Birthday parties. Let's talk about it.

Parties, gatherings, events, picnics, etc., where there will be lots of people, noise/music, activity, chatter/laughing, and hidden, unspoken rules for "appropriate" behavior.

The event may even be outdoors, which brings a whole host of safety concerns.

Or, the event could be near a body of water (pool party), which definitely adds even more safety concerns.

For parents with Autistic children, or another disability, do you just not go??? Is that the way to do this? How do you get a child through elementary school without ever attending a birthday party?? These days, kids have to invite the whole class. So in an average school year, your child may receive several birthday invitations, to loud, active, parties full of running, screaming kids, hopped up on sugar and soda.

Before we jump into what to do, let's back up a bit and describe the challenges: Why are birthday parties sometimes so not fun, and so very hard? 

Birthday parties/large gatherings are (often) loud, full of junk food/ice cream/candy/cake, full of people, tantalizing presents, music or entertainment, and the expectation to socialize ("You kids go play"). All of this can combine for quite the sensory nightmare.

Your Autistic child may find the event overstimulating, scary, uncomfortable, or painful (overstimulation that one cannot leave can be painful). Your child also may be unable to tell you any of that, which leaves demonstrating the discomfort through their behavior.

I have seen this up close many times, both "on the clock" and off the clock. I've been at kids birthday parties and seen that girl or boy seriously struggling and having an awful time, or attended birthday events with clients to provide support during the party. 

I think its critical to reset expectations and have a clear understanding of just how scary parties can be for Autistic children or adolescents (I'm not mentioning adults because, typically, adults with disabilities are not forced to attend events they seem not to enjoy, the way small children are).

The questions below should be carefully considered based on your child's age, temperament, sensory profile, and support needs, with strategies in place in case the party experience goes badly. Have a plan, then have a backup plan, and don't go it alone. Bring at least 1 other adult with you, or if you are hosting the event, assign helpers among family ands friends who know what to do and will quickly jump in if your child is having a hard time.

Things to Consider:

- Do you have to attend/throw the party? No really, think about that. What would happen if you just...didn't go? Or what would happen if your child didn't have a 4th birthday party? I'm pretty sure the earth would still keep spinning. Sometimes, the level of support that would be needed as well as the needed accommodations aren't feasible. In that case, is it better to force your child through something they are unlikely to enjoy, or to just skip it? I'm not saying forever, and this could even be a case by case decision. Small party at a neighbor's home? Sure. Huge community pool party with 6 clowns, a DJ, and group party games? Maybe not.

- Don't try to stay the whole time, instead play it by ear. For some children, they aren't excited about the cake (feeding issues are common with Autism). They don't care about the social games or group activities. They don't yet have the ability to wait, so they won't understand why they can't start ripping into set aside food or activities (and may not understand why they can't open someone else's gifts). What will YOUR child do at the party that they find fun, entertaining, and is safe? Think about that, before you take them to a 2 hour birthday party.

- Understand that vigilant supervision may be needed. This does mean dropping your child off may not be a safe option (as the party host will be super busy), and if you stay with your child, you may need to keep them in eyesight at all times. It isn't unusual for my clients to 100% "veer off from the group" during parties, only to be found sometime later upstairs in a closet, or trying to access YouTube on the family laptop, or casually digging through someone's refrigerator. These can be very embarrassing moments, that could easily be prevented by keeping a close eye on your child, especially if the party or event will be held outdoors.

- Speaking of embarrassing, there is nothing embarrassing about accommodations or supports. If you are taking your child to a party or event where they can't wear their noise canceling headphones, or freely STIM (family members, sadly, can be very judgmental about stimmy kids at birthday parties)  without being treated poorly, that may not be the kind of event you want to attend. Again, parties are overstimulating for many Autistics. So it makes sense that they will do MORE of what helps them calm or regulate in response to being at the party. In other words, if most of the kids are quietly playing Candyland, but your child is in a separate room happily squealing and jumping, while chewing on a straw, will this be a problem for other people at the party? If so, I don't think your child is the problem.

