Using Lego© materials in therapy for children with ASD has been found to have many benefits, including:
motivation to initiate social contact with peers;
ability to sustain interaction with peers for a period of time; and
overcoming autistic symptoms of aloofness and rigidity
Lego groups consist of 3 children and a facilitator
Each child is assigned a specific role
The group work together on a Lego project
Many skills are required including
general social communication skills
The skills learned during Lego Therapy have been found to generalise to other situations
Children report higher levels of enjoyment from participating in Lego Based Therapy than other therapies
Children whose language skills are intact have been found to do better than those with language impairment.
We have all heard of Lego© – we know that it is loved by children (and adults) of all ages. In fact, the majority of us have probably enjoyed playing with Lego construction toys at some point! While we know that Lego promotes creativity and can help develop fine motor skills, what we may not be aware of is a recent phenomenon where Lego is used as part of a highly structured social development programme for children on the Autism Spectrum (ASD). Deficits in the area of social skills is one of the key characteristic of ASD and this intervention has been found to improve some aspects of social competence, including motivation to initiate interaction with peers, the ability to sustain interaction with peers and overcoming autistic symptoms of aloofness and rigidity.
Why are Social Skills Important?
It is widely known that social skills are needed to form meaningful relations and enable us to function successfully in everyday life. Research has found that people with ASD do not always naturally acquire sophisticated social skills and therefore require direct teaching. Many authors have highlighted the importance of engaging children with ASD in therapeutic and educational interventions which address these core social deficits.
Owens et al. (2008) states that social impairment is a fundamental aspect of the diagnosis of Autism. She outlines that children with autism are less likely to initiate interactions with peers, spend less time interacting with peers, have lower ‘‘quality’’ interactions and spend a larger amount of time in non-social play. This indicates a need to help children with ASD develop social skills, which are hugely important to their future and will reduce the risk of isolation.
What Social Skills Interventions are currently being used?
It is important to state firstly that while there are many social skills interventions available, there are few which are strongly supported by evidence.
Owens et al. (2008) outlines some of the approaches used for teaching social skills to children with high-functioning autism. These include Social Stories (Gray, 1998), Peer-Mediated interventions and Social Skills groups. Advantages and disadvantages to each of these approaches have been identified, for example:
- Social Stories are accessible and easy to implement; however, studies evaluating its effectiveness report variable results;
- Peer Mediated interventions have some good evidence for their effectiveness at improving social competence, but they are reportedly complex and time-consuming;
- Finally, research suggests that clinic-based social skills groups can be effective at teaching appropriate social initiations and responses, emotion recognition and group problem solving, though generalisation is still a problem.
While there continues to be limited data available on outcome efficacy for improving social skills, it is thought that using a ‘naturalistic approach’ may help children generalise new social skills. Using naturally reinforcing materials and activities in settings as close to everyday life as possible, as well as appealing to children’s natural interests, is thought to promote learning by increasing motivation to participate in interventions. It is hypothesised that this will then improve the generalisation of skills to every day settings. An intervention which has taken this approach is Lego Based Therapy.
What is Lego Based Therapy?
Lego Based Therapy is a social skills programme which was developed and researched by LeGoff in 2004. This therapy incorporates the ‘constructive application’ outlined by Attwood (1998), which states that using the child’s natural interests helps to motivate learning and behaviour change. It also includes the recommendation by Koegel (1995) of capitalising on a child’s choice of materials to improve motivation, and using natural reinforcers, which result directly from the child’s appropriate responses and skill acquisition.
The use of Lego in therapy is much more than simply playing with the Lego bricks, rather it is a highly structured programme which aims to get children working together. It is thought that the predictable nature of Lego play makes it appealing to children with social communication difficulties. In addition, it uses a child’s natural interests to stimulate learning.
What does Lego Based Therapy Involve?
LeGoff (2006) recommends that children first learn a set of ‘LEGO© Club’ rules and develop LEGO© building skills, including collaborative building, in individual therapy. Some rules may include:
- Build things together!
