at which children increased their symbolic play skills. This remained consistent at the 6 month follow up.
Highest Play Level Achieved
Children in the JASPER group increased more in achieving higher levels of play than their peers in the PEI group. However, at 6 months, the difference between the achievement of highest play level between groups was not significant.
Reynell Receptive Language
The group to which the children belonged had no impact on the rate of their receptive language improvement scores. Children in both groups improved their receptive language skills by approximately 17 months over the 9 months of the study and follow up (Kasari, Gulsrud, Paparella, Hellemann, & Berry, 2015, p. 560).
Reynell Expressive Language
The group to which the children belonged had no impact on the rate of their expressive language improvement scores. Children in both groups improved their receptive language skills by an average of 10 months over the 9 month time frame (Kasari, Gulsrud, Paparella, Hellemann, & Berry., 2015, p. 560).
Parent Stress Index
Parents in the PSI group reported statistically significant lower stress in the child-related domain. At follow up, more parents reported lower levels of stress in this domain, but there was no difference based on the group to which they belonged. Parents in the PSI and JASPER group reported insignificantly different levels of stress for the parent-related domain.
Classroom observations
Children in the JASPER group spent statistically significant more time jointly engaging with their teacher than their peers in the PEI group by the end of treatment. The children in the JASPER group increased from 5.7 minutes to 8.9 minutes jointly engaging with their teacher. Children in the PEI group increased from 6.9 minutes to 7.4 minutes.
Things to Consider
The external validity of the study is limited as the children were recruited from an early intervention program that they all attended. We all work with children who tend to come from a variety of settings and attend a variety of programs.
It’s exciting that children in the JASPER group made gains in functional play skills and achieved higher levels of play by the end of intervention. However, the gains did not remain significantly different than those who did not receive the treatment. The authors mention exploring providing parents with sessions after intervention to ensure that the carryover at home continues.
Carryover from Parents to Classroom
I did find it impressive that the children’s joint attention carried over to engaging with their teachers even though the children were learning the skills at home. Also noteworthy is that the children from the JASPER group continued to have higher joint attention at the time of follow up.
I love structure and routine, and I need to learn more about the JASPER program to develop my opinion of it. You can also find more information about it here. It even seems that there is a training you can complete for free. I think it’s important to give kids the lead with play, but I do think we as adults can effectively scaffold their play by using specific techniques that may reach them most. For a lot of kids, you might not have to think too hard to figure them out. However, as kids on the Spectrum process in a unique way, we always have to be open to learning how to most effectively communicate with and reach them also.
What Do You Think?
Have you heard of the JASPER model before? What other strategies or programs have you used to promote play skills for children on the Autism Spectrum?
References
Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology,83(3), 554-563. doi:10.1037/a0039080