- Take preferred foods, toys, and leisure items with you. Please do not expect that your child who eats 3 foods at home, will magically attend a birthday party and chow down on Cheetos, cake, and pizza. If they won't eat it at home, they likely won't eat it at the party. Also, don't withhold stim items or comfort toys because the child is in public, and other people will see. Those favored items may help keep your child calm and comfortable, in a chaotic and loud setting. On that note, it can be helpful to bring items your child may grab, snatch, or steal, if they see it in public. For example, I worked with a boy once who loved to suck on pencils. If he was out somewhere and saw a pencil, he would try to grab it and put it in his mouth. So in that situation, I'd recommend bringing oral sensory items with you so the child doesn't need to hunt throughout someone else's home for something to satisfy that chewing desire. Think about things like this in advance, and plan accordingly.

- The biggest tip, and the one I see cause parents the most pain and distress, is this: Please don't expect your child to be a different person socially, just because you're at a birthday party. If your child is not very social at home, they likely won't be very social with 23 other kids present. In fact, they may exhibit new behaviors you usually don't see at home (such as pushing, swatting at, or running off to get away from the other kids). This can be very hard for parents to watch. So can bullying and stigma, such as if your child DOES want to join the play, and the other kids are being mean or cruel to your child. Remember that earlier tip about close supervision? It's very important to watch how your child interacts with the other children, so you can stop any bullying or rudeness in its tracks, and so you can monitor when your child's social battery is "full". Most of my clients fill up that social battery very fast.....maybe 15-25 minutes of social interaction, and they're done. And that is OKAY. Not all children want to "Go play" with their peers for hours and hours. Observe your child, redirect them to solo play or maybe a calming activity as needed, and when they seem to be all done with being around so many people, its time to head for the door so the event can end on a high note. Don't be ashamed or embarrassed to say "S/He's ready to go now. Thanks for inviting us, bye guys!". 

I hope the largest theme coming across in this post is that large events/birthday parties aren't necessarily about you, as the parent. They aren't about the party host, the games, the clown, catching up with friends, hanging out, etc. They are about helping your child be successful, in what is likely a highly overstimulating scenario.

It is important to provide your child with the support and tools they need to engage with the event, to endure the event (again, consider if it would be best not to go if they seem to just be "enduring" parties), or to excel at the event. Whether the bar is set at engagement, endurance, or excelling, will depend on your child. 

And don't lose hope and feel defeated if right now, you are at an endurance level. That doesn't mean things will always be that way! As your child grows and matures, and most importantly as they develop more skills and abilities, they may begin to enjoy parties. Maybe even, to have fun at parties.

Give it time, and be patient. Both with your child, and with yourself.

*Recommended Resources & Resources:

Autism- Managing Overstimulation

What is Overstimulation? 

Autism & Sensory Overload

Ghanouni, P., & Quirke, S. (2022). Resilience and Coping Strategies in Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders, 1–12. 

Coping & Calming Skills 

Forced "Fitting In' can cause harm 

Parties & Social Events

The Mental Effort of Being Autistic 

Sensory Differences- A Guide

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Tameika Meadows, BCBA, Blog Author

Impairments in social communication are a key deficit of Autism, and can be seen across the varying range of the spectrum.

Social communication is a big word that can include many difficulties, such as making friends, maintaining friendships, being appropriate near peers, sharing or turntaking, empathy or perspective taking, initiating peer play, joining ongoing peer play, responding to peers, self-advocacy, conflict-resolution, getting AND keeping a job, etc.

 
When clinicians throw around the term "social skills", we are really talking about a lottttt of skills!

Some people have the mistaken belief that ABA therapy only focuses on 1:1 instruction, and therefore isn't appropriate to target peer social interaction. Nope, not true.
ABA therapy can absolutely include targeted social skills instruction. Depending on the age of the learner and their specific social deficits, that will impact how social goals are assessed and selected. 

Parents of very young children usually want to work on: sharing, playing with peers instead of isolating, playing with toys instead of hoarding toys, reducing aggression towards peers, etc.

Parents of teens or young adults usually want to work on: initiating conversation, increasing MLU (jargon translation= you want your child to use more than 1-2 words to make a statement or answer a question), buying items in the community, talking to community helpers (e.g. a police officer), going on job interviews, assertiveness, dating, etc.


