Playful Occupational Therapy Intervention for Children and
Post on 03-Feb-2022
2 Views
Preview:
Transcript
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 1
Playful Occupational Therapy
Intervention for Children and
Adolescents with Autism
Innovative Creative and Evidence-
Based Strategies for Success
copy Susan L Spitzer PhD OTRL Heather Miller Kuhaneck PhD OTRL FAOTA
Elissa Longo OTD OTRL
Introduction to Speakers Susan L Spitzer PhD OTRL
Adjunct Assistant Professor of Clinical Occupational
Therapy University of Southern California
Private Practice Pasadena CA
Heather Miller Kuhaneck PhD OTRL FAOTA
Clinical Assistant Professor Sacred Heart University
Elissa Longo OTD OTRL
Sacred Heart University
Learning Objectives Understand the evidence supporting a playful approach
to occupational therapy intervention with children and
adolescents with autism
Identify opportunities for innovative creative and
evidence-based playful occupational therapy
intervention with children and adolescents with autism
Consider ways to implement playful occupational
therapy in onersquos own clinic and school setting
The Importance of Play
Child Development
In studies of typical children play has been associated with
Divergent and convergent thinking (Fisher 1992 Russ
Robbins amp Christiano 1999 Wyver amp Spence 1999)
Associative fluency or the ability to suggest alternative uses
for an object (Dansky amp Silverman 1973)
Creativity (Howard-Jones Taylor amp Sutton 2002 Saracho
2002)
Flexibility in approach to problem solving (Pepler amp Ross
1981)
Metacognition and self-regulation strategies (Whitebread
Coltman Jameson amp Lander 2009)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
The Importance of Play Autism
Documented neurological deficits in multiple
brain areas in autism
Animal research suggests that play impacts
these brain regions
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Through brain plasticity- play
could provide environmental
enrichment of the sort that
improves function and changes
developmental trajectories
The Importance of Play
Family- amp Child-Centered Care
ldquoFamily-centered service recognizes that each family is unique
that the family is the constant in the childrsquos life and that they
are the experts on the childrsquos abilities and needs The family
works together with service providers to make informed
decisions about the services and supports the child and family
receive In family-centered service the strengths and needs of
all family members are consideredrdquo(King et al 2004)
FCC is about maximizing parents ability to foster their childrsquos
development and well being
Often what families care about = play and friendships
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 2
The State of Play in OT What we did 10+ years
ago (Couch Dietz amp
Kanny (1998)
What do we do now
(Brown et al 2005
Howard 2002 Kramer
et al 2009 Kuhaneck amp
Tanta in preparation
Rodger et al 2006
Saleh et al 2008)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
The State of Play in OT
Barriers Reported barriers
Funding sources
Contextual factors(ie
school based practice)
Removing barriers
Goal writing
Education of others
Family members as allies
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Play-Based amp Occupation-Focused
Intervention in Occupational Therapy (Kuhaneck Spitzer amp Miller 2010)
Play amp Pediatric OT Play as an occupation (Parham 2008)
The missing piece of meaning
Play in natural environments daily life
Contextual influences
Physical safety
Space for play
Time for play
Availability of developmentally appropriate amp preferred play
materials
Appropriate social interaction
Play-Based amp Occupation-Focused
Intervention in Occupational Therapy (contrsquod) (Parham 2008)
Best practice
We must become more comfortable with play as a
GOAL rather than a means to achieve some other goal
But- we must be able to explain to others why play is
important
For some children especially those with autism being
able to play IS an important goal- as we will now see
Capabilities and difficulties of
children with autism
in relation to play
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
bull Play Skills The StructureForm of Play bull Delayed or different in quality amp quantity- Spitzer (2008)
Play difficulties in children
with autism Object play
Both extreme preoccupation with and
atypical use of objects is noted
(Baranek et al 2005 Ozonoff et al
2008 Rowland amp Schweigert 2009
Williams 2003 Williams Costall amp
Reddy 1999 Williams Kendell-
Scott amp Costall 2005)
Objects hold the potential for fear
and anxiety (Grandin 1997)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 3
Play difficulties in children
with autism Functional Play
No differences in frequency
Differences in quality and
total time spent in this realm
(Charman et al 1997
Jarrold Boucher amp Smith
1996 Lewis amp Boucher
1988 Williams 2003
Williams Costall amp Reddy
1999)
Play Difficulties in Children with
Autism Symbolic Play
Less likely to engage in pretend play
Spend less total time in pretend play
Impaired in production of novel
pretend acts
BUT - Are capable of pretending-
especially when elicited by an adult
(Charman amp Baron-Cohen 1997 Hobson
Lee amp Hobson 2009 Jarrold 2003
Jarrold et al 1996 Lewis amp Boucher
1988 Libby et al 1998)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play difficulties in Children with
Autism Natural free play with peers Greater differences noted in play when
free play is observed (vs elicited play)
Interactions with others rare and when
they occur- are most often with adults
Play episodes are brief
In one study- preferred play and play
objects were sensorimotor in nature
(Holmes and Procaccino 2009 Holmes amp
Willoughby 2005 McGee Feldman and
Morrier 1997)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play in Children with Autism
The Experience
The Experience of Play Motivation amp Mental Health
Play and individual meaning
Play and the self as an occupational being
The experience of play for children with autism
Spitzer (2008)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Assessment Examining
Personal Meaning in
Occupations of Children
with Autism
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Socially Framed Activities Self-care work school
Unconventional Activities
Spitzer (2010)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 4
Gathering Information about likes dislikes preferences
Observations
Interviewsreports
participation
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Identifying unconventional Occupations
Intentional actions
A set of actions
With meaning
Spitzer (2003b 2010)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
The Challenge of Identifying Meaning and Intention
The childrsquos perspective often is different due to
differences in
development
language amp
perception
Spitzer (2003a)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
An essential component
ldquoa sophisticated understanding of the unique qualities
of the activitiesrdquo (Fidler amp Velde 1999 p 2)
sensory experience physical characteristics childrsquos
skill other child characteristics
Detailsnuances of what amp how the child does the
activity are critical
Helps identify what is the occupation
Assessment
Child-Specific Activity Analysis
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Framing the Occupation
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
Assessment
What is the Occupation
The What and How
BehavioralMaterial Content
observations of obvious and subtle
behaviors and use of materials
The Why Subjective
Meaning
making connections
to infer amp interpret meaning
Meaning and Intention in Occupation
(Williams 1998 Spitzer 2001 2003b)
Assessment
Clinical Reasoning amp
Interpretation
Details from
Activity Analysis
What was
includedexcluded
Was it choice skill
or context
Why do it
Meaning
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 5
Case examples ldquoPlaying withrdquo Dirt for Mike amp Alex
Assessment
Clinical Reasoning amp
Interpretation
Being Playful
Therapeutic Use of Self in
Pediatric OT for Children with
Autism
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Communication
Understanding the Child
Communicating that Therapy is fun
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Therapeutic Use of Self
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Suspend adult assumptions (ie superiority) (Curtin
2001 Fine amp Sandstrom 1988)
Level power differencesinequalitymdashavoid being an
authority figure minimize stopping and directing of the
client let them show us (Curtin 2001 Fine amp
Sandstrom 1988)
Look for effectimpact of adult presence (Fine amp
Sandstrom 1988)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Assume all actions are potentially communicative (Durig
1996)
Attend to communication through occupational
engagement especially shared occupations (Grandin amp
Scariano 1986 Spitzer 2003a Williams 1992)
Look for individualized communication strategies around
shared routines physical environment likes and dislikes
and bodily expressions (Goode 1980 1994 Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Develop a shared history with the clientmdashunderstand
their favorite objects and preferences and participate in
activities with them (Goode 1980 1994 Spitzer 2003a)
Interview other people knowledgeable about the client
Follow the clientrsquos directionsmdashat times let them lead
usldquopassive obediencerdquo (Goode 1980)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 6
Imitate physically simulate or imagine the individualrsquos
sensory experience of the occupation to ldquofeelrdquo the
experience (Goode 1980 Spitzer 2003a)
Sharpen conscious awareness of various auditory
visual tactile and kinesthetic sensations (Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Communicating that Therapy is
Fun Eyes
Face
Body
Touch
Voice (vocalizations)
Use a playful tone
Vary pitch loudness rhythm
Repeat sounds
Imitate sounds and ways that sounds are used by child
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Language
Minimize directive language
Imitate childrsquos words
Match language to childrsquos development
song melody rhythm or different voice (eg accent)
ldquokid playrdquo words phrases and sounds
humor jokes and mischievous tone
ldquoTalkingrdquo of inanimate objects
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Empathy amp Rapport
Empathymdashinformed caring
Rapport amp Therapeutic Relationshipmdashworking alliance or
bond (Tickle-Degnen 2002)
Being Playful
Demonstrating Empathy amp
Rapport
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Demonstrating Empathy amp