- If you break it you have to fix it or ask for help to fix it.
- If someone else is using it, don’t take it, ask first.
- Use indoor voices – no yelling.
- Keep hands and feet to yourself.
- Use polite words.
- Clean up and put things back where they came from.
- Do not put Lego bricks in your mouth.
Children are then introduced to a group of peers, ideally including some group members who do not have social skills deficits. The group meets regularly, usually on a weekly basis for approximately 90 minutes. During the therapy session, the group engages in collaborative LEGO© building activities and other projects. Each group is tailored to the skill level of the participants.
The group consists of 3 children and a therapist/facilitator. Each child is given one of the following roles:
- The engineer – describes the instructions
- The supplier – finds the correct pieces
- The Builder – puts the pieces together
Children play their role for a certain length of time, or for a certain number of steps in the instructions and then swap around. This division of labour with a common purpose allows children to practice joint attention, turn taking, sharing, joint problem-solving, listening and general social communication skills. The group gradually move to more complex LEGO structures which may take several sessions to complete.
The group also involves a ‘Freestyle’ LEGO activity. During this part of the group, children design and build a model in pairs. This allows children to practice compromise, expressing their ideas clearly and taking other people’s perspectives and ideas into account. The ‘freestyle activity’ is less structured and therefore tends to be more challenging for children with autism.
Throughout the group the children must communicate with each other and follow social rules in order to complete the project. Many skills are required to build the Lego model. Some of the skills needed include
- verbal and non-verbal communication,
- joint problem-solving,
- joint creativity and
- joint attention to the task.
Once children can demonstrate the skills at a particular level, they can be given a certificate to reward their achievement in front of all the children (e.g. when they built in a group successfully for the first time, they may be given a ‘‘LEGO Builder’’ certificate). It was found that when children were awarded certificates on an individual rather than a group basis, they were highly motivated to participate socially and build models together so that they could move up to the next level.
While supervision by the facilitator is constant, the support they provide is gradually reduced. The facilitator’s role is not to point out specific social problems or give solutions to social difficulties; rather to highlight the presence of a problem, and help children to devise their own solutions. Solutions which the children have come up with are practised until they use it more independently, and the facilitator can remind children of strategies in the future if similar difficulties arise.
Does it work?!
A number of studies have been completed to determine the efficacy of this intervention, including two studies by LeGoff, the creator of the programme.
In 2004, he used observations and a rating scale to find that LEGO as a therapeutic medium was effective in improving
- motivation to initiate social contact with peers;
- ability to sustain interaction with peers for a period of time; and
- overcoming autistic symptoms of aloofness and rigidity.
These improvements were made after 12 weeks of intervention. It was also identified that these improvements were not only sustained but even greater after 24 weeks.
He found that following 24 weeks of therapy (a combination of weekly group and individual therapy), the frequency of initiating social contact and the duration of social interactions in the school playground significantly increased following therapy. These positive results suggest that generalisation of the new skills occurred, at least to one other setting. These findings were further supported in 2006 when LeGoff completed a 3-year follow-up with the students. Participants improved significantly more receiving LEGO therapy than receiving unspecified 1:1 paraprofessional support.
Another advantage of the Lego Based Intervention is the level of enjoyment which children reported while participating in the group. More children rated their level of enjoyment as ‘high’ in comparison to other social skills interventions, while high levels of satisfaction from parents was conveyed as well as positive feedback from teachers.
It should be noted that studies have identified that LEGO© therapy works better for children who have relatively intact language abilities. However, participants with language impairment still showed significant gains.
While the results of the studies are encouraging, it is important to note that there are some limitations and it is important that further research is completed in this area.
Gray, C. A. (1998). Social stories and comic strip conversations with students with Asperger syndrome and high-functioning autism. In E. Schopler & G. B. Mesibov (Eds.), Asperger syndrome or high functioning autism? Current issues in autism (pp. 167–198).