There are also many ABA programs that offer formal social skill groups to families, where learners are grouped together based on interests, abilities, age, or other factors, to participate in games and activities as a group. But the games are far more than just "games", they are actually carefully designed to target specific social skill deficits. If you are already receiving ABA therapy services, ask if your child can participate in a social group with other clients.


Behavior Analysis has many empirically validated strategies to add to the social skills conversation, and also (depending on the funding source) the ABA provider can target social skills in a group format, at school, or out in the community, to ensure proper generalization. For example:

• Reinforcement for the win! Social skills training should include reinforcement individualized to the learner, and also should work to pair (transfer) reinforcement to peers, as pre-intervention the learner may not find interacting with peers to be all that fun ;-(
• Data collection. If no one is collecting data, reviewing that data, and evaluating that data to make treatment decisions then what is happening is not ABA.
• Generalization. Also known as, "real life". Learning social skills in the ABA clinic, or at school, or on the playground, will not necessarily generalize to other settings and other kids. Intentional generalization into real-world, real life scenarios is a must.
• Structure. This may sound weird, but it does NOT mean that the learner must do the same thing, in the same order, for each peer interaction. It means that the learner should be able to predict what will happen in social group today, they know the rules of social group, and they understand what rewards they contact during social group. These things should be somewhat predictable, from the perspective of the learner.
• Break down concepts visually or tangibly. Help learners understand abstract concepts through video modeling, games, visuals, or manipulatives, that they can touch, see, etc.
• Follow an evidence based curriculum.....just not too closely. While it is important to have a tool to create the lesson plan for social instruction, I'd also recommend individualizing the curriculum as much as possible across learners. Modifying the curriculum to make the content more relevant to the learner will go a long way to helping social instruction gains "stick", and be salient for the individual receiving intervention.
• Behavior management. So obviously, challenging or disruptive behaviors will interfere with learning during social interaction time. These behaviors can also frighten, intimidate, or confuse other peers present, which works against the goal of interacting with peers. This is why ABA providers are a qualified to implement these kinds of interventions, because we already have the tools to decrease inappropriate behaviors and increase appropriate behaviors, and keep the social interaction on track.

*Resources:

Mission Cognition

Crafting Connections (I love this book!)

Social Skills Training for Youth with Autism Spectrum Disorders, Otero, Tiffany L. et al. Child and Adolescent Psychiatric Clinics, Volume 24, Issue 1, 99 - 115

A Review of Peer-Mediated Social Interaction Interventions for Students with Autism in Inclusive Settings, Watkins, L., O’Reilly, M., Kuhn, M. et al. J Autism Dev Disord (2015) 45: 1070

Making & Keeping Friends

Baker, J.E. (2004). Social Skills Training: For Children and Adolescents with Asperger Syndrome and Social-Communication Problems. Shawnee Mission, KS: Autism Asperger Publishing Co.

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Tameika Meadows, BCBA, Blog Author

*Suggested Reading: "The Hidden Curriculum for Understanding Unstated Rules in Social Situations for Adolescents and Young Adults"


The hidden curriculum can be defined as those invisible and unspoken rules of  society/community that we are all expected to follow, and often face negative reactions for failing to follow.

Examples? Sure:

*During checkout, the cashier may ask if you found everything ok. It's a way of being polite. They do not expect you to say "No, I couldn't find milk, eggs, flour, or lemons. Come help me find them"

*It's fine if a toddler on a plane is loudly singing the ABC song to himself. If he's still loudly singing 10 minutes later, his parents will start getting some very angry looks from other passengers 

*Do not ever get onto an elevator and stand with your back to the door, directly facing the other people on the elevator

*When you see a "free samples" sign, it is fine to take one. It is much less fine to take 5

*Any look towards another person that exceeds a few seconds is considered "staring". People may make an odd face at you if you don't break off the stare when they catch you


And on, and on, and on.

Teaching play skills? Sure, we have a program for that. How about language? Not a problem. Toileting? Of course. But the difficulty with teaching hidden curriculum is in its very unclear shades of gray. If typically developing adults have a hard time navigating invisible social waters, then how well do you think a child with Autism will do?

