A toddler walked into my occupational therapy evaluation, avoiding eye contact and quickly moving towards the toys in the room. I watched him pick up a toy, deem it unacceptable, and move on to another. This process repeated itself for quite a while as I discussed concerns with his mother, until at last he found a toy train with wheels. Fixated on the wheels, he sat on the floor with the toy in his hands and spun them, staring at their rotation continuously.
After a few minutes, I went over to try to play with him. At first he just ignored my attempts, walking away whenever I came near. He quickly became agitated as I persisted. I was intervening, after all; all he wanted was to continue his spinning activity, and I was in his way. In a fit of frustration, he threw himself on the floor and started crying, unable to verbally communicate his exasperation.
His mother and I helped him calm down and began to discuss his play skills. She explained that her son gravitates towards toys but she has noticed that he does not use them as they were intended, just like when he spun the wheels of the train repetitively. She stated that disinterest in interacting with others was also typical for him, and that her attempts were met with little to no success. Usually, she said, she just gave up and let him be by himself, discouraged that she consistently made him upset when she would try to join in. She asked, “Can OT work on that?”
My answer of course was YES!
A child’s “occupation” at a young age is very simple: to play. Through play children learn countless lessons and develop valuable skills such as motor coordination, spatial awareness, and appropriate social interaction. Sometimes, the skill of play is something that does not come naturally for children. They may have to learn how to play.
Early on as an OT student, I watched an interview with Dr. Stanley Greenspan, who pioneered what’s known as the Floortime approach. Dr. Greenspan believed that in order to engage and play with a child, you literally have to get on the floor to be on their level. In the interview I watched, Dr. Greenspan referenced a child who participates in repetitive play schemes, and said something along the lines of, “Well, if you can’t plan and sequence, you’re going to repeat.” This concept was groundbreaking for me: a child who is repetitively spinning, watching toys fall, or lining up cars most likely has a motor planning deficit. If a child cannot come up with a play scheme, sequence the steps, and follow through with their plan (eg: rolling a train on a track under a tunnel) – of course they are going to repeat what they do know how to do (eg: spin the wheels). It’s not necessarily disinterest in play; it is a deficit on knowing how to play!
Dr. Greenspan’s quote continues to guide how I teach children, like the one mentioned above, to expand their play repertoire. When that little boy came to each occupational therapy session after the initial evaluation, my goals were to build good rapport, show him how to play differently, and show him how playing with other people can be so much fun. The way I “showed” him was by entering his world first until I had his attention, then extending our interaction just a little bit at a time. Since he loved to spin toys, I started with a few different ball towers. He began our sessions with just spinning the balls, which I would join him in- but then I would take a ball to the ball tower, place my ball at the top, and watch it roll down. He watched me, clearly interested but unsure on what to do. I gently touched his hand holding the ball, then touched where it was supposed to go at the top, giving him a physical cue to show him how to plan out the sequence. He was motivated to try it, because this fun activity also incorporated his love of watching things spin. After a few more physical and auditory cues, he slowly but surely learned the sequence; place the ball at the top of the tower, watch it roll down, and repeat.
It went this way for many sessions. I would join him in spinning toys, rolling balls, and pressing buttons- and when he giggled with me, I would then find a way to add a step to what we were doing. It has been a process, but his play skills and interaction with others have improved drastically.
The tenets of Dr. Greenspan’s Floortime Approach provide a treatment approach that I have found to be successful. Teaching parents how to successfully play with their child is a vital part of treatment as well, not only for their child’s development and learning, but for their own role as a parent. Below I have outlined strategies on how to facilitate more successful play with a child who struggles in this area.
- Meet them on their level, on the floor. Just being on the floor with your child is instantly more engaging for them. Crawling, laying down, rolling- your child does it, you do it too!
- Follow their lead, then expand it. Your child lines up the cars? Start by lining them up too, then show them how you can push the line of cars using the back car. All of a sudden, your car line is moving towards the end of the coffee table, falling hilariously one by one. Your child then brings the fallen cars back to you to put at the end of the line. What started as lining up cars has grown into a multi- step play scheme!
- Include high affect and big movements. Using a voice that fluctuates in volume and tone can catch the attention of your child and be more engaging. For a child who has difficulty acknowledging others during play, big exaggerated movements, sounds and facial expressions can really help!
- Understand their sensory needs and preferences. Have a kiddo who likes to watch things spin? Take turns placing balls at the top of a ball tower. Have a child who loves to crash? Make a game out of jumping to and falling on the sofa cushions. Choose play activities that match what they like!
- If you have their attention, keep it. It’s okay if you’ve been playing with the same toy for an hour. If you have their attention and are interacting back and forth in play, keep it going! Drawing out interactions to capitalize on the anticipation factor, such as waiting for a bubble to be blown, is helpful as well.
There’s definitely a delicate balance in teaching your child how to play more functionally while enjoying it at the same time. If you feel your child could use some guidance in learning how to play, reach out to your pediatrician for a referral to occupational therapy.