Often the most difficult aspect of beginning a new recreation activity is getting started. It can be overwhelming when one is not sure what one wants to do. This section of the manual describes steps and processes to help an individual with autism become involved in a recreation activity of choice. While each of the items is dependent on the individual, the fundamental strategies will be the same when employing structured teaching and visual strategies.

A personal strength's perspective forms the foundation of the service delivery model. Control and choice are at the core of self-determination and should be principles on which the assessment takes place. Areas to assess include:

• Personal Strengths - Identify the abilities and strengths of the person. In addition, ask the person with autism to identify his/her own positive qualities, skills and strengths. For example, if John has great abilities in adding and Mary can remember all the words to many songs, then John may have great interest and success with a table top game that requires adding while Mary may enjoy singing in a choir.
• Goals & Wishes - It is important to know the dreams and wishes of the person with autism. Sometimes teachers and parents focus so much on immediate goals and outcomes that they miss an opportunity to learn the unexpected - the wish of the person with autism. When working with a child with autism, it is also helpful to ask other family members, friends, and teachers what recreation goals they might also have for the person.
• Learning Style - This area is designed to assist in selecting the most useful educational strategies. If a person with autism is unable to read, the interventions may need to be pictorial or have specific items used. Many individuals with autism do not understand pictures. Often the physical items, such as a basketball, paint set, a cup, will need to be used for the individual to understand. For example, the instructions for how to do a paper weaving project will need to be done in a series of pictures instead of written in words. It is important to note that there are many aspects of the individual’s life outside of "traditional" recreation activities that are possibilities for self-determined skill mastery and community involvement. It is also important to use the structure and systems that are in place in other aspects of the person's life in the area of recreation. For example, Bob can not read, uses a left-to-right photo schedule at school, and needs clear boundaries established for him to understand an activity. His teachers know this approach works best for him, so when teaching him how to color a picture she will use dried penne pasta glued to the page around the picture so Bob can know where to color. The teacher will also use pictures for the directions and will add a time for coloring to his daily school schedule.
• Leisure Interests & Satisfaction - When addressing questions relating to the individual's leisure skills and interests, be careful to use the terminology with which the individual is most comfortable (recreation, leisure, play, fun, pleasure, enjoyment, free time). Some people with autism might be asked to evaluate their present degree of satisfaction with leisure/recreation/time use (in whatever terms are most meaningful to the individual). This question will hopefully set the stage for the next topic: What would you like to get out of recreation? How would you like things to be different? For a person who can not answer this question, offering a choice board of activities, talking to others who have information about favorite activities, or observing the person during activities can help give indications of leisure interests. Again, even using pictures does not include the entire spectrum of autism; some people will not understand the pictures.

• Meaningful Routines - You should determine how the individual with autism spends his/her time, and then note what changes in his routine he/she would like to make. The emphasis is on establishing a personally meaningful routine that includes a balance of leisure, work, self-care, and other commitments. Having this balance can help relieve stress, as well as increase the quality of life the person has. It is important to make sure the activities are meaningful to the person with autism.
• Use of Resources - It is important to understand that resources mean more than just activity supplies. It encompasses resources found in one’s home and a wide range of community resources, such as stores, parks, library, bank, bus system, etc. What is important is the availability of resources, and the individual's present ability to access these resources with or without assistance. If s/he presently uses selected resources with assistance, note who assists and the type of assistance needed, and note who the people are with whom they participate.
• Initiation/Planning - It is important to note who is responsible for the majority of the recreation initiation and planning for the individual with autism. Do family members or support staff always set up or start the activity? Is the individual able to assist with or take on the planning of an activity? The less the person with autism needs to rely on others and the more he/she can rely on schedules, structure, and him/herself for the planning, the better. For example, if Sarah likes to go to movies, she should be taught the process for planning to go to the movies. In addition, she should have a structure that visually prompts her to choose an activity, including reminding her of favorite activities, such as going to the movies. Before going to the movies, Sarah is given a schedule card that prepares her for going to the movies. The first card prompts her (by showing a picture of a newspaper) to find out the time and location of the movie she wants to see. The next card shows the amount of money that she will need to obtain for the movie. The third card shows a picture of a clock, prompting Sarah to determine what time they will have to leave for the movie. The last card is a picture of the family car, which indicates to Sarah that she needs to leave the house and get into the car to go to the movies.