Rapport in Play Sharing Controlmdashpartners
Spontaneity amp Flexibility
Managing Challenges in Play
Focusing on Future Possibilities
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 7
occupational therapy literature on therapeutic use of self
OTs report relationship to outcomes (Cole amp McLean 2003
Gahnstrom-Strandqvist Tham Josephsson amp Borell
2000 Hasselkus amp Dickie 1994 Rosa amp Hasselkus 1996
Taylor Lee Kielhofner amp Ketkar 2009)
Correlated with clientsrsquo perceived outcomes (Law 1998
Darragh Sample amp Krieger 2001 Palmadottir 2003
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in general
Greater complexitylevel more engagement longer play
episodes (Fiese 1990 Haight amp Miller 1992 Sorce amp
Emde 1981 Slade 1987)
Feedback amp encouragement to use interactive strategies
more frequentlymore competent play (Belsky Goode amp
Most 1980)
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in children with disabilities
Amount of play playfulness (Lawson Parrinello amp Ruff
1992 Daunhauer Coster Tickle-Degnen amp Cermak 2007
Chiarello Huntington amp Bundy 2006 Evans amp Meyer
1999)
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Autism amp Adult-Child Play
Nadel Martini Field Escalona and Lundy (2008)
looked at approached and touched adults more frequently when adult more often looked at the child smiled at the child moved toward the child had relaxed body tone made sounds imitated the child and was playful
Tiegerman amp Primavera (1981)
frequency amp duration of object manipulation was greatest when the adult imitated the child by using both the materials and methods of play that the child chose rather than different action or object
Skaines Rodger amp Bundy (2006)
adult structure of play increased playfulness
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Playful Strategies
Selecting Adapting amp Creating
Activities that Children
Want to Do
Playful Strategies Using Personal Interests amp Preferences to Reframe
ldquoWorkrdquo into ldquoPlayrdquo (in therapy amp daily life)
Embedding ldquoPlayrdquo in ldquoWorkrdquo
Expanding Current Occupations
Adapting Individual Interests into Shared Social
Activities
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 8
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
The What and How
BehavioralMaterial Content
The Why Subjective
Meaning
Reframing ldquoWorkrdquo into ldquoPlayrdquo What they Like to Do (more
like play)
Visual feedback
Construction
Sensory properties
Sensorimotor engagement
Favorite toys
Narratives from favorite stories or movies
(Spitzer 2008)
What They Need to Do (often more work)
ADLsSelf-Care
Sleep
Education
ldquoPlayrdquo
Social Participation
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Video Case Self-Care
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Self-CareDressing
Kuhaneck Spitzer amp Miller (2010)
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing
Materials (sensory objects etc)
A passiontopic (food cars geography presidents)
Theme of interest--Silly or ldquoinappropriaterdquo or ldquotrickyrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Writing
Writing Work Car Writing Game
Kuhaneck Spitzer amp Miller (2010)
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 9
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing More examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of ldquoPlayrdquo Activities Soccer
Kuhaneck Spitzer amp Miller (2010)
ldquoHorses vs Wolvesrdquo
Embedding ldquoPlayrdquo in ldquoWorkrdquo
The Case of Beneficial ldquoOff-Taskrdquo Behavior
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case Part II
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Lack of interests
Narrow Interests
Limited Interests amp Social Play
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 2
The State of Play in OT What we did 10+ years
ago (Couch Dietz amp
Kanny (1998)
What do we do now
(Brown et al 2005
Howard 2002 Kramer
et al 2009 Kuhaneck amp
Tanta in preparation
Rodger et al 2006
Saleh et al 2008)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
The State of Play in OT
Barriers Reported barriers
Funding sources
Contextual factors(ie
school based practice)
Removing barriers
Goal writing
Education of others
Family members as allies
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Play-Based amp Occupation-Focused
Intervention in Occupational Therapy (Kuhaneck Spitzer amp Miller 2010)
Play amp Pediatric OT Play as an occupation (Parham 2008)
The missing piece of meaning
Play in natural environments daily life
Contextual influences
Physical safety
Space for play
Time for play
Availability of developmentally appropriate amp preferred play
materials
Appropriate social interaction
Play-Based amp Occupation-Focused
Intervention in Occupational Therapy (contrsquod) (Parham 2008)
Best practice
We must become more comfortable with play as a
GOAL rather than a means to achieve some other goal
But- we must be able to explain to others why play is
important
For some children especially those with autism being
able to play IS an important goal- as we will now see
Capabilities and difficulties of
children with autism
in relation to play
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
bull Play Skills The StructureForm of Play bull Delayed or different in quality amp quantity- Spitzer (2008)
Play difficulties in children
with autism Object play
Both extreme preoccupation with and
atypical use of objects is noted
(Baranek et al 2005 Ozonoff et al
2008 Rowland amp Schweigert 2009
Williams 2003 Williams Costall amp
Reddy 1999 Williams Kendell-
Scott amp Costall 2005)
Objects hold the potential for fear
and anxiety (Grandin 1997)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 3
Play difficulties in children
with autism Functional Play
No differences in frequency
Differences in quality and
total time spent in this realm
(Charman et al 1997
Jarrold Boucher amp Smith
1996 Lewis amp Boucher
1988 Williams 2003
Williams Costall amp Reddy
1999)
Play Difficulties in Children with
Autism Symbolic Play
Less likely to engage in pretend play
Spend less total time in pretend play
Impaired in production of novel
pretend acts
BUT - Are capable of pretending-
especially when elicited by an adult
(Charman amp Baron-Cohen 1997 Hobson
Lee amp Hobson 2009 Jarrold 2003
Jarrold et al 1996 Lewis amp Boucher
1988 Libby et al 1998)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play difficulties in Children with
Autism Natural free play with peers Greater differences noted in play when
free play is observed (vs elicited play)
Interactions with others rare and when
they occur- are most often with adults
Play episodes are brief
In one study- preferred play and play
objects were sensorimotor in nature
(Holmes and Procaccino 2009 Holmes amp
Willoughby 2005 McGee Feldman and
Morrier 1997)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play in Children with Autism
The Experience
The Experience of Play Motivation amp Mental Health
Play and individual meaning
Play and the self as an occupational being
The experience of play for children with autism
Spitzer (2008)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Assessment Examining
Personal Meaning in
Occupations of Children
with Autism
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Socially Framed Activities Self-care work school
Unconventional Activities
Spitzer (2010)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 4
Gathering Information about likes dislikes preferences
Observations
Interviewsreports
participation
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Identifying unconventional Occupations
Intentional actions
A set of actions
With meaning
Spitzer (2003b 2010)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
The Challenge of Identifying Meaning and Intention
The childrsquos perspective often is different due to
differences in
development
language amp
perception
Spitzer (2003a)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
An essential component
ldquoa sophisticated understanding of the unique qualities
of the activitiesrdquo (Fidler amp Velde 1999 p 2)
sensory experience physical characteristics childrsquos
skill other child characteristics
Detailsnuances of what amp how the child does the
activity are critical
Helps identify what is the occupation
Assessment
Child-Specific Activity Analysis
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Framing the Occupation
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
Assessment
What is the Occupation
The What and How
BehavioralMaterial Content
observations of obvious and subtle
behaviors and use of materials
The Why Subjective
Meaning
making connections
to infer amp interpret meaning
Meaning and Intention in Occupation
(Williams 1998 Spitzer 2001 2003b)
Assessment
Clinical Reasoning amp
Interpretation
Details from
Activity Analysis
What was
includedexcluded
Was it choice skill
or context
Why do it
Meaning
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 5
Case examples ldquoPlaying withrdquo Dirt for Mike amp Alex
Assessment
Clinical Reasoning amp
Interpretation
Being Playful
Therapeutic Use of Self in
Pediatric OT for Children with
Autism
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Communication
Understanding the Child
Communicating that Therapy is fun
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Therapeutic Use of Self
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Suspend adult assumptions (ie superiority) (Curtin
2001 Fine amp Sandstrom 1988)
Level power differencesinequalitymdashavoid being an
authority figure minimize stopping and directing of the
client let them show us (Curtin 2001 Fine amp
Sandstrom 1988)
Look for effectimpact of adult presence (Fine amp
Sandstrom 1988)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Assume all actions are potentially communicative (Durig
1996)
Attend to communication through occupational
engagement especially shared occupations (Grandin amp
Scariano 1986 Spitzer 2003a Williams 1992)
Look for individualized communication strategies around
shared routines physical environment likes and dislikes
and bodily expressions (Goode 1980 1994 Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Develop a shared history with the clientmdashunderstand
their favorite objects and preferences and participate in
activities with them (Goode 1980 1994 Spitzer 2003a)
Interview other people knowledgeable about the client
Follow the clientrsquos directionsmdashat times let them lead
usldquopassive obediencerdquo (Goode 1980)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 6
Imitate physically simulate or imagine the individualrsquos
