Preference and Play in Autism Spectrum Disorder
Deficits in social communication and peer interaction are common in autism spectrum disorder (ASD). Many clinicians try to facilitate play between a child with ASD and a peer by placing them together with toys or for other activities, but this approach raises a question: can choice and preference assessment help in this type of treatment?
This question arose while I was working on cooperative play with a four-year-old male client with ASD when I was a student in the Applied Behavior Analysis (ABA) masters program at Shenandoah University. The setting was a social skills group offered at the West Virginia clinic for three-and four-year-olds. In this group, we had the assistance of two typical peers, who helped in our teaching and modeled some of the social deficits we were addressing with our clients.
The treatment option we used was a mixture of a multiple stimulus without replacement (MSWO) preference assessment and peer lead play sessions.
At the beginning of each session, I would conduct an MSWO preference assessment with my client. I would layout four items in a line on a table. The client would pick one and would then have 30-seconds to play with it. I would identify the first one chosen as the most preferred item for that session. After the brief play period, I would present the remaining three items for him or her to pick from once more. This would continue until there was one item left—the least preferred item. The most and least preferred items would be used during the play sessions that followed. To determine the order of items being presented each session, I would flip a coin.
I utilized two types of session for this treatment: therapist facilitated and free play. During the therapist facilitated sessions, I would teach techniques to the peer in order to facilitate play during 30-second intervals. Once the 30-seconds were up, I would sit back for 60-seconds as the peer played with the client (for a total of four minutes). This continued for six minutes.
During these sessions, I found that preference for an item was important in facilitating social interactions. My client was more likely to engage in cooperative play with a peer when playing with the most-preferred rather than least-preferred item.
From this, I’ve come to believe more generally that preference for an item can help motivate a child to want to engage with a peer when that peer is playing with the toy.
I continue working with my client today, and I see him gradually becoming more aware of his peers and of the environment around him during the social skills group. I’ve also seen him become more aware of his environment at home. While I don’t know for sure if this treatment package has directly caused this awareness, I do believe it has helped.