Assessment is a process. It is a collaborative effort that involves gathering information about preferred activities from the person with autism and those who know him/her. Through an inventory list, such as the one suggested in Section I, photographs, or computer images, the person with autism may help identify activities that are of interest. However, not all people with autism are able to identify these activities. Sometimes indicated interest is subtle, such as leaning forward in the chair to get a better look at a picture, or pausing to look longer at another picture, or a positive look on the face of the person with autism. In addition, talking with people who know the person well - family members, friends, teachers, residence staff, therapists, and others to gather information about favorite activities, strengths, and other interests is important to ensure the needed information is obtained.

While the focus is on recreation, play, and leisure interests, it is also crucial to consider anything that will impinge upon the ability of the person with autism to carry out a leisure activity. Such barriers include level of social development, behavior challenges, and sensory issues. For example, if Timothy has trouble with loud noises, a noisy game, crowded environment, or loud music would probably not be good choices for him. On the other hand, if he is very good at matching colors, a variety of games that require the matching of colors could be very interesting and positive for Timothy.

Another important component is the family’s goals and interests related to leisure time. The family may be more interested in activities that they can do as a whole family – or they may prefer independent activities their child can do after school or during dinner preparation. The family plays a role in determining the goals of the intervention.

Exactly how does anyone conduct an assessment? A variety of tools exist, including verbal self-reports. Because some people with autism cannot give a verbal self-report, it is important to gather information from a number of different sources. All people who interact with the individual -parents, teachers, therapists, job coaches, siblings, residential staff, etc. - are potential informants. It is important to ask not only about leisure interests that already exist, but also about potential interests that have yet to be explored. Because a person can only have interests in activities to which he/she has been exposed, interests will be limited by past experiences. Often new activities and experiences will need to be offered to the person with autism in order to determine whether they are of interest. For example, Jeff is nonverbal, but is able to choose and point to pictures when asked about certain aspects of the picture. After talking to his parents, the CTRS learned that Jeff loved airplanes. When the CTRS met with Jeff, he pointed to the picture of the airplane and the CTRS confirmed this to be a favorite item. She then helped Jeff learn how to build a simple model airplane and learn a new board game that involved airplanes. Jeff's brother learned the airplane game, as well. After several months of working with the CTRS, Jeff and his brother were able to play the airplane game for 20-30 minutes at a time.
 
 

Another way to gather information is through observation. Observing the person at home, job, or classroom during unstructured free time is the best way to see what kinds of activities are already available, as well as what skills the person has. An important concept to remember is that the visual system of structured teaching (as described on page 3[of this draft]) is as important during recreation or "free time" as any other time for the person with autism. Because of the nature of recreation and play, it is sometimes erroneously felt that playtime should be less structured. When the activity lacks structure, it may set the person up for failure and frustration. Interests, choices, strengths, as well as visual system, structure, and the manner in which the person learns best should all be taken into account when setting up the areas and activities for recreation. A parallel exists between the systems that help a person with autism with academics or on a job, and the systems that will help that person with recreation. For example, if Bill continually goes to the dress-up area of his preschool classroom, there is a good chance that playing dress-up interests him. However, he will probably require some structure, such as looking at photos of people dressed up to copy, or have a story available to help with the costumes and how to act out the scene. This can become a self-initiated play act at home and school after working together with the CTRS or teacher.

When helping to determine activities that the person with autism wants to do and has the skills to pursue, it can be helpful to think of leisure skills as falling into 3 categories: passing, emerging, and failing. Passing means the person can participate in the activity independently. When a skill is emerging, the person knows what the activity is and attempts to participate, but has trouble with the skills needed. When a person is said to fail, he/she has no knowledge or ability to participate in the activity.

In addition, think of leisure interests being rated as high, middle and low. The middle category should be quite broad, since you do not want to be eliminate anything until you are pretty sure it’s not an interest. At that point, start teaching with an activity that has high interest and emerging skill. (Presumably, you don’t need to teach an activity that has already been considered a pass.) Throughout the intervention, you will re-assess those "novel" activities while you continue to introduce brand-new ones.