I think another difficulty with teaching in this invisible domain of social skills, is trying to do so within a structured therapy session. Social skills don't always fit into neat boxes, or a jam-packed therapy session from 2-4. To work on these areas of gray we need to go OUT THERE.
Out there is simply into the child's community, where they live, work, play, or attend school. It is often through being out and about with my clients that I see areas of deficit I was previously unaware of, and think to myself "Ooooo, we need to work on that".

Yet another difficulty with teaching in this invisible domain is that the wrong answer is not always obvious. Just think of someone you know who is a bit abrasive or loud. At social gatherings, you can see other people giving each other the side eye, obsessively checking their watch, or clearly saying lies to leave a conversation with that abrasive or loud person. But does the person seem to notice those cues? Not always, no. Unless someone plainly says "Hey look: you are shouting and spraying spit on my shirt, and you're also kind of ignorant and boring. I don't want to talk to you anymore", that person may never truly understand how others perceive them. And it's unlikely that will happen, because it would be extremely rude to tell someone that! So the person does not get the blunt feedback they need, because to give that blunt feedback would make the other person seem abrasive and rude.


Social skills are difficult. Like, Jenga difficult.

So what can be done?

• Realize that this invisible area of social development will not magically descend upon your child like fairy dust. It will likely need to be taught, very intentionally, and with lots of generalization/real life examples.
• Don't expect it to be easy, or simple. It won't be.
• As much as you can, expose your child to same age peers. I spend a lot of time at work watching kids interact, and the results can be hilarious. Kids say things adults would never say, but that kids with poor social skills need to hear. Like: "Oh my GOSH you already said that like 4 times! I don't care".
• Evidence based strategies such as video modeling and social strips/social stories can be particularly helpful to break down complex social skill instruction, particularly if the learner has the communicative and cognitive ability to follow a story.
• Stop being so nice to your child. I'm not saying be a jerk, but the honest feedback your child gets on the playground won't exactly be dipped in sugar first. Practice giving in the moment feedback when your child interrupts someone, stands too close, or smells like they need a shower.
• If you are already receiving ABA therapy services, ask if social groups are an option.
• Make sure your child understands that social rules are a complicated matter. Almost every social rule has an "except when...." caveat. This is not a concept that will be helped by black and white thinking; flexible thinking will be key.

For more information about Hidden Curriculum, look for the publications of Brenda Smith Myles

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Tameika Meadows, BCBA, Blog Author

 Recommended Reading: Emotional Intelligence

I covered this topic a little in my Top Ten post, but coping skills are often a skill deficit I see across many of my clients regardless of their age or cognitive ability. 

In the young clients this may look like a screaming tantrum, and in the older clients it may look more like kicking holes in the walls of their home. The same issue is fueling both outbursts: challenges with Emotional Regulation.

I find that parents and teachers can often identify consequent strategies, or those techniques they should apply once the problem behavior is occurring. It’s identifying antecedent strategies, or ways to prevent the problem behavior that many people don’t think of, or don’t plan for. This is usually reflected in the kinds of questions I get asked, such as “What do we do when s/he does (behavior)” and rarely “What can we do to prevent (behavior) from happening?”

Coping skills teach the skills of self-management, labeling one’s own emotional state, controlling impulses, engaging in thoughtful behavior, and making good choices. 

Despite how it may appear, most individuals don’t go from “0-60” in the blink of an eye. Emotions have been simmering inside and building, sometimes for hours, sometimes for days, and what you or I may consider a harmless event can set the person off. 

To anyone observing, it would seem like the behavior came out of nowhere. My vocal clients will often tell me about behavioral outbursts they had, and something that happened sometimes days before the outburst was a trigger. Maybe a kid at school called them a name, and they perseverated on that for days before exploding at home when they were told to turn off a video game. 

Children who have difficulty regulating their emotional state are easily triggered. There are many, many things that cause them to become frustrated, angry, or upset, and sometimes these triggers change without warning. For example maybe Chris usually gets upset when babies cry on TV, and then one day at the mall a baby in a nearby stroller sets Chris off into a full meltdown.