sensory experience of the occupation to ldquofeelrdquo the
experience (Goode 1980 Spitzer 2003a)
Sharpen conscious awareness of various auditory
visual tactile and kinesthetic sensations (Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Communicating that Therapy is
Fun Eyes
Face
Body
Touch
Voice (vocalizations)
Use a playful tone
Vary pitch loudness rhythm
Repeat sounds
Imitate sounds and ways that sounds are used by child
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Language
Minimize directive language
Imitate childrsquos words
Match language to childrsquos development
song melody rhythm or different voice (eg accent)
ldquokid playrdquo words phrases and sounds
humor jokes and mischievous tone
ldquoTalkingrdquo of inanimate objects
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Empathy amp Rapport
Empathymdashinformed caring
Rapport amp Therapeutic Relationshipmdashworking alliance or
bond (Tickle-Degnen 2002)
Being Playful
Demonstrating Empathy amp
Rapport
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Demonstrating Empathy amp
Rapport in Play Sharing Controlmdashpartners
Spontaneity amp Flexibility
Managing Challenges in Play
Focusing on Future Possibilities
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 7
occupational therapy literature on therapeutic use of self
OTs report relationship to outcomes (Cole amp McLean 2003
Gahnstrom-Strandqvist Tham Josephsson amp Borell
2000 Hasselkus amp Dickie 1994 Rosa amp Hasselkus 1996
Taylor Lee Kielhofner amp Ketkar 2009)
Correlated with clientsrsquo perceived outcomes (Law 1998
Darragh Sample amp Krieger 2001 Palmadottir 2003
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in general
Greater complexitylevel more engagement longer play
episodes (Fiese 1990 Haight amp Miller 1992 Sorce amp
Emde 1981 Slade 1987)
Feedback amp encouragement to use interactive strategies
more frequentlymore competent play (Belsky Goode amp
Most 1980)
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in children with disabilities
Amount of play playfulness (Lawson Parrinello amp Ruff
1992 Daunhauer Coster Tickle-Degnen amp Cermak 2007
Chiarello Huntington amp Bundy 2006 Evans amp Meyer
1999)
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Autism amp Adult-Child Play
Nadel Martini Field Escalona and Lundy (2008)
looked at approached and touched adults more frequently when adult more often looked at the child smiled at the child moved toward the child had relaxed body tone made sounds imitated the child and was playful
Tiegerman amp Primavera (1981)
frequency amp duration of object manipulation was greatest when the adult imitated the child by using both the materials and methods of play that the child chose rather than different action or object
Skaines Rodger amp Bundy (2006)
adult structure of play increased playfulness
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Playful Strategies
Selecting Adapting amp Creating
Activities that Children
Want to Do
Playful Strategies Using Personal Interests amp Preferences to Reframe
ldquoWorkrdquo into ldquoPlayrdquo (in therapy amp daily life)
Embedding ldquoPlayrdquo in ldquoWorkrdquo
Expanding Current Occupations
Adapting Individual Interests into Shared Social
Activities
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 8
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
The What and How
BehavioralMaterial Content
The Why Subjective
Meaning
Reframing ldquoWorkrdquo into ldquoPlayrdquo What they Like to Do (more
like play)
Visual feedback
Construction
Sensory properties
Sensorimotor engagement
Favorite toys
Narratives from favorite stories or movies
(Spitzer 2008)
What They Need to Do (often more work)
ADLsSelf-Care
Sleep
Education
ldquoPlayrdquo
Social Participation
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Video Case Self-Care
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Self-CareDressing
Kuhaneck Spitzer amp Miller (2010)
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing
Materials (sensory objects etc)
A passiontopic (food cars geography presidents)
Theme of interest--Silly or ldquoinappropriaterdquo or ldquotrickyrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Writing
Writing Work Car Writing Game
Kuhaneck Spitzer amp Miller (2010)
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 9
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing More examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of ldquoPlayrdquo Activities Soccer
Kuhaneck Spitzer amp Miller (2010)
ldquoHorses vs Wolvesrdquo
Embedding ldquoPlayrdquo in ldquoWorkrdquo
The Case of Beneficial ldquoOff-Taskrdquo Behavior
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case Part II
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Lack of interests
Narrow Interests
Limited Interests amp Social Play
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 3
Play difficulties in children
with autism Functional Play
No differences in frequency
Differences in quality and
total time spent in this realm
(Charman et al 1997
Jarrold Boucher amp Smith
1996 Lewis amp Boucher
1988 Williams 2003
Williams Costall amp Reddy
1999)
Play Difficulties in Children with
Autism Symbolic Play
Less likely to engage in pretend play
Spend less total time in pretend play
Impaired in production of novel
pretend acts
BUT - Are capable of pretending-
especially when elicited by an adult
(Charman amp Baron-Cohen 1997 Hobson
Lee amp Hobson 2009 Jarrold 2003
Jarrold et al 1996 Lewis amp Boucher
1988 Libby et al 1998)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play difficulties in Children with
Autism Natural free play with peers Greater differences noted in play when
free play is observed (vs elicited play)
Interactions with others rare and when
they occur- are most often with adults
Play episodes are brief
In one study- preferred play and play
objects were sensorimotor in nature
(Holmes and Procaccino 2009 Holmes amp
Willoughby 2005 McGee Feldman and
Morrier 1997)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play in Children with Autism
The Experience
The Experience of Play Motivation amp Mental Health
Play and individual meaning
Play and the self as an occupational being
The experience of play for children with autism
Spitzer (2008)
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Assessment Examining
Personal Meaning in
Occupations of Children
with Autism
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Socially Framed Activities Self-care work school
Unconventional Activities
Spitzer (2010)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 4
Gathering Information about likes dislikes preferences
Observations
Interviewsreports
participation
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Identifying unconventional Occupations
Intentional actions
A set of actions
With meaning
Spitzer (2003b 2010)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
The Challenge of Identifying Meaning and Intention
The childrsquos perspective often is different due to
differences in
development
language amp
perception
Spitzer (2003a)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
An essential component
ldquoa sophisticated understanding of the unique qualities
of the activitiesrdquo (Fidler amp Velde 1999 p 2)
sensory experience physical characteristics childrsquos
skill other child characteristics
Detailsnuances of what amp how the child does the
activity are critical
Helps identify what is the occupation
Assessment
Child-Specific Activity Analysis
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Framing the Occupation
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
Assessment
What is the Occupation
The What and How
BehavioralMaterial Content
observations of obvious and subtle
behaviors and use of materials
The Why Subjective
Meaning
making connections
to infer amp interpret meaning
Meaning and Intention in Occupation
(Williams 1998 Spitzer 2001 2003b)
Assessment
Clinical Reasoning amp
Interpretation
Details from
Activity Analysis
What was
includedexcluded
Was it choice skill
or context
Why do it
Meaning
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 5
Case examples ldquoPlaying withrdquo Dirt for Mike amp Alex
Assessment
Clinical Reasoning amp
Interpretation
Being Playful
Therapeutic Use of Self in
Pediatric OT for Children with
Autism
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Communication
Understanding the Child
Communicating that Therapy is fun
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Therapeutic Use of Self
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Suspend adult assumptions (ie superiority) (Curtin
2001 Fine amp Sandstrom 1988)
Level power differencesinequalitymdashavoid being an
authority figure minimize stopping and directing of the
client let them show us (Curtin 2001 Fine amp
Sandstrom 1988)
Look for effectimpact of adult presence (Fine amp
Sandstrom 1988)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Assume all actions are potentially communicative (Durig
1996)
Attend to communication through occupational
engagement especially shared occupations (Grandin amp
Scariano 1986 Spitzer 2003a Williams 1992)
Look for individualized communication strategies around
shared routines physical environment likes and dislikes
and bodily expressions (Goode 1980 1994 Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Develop a shared history with the clientmdashunderstand
their favorite objects and preferences and participate in
activities with them (Goode 1980 1994 Spitzer 2003a)
Interview other people knowledgeable about the client
Follow the clientrsquos directionsmdashat times let them lead
usldquopassive obediencerdquo (Goode 1980)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 6
Imitate physically simulate or imagine the individualrsquos
sensory experience of the occupation to ldquofeelrdquo the
experience (Goode 1980 Spitzer 2003a)
Sharpen conscious awareness of various auditory
visual tactile and kinesthetic sensations (Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Communicating that Therapy is
Fun Eyes
Face
Body
Touch
Voice (vocalizations)
Use a playful tone
Vary pitch loudness rhythm
Repeat sounds
Imitate sounds and ways that sounds are used by child
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Language
Minimize directive language
Imitate childrsquos words
Match language to childrsquos development
song melody rhythm or different voice (eg accent)
ldquokid playrdquo words phrases and sounds
humor jokes and mischievous tone
ldquoTalkingrdquo of inanimate objects
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Empathy amp Rapport
