What is Lego Therapy? Clinical Insight

What is LEGO® Therapy?

LEGO® therapy was developed as a social skills program in 2004 by Daniel B. LeGoff, a Canadian-born licensed pediatric neuropsychologist. The purpose of the program was to use children’s natural interest in play to help behavioural challenges, increase social competency and improve communication skills. There is documentation of previous studies using Lego therapy interventions. For example, Altman and Esber (1995) used LEGO®-based therapy on nine adolescents between the ages 11 and 16 with severe disruptive behaviour disorders. Altman and Esber highlighted the effects of the intervention on attention and collaborative work.

Now, you might be wondering “Ok, but why LEGO®?”. The story goes like this…

One day, Daniel LeGoff observed two of his clients. Both 8 years old and diagnosed with Asperger’s Syndrome (we know today that this is no longer considered a diagnosis on its own), play excitedly and talking together in the waiting room. They both had brought LEGO® creations to the clinic, and as one was leaving and the other was arriving, they ran into each other. In previous interactions, these children had exhibited very little interest in each other. This time, parents agreed on letting their children work together while using their LEGO® sets. Daniel LeGoff’s clients cooperated fully and started developing social skills such as turn taking and sustaining eye contact. Compliance was not a problem as long as they were allowed to play with their LEGO® sets (LeGoff et al, 2004).

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LEGO® based therapy is a form of mixed naturalistic developmental behavioural intervention conceived based on the natural interest of children, particularly those with ASD. This therapeutic intervention promotes collaboration between the participants, interdependence, common goals, turn-taking, group results, mutual respect, positive moods, and appreciation for each other’s work.

According to Gallo-Lopez and Rubin (2012), LEGO® based therapy can be allocated among the so-called play-based interventions. LEGO® based interventions uses playful methods to target other social outcomes. The types of interventions that Lego therapy shares with other play-based interventions include (Gibson, Pritchard, & Lemos, 2020):

• Feedback-based
• Social Skills Group
• Activity Schedule
• Collaboration Based

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Behavioural, social and communication challenges of children with autism spectrum disorder (ASD)

Children with ASD might experience behavioural and emotional challenges. According to the American Speech-Language-Hearing Association (ASHA) Practice Portal, children’s behavioural and emotional challenges include:

• Problems dealing with routine changes
• Problems generalising skills to other settings
• Using objects in unusual ways, and developing uncommon attachments to objects
• Sleeping problems
• Anxiety, social withdrawal, and depression
• Using idiosyncratic strategies for self-regulation (e.g., hand flapping), and unconventional behavioural and emotional expressions (e.g., tantrums).
• Using repetitive patterns of behaviour.

Deficits in social competency are also a defining characteristic of individuals with ASD. Deficits in this area can affect a child’s ability to share with others, take turns in a conversation, make appropriate eye-contact, follow social rules, and understanding unspoken rules.

Children with ASD can also exhibit communication deficits both in the ability to produce (expressive) and understand language (receptive).

Seven areas of deficits are identified including:

• Delayed impaired acquisition of words, word combinations and syntax
• Deficits in use and understanding of nonverbal and verbal communication
• Vocal development deficits
• Symbolic play deficits
• Conversation deficits
• Literacy Deficits
• Executive functioning deficits

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What happens in LEGO therapy?

The most common used method of LEGO therapy involves at least three participants. Each of the participants plays a role which could be “supplier”, “builder”, and “engineer”.

• Supplier: Locates and retrieves the blocks as instructed by the engineer. This participant interprets the instructions and determines which pieces are needed for each step.
• Builder: Assembles the blocks according to the instructions of the engineer.
• Engineer: Describes the bricks to the supplier, explains the builder how to build the model, answers questions, and makes sure the model is built correctly.
• Facilitator: The adult running the program offers ideas and strategies to support the group.

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What age is LEGO therapy suitable for?

Lindsay and Cassiani’s (2017) scoping review, which included 15 studies involving a total of 293 participants between the ages of 5-16 (mean age 8.7 years), reported improvement in at least one of the following areas:

• social interactions/initiations
• adaptive socialisation
• play
• communication skills
• social competence
• social confidence
• ASD-specific behaviours
• belonging
• family relationships
• coping
• making new friends
• Independence
• interpersonal skills

A systematic review conducted by Narzisi et al (2021) which included 19 studies published over a 16-year period revealed positive outcomes including the empowerment of social skills in the treated subjects, a positive impact on autistic symptoms such as aloofness and rigidity, enhancement in verbal communication abilities and improved family relationships.

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How do you carry out LEGO therapy?

There are certain specific rules to be followed during the implementation of LEGO therapy. This information can be found in the book “Lego Based Therapy” by Daniel LeGoff, where he provides detailed information about the origins of this intervention and the specifics of how to implement it.

Participants who don’t have the ability to engage in verbal communication yet will not participate in groups until they can understand the rules and display appropriate behavior.

The rules are explained and displayed in the therapy room so participants can monitor their behavior.

1. Build Together!
2. If you break something, you have to fix it, or ask for help to fix it
3. If someone is using something, do not grab it, ask first.
4. Speak quietly and do not scream
5. Keep your hands and feet close to your body
6. Use kind words
7. Clean the materials and place them where they were
8. Do not put the pieces in your mouth

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How long should a LEGO therapy session be?

Your final considerations should include, that even though LEGO® therapy has been widely accepted and disseminated, we should keep in mind that the literature demonstrating the positive effects of this intervention is still quite limited and mixed. Therefore, it is advised to combine LEGO® therapy with other conventional interventions to ensure better results. These sessions will therefore be a duration of a traditional session. With the support of noala, find out how we can support you and your family.

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References

Altman, A., & Esber, J. (1995). Lego therapy. Journal of Psychosocial Nursing and Mental Health Services, 33(8), 48-49

American Speech-Language-Hearing Association (n.d.). Autism (Practice Portal). Retrieved August, 24, 2022‍

Gallo-Lopez L., Rubin L.C. Play-Based Intervention for Children and Adolescent with Autism Spectrum Disorders. Routledge; London, UK: 2012‍

Gibson, J. L., Pritchard, E. J., & de Lemos, C. (2020). Play-based interventions to support social and communication development in autistic children aged 2-8 years: A scoping review [Preprint]. PsyArXiv

LeGoff, D. B., Gomez De La Cuesta, G., Krauss, G. W., & Baron-Cohen, S. (2014). LEGO-Based Therapy: How to build social competence through Lego-Based Clubs for children with autism and related conditions. Jessica Kingsley Publishers.

Lindsay, S., Hounsell, K. G., & Cassiani, C. (2017). A scoping review of the role of LEGO® therapy for improving inclusion and social skills among children and youth with autism. Disability and Health Journal, 10(2), 173-182. https://doi.org/10.1016/j.dhjo.2016.10.010

Narzisi, A., Sesso, G., Berloffa, S., Fantozzi, P., Muccio, R., Valente, E., Viglione, V., Villafranca, A., Milone, A., & Masi, G. (2021). Could you give me the blue brick? Lego®-based therapy as a social development program for children with autism spectrum disorder: a systematic review. Brain Sciences, 11(6), 702.

Ramalho, N. C. P., & Sarmento, S. M. de S. (2019). LEGO® therapy as an intervention in autism spectrum disorders: An integrative literature review. Revista CEFAC, 21.