As explained in the following article, looking at these categories of skill, interest, and independence is a good way to determine a good first activity to offer the person with autism.

Developing Successful Play Activities for Individuals with Autism by Sally Brockett

Puzzle Pass Medium High

String Beads Fail Low Low

Pop Up Box Pass High High

Magnet Blocks Emerging High High

1. What will he do?
2. How much will he do?
3. When is it finished?
4. What happens once it is finished?

1. Left to right, with a Finish Box – child takes each activity box in order from left to right until he reaches the last box, which contains a reinforcement for completing the tasks. This is the lowest level or easiest system.
2. Matching (color, alphabet, or numbers) – child matches an activity card to the activity box, completes the activity contained in the box, then moves to the next card, matching it to the next box, until he reaches the reward box or card.
3. Written system – tasks may be written on cards or lists.

1. Pick up the color card from the Velcro strip, turn to the shelves on the left and attach the color card to the matching color card on the activity box. (Initially, there will be only one box on the shelf.)
2. Carry the box to the work table and remove the materials for the activity.
3. Proceed through the activity to completion. Since he has already mastered this activity, he should not need a lot of prompts.
4. Place completed work back into the activity box. He should not take apart or undo his work. In other words, he should not remove the pieces from a completed puzzle, the completed puzzle is put into the activity box.
5. Place the completed activity box into the large finished tub on his right.
6. Pick up the reward card and give it to the parent or teacher.

• Activities must be interesting for each individual child.
• Allow the child to choose a reinforcing activity that can be earned when work is completed.
• Design materials so they stay assembled when put into the finished box. (Use Velcro, magnetic tape, etc.)
• The activity must be previously mastered by the child.
• Teach the child not to undo work that has been completed. You need to be able to check it.
• Activities must be changed daily or every other day.
• Arrange work so a favorite activity follows a less preferred activity.
• Monitor work and reteach any skill that begins to deteriorate.

It is important to keep goals as simple as possible, especially when first addressing recreation. Take into consideration the information learned in the assessment, such as:

What are favorite activities?

What are interests?

How does the individual learn best?

What skills does the person have that will enhance the learning of a new activity?

What experiences & outcomes would be the most beneficial and enjoyable for the
person?

When establishing goals, the support person should determine what the person with autism enjoys, what he/she thinks the person with autism would want to do, what functional skills and goals would be helpful, as well as determining the age appropriateness of the activity.

When helping a person with autism explore recreation options, introduce some novel materials or activities and see how the person responds. New materials and activities can be one significant area of difficulty. Just because a child with autism does not respond positively the first time an activity is presented does not necessarily mean that you should give up on that activity. It may be the novelty itself that’s the problem. Because a characteristic of autism is a resistance to change routine, an activity may need to be introduced multiple times before it is accepted. It may take several opportunities to distinguish the resistance to change from true disinterest. It can be difficult to determine when to keep introducing an activity and when to try something else. If the person is showing any interest or increasing positive reactions toward the activity, it is often good to reintroduce it later. If an activity has been presented five or more times and the person has strong negative reactions to it each time, it may be time to try something else. However, just because an activity does not seem to be of interest at that particular time, it does not mean that it will not be of interest in the future.

People with autism, like all of us, can experience changes in interests and preferences.

For example, from the assessment the CTRS determined that the activities that George participates in most frequently were: bouncing a basketball, swimming, roller skating, playing a modified version of the card game Solitaire, drawing with magic markers, and listening to CD's. George does not initiate any of these activities and requires encouragement, and often assistance, to participate. He often does not engage in the activities for longer than 10 minutes at a time. It was determined that George learns best using a visual system and schedule and when he receives a reward as a motivator. George's teacher and parents determined that the recreation goals that are most important for him are: being able to independently participate in an activity for 20 minutes while his mother cooks dinner, to participate in an activity with his sister for 15 minutes, and to increase his level of physical exercise from 10 to 15 minutes. With the help of the CTRS, George's parents set up a system for George to draw and listen to music for 10 minutes each evening, with plans to add one minute to the time every week. In addition, George's sister started playing a modified game of basketball with George each day after school. At first, his mother helped with this activity, but with explanations to George's sister about the best way to help George play, and familiarity of the activity with George, the siblings were able to play alone after two months. Through these two activities, George was able to work toward the goals established and increase his leisure skills and physical exercise.