Empathymdashinformed caring
Rapport amp Therapeutic Relationshipmdashworking alliance or
bond (Tickle-Degnen 2002)
Being Playful
Demonstrating Empathy amp
Rapport
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Demonstrating Empathy amp
Rapport in Play Sharing Controlmdashpartners
Spontaneity amp Flexibility
Managing Challenges in Play
Focusing on Future Possibilities
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 7
occupational therapy literature on therapeutic use of self
OTs report relationship to outcomes (Cole amp McLean 2003
Gahnstrom-Strandqvist Tham Josephsson amp Borell
2000 Hasselkus amp Dickie 1994 Rosa amp Hasselkus 1996
Taylor Lee Kielhofner amp Ketkar 2009)
Correlated with clientsrsquo perceived outcomes (Law 1998
Darragh Sample amp Krieger 2001 Palmadottir 2003
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in general
Greater complexitylevel more engagement longer play
episodes (Fiese 1990 Haight amp Miller 1992 Sorce amp
Emde 1981 Slade 1987)
Feedback amp encouragement to use interactive strategies
more frequentlymore competent play (Belsky Goode amp
Most 1980)
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in children with disabilities
Amount of play playfulness (Lawson Parrinello amp Ruff
1992 Daunhauer Coster Tickle-Degnen amp Cermak 2007
Chiarello Huntington amp Bundy 2006 Evans amp Meyer
1999)
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Autism amp Adult-Child Play
Nadel Martini Field Escalona and Lundy (2008)
looked at approached and touched adults more frequently when adult more often looked at the child smiled at the child moved toward the child had relaxed body tone made sounds imitated the child and was playful
Tiegerman amp Primavera (1981)
frequency amp duration of object manipulation was greatest when the adult imitated the child by using both the materials and methods of play that the child chose rather than different action or object
Skaines Rodger amp Bundy (2006)
adult structure of play increased playfulness
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Playful Strategies
Selecting Adapting amp Creating
Activities that Children
Want to Do
Playful Strategies Using Personal Interests amp Preferences to Reframe
ldquoWorkrdquo into ldquoPlayrdquo (in therapy amp daily life)
Embedding ldquoPlayrdquo in ldquoWorkrdquo
Expanding Current Occupations
Adapting Individual Interests into Shared Social
Activities
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 8
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
The What and How
BehavioralMaterial Content
The Why Subjective
Meaning
Reframing ldquoWorkrdquo into ldquoPlayrdquo What they Like to Do (more
like play)
Visual feedback
Construction
Sensory properties
Sensorimotor engagement
Favorite toys
Narratives from favorite stories or movies
(Spitzer 2008)
What They Need to Do (often more work)
ADLsSelf-Care
Sleep
Education
ldquoPlayrdquo
Social Participation
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Video Case Self-Care
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Self-CareDressing
Kuhaneck Spitzer amp Miller (2010)
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing
Materials (sensory objects etc)
A passiontopic (food cars geography presidents)
Theme of interest--Silly or ldquoinappropriaterdquo or ldquotrickyrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Writing
Writing Work Car Writing Game
Kuhaneck Spitzer amp Miller (2010)
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 9
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing More examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of ldquoPlayrdquo Activities Soccer
Kuhaneck Spitzer amp Miller (2010)
ldquoHorses vs Wolvesrdquo
Embedding ldquoPlayrdquo in ldquoWorkrdquo
The Case of Beneficial ldquoOff-Taskrdquo Behavior
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case Part II
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Lack of interests
Narrow Interests
Limited Interests amp Social Play
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 4
Gathering Information about likes dislikes preferences
Observations
Interviewsreports
participation
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Identifying unconventional Occupations
Intentional actions
A set of actions
With meaning
Spitzer (2003b 2010)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
The Challenge of Identifying Meaning and Intention
The childrsquos perspective often is different due to
differences in
development
language amp
perception
Spitzer (2003a)
Assessment
Occupational Profile
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
An essential component
ldquoa sophisticated understanding of the unique qualities
of the activitiesrdquo (Fidler amp Velde 1999 p 2)
sensory experience physical characteristics childrsquos
skill other child characteristics
Detailsnuances of what amp how the child does the
activity are critical
Helps identify what is the occupation
Assessment
Child-Specific Activity Analysis
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Framing the Occupation
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
Assessment
What is the Occupation
The What and How
BehavioralMaterial Content
observations of obvious and subtle
behaviors and use of materials
The Why Subjective
Meaning
making connections
to infer amp interpret meaning
Meaning and Intention in Occupation
(Williams 1998 Spitzer 2001 2003b)
Assessment
Clinical Reasoning amp
Interpretation
Details from
Activity Analysis
What was
includedexcluded
Was it choice skill
or context
Why do it
Meaning
LO Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 5
Case examples ldquoPlaying withrdquo Dirt for Mike amp Alex
Assessment
Clinical Reasoning amp
Interpretation
Being Playful
Therapeutic Use of Self in
Pediatric OT for Children with
Autism
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Communication
Understanding the Child
Communicating that Therapy is fun
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Therapeutic Use of Self
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Suspend adult assumptions (ie superiority) (Curtin
2001 Fine amp Sandstrom 1988)
Level power differencesinequalitymdashavoid being an
authority figure minimize stopping and directing of the
client let them show us (Curtin 2001 Fine amp
Sandstrom 1988)
Look for effectimpact of adult presence (Fine amp
Sandstrom 1988)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Assume all actions are potentially communicative (Durig
1996)
Attend to communication through occupational
engagement especially shared occupations (Grandin amp
Scariano 1986 Spitzer 2003a Williams 1992)
Look for individualized communication strategies around
shared routines physical environment likes and dislikes
and bodily expressions (Goode 1980 1994 Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Develop a shared history with the clientmdashunderstand
their favorite objects and preferences and participate in
activities with them (Goode 1980 1994 Spitzer 2003a)
Interview other people knowledgeable about the client
Follow the clientrsquos directionsmdashat times let them lead
usldquopassive obediencerdquo (Goode 1980)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 6
Imitate physically simulate or imagine the individualrsquos
sensory experience of the occupation to ldquofeelrdquo the
experience (Goode 1980 Spitzer 2003a)
Sharpen conscious awareness of various auditory
visual tactile and kinesthetic sensations (Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Communicating that Therapy is
Fun Eyes
Face
Body
Touch
Voice (vocalizations)
Use a playful tone
Vary pitch loudness rhythm
Repeat sounds
Imitate sounds and ways that sounds are used by child
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Language
Minimize directive language
Imitate childrsquos words
Match language to childrsquos development
song melody rhythm or different voice (eg accent)
ldquokid playrdquo words phrases and sounds
humor jokes and mischievous tone
ldquoTalkingrdquo of inanimate objects
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Empathy amp Rapport
Empathymdashinformed caring
Rapport amp Therapeutic Relationshipmdashworking alliance or
bond (Tickle-Degnen 2002)
Being Playful
Demonstrating Empathy amp
Rapport
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Demonstrating Empathy amp
Rapport in Play Sharing Controlmdashpartners
Spontaneity amp Flexibility
Managing Challenges in Play
Focusing on Future Possibilities
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 7
occupational therapy literature on therapeutic use of self
OTs report relationship to outcomes (Cole amp McLean 2003
Gahnstrom-Strandqvist Tham Josephsson amp Borell
2000 Hasselkus amp Dickie 1994 Rosa amp Hasselkus 1996
Taylor Lee Kielhofner amp Ketkar 2009)
Correlated with clientsrsquo perceived outcomes (Law 1998
Darragh Sample amp Krieger 2001 Palmadottir 2003
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in general
Greater complexitylevel more engagement longer play
episodes (Fiese 1990 Haight amp Miller 1992 Sorce amp
Emde 1981 Slade 1987)
Feedback amp encouragement to use interactive strategies
more frequentlymore competent play (Belsky Goode amp
Most 1980)
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in children with disabilities
Amount of play playfulness (Lawson Parrinello amp Ruff
1992 Daunhauer Coster Tickle-Degnen amp Cermak 2007
Chiarello Huntington amp Bundy 2006 Evans amp Meyer
1999)
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Autism amp Adult-Child Play
Nadel Martini Field Escalona and Lundy (2008)
looked at approached and touched adults more frequently when adult more often looked at the child smiled at the child moved toward the child had relaxed body tone made sounds imitated the child and was playful
Tiegerman amp Primavera (1981)
frequency amp duration of object manipulation was greatest when the adult imitated the child by using both the materials and methods of play that the child chose rather than different action or object
Skaines Rodger amp Bundy (2006)
adult structure of play increased playfulness
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Playful Strategies
Selecting Adapting amp Creating
Activities that Children
Want to Do
Playful Strategies Using Personal Interests amp Preferences to Reframe
ldquoWorkrdquo into ldquoPlayrdquo (in therapy amp daily life)
Embedding ldquoPlayrdquo in ldquoWorkrdquo
Expanding Current Occupations
Adapting Individual Interests into Shared Social
Activities
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 8
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
