Such small achievements that no one else notices - Anthony Skiing

Anthony needs extra help to participate in a lot of activities. When he was diagnosed with autism aged 4, we started to understand why Anthony found some things difficult. Why he had to put the coloured pencils back on their box in the same place, why he didn't seem happy with surprises on his birthday and why he couldn't focus in a nursery full of other children, loud sounds and bright lights. But that has never meant he can't try something new.  And when his Dad and I returned from Courchevel earlier this year, it sparked a new idea for him.

Identifying normal repetitive play

I have been watching Jane repeat the same play sequence whenever she is presented with a tea set.  Jane has two older brothers with autism so she is more likely to be on the autistic spectrum than another little girl who has no autism in the family.  I'm watching to see if this play might indicate that she has a lack of social imagination. 

Difficulty with social imagination is one of the 'triad' of impairments that leads to an autism diagnosis. Our social imagination lets us understand and predict what other people are going to do or how an unfamiliar situation may turn out. Some children with autism find imaginative play very difficult and others can use their imagination but because they find guessing the next step in a social situation difficult, they prefer to act out the same scenes each time.  

However, children also learn through repetition. Practising new words and skills is part of being a toddler and should be typical as Jane is nearly two and a half years old.

Jane has been repeating a game we have shown her about making a cup of tea.  Pouring the tea from a teapot into a cup and bringing it to an adult. She then asks them to drink it, asks if they are finished and then takes the cup away.  Here are some things I've noticed and engaged in that indicates to me this might be normal play.

Jane's routine is usually functional, which means things can be used for what they are.  However, Jane can also use substitution in this routine.  This means if presented with a tea set without a teapot and presented with another object, for example a jug or bowl, Jane is happy to pretend this is the teapot.  If there are no substitutions, Jane can also pretend she is holding a teapot, and this is using her imagination too.  Beyond, this Jane was quite happy to bring me a coffee instead and when I said I was hungry, she offered me a piece of cake. This shows she can cope with, think about and engage in changes to the play sequence. To my delight this was cooked in an imaginary microwave in the bookcase.  And as I'm handed my cake, it's obvious that Jane is having fun. A few minutes later she's left the activity and come to watch the television.

However, I could be concerned if Jane appeared anxious or extremely focused during the tea routine.  I would note if she was upset by changing it or unable to have intervention in the play. I'd also be concerned if Jane was unable to finish her routine without getting upset or persisted in only playing with this set, whether she was enjoying it or not.  I can also look for a specific type of repetitive behaviour called 'stimming' which tends to be a sensory adjustment.

Repetitive behaviours, obsessions and routines can limit a child's participation in other activities, cause stress or anxiety.  However they can also lead to enjoying special interests or help someone stay calm or cope with a situation like David does. I'm likely to continue to monitor Jane's progress with watchful eyes.  For now, it looks like I'll be enjoying imaginary cake.

External links
Ambitious About Autism - Repetitive behaviours and stimming
NAS - About autism