 It isn’t unusual that triggers grow, or generalize, to the point where parents or teachers can spend the whole day putting out behavioral fires or desperately trying to eliminate stressors from the child’s environment (which in some settings, is nearly impossible to do). This can put an incredible amount of stress on the caregivers.

If this is something you are currently struggling with in your child or a student, let me suggest approaching this problem in a different way. What if you could teach the individual to identify when they have been triggered, to select an option to de-escalate, and to implement that choice? Well, you can.

Most successful adults have a variety of coping skills that are used every day, across a variety of situations. We all have things we do when we feel ourselves getting stressed at work or irritated with our spouse. Most of us don’t need someone to tell us to go “calm down”. This is because we have the ability to identify what triggers us and make a decision about how to handle it. Unfortunately disabled individuals may not have this ability.

 I sometimes describe this to a family by saying that when their child gets upset, they open a cabinet of options in their mind filled with choices like “break something”, “hit my brother”, or “punch a wall”. So saying to that child that they need to “make better choices” when they are angry doesn’t mean anything, because they don’t KNOW any other choices to make. So my job is to fill up that mental cabinet with multiple appropriate choices for the child to choose from when they need to calm down.

Helping children learn coping skills can’t just be about what to do when the problem behaviors occur. There has to be a focus on preventing the behaviors, and practicing the strategies both when the child is calm, and when they are escalated. Use prompting and reinforcement to teach the strategies to the child, and help them to understand that not being in control of their emotions has consequences (disciplinary action at school, losing privileges at home, being removed from a preferred Community location, etc.).

Here are some helpful strategies for teaching coping skills. This information may need to be modified depending on the age of the individual, and cognitive ability. 

Remember, practice is necessary! Use repetition & reinforcement (the two R’s!) to teach the skills, individualizing the strategy for the specific person:

Strategies:

• Silent counting – Tell the individual to close their eyes and count to 10 or 15 in their head. This can provide the individual with needed time to quietly calm down, and can give them something to focus their thoughts on.
• Teach hobbies – Teach the child leisure skills or hobbies that they can engage in when they begin to escalate and need to “take a break”. Examples include writing in a journal, doing a crossword puzzle, playing Solitaire, doing a puzzle, stringing beads, or folding clothes (this can be very calming, and it is also a helpful life skill).
• Meditative Deep Breathing – Have the individual breathe in deeply as he or she says “Calm in”, hold the breath for a moment, then release the breath slowly as he or she says “Anger out”. Repeat.
• Close Eyes & Imagine- Close eyes and imagine a peaceful scene. The teacher or parent will narrate a peaceful scene (or remain quiet if the child prefers). For example, “We’re at the beach watching the waves go in and out…in and out…in and out. The sky is so blue, and the sun feels good on your face”.
• Progressive Muscle Relaxation – Practice tightening and then relaxing various muscle groups from the toes all the way up to the head. Clench/tighten the muscle group tightly, hold for 3 seconds, and release. Repeat.
• Slow Stretching – Stretch arms over head, to the side, and down to the floor for a count of 5 seconds. Repeat.
• Exercise – Take a walk, do yoga movements, run on a treadmill, do 10 jumping jacks.
• Distraction – Put the child on task, by having them complete a simple motor activity that does not require language (even a verbal child may be unable to communicate once they are escalated). Examples include: coloring, blowing bubbles, squeezing objects, sorting items, filling a container with blocks, etc.
• Write down/Draw a picture of how you feel – Encourage him/her to write down words that describe how he or she feels, or to draw a picture.
• Fast/Slow – Have Him/her complete simple motor actions very quickly, and then very slow. Examples include rubbing hands together, squeezing thighs with palm of hands, making and releasing fists, etc.
• Whisper Only – Sit (or lay down) in a darkened area with him/her and speak only in whispers. It may be helpful to let the individual lay down on pillows or across a bean bag chair.
• Rhythmic activities – Bouncing, rocking, jiggling, pacing, swinging (it is important not to inadvertently teach the child that engaging in problem behavior is how to request these activities).
• Listen to Music with Headphones – Allow him/her to listen to calming music in a darkened room with headphones/earbuds on. It may be helpful to also allow the individual to wear a blindfold/eye mask.