The What and How
BehavioralMaterial Content
The Why Subjective
Meaning
Reframing ldquoWorkrdquo into ldquoPlayrdquo What they Like to Do (more
like play)
Visual feedback
Construction
Sensory properties
Sensorimotor engagement
Favorite toys
Narratives from favorite stories or movies
(Spitzer 2008)
What They Need to Do (often more work)
ADLsSelf-Care
Sleep
Education
ldquoPlayrdquo
Social Participation
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Video Case Self-Care
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Self-CareDressing
Kuhaneck Spitzer amp Miller (2010)
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing
Materials (sensory objects etc)
A passiontopic (food cars geography presidents)
Theme of interest--Silly or ldquoinappropriaterdquo or ldquotrickyrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Writing
Writing Work Car Writing Game
Kuhaneck Spitzer amp Miller (2010)
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 9
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing More examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of ldquoPlayrdquo Activities Soccer
Kuhaneck Spitzer amp Miller (2010)
ldquoHorses vs Wolvesrdquo
Embedding ldquoPlayrdquo in ldquoWorkrdquo
The Case of Beneficial ldquoOff-Taskrdquo Behavior
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case Part II
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Lack of interests
Narrow Interests
Limited Interests amp Social Play
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 5
Case examples ldquoPlaying withrdquo Dirt for Mike amp Alex
Assessment
Clinical Reasoning amp
Interpretation
Being Playful
Therapeutic Use of Self in
Pediatric OT for Children with
Autism
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Communication
Understanding the Child
Communicating that Therapy is fun
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Therapeutic Use of Self
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Suspend adult assumptions (ie superiority) (Curtin
2001 Fine amp Sandstrom 1988)
Level power differencesinequalitymdashavoid being an
authority figure minimize stopping and directing of the
client let them show us (Curtin 2001 Fine amp
Sandstrom 1988)
Look for effectimpact of adult presence (Fine amp
Sandstrom 1988)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Assume all actions are potentially communicative (Durig
1996)
Attend to communication through occupational
engagement especially shared occupations (Grandin amp
Scariano 1986 Spitzer 2003a Williams 1992)
Look for individualized communication strategies around
shared routines physical environment likes and dislikes
and bodily expressions (Goode 1980 1994 Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Develop a shared history with the clientmdashunderstand
their favorite objects and preferences and participate in
activities with them (Goode 1980 1994 Spitzer 2003a)
Interview other people knowledgeable about the client
Follow the clientrsquos directionsmdashat times let them lead
usldquopassive obediencerdquo (Goode 1980)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 6
Imitate physically simulate or imagine the individualrsquos
sensory experience of the occupation to ldquofeelrdquo the
experience (Goode 1980 Spitzer 2003a)
Sharpen conscious awareness of various auditory
visual tactile and kinesthetic sensations (Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Communicating that Therapy is
Fun Eyes
Face
Body
Touch
Voice (vocalizations)
Use a playful tone
Vary pitch loudness rhythm
Repeat sounds
Imitate sounds and ways that sounds are used by child
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Language
Minimize directive language
Imitate childrsquos words
Match language to childrsquos development
song melody rhythm or different voice (eg accent)
ldquokid playrdquo words phrases and sounds
humor jokes and mischievous tone
ldquoTalkingrdquo of inanimate objects
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Empathy amp Rapport
Empathymdashinformed caring
Rapport amp Therapeutic Relationshipmdashworking alliance or
bond (Tickle-Degnen 2002)
Being Playful
Demonstrating Empathy amp
Rapport
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Demonstrating Empathy amp
Rapport in Play Sharing Controlmdashpartners
Spontaneity amp Flexibility
Managing Challenges in Play
Focusing on Future Possibilities
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 7
occupational therapy literature on therapeutic use of self
OTs report relationship to outcomes (Cole amp McLean 2003
Gahnstrom-Strandqvist Tham Josephsson amp Borell
2000 Hasselkus amp Dickie 1994 Rosa amp Hasselkus 1996
Taylor Lee Kielhofner amp Ketkar 2009)
Correlated with clientsrsquo perceived outcomes (Law 1998
Darragh Sample amp Krieger 2001 Palmadottir 2003
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in general
Greater complexitylevel more engagement longer play
episodes (Fiese 1990 Haight amp Miller 1992 Sorce amp
Emde 1981 Slade 1987)
Feedback amp encouragement to use interactive strategies
more frequentlymore competent play (Belsky Goode amp
Most 1980)
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in children with disabilities
Amount of play playfulness (Lawson Parrinello amp Ruff
1992 Daunhauer Coster Tickle-Degnen amp Cermak 2007
Chiarello Huntington amp Bundy 2006 Evans amp Meyer
1999)
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Autism amp Adult-Child Play
Nadel Martini Field Escalona and Lundy (2008)
looked at approached and touched adults more frequently when adult more often looked at the child smiled at the child moved toward the child had relaxed body tone made sounds imitated the child and was playful
Tiegerman amp Primavera (1981)
frequency amp duration of object manipulation was greatest when the adult imitated the child by using both the materials and methods of play that the child chose rather than different action or object
Skaines Rodger amp Bundy (2006)
adult structure of play increased playfulness
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Playful Strategies
Selecting Adapting amp Creating
Activities that Children
Want to Do
Playful Strategies Using Personal Interests amp Preferences to Reframe
ldquoWorkrdquo into ldquoPlayrdquo (in therapy amp daily life)
Embedding ldquoPlayrdquo in ldquoWorkrdquo
Expanding Current Occupations
Adapting Individual Interests into Shared Social
Activities
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 8
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
The What and How
BehavioralMaterial Content
The Why Subjective
Meaning
Reframing ldquoWorkrdquo into ldquoPlayrdquo What they Like to Do (more
like play)
Visual feedback
Construction
Sensory properties
Sensorimotor engagement
Favorite toys
Narratives from favorite stories or movies
(Spitzer 2008)
What They Need to Do (often more work)
ADLsSelf-Care
Sleep
Education
ldquoPlayrdquo
Social Participation
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Video Case Self-Care
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Self-CareDressing
Kuhaneck Spitzer amp Miller (2010)
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing
Materials (sensory objects etc)
A passiontopic (food cars geography presidents)
Theme of interest--Silly or ldquoinappropriaterdquo or ldquotrickyrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Writing
Writing Work Car Writing Game
Kuhaneck Spitzer amp Miller (2010)
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 9
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing More examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of ldquoPlayrdquo Activities Soccer
Kuhaneck Spitzer amp Miller (2010)
ldquoHorses vs Wolvesrdquo
Embedding ldquoPlayrdquo in ldquoWorkrdquo
The Case of Beneficial ldquoOff-Taskrdquo Behavior
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case Part II
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Lack of interests
Narrow Interests
Limited Interests amp Social Play
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 6
Imitate physically simulate or imagine the individualrsquos
sensory experience of the occupation to ldquofeelrdquo the
experience (Goode 1980 Spitzer 2003a)
Sharpen conscious awareness of various auditory
visual tactile and kinesthetic sensations (Spitzer
2003a)
From Spitzer (2004) adapted from Spitzer (2003)
Being Playful
Understanding the Child
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Communicating that Therapy is
Fun Eyes
Face
Body
Touch
Voice (vocalizations)
Use a playful tone
Vary pitch loudness rhythm
Repeat sounds
Imitate sounds and ways that sounds are used by child
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Language
Minimize directive language
Imitate childrsquos words
Match language to childrsquos development
song melody rhythm or different voice (eg accent)
ldquokid playrdquo words phrases and sounds
humor jokes and mischievous tone
ldquoTalkingrdquo of inanimate objects
Kuhaneck Spitzer amp Miller (2010)
Being Playful
Communicating that Therapy is
Fun
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Empathy amp Rapport
Empathymdashinformed caring
Rapport amp Therapeutic Relationshipmdashworking alliance or
bond (Tickle-Degnen 2002)
Being Playful
Demonstrating Empathy amp
Rapport
LO Consider ways to implement playful occupational therapy in onersquos own clinic and school setting
Being Playful
Demonstrating Empathy amp
Rapport in Play Sharing Controlmdashpartners
Spontaneity amp Flexibility
Managing Challenges in Play
Focusing on Future Possibilities
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 7
occupational therapy literature on therapeutic use of self
OTs report relationship to outcomes (Cole amp McLean 2003
Gahnstrom-Strandqvist Tham Josephsson amp Borell
2000 Hasselkus amp Dickie 1994 Rosa amp Hasselkus 1996
Taylor Lee Kielhofner amp Ketkar 2009)
Correlated with clientsrsquo perceived outcomes (Law 1998
Darragh Sample amp Krieger 2001 Palmadottir 2003
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in general
Greater complexitylevel more engagement longer play
episodes (Fiese 1990 Haight amp Miller 1992 Sorce amp
Emde 1981 Slade 1987)
Feedback amp encouragement to use interactive strategies
more frequentlymore competent play (Belsky Goode amp
Most 1980)
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in children with disabilities
Amount of play playfulness (Lawson Parrinello amp Ruff
1992 Daunhauer Coster Tickle-Degnen amp Cermak 2007
Chiarello Huntington amp Bundy 2006 Evans amp Meyer
1999)
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Autism amp Adult-Child Play
Nadel Martini Field Escalona and Lundy (2008)
