Play therapy is not new in the autism field; therapists have incorporated play into treatments and interventions for decades. Lego-based therapy, however, posits that there is something unique about Lego itself, which helps autistic children acquire social skills on a level that's more resonant than rote.
Founded in 1932 by Danish carpenter Ole Kirk Christiansen, Lego is a portmanteau of two Danish words: "leg" and "godt," which, combined, means "play well." The toy company initially made a variety of metal and wooden toys. But the onset of World War II, and the accompanying need to make weapons and ammunition, put a stop to metal-toy production. And the wooden toys created supply-and-demand problems, especially after a massive fire took out one of Lego's warehouses in 1960.
That was the same year that Godtfred Christiansen, the son of founder Ole Christiansen, discontinued the wooden toys entirely to focus on the company's plastic toys and, more specifically, their plastic building bricks, first known as automatic binding blocks. Designed with studs on top and tubes underneath, the bricks, patented in 1958, were designed to firmly interlock and detach from one another.
The instructions that Lego provided to build sets from these plastic bricks were deliberately nonverbal; step-by-step pictures meant that the brand was globally accessible. And one of the overarching selling points of Lego bricks is what the company still refers to as the System. Regardless of whether the bricks were molded in the mid-20th century or last week, they all fit together, forming a continuity that spans multiple sets and decades. Consider: A Lego builder can combine six 4x2 studded bricks nearly 1 billion different ways.
Consider: A Lego builder can combine six 4x2 studded bricks nearly 1 billion different ways.
This structured reconfigurability also speaks to a characteristic of autism. As a disorder, it skews disproportionately male, and boys are four times more likely to be diagnosed with autism than girls. The Lego-therapy model follows an approach of triangulated interaction: this idea that boys socialize best while working on something collaboratively.
"There's