 

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Tameika Meadows, BCBA, Blog Author

Emotional Intelligence is defined as the ability to identify and manage your own emotions and the emotions of others. This includes emotional self-regulation, problem solving, and modifying your own behavior to impact the emotions of someone else (source: Psychology Today.com).

My Recognizing & Labeling Emotions post was about teaching individuals with Autism to receptively and expressively identify the basic human emotions.

So what about taking a step beyond just identifying a “happy” facial expression to associating events related to emotions, processing ones own emotions, thinking about how your own actions impacts what others feel, or moving into more complex/multifaceted emotions like  worry, guilt, disgust, jealousy, rage, contentment, suspicion, or courage?

As I said in my previous emotions post, teaching emotions can get pretty complex! If ADULTS struggle to process, label, and appropriately manage their emotional state, how much harder is all of this for children??

This post is about programs I may write for older clients, or clients more on the milder end of the Spectrum, who can struggle mightily in the area of emotional intelligence. 
These individuals are usually very bright and socially aware, which can make other people judge them much more harshly when they have a bad day, a bad moment, or blow up on someone with yelling, cursing, and screaming. 

Just because an individual makes great grades, is conversational, and can easily complete daily living activities, does not mean they possess emotional intelligence. 

Let's look at a few examples:

1. Therapist gives David a math worksheet to complete. David reaches a difficult problem, and promptly bursts into tears and shouts “I’m so stupid”, before ripping the paper in half.
2. Therapist is at the park playing a game with Kayla when another child walks up to join their play. Kayla covers her nose with her hands and says “Wow, you smell”. The other child starts crying and walks off.
3. Christopher is standing in the lunch line at school when a student accidentally bumps into him. The other child says “I’m sorry”. Christopher pushes the child to the floor. When the teacher later asks Christopher why he did that, he says “That kid picked a fight with me”.

Here are some helpful strategies for teaching emotional intelligence, with a resource at the bottom for teaching self-regulation:

(I suggest using large, color photographs and generating discussion about the social scenarios pictured.  Steer the discussion to real-life events or recent blow-ups, and discuss alternatives for future behaviors. This strategy should be part of a comprehensive treatment plan to develop complex social skills.)

Ask: What are these children doing? What games do you like to play with your friends?

Ask: Is that boy paying attention in class? How can you tell he isn’t? How do you think that makes the teacher feel?

Ask: How does this boy feel? How do you know that? Tell me about a time you felt sad/lonely. If you saw him what could you say to make him feel better?

Ask: What are they doing? How would you feel if some kids did that to you? Whats a good way to handle that?

Ask: How does the girl in the middle feel? What do you think the other two girls are saying? Tell me about a time you felt left out from the group. How did you handle it?

*Resource:
The Incredible 5 Point Scale by Kari Buron & Mitzi Curtis is an amazing resource that uses a behavioral thermometer system to teach: how to recognize your emotional state, how to determine an appropriate reaction, how to identify triggers, and how to problem solve appropriate solutions to deescalate once you have been triggered. I've used it with clients of varying ages, and abilities (with some slight modifications).

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Tameika Meadows, BCBA, Blog Author

Play skills for individuals with Autism can be difficult to teach. Before just jumping in, it's important to look at the why of intervention. 
Why are play skills being targeted? Is this a necessary skill for intervention? Is the lack of appropriate play skills a true deficit, is it causing issues at school or with peers, or are toys/play items being used for challenging behaviors (such as chewing on the doll's clothing, instead of playing with the doll)?

If this skill is selected for intervention, there are many resources and strategies available to help strengthen play behavior, which will help strengthen socialization behaviors.

Play challenges for many of my clients can include inability to play meaningfully with any toy items (which impacts ability to keep self appropriately on task during the day), mouthing behaviors (which can be dangerous), toy hoarding (which can lead to aggression if a peer tries to join the play), and rigidity with structured games (which can impact being able to play rule based games with other kids). 
Especially for many of my older clients who do want to interact with peers, and do seek to join peer play scenarios, it is essential to first work on play skills and interacting with toys in order for true socialization to occur.