looked at approached and touched adults more frequently when adult more often looked at the child smiled at the child moved toward the child had relaxed body tone made sounds imitated the child and was playful
Tiegerman amp Primavera (1981)
frequency amp duration of object manipulation was greatest when the adult imitated the child by using both the materials and methods of play that the child chose rather than different action or object
Skaines Rodger amp Bundy (2006)
adult structure of play increased playfulness
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Playful Strategies
Selecting Adapting amp Creating
Activities that Children
Want to Do
Playful Strategies Using Personal Interests amp Preferences to Reframe
ldquoWorkrdquo into ldquoPlayrdquo (in therapy amp daily life)
Embedding ldquoPlayrdquo in ldquoWorkrdquo
Expanding Current Occupations
Adapting Individual Interests into Shared Social
Activities
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 8
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
The What and How
BehavioralMaterial Content
The Why Subjective
Meaning
Reframing ldquoWorkrdquo into ldquoPlayrdquo What they Like to Do (more
like play)
Visual feedback
Construction
Sensory properties
Sensorimotor engagement
Favorite toys
Narratives from favorite stories or movies
(Spitzer 2008)
What They Need to Do (often more work)
ADLsSelf-Care
Sleep
Education
ldquoPlayrdquo
Social Participation
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Video Case Self-Care
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Self-CareDressing
Kuhaneck Spitzer amp Miller (2010)
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing
Materials (sensory objects etc)
A passiontopic (food cars geography presidents)
Theme of interest--Silly or ldquoinappropriaterdquo or ldquotrickyrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Writing
Writing Work Car Writing Game
Kuhaneck Spitzer amp Miller (2010)
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 9
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing More examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of ldquoPlayrdquo Activities Soccer
Kuhaneck Spitzer amp Miller (2010)
ldquoHorses vs Wolvesrdquo
Embedding ldquoPlayrdquo in ldquoWorkrdquo
The Case of Beneficial ldquoOff-Taskrdquo Behavior
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case Part II
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Lack of interests
Narrow Interests
Limited Interests amp Social Play
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 7
occupational therapy literature on therapeutic use of self
OTs report relationship to outcomes (Cole amp McLean 2003
Gahnstrom-Strandqvist Tham Josephsson amp Borell
2000 Hasselkus amp Dickie 1994 Rosa amp Hasselkus 1996
Taylor Lee Kielhofner amp Ketkar 2009)
Correlated with clientsrsquo perceived outcomes (Law 1998
Darragh Sample amp Krieger 2001 Palmadottir 2003
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in general
Greater complexitylevel more engagement longer play
episodes (Fiese 1990 Haight amp Miller 1992 Sorce amp
Emde 1981 Slade 1987)
Feedback amp encouragement to use interactive strategies
more frequentlymore competent play (Belsky Goode amp
Most 1980)
Being Playful Evidence
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
interdisciplinary research on adultndashchild play adult
actions can influence play in children with disabilities
Amount of play playfulness (Lawson Parrinello amp Ruff
1992 Daunhauer Coster Tickle-Degnen amp Cermak 2007
Chiarello Huntington amp Bundy 2006 Evans amp Meyer
1999)
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Autism amp Adult-Child Play
Nadel Martini Field Escalona and Lundy (2008)
looked at approached and touched adults more frequently when adult more often looked at the child smiled at the child moved toward the child had relaxed body tone made sounds imitated the child and was playful
Tiegerman amp Primavera (1981)
frequency amp duration of object manipulation was greatest when the adult imitated the child by using both the materials and methods of play that the child chose rather than different action or object
Skaines Rodger amp Bundy (2006)
adult structure of play increased playfulness
Being Playful Evidence
LO Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Playful Strategies
Selecting Adapting amp Creating
Activities that Children
Want to Do
Playful Strategies Using Personal Interests amp Preferences to Reframe
ldquoWorkrdquo into ldquoPlayrdquo (in therapy amp daily life)
Embedding ldquoPlayrdquo in ldquoWorkrdquo
Expanding Current Occupations
Adapting Individual Interests into Shared Social
Activities
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 8
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
The What and How
BehavioralMaterial Content
The Why Subjective
Meaning
Reframing ldquoWorkrdquo into ldquoPlayrdquo What they Like to Do (more
like play)
Visual feedback
Construction
Sensory properties
Sensorimotor engagement
Favorite toys
Narratives from favorite stories or movies
(Spitzer 2008)
What They Need to Do (often more work)
ADLsSelf-Care
Sleep
Education
ldquoPlayrdquo
Social Participation
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Video Case Self-Care
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Self-CareDressing
Kuhaneck Spitzer amp Miller (2010)
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing
Materials (sensory objects etc)
A passiontopic (food cars geography presidents)
Theme of interest--Silly or ldquoinappropriaterdquo or ldquotrickyrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Writing
Writing Work Car Writing Game
Kuhaneck Spitzer amp Miller (2010)
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 9
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing More examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of ldquoPlayrdquo Activities Soccer
Kuhaneck Spitzer amp Miller (2010)
ldquoHorses vs Wolvesrdquo
Embedding ldquoPlayrdquo in ldquoWorkrdquo
The Case of Beneficial ldquoOff-Taskrdquo Behavior
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case Part II
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Lack of interests
Narrow Interests
Limited Interests amp Social Play
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 8
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Note Adapted with permission from ldquoWith and Without Words Exploring Occupation in Relation to Young Children with Autismrdquo by Susan L Spitzer 2003 Journal of Occupational Science 10(2) p 74 Copyright 2003 by Journal of Occupational Science
The What and How
BehavioralMaterial Content
The Why Subjective
Meaning
Reframing ldquoWorkrdquo into ldquoPlayrdquo What they Like to Do (more
like play)
Visual feedback
Construction
Sensory properties
Sensorimotor engagement
Favorite toys
Narratives from favorite stories or movies
(Spitzer 2008)
What They Need to Do (often more work)
ADLsSelf-Care
Sleep
Education
ldquoPlayrdquo
Social Participation
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
Video Case Self-Care
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Self-CareDressing
Kuhaneck Spitzer amp Miller (2010)
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing
Materials (sensory objects etc)
A passiontopic (food cars geography presidents)
Theme of interest--Silly or ldquoinappropriaterdquo or ldquotrickyrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo
The Work of Writing
Writing Work Car Writing Game
Kuhaneck Spitzer amp Miller (2010)
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 9
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing More examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of ldquoPlayrdquo Activities Soccer
Kuhaneck Spitzer amp Miller (2010)
ldquoHorses vs Wolvesrdquo
Embedding ldquoPlayrdquo in ldquoWorkrdquo
The Case of Beneficial ldquoOff-Taskrdquo Behavior
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case Part II
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Lack of interests
Narrow Interests
Limited Interests amp Social Play
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 9
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of Writing More examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Reframing ldquoWorkrdquo into ldquoPlayrdquo The Work of ldquoPlayrdquo Activities Soccer
Kuhaneck Spitzer amp Miller (2010)
ldquoHorses vs Wolvesrdquo
Embedding ldquoPlayrdquo in ldquoWorkrdquo
The Case of Beneficial ldquoOff-Taskrdquo Behavior
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Embedding ldquoPlayrdquo in
ldquoWorkrdquoVideo Case Part II
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Lack of interests
Narrow Interests
Limited Interests amp Social Play
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 10
Expanding Current Occupations
Lack of Interests
Create occupational appeal (Munier Myers amp Pierce
2008) then gradually grade and adapt
A way to ldquoget-inrdquo
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests amp Opposition to Other Things
Combine elements of what the child likes with elements of
what they need to do
Start where the child is
Explain and negotiate Example cards
Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current
Occupations Video Case
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Expanding Current Occupations
Narrow Interests (amp Opposition to Other Things)
Kuhaneck Spitzer amp Miller (2010)
Expanding Current Occupations
bull Recognizing amp Extending Hints of Play Kuhaneck Spitzer amp Miller (2010) Spitzer (2008)
Case Examples
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 11
Expanding Current Occupations Recognizing amp Extending Hints of Play
Construction amp Destruction ldquoDonrsquot Break the Icerdquo
Kuhaneck Spitzer amp Miller (2010)
Adapting Individual Interests into
Shared Social Activities
Example Tag Games Follow-the-____ Leader Games
Example New Pretend Games
L O Identify opportunities for innovative creative and evidence-based playful occupational therapy intervention with children and adolescents with autism
Application to Adolescents
Many of the strategies we have discussed can be
adapted for use with older children and adolescents
Adolescents also need play leisure opportunities and
the ability to socialize with peers
Case Studies Play in
Adolescents with ASD Reframing Work into Play
Reporter Daniel amp Paul
Ari from the Future
Ideas for Play in Adolescents
with ASD Video games or themes
Elements to rename Alert Program ldquospeedsrdquo
Sports or sport themes
Create a new ldquosportrdquo
Made-up games to promote social interactionnegotiation