Incorporating strong and unusual interests is an issue that is important to address. Sometimes these unusual interests can be viewed as "not appropriate." Using a personal-strengths and personal choice perspective the goal would not be to eliminate these strong and unusual interests, but instead, to expand them. For example, if Mary likes to wave straws, give her a baton with a ribbon that is used in rhythmic gymnastics. This can give her the stimulation of her preferred activity, yet expands upon it in a way that makes it more socially acceptable and offers additional opportunity for skill development and social interaction. For Roger, a fascination with local newscasters can be turned into a game. Finding pictures of the newscasters and creating a matching game expands his interest.

Sometimes, however, the interest is not what the support person assumes. For example, Terry played with toy cars during free play at school. However, he continually lined them up, and never played with them in a "usual" manner. The CTRS worked to teach Terry how to "drive" the cars and then "park" them. She did this by creating a visual system that included building a garage (place to start), roads to "drive" (where to go), and a parking lot to be able to "park" the cars in a line (finished), as he liked to do. After many attempts, it was determined that the interest was not in playing with the cars themselves, but in the lining up. It just happened that the cars that were available for him to line up. An additional example is illustrated by Jill, who always wanted to hold pictures of ballerinas. From this, the parents thought Jill wanted to take ballet lessons and learn to dance. When dance lessons were not successful, the parents found out that it was the pink tutus and leotards that held Jill's interest, not the dancers themselves. Therefore, pictures incorporating dancers in pink tutus were used to establish a game. In addition, the parents allowed Jill to wear her leotard and tutu around the house to play dress up. She was content with these new activities.

Play and recreation skills are often more abstract and unpredictable than school or work and require a task analysis. Therefore, the first step is to break each skill down into small steps and figure out how to make the skill clear, concrete, and somewhat predictable. For example, when taking Raoul swimming at the local YMCA, the environment was very stimulating, the rules (social and physical) were unclear, and he was thus unsure of what to do. The strategies used included giving Raoul social rules to follow when swimming, such as a written list that includes: when we swim, we don’t run near the pool, we go directly to the pool without swinging on the lifeguard stand, we don't try to dunk other swimmers in the pool, and when Miss Jenny says it is time to get out of the pool, we exit quietly and calmly. Other strategies that helped were going swimming during times when the pool was less crowded, and using a schedule showing the sequence of activities helped him. He soon understood what was expected: when he started the activity, how to enter the pool, what was considered appropriate behavior, and when the activity ended.

What is taught to the person with autism will depend on the established goals. A leisure intervention may have numerous goals such as: learn leisure activity skill, increase social interaction, or increase community involvement.

The skill should first be taught in isolation. Once some degree of familiarity or proficiency is reached, the skill can then be taken into the social realm. For example, when Sonya indicated that she wanted to learn how to play softball, the CTRS and her parents worked with her on a one-to-one basis in the backyard, practicing the skills of throwing, catching, and batting the ball for several months before signing her up for a beginning softball league.

The social aspects of leisure are so difficult for children with autism that they need to be prepared carefully for transitions. Because a transition (changing from one activity to another) can be difficult for children with autism, it should be handled gradually. For example, it may be best to begin with a single peer and work towards the larger group. For example, if Vincent were to begin the process of learning to play Candyland with his brother, the steps might be:

1. On a piece of paper, draw a series of 10 connected squares, each a different color.


Create an additional set of matching squares, with each individual square cut. Teach

Vincent, on a one-to-one basis, how to match the cut squares with the connected squares and to learn how to progress (move forward with his "man") on the board.

2. After Vincent masters the above step, get the gingerbread man game piece from the


Candyland game. Teach him how to move the game piece along the connected squares, based upon the cut square cards that he picks.

3. Once Vincent demonstrates he understands this process, make a new series of connected squares using the colors found on a Candyland board, with the colors repeating in a pattern. (Red, yellow, orange, purple, blue, green, red, yellow, orange, purple, blue, green, etc.) Use the actual single square cards from the Candyland game. Have Vincent draw the card from the pile, and move the game piece along the series of connected squares. Visual cues, such as an arrow for direction, may be needed on the created game board.
4. After Vincent has mastered step 3 above, use the actual Candyland game board to play the game (still by himself, with assistance). Use only the Candyland cards that


have single color squares (remove all double and specialty cards from the deck). Once again, because of the visual complexity of the Candyland board, some of the pictures may need to be covered with white paper, or arrows drawn to indicate the direction to move.