Play skills affect a variety of learning situations, particularly at school. A child who cannot play appropriately might have a hard time making social connections with other kids. This is because for children, much of their communication and interaction occurs through play. This is where bonds of friendship often emerge, and are strengthened over time. 
In a home setting, the same is true for sibling interaction. When I have clients who have poor relationships with siblings, at the heart of the issue there's usually challenges around play skills.

See, play can be pretty important!

Here is a basic hierarchy of play skills, based on typical developmental (*translation: general outline, not iron-clad rules):

• Solitary play- Carrie will play or engage with a toy, as long as no one sits next to her or tries to interact with her. If someone tries to sit down with Carrie, she turns her back to the person or scoots away. If the person tries to touch her toy, she gets up and walks away.
• Parallel play- Carrie will play or engage with a toy while in close proximity to other children or adults, and sometimes she will look at how the other child is engaging with their own toy. Mainly, Carrie focuses on her own toy and does not interact with the peer or adult.
• Interactive play- Carrie will share a toy with a peer or adult, and will take turns appropriately. This could include passing a toy back and forth, or imitating each others play. Carrie may still play silently, or avoid eye contact with the other person.
• Cooperative play- Carrie will play and engage with another person, while playing with separate toys or sharing one toy. Carrie will look at the other person and make eye contact. This could include building a block tower together, or working together to solve a puzzle.
• Pretend play- Carrie will engage in imaginative play (either alone or with others) that involves elements of pretend. This could include cuddling a doll and pretending the doll is crying, cooking a pretend meal using Play-Dough, or playing dress up (Dress up play should include an understanding of the character. Such as putting on a fireman hat and pretending to be a fireman).
• Rule based play- Carrie will play highly social and competitive games with other persons, such as sports, board games, card games, and video games. Carrie can also play games that other children make up on the spot and can easily adhere to rules of the game that constantly change.

You can likely view these basic definitions and already see where your child or client is in their play skill development. 

Depending on the specific individual, some children may progress through levels out of order, in order, or remain at one particular level as they age. Is this an issue?
Again, it depends on what specifically is happening with the individual child and what problems are being caused socially due to play skill impairments.

The most important takeaway is to help support your child or client based on their specific ability to meaningfully form friendships, and interact with peers.

See below for some general (again, NOT iron-clad rules) guidelines for teaching play skills. The thing about play is.... it's play :-)

If teaching it isn't all that fun, then the child probably isn't having much fun. Be creative, go off-script, and also don't forget about mud, water, slime, glue, glitter, etc. Play shouldn't always be nice and neat.

• It is typically easier to teach play skills with an adult first, before bringing in peers. Adults are more predictable and less demanding than children, and for this reason children with social impairments may easily play or interact with adults but avoid, hit, or refuse to play with peers.
• It is best to start teaching play skills with simple cause-and-effect toys, such as a Jack- in- The- Box or a keyboard. Avoid imaginative, work -based, or abstract toys, such as puzzles, figurines, dolls, or Play Dough. If you hand a child with limited play skills a lump of Play Dough, they may have no idea what to do with it.
• Many people don’t realize it, but strong imitation skills can be a pre-requisite of pretend play. A child who cooks a pretend meal, or comforts a “crying” baby doll, is a child who has observed someone else perform these actions and is now acting like so-and-so during their play.
• In order to teach play skills, you should be fun to play with. That may sound obvious, but if the roles were reversed would YOU want to play with you? 
• It is so important to minimize problem behaviors during play. Challenging behaviors impede skill acquisition. Conduct a FBA to determine the function of the problem behavior and create a behavior plan. Work on these behaviors before introducing peers into the play sessions.
• Talk and make sounds during play. Children typically talk or babble while they are playing (even if they play alone) so be sure to model this.

Recommended Resources: 

“Teaching Playskills to Children with Autistic Spectrum Disorder” By Melinda Smith 

(blog) How to Play Effectively with Children with Autism

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Tameika Meadows, BCBA, Blog Author