Social media combined with the work of keyboarding
Other personal interests
Explain to a peer to share
Bring a favorite item
Card ldquoGamesrdquomdashcommercially available or have them make-up
Focusing on Outcomes We will be more likely to work with children in a playful
fashion and to work on play specifically if we assess
and write goals for play
Sample play goals and objectives for children with
autism
Common concerns with reimbursement and otherrsquos
perceptions
Supporting the importance of play using evidence
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 12
Play Evidence Evidence on Effectiveness Incorporating Play
Play is an effective modality in OT (amp other interventions)
for developing skills in children with disabilities (for
example Case-Smith 2000 Esdaile 1996 OrsquoConnor amp
Stagnitti 2011 Olson Heaney amp Soppas-Hoffman 1989
Sakemiller amp Nelson 1998 Sparling Walker amp
Singdahlsen 1984)
Play-based approaches are valued by parents (Stahmer et
al 2011)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Evidence on Effectiveness Incorporating Personal
Interests
Research supports that including child choice preference
or interest can be an effective strategy for promoting
engagement in toy play and social play in children with
autism (ie Baker Koegel amp Koegel 1998 Koegel Dyer
amp Bell 1987 Reinhartsen Garfinkle amp Wolery 2002
Vismara amp Lyons 2007)
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Play Evidence Future Research on Incorporating Personal Interests amp
Play
Is it more effective
For which outcomes
L O Understand the evidence supporting a playful approach to occupational therapy intervention with children and adolescents with autism
Life should be more than compliance and
actions and expression should be more than
training and a means to an end Life should at
some point be a rewarding end in itselfrdquo Donna Williams (1996 p 128)
an adult with autism
Thank you children amp their families colleagues mentors friends family amp you
Questions amp Answers
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 13
References Baker MJ Koegel RL amp Koegel L K (1998)
Increasing the social behavior of young children with
autism using their obsessive behaviors Journal of the
Association for Persons with Severe Handicaps 23(4)
300-308
Baranek G T Barnett C R Adams E M Wolcott N
A Watson L R amp Crais E R (2005) Object play in
infants with autism Methodological issues in
retrospective video analysis American Journal of
Occupational Therapy 59(1) 20-30
Bauminger Namp Shulman C (2003) The development
and maintenance of friendship in high-functioning
children with autism maternal perceptions Autism
7(1) 81-97
Bauminger N Solomon M amp Rogers SJ (2010)
Predicting friendship quality in autism spectrum
disorders and typical development Journal of Autism
and Developmental Disorders 40(6) 751-61
Bauminger N Solomon M Aviezer A Heung K
Gazit L Brown J amp Rogers SJ (2008) Children
with autism and their friends a multidimensional study
of friendship in high-functioning autism spectrum
disorder Journal of Abnormal Child Psychology 36(2)
135-50
Belsky J Goode M K amp Most R K (1980) Maternal
stimulation and infant exploratory competence Cross-
sectional correlational and experimental analyses
Child Development 51 1168ndash1178
Blunden P (2001) The therapeutic use of play In L
Loughler (Ed) Occupational Therapy for Child and
Adolescent Mental Health London Harcourt
Brown S (2009) Play How it shapes the brain opens
the imagination and invigorates the soul New York
Penguin Books
BrownT G Rodger S Brown A amp Roever C (2005)
A comparison of Canadian and Australian paediatric
occupational therapists Occupational Therapy
International 12 137ndash161 doi 101002oti
Case-Smith J (2000) Effects of occupational therapy
services on fine motor and functional performance in
preschool children American Journal of Occupational
Therapy 54 372ndash380
Chiarello L A Huntington A amp Bundy A (2006) A
comparison of motor behaviors interaction and
playfulness during mother-child and father-child play
with children with motor delay Implications for early
intervention practice Occupational amp Physical Therapy
in Pediatrics 26(12) 129ndash152
Cole M B amp McLean V (2003) Therapeutic
relationships re-defined Occupational Therapy in
Mental Health 19(2) 33ndash56
Catmur C Walsh V amp Heyes C (2009) Associative
sequence learning the role of experience in the
development of imitation and the mirror system
Philosophical Transactions of the Royal Society Series
B - Biological Sciences 364 2369-2380
Charman T Swettenham J Baron-Cohen S Cox A
Baird G amp Drew A (1997) Infants with autism An
investigation of empathy pretend play joint attention
and imitation Developmental Psychology 33(5) 781-
789
Charman T amp Baron-Cohen S (1997) Brief report
Prompted pretend play in autism Journal of Autism and
Developmental Disorders 27(3) 325-332
Couch K J Deitz J C amp Kanny E M (1998) The role
of play in pediatric occupational therapy American
Journal of Occupational Therapy 52 111ndash117
Curtin C (2001) Eliciting childrenrsquos voices in qualitative
research American Journal of Occupational Therapy
55 295ndash302
Dansky J L amp Silverman I W (1973) Effects of play on
associative fluency in preschool-aged children
Developmental Psychology 9 38ndash43
Darragh A R Sample P L amp Krieger S R (2001)
ldquoTears in my eyes lsquocause somebody finally
understoodrdquo Client perceptions of practitioners
following brain injury American Journal of Occupational
Therapy 55 191ndash199
Daunhauer L A Coster W J Tickle-Degnen L amp
Cermak S A (2007) Effects of caregiver-child
interactions on play occupations among young children
institutionalized in Eastern Europe American Journal of
Occupational Therapy 61 429ndash440
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 14
Desha L Ziviani J amp Rodger S (2003) Play
preferences and behavior of preschool children with
autistic spectrum disorder in the clinical environment
Physical and Occupational Therapy in Pediatrics
23(1) 21-42
Diamond A Barnett WS Thomas J amp Munro S (2007)
Preschool program improves cognitive control
Science 318 1387-1388
Donnelly J amp Bovee J (2003) Reflections on play
Recollections from a mother and her son with Asperger
syndrome Autism 7(4) 471-476
Durig A (1996) Autism and the crisis of meaning Albany
NY State University of New York Press
Elkind D (2007) The power of play Cambridge MA De
Capo Press Ginsburg K R and the Committee on
Communications and the Committee on Psychosocial
Aspects of Child and Family Health (2007) The
importance of play in promoting healthy child
development and maintaining strong parent-child
bonds Pediatrics 119 182-191
Esdaile S A (1996) A play focused intervention involving
mothers of preschoolers American Journal of
Occupational Therapy 50 113ndash123
Evans I M amp Meyer L H (1999) Modifying adult
interactional style as positive behavioural intervention
for a child with Rett syndrome Journal of Intellectual amp
Developmental Disability 24 191ndash205
Fiese B H (1990) Playful relationships A contextual
analysis of mother-toddler interaction and symbolic
play Child Development 61 1648ndash1656
Fidler G S amp Velde B P (1999) Activities Reality and
symbol Thorofare NJ Slack
Fine G A amp Sandstrom K L (1988) Knowing children
Participant observation with minors Newbury Park CA
Sage
Fisher E P (1992) The impact of play on development A
meta-analysis Play and Culture 5 159ndash181
Flanigan A (2001) Occupational therapy with
adolescents In L Loughler (Ed) Occupational Therapy
for Child and Adolescent Mental Health London
Harcourt
Gahnstrom-Strandqvist K Tham K Josephsson S amp
Borell L (2000) Actions of competence in
occupational therapy practice Scandinavian Journal of
Occupational Therapy 7 15ndash25
Garciacutea-Villamisar D A and Dattilo J (2010) Effects of a
leisure programme on quality of life and stress of
individuals with ASD Journal of Intellectual Disability
Research 54 611ndash619 doi 101111j1365-
2788201001289x
Goode D A (1980) The world of the congenitally deaf-
blind In J Jacobs (Ed) Mental retardation A
phenomenological approach (pp 187ndash207)
Springfield IL Charles C Thomas
Goode D (1994) A world without words The social
construction of children born deaf and blind
Philadelphia Temple University Press
Grandin T (1997) Thinking the Way Animals Do
httpwwwgrandincomreferencesthinkinganimalsht
ml
Grandin T amp Scariano M M (1986) Emergence
Labeled autistic Novato CA Arean Press
Guest A amp Schneider B (2003) Adolescentsrsquo
extracurricular participation in context The mediating
effects of schools community and identity Sociology of
Education 76 89-109
Haight W L amp Miller P J (1992) The development of
everyday pretend play A longitudinal study of mothersrsquo
participation Merrill-Palmer Quarterly 38 331ndash349
Hasselkus B R amp Dickie V A (1994) Doing
occupational therapy Dimensions of satisfaction and
dissatisfaction American Journal of Occupational
Therapy 48 145ndash154
Hobson R P amp Lee A (1999) Imitation and
identification in autism Journal of Child Psychology
and Psychiatry 40(4) 649-659
Holmes R M amp Procaccino J K (2009) Autistic
childrenrsquos play with objects peers and adults in a
classroom setting In C D Clark (Ed) Transactions at
play Play and culture studies Volume 9 (pp 86ndash103)
New York University Press of America Inc
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 15
Holmes E amp Willoughby T (2005) Play behavior of
children with autism spectrum disorders Journal of
Intellectual amp Developmental Disability 30 156ndash163
Howard-Jones P A Taylor J R amp Sutton L (2002)
The effect of play on the creativity of young children
during subsequent activity Early Child Development
and Care 172 323ndash328
Howard L (2002) A survey of paediatric occupational
therapists in the United Kingdom Occupational
Therapy International 9 326ndash343 doi 101002oti172
Jarrold C (2003) A review of research into pretend play
in autism Autism 7(4) 379-390
Jarrold C Boucher J amp Smith P (1993) Symbolic play
in autism A review Journal of Autism and
Developmental Disorders 23 281-309
King G Law M King S Hurley P Hanna S Kertoy
M Rosenbaum P amp Young N (2004) Childrenrsquos
Assessment of Participation and Enjoyment (CAPE)
and Preferences for Activities of Children (PAC) San
Antonio TX Harcourt Assessment
Koegel RL Dyer K amp Bell LK (1987) The influence
of child-preferred activities on autistic childrenrsquos social
behavior Journal of Applied Behavior Analysis 20(3)
243-252
Kramer J Bowyer P OrsquoBrien J Kielhofner G amp
Maziero-Barbosa V (2009) How interdisciplinary
