Playtime with purpose
With each structured play session, Amanda Bryce could see her pre-school son gradually understand what to do with all the toys around him.
"He was getting a real understanding of the world too," she says. He had, for example, linked an ambulance he saw in the street to the sound of a siren he'd made at one of the sessions.
Lesley Burns says the play sessions have helped her son to became generally "more tolerant of the world", even a specific difficulty he has with textiles, and she was thrilled when he started to tell jokes.
Linda Johnston says it seemed as though a light had been switched on in her son's head and he was calm and happy after every session.
These boys and 17 other young children with autistic spectrum disorders were recently part of an early intervention project in South Lanarkshire to try to address their problems.
The Share project, which was run jointly by the Scottish Society for Autism, the University of Strathclyde and the local authority, focused on a sharply defined method of play as a means of developing the children's difficulties with social interaction and motivation, communication and imaginative representation, the triad of social impairments for people with autism.
Experienced advisers from the Autism Advisory and Consultancy Service visited each child for one hour a week over 15 weeks, either at home or in their nursery school. They were introduced to the children as "someone who's come to play" and greeted with varying levels of acceptance. However, with gentle coaxing, even the most reluctant children began to explore the boxes of toys and engage with their adviser.
The format of the play sessions centred on a pair of boxes, one for the child and one for the adviser. Each box contained six to eight different types of toys ,with a matching or related equivalent in the other box. For example, a doll and a train engine matched with a different doll and a train carriage in the other box. The toys and the choice of decoration for the boxes were selected to reflect and suit childrens' interests, on the advice of their parents.
During the play sessions the adviser would encourage a range of different types of play to develop the child's interactive and communicative skills.
Children were encouraged to relate their toy to the adviser's equivalent one. In joint expressive or attentive play, for example, the child was encouraged to pick up on facial expressions or hand movements to join in with the games.
Autism adviser Caroline Schofield says blowing bubbles proved a successful way to engage one of her children in play. As he learned to follow Caroline by blowing his own bubbles, he also developed the play skill of introducing a representational other person - a doll - that he imagined joining in with the bubble blowing too. This was a significant breakthrough for a child on the autistic spectrum, for whom role play is a very difficult concept.
Linda Johnston says that her daughter, who like her brother has an autistic spectrum disorder, also developed a new sense of imaginative play which extended role-play with dolls and teddies far beyond what she had done before.
A key feature of each session was that the child and adviser played alone, with a few exceptions where the children wanted their mothers to stay with them. Forming close relationships, sometimes after a reluctant start, was central to success. Amanda Bryce says her son couldn't wait for Mary to come, although initially he had seen the sessions as an interruption to his previously quiet time with cartoons after a morning at nursery school.
Another boy proudly declared that his adviser was "just for me!"
The parents credit the success of the project to the skills of the individual advisers. "They had bags of confidence and found the children's strengths from the word go," says one. "There was absolutely no emphasis on the negative."
Sharon Holton says the Share project has made a huge difference to family life. Her son has since coped "brilliantly" with visits to shopping centres and a big family celebration.
Colin and Linda Jarvie emphasise the value of what they learned about the potential of varied types of play with their son. Considering a different use of language had influenced their approach to play, focusing on the positive and encouraging. Success in terms of forming a new relationship was also very encouraging. "He had never taken to anyone before," they say.
For the advisers, successes could be identified even in the early stages of the project. They were encouraged by the smallest signs, be it slight eye contact, change in body language or facial expression. For Jackie Cramb, one boy's initial rejection of her was quite significant in that he took her hand and calmly led her to the door. "We had at least made contact," she says.
After each session the advisers provided parents with a follow-up report and some sessions were video taped to help with assessment. Teamwork was key to success, with the involvement of, for example, speech therapists in integrating language development.
The advisers say that familiarity with the difficulties and deficits of autistic spectrum disorders was paramount, though their aim was to work on the foundations of interaction and communication that are not so much deficits as aspects of development which have not progressed.
The project team, headed by Helen Marwick, co-director of the University of Strathclyde's National Centre for Autism Studies, and Gilbert MacKay, professor of special education at the university, do not give the impression of creating a quick-fix cure for the disabling effects of autism.
Adviser Mary Hamilton says: "We're helping the children to predict and understand structures in a very basic sense." For example, through the play sessions she helped one boy to make sense of the reasons for having balloons at a party. For another boy she was working with, the representational other person - a teddy bear - played an important role in structuring toilet routines.
The project, which was funded by an innovation grant from the Scottish Executive Education Department, was completed in March and though the research findings have not yet been published, Dr Marwick is very pleased with the outcomes. Most parents reported significant and positive changes in their children's behaviour.
The team of advisers is keen to continue with the project, extending practice and liaison with the original cohort of 20 children - who are about to start in full-time Primary 1 education, mostly within specialist support provision - and making the work available to a wider group of parents and children.
The team is also considering new ideas, for example, more involvement of the parents. The development of group and peer play would give a broader perspective on work with the triad of impairments.
Lisa Glashan, who is a pre-school outreach teacher in the Autistic Spectrum Base at Chatelherault Primary in Hamilton, emphasises the importance of liaison with teachers to extend the benefits of the project into the classroom context.
"The project," she says, "has spawned all sorts of ideas that extend beyond pre-school and into lifelong learning."
National Centre for Autism Studies, Strathclyde University, tel 0141 950 3742 www.strath.ac.ukautism-ncaswww.autism-in-scotland.org.uk