5. At the time that Vincent has mastered the Candyland game using the board, pieces,


and selected cards, turn taking should be introduced. Vincent's mother will take an index card and on one side will write "Vincent's turn" and on the other side with write "Mommy's turn." In addition, a small photo of Vincent and his mother will be on the side corresponding with each person’s name. Vincent's mother will help Vincent learn the concept of taking turns by using this index card as a visual cue.

6. Only after Vincent knows the game well and can take turns, even with verbal prompts, should Vincent's brother Jimmy be introduced to the process. As Jimmy


knows how to play Candyland, the two boys will begin to play together, with their mother supervising and prompting. (A new index card for turn taking with "Vincent's

turn" on one side and "Jimmy's turn" on the other will probably need to be made.)

7. Once all these steps are accomplished, the boys can be expected to be able to play Candyland together.

Another important concept is teaching the skill in the appropriate context. If the goal is to teach a student how to order his own ice cream, first practice in the classroom or home. It is critical, however, that the skill be applied in the real environment, the ice cream shop, to address generalization. For Vincent, who learned Candyland above, it may be difficult to play Candyland at school, even once his skills are mastered, simply because the setting is different from home, where he learned the skills to play the game. If his teacher works with him on the game of Candyland at school, he may be able to generalize what he knows from home and be able to participate in the school setting as well.

Choice making is difficult for most people with autism and often needs to be taught, if possible. A choice board is a board or notebook that has places for several pictures on it. Using a choice board can make this process more visual, structured, and therefore easier. Having a visual system to be able to see and understand the options offered makes it much easier for the person with autism to make a choice. To use a choice board, place pictures or words (whatever is more meaningful) on a board or notebook and present it to the person so a selection can be made. For example, when Kevin was first presented with a choice board, he could only choose from two different activities at a time. If three or more choices were offered, he was not able to make a decision about which activity to pursue. In addition, because he was used to a schedule that went from top to bottom and a work system that went from left to right, it was important to not place the choices in a horizontal or vertical row. If his teacher placed the choices in a horizontal or vertical row, he would always choose the top or left one, thinking it was a schedule to follow. His choice board was made with his choices placed diagonally. Some time later, when he was able to choose from four choices, his teacher set the choices in a circle pattern on his choice board.

When teaching a person with autism how to play a board game, or participate in a recreation activity, it is important to break it down into steps, as mentioned before. However, after the person with autism has mastered the skill of the game, it is also important to teach him/her all aspects of the activity, including setup and cleanup. These are steps that are sometimes forgotten. Often, a person with autism has others to initiate the activity, set it up, and clean it up afterward. While that person may know how to play the game, he/she could never do it independently or with another person who does not know those steps. Showing the person with autism where the game is kept, how to get it down, set it up, start it, know when it is finished, and clean up and put the game away are important aspects of a complete leisure experience.

A visual system, using either pictures or words, can be helpful. For example, if the person with autism chooses the game HiHo! Cherry-O, from a choice board, there should be a visual prompt as to where the game is kept. Once the person goes to where the game is kept, there should be a system for how to locate the game. This system might be accomplished by having a picture of a cherry on the choice card that matches a picture of a cherry that has been placed on the end of the game box. The person with autism can match the cherries and know this is the selected activity.

The system itself could be placed inside the game box a system as a visual prompt to show how to set up the game. This can be accomplished by a written or picture method, whichever is best for the person with autism. The system should show:

* how to set up the game, (a photo of all the cherries set up in the tree)

* how to start the game, (a photo showing a finger spinning the spinner, a second photo

One of the most difficult times for children with autism is during free play. This is primarily because the time is the least structured, has many social aspects, and involves initiation and follow through. To help a person with autism become successful during independent free time, he or she must be able to participate in a recreation activity independently. This requires one-on-one work so that the child can learn and practice the skills necessary to play independently. Once the skill is mastered, the child can participate in the activity during free play. A choice board or visual schedule, as described in the previous sections, are useful when helping the child get started during free play.