pediatric practitioners choose assessments Canadian
Journal of Occupational Therapy 76(1) 56-64
Kuhaneck HM Spitzer S L amp Miller E (2010)
Activity Analysis Creativity and Playfulness in
Pediatric Occupational Therapy Making Play Just
Right Boston MA Jones and Bartlett Publishers
LLC
Kuhaneck amp Tanta in preparation
Kuo MH Orsmond GI Cohn ES amp Coster WJ
(2011) Friendship characteristics and activity patterns
of adolescents with an Autism Spectrum Disorder
Autism doi 1011771362361311416380
Law M (1998) Does client-centered practice make a
difference In M Law (Ed) Client-centered
occupational therapy (pp 19ndash27) Thorofare NJ Slack
Lawson K R Parrinello R amp Ruff H A (1992)
Maternal behavior and infant attention Infant Behavior
and Development 15(2) 209ndash229
Lewis V amp Boucher J (1988) Spontaneous instructed
and elicited play in relatively able autistic children
British Journal of Developmental Psychology 6 325ndash
338
Lewis V amp Boucher J (1995) Generativity in the play of
young people with autism Journal of Autism and
Developmental Disorders 25(2) 105-121
Libby S Powell S Messer D amp Jordan R (1997)
Imitation of pretend play acts by children with autism
and Down syndrome Journal of Autism and
Developmental Disorders 27(4) 365-383
Loughler L (2001) Occupational therapy in child and
adolescent mental health In L Loughler (Ed)
Occupational Therapy for Child and Adolescent Mental
Health London Harcourt
McGee G G Feldman R S amp Morrier M J (1997)
Benchmarks of social treatment for children with
autism Journal of Autism and Developmental
Disorders 27 353-364
Munier V Myers C T amp Pierce D (2008) Power of
object play for infants and toddlers In L D Parham amp
L S Fazio (Eds) Play in occupational therapy for
children (2nd ed pp 219ndash249) St Louis MO Mosby
Elsevier
Nadel J Martini M Field T Escalona A amp Lundy B
(2008) Children with autism approach more imitative
and playful adults Early Child Development and Care
178(5) 461-465
OrsquoConnor C amp Stagnitti K (2011) Play behavior
language and social skills The comparison of a play
and a non-play intervention within a specialist school
setting Research in Developmental Disabilities 32
1205-1211
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 16
Olson L Heaney C amp Soppas-Hoffman B (1989)
Parent-child activity group treatment in preventive
psychiatry Occupational Therapy in Health Care 6
29ndash43
Orsmond GI amp Kuo HY (2011) The daily lives of
adolescents with an autism spectrum disorder
Discretionary time use and activity partners Autism
15(5) 579-99
Ozonoff S Macari S Young G S Goldring S
Thompson M amp Rogers S J (2008) Atypical object
exploration at 12 months of age is associated with
autism in a prospective sample Autism 12 457ndash472
Palmadottir G (2003) Client perspectives on
occupational therapy in rehabilitation services
Scandinavian Journal of Occupational Therapy 10
157ndash166
Panksepp J (2010) Science of the Brain as a Gateway
to Understanding Play American Journal of Play 2
Panksepp J (2007) Can PLAY Diminish ADHD and
Facilitate the Construction of the Social Brain Journal
of the Canadian Academy of Child and Adolescent
Psychiatry 16(2) 57-66
Parham L D (2008) Play and occupational therapy In L
D Parham amp L S Fazio (Eds) Play in occupational
therapy for children (2nd ed pp 3ndash42) St Louis MO
Mosby
Pelligrini A (2009) The role of play in human
development Oxford Oxford University Press
Pepler D J amp Ross H S (1981) The effects of play on
convergent and divergent problem solving Child
Development 52 1202ndash1210
Preissler M A (2006) Play and autism Facilitating
symbolic understanding In D G Singer R M
Golinkoff amp K Hirsch-Pasek (Eds) Play = Learning
New York Oxford University Press
Reinhartsen D B Garfinkle A N amp Wolery M (2002)
Engagement with toys in two-year-old children with
autism Teacher selection versus child choice
Research and Practice for Persons with Severe
Disabilities 27(3) 175ndash187
Richler J Bishop SL Kleinke JR amp Lord C (2007)
Restricted and repetitive behaviors in young children
with autism spectrum disorders Journal of Autism and
Developmental Disorders 37(1) 73-85
Rodger S Brown G T Brown A amp Roever C (2006)
A comparison of paediatrics occupational therapy
university program curricula in New Zealand Australia
and Canada Physical and Occupational Therapy in
Pediatrics 26 153-80
Rodger S Brown G T amp Brown A (2005) Profile of
paediatric occupational therapy practice in Australia
Australian Occupational Therapy Journal 52 311ndash325
doi 101111j1440-1630200500487x
Rosa S A amp Hasselkus B R (1996) Connecting with
patients The personal experience of professional
helping Occupational Therapy Journal of Research
16 245ndash260
Rowland C M amp Schweigert P D (2009) Object
lessons How children with autism spectrum disorders
use objects to interact with the physical and social
environments Research in Autism Spectrum
Disorders 3(2) 517-527
Russ SW Robins AL amp Christiano BA (1999)
Pretend play Longitudinal prediction of creativity and
affect in fantasy in children Creativity Research
Journal 12 129ndash139
Sakemiller L M amp Nelson D L (1998) Eliciting
functional extension in prone through the use of a
game American Journal of Occupational Therapy
52(2) 150-157
Saleh M N Korner-Bitensky N Snider L Malouin F
Mazer B Kennedy E amp Roy MA (2008) Actual vs
best practices for young children with cerebral palsy a
survey of paediatric occupational therapists and
physical therapists in Quebec Canada Developmental
Neurorehabilitation 11(1) 60-80
Saracho O N (2002) Young Childrenʼs Creativity and
Pretend Play Early Child Development and Care
172(5) 431-438
Skaines N Rodger S amp Bundy A (2006) Playfulness
in children with autistic disorder and their typically
developing peers British Journal of Occupational
Therapy 69 505ndash512
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 17
Slade A (1987) A longitudinal study of maternal
involvement and symbolic play during the toddler
period Child Development 58 367ndash375
Sorce J F amp Emde R N (1981) Motherrsquos presence is
not enough Effect of emotional availability on infant
exploration Developmental Psychology 17 737ndash745
Sparling J W Walker D F amp Singdahlsen J (1984)
Play techniques with neurologically impaired
preschoolers American Journal of Occupational
Therapy 38 603ndash612
Spitzer S L (2001) No words necessary An
ethnography of daily activities with children who dont
talk Unpublished doctoral dissertation University of
Southern California Los Angeles
Spitzer S L (2003a) Using participant observation to
study the meaning of occupations of young children
with autism and other developmental disabilities
American Journal of Occupational Therapy 57(1) 66ndash
76
Spitzer S L (2003b) With and without words Exploring
occupation in relation to young children with autism
Journal of Occupational Science 10(2) 67ndash79
Spitzer S L (2008) Play in children with autism
Structure and experience In L D Parham amp L S
Fazio (Eds) Play in occupational therapy for children
(2nd ed pp 351ndash374) St Louis MO Mosby Elsevier
Spitzer S L (2010) Common and Uncommon Daily
Activities in Children with an Autism Spectrum
Disorder Challenges and Opportunities for Supporting
Occupation In H Miller Kuhaneck amp R Watling (Eds)
Autism A Comprehensive Occupational Therapy
Approach (3rd ed pp 203-233) Bethesda MD
American Occupational Therapy Association
Stahmer A C Brookman-Frazee L Lee E Searcy K
amp Reed S (2011) Parent and multidisciplinary provider
perspectives on earliest intervention for children at risk
for autism spectrum disorders Infants amp Young
Children 24(4) 344-363
Taylor RR Lee SW Kielhofner G amp Ketkar M
(2009) Therapeutic use of self A nationwide survey of
practitionersrsquo attitudes and experiences American
Journal of Occupational Therapy 63 198-207
Tickle-Degnen L (2002) Client-centered practice
therapeutic relationship and the use of research
evidence American Journal of Occupational Therapy
56 470ndash474
Tiegerman E amp Primavera L (1981) Object
manipulation An interactional strategy with autistic
children Journal of Autism and Developmental
Disorders 11(4) 427-438
Vismara L A amp Lyons G L (2007) Using perseverative
interests to elicit joint attention behaviors in young
children with autism Theoretical and clinical
implications for understanding motivation Journal of
Positive Behavior Interventions 9(4) 214ndash228
Vroman K (2010) In transition to adulthood the
occupations and performance skills of adolescents In
Case- Smith J amp OrsquoBrien J (Eds) Occupational
Therapy for Children (6th edition pp 84-107) Maryland
Heights MO Mosby -Elsevier
Whitebread D Coltman P Jameson H amp Lender R
(2009) Play cognition and self regulation What
exactly are children learning when they learn through
play Educational amp Child Psychology 26 40ndash52
Williams D (1992) Nobody nowhere The extraordinary
autobiography of an autistic New York Times Books
Williams D (1996) Autism An Inside-Out Approach
Bristol PA Jessica Kingsley Publishers
Williams D (1998) Autism and sensing The unlost
instinct Philadelphia Jessica Kingsley Publishers
Williams E Kendell-Scott L amp Costall A (2005)
Parentsrsquo experiences of introducing every day object
use to their children with autism Autism 9 495ndash514
Williams E (2003) A comparative review of early forms
of object-directed play and parent-infant play in typical
infants and young children with autism Autism 7(4)
361-377
Williams E Costall A amp Reddy V (1999) Children with
autism experience problems with both objects and
people Journal of Autism and Developmental
Disorders 29(5) 367-378
Williams E Reddy V amp Costall A (2001) Taking a
closer look at functional play in children with autism
Journal of Autism and Developmental Disorders 31(1)
67-77
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
AOTA Annual Conference April 27 2012 Indianapolis IN
ldquoPlayful OT Intervention for Children and Adolescents with Autismrdquo Copyright copy 2012 by Susan L Spitzer Heather Miller Kuhaneck amp Elissa Longo 18
Wolfberg P J (1999) Play and imagination in children
with autism New York Teachers College Press
Wulff S B (1985) The symbolic and object play of
children with autism A review Journal of Autism and
Developmental Disorders 15 139-148
Wyver Shirley R amp Spence Susan H (1999) Play and
divergent problem solving Evidence supporting a
reciprocal relationship Early Education and
Development 10 419ndash444
Ziviani J Boyle M amp Rodger S (2001) An introduction
to play and the preschool child with autistic spectrum
disorder British Journal of Occupational Therapy
64(1) 17-22
top related