Issues of socialization, integration, and peer interaction can also be introduced by the teacher, parent, or CTRS once the child with autism is able to participate in the activity independently. For example, Max had a hard time during free play. The CTRS worked with him to be able to play independently in the sandbox, making sand castles, roads, and playing with sand toys. Once he was able to play in the sandbox by himself, the teacher added a picture of the sandbox to his schedule to indicate it was free play time. When Max saw the picture of the sandbox, he knew where he was supposed to go and what he was supposed to do. During the time that Max played in the sandbox, there was a series of baskets lined up on the edge of the sandbox from left to right to prompt him as to what he would play in the sandbox. Within these baskets were a castle mold (to build a sandcastle), a shovel & a car (to build roads), and in the last was a truck that was used in the sandbox. Using these items and basket system helped Max to understand what he was to do while he was playing in the sandbox, and allowed him to play independently. This entire visual system also made a difference in his ability to use his free play, as well as decreasing inappropriate behaviors during the free play time.

Once resources relevant to the individual's choices have been identified, support the individual in observing and sampling a variety of these recreation opportunities. Recreation sampling allows the individual to obtain additional information to make an informed choice regarding their leisure choices. Sampling ideas may include visiting a ceramics shop to determine if this is really what the person had in mind. It might also involve visiting a gym, trying a swim class, or testing some equipment or game. It may take several times of introducing the person with autism to the activity before he/she feels comfortable with it. Some individuals may find it difficult to make a choice by simply viewing a one-dimensional picture of an activity. Some may need to observe a wide variety of recreation activities. Others may want to participate in a few different types of activities before choosing.

Exposure should precede choice. It is critical that complete information and experiences are provided to the individual before choices are to be made. For example, if bowling, swimming, and going out to eat are the only recreation activities to which a person has been exposed, then we can only expect that person to choose from bowling, swimming, or going out to eat when asked, "what do you want to do?" That person would almost never choose painting or going for a walk because he/she does not really know about those activities. For a person, especially a person with autism, to be able to select or initiate activities, he/she must have tried those activities in the past or have some concept of the activity, its requirements and benefits.

Some participation in recreation activities occurs in a community setting. To help support community involvement, the following steps are recommended:

• Based on the list of favorite activities or activities that the individual wants to try , the teacher, parent, residential staff, or CTRS would assist the individual in identifying community resources, such as swimming pools, bowling lanes, ceramics shops, music schools,
• appropriate to the individual's leisure choices. This exploration of resources may involve thumbing through phone books, reviewing brochures of area agencies, visiting the local visitor's center, using the computer/internet, and talking to friends about their recreation participation.

Community safety issues should also be addressed. Skills would include (based upon the abilities of the person): not touching others inappropriately, not aggressing toward him/her self or others, using a pay phone (and knowing whom to call), crossing the street, telling time, and using money. Many of these are a necessary part of leisure participation, and can be taught or enhanced through recreation opportunities.

Transportation can be a barrier to participation for many individuals, and some will need to learn to utilize public bus or subway systems. This in itself can become a safety issue. For example, when Tony was learning to use the library, the CTRS had to teach him how to safely cross the street to get to the bus stop from his house, ensure that Tony knew the times the bus came and how much it cost. In addition, she made sure that he was able to make the correct change needed to ride the bus. The CTRS made a reminder card that had bus times, costs, safety reminders, bus stops, and who to call if he needed help. This card helped give Tony visual cues when he was able to take the bus to the library independently in case he needed a reminder. This reminder, and the work the CTRS did with Tony, helped Tony be as safe as he could be in the community.

For Alan, the CTRS worked with him to be able to go to a favorite park to feed the geese. Because Alan did not have the ability to be alone in the community, he required the assistance of at least one staff or family member when he was participating in the community. Initially, Alan would approach strangers at the park and want to touch their elbows. This bothered many people there, as they did not understand what was happening or why he was doing this. The CTRS developed a system to give Alan the bag of feed, as well as a series of cards with photographs of items to match on their way to the pond once they arrived at the park. As Alan matched the photos of the items (a mailbox, a sign, the bathroom, and a goose in the pond), he understood why they were there and what was expected of him when he was in the community. This decreased the inappropriate touching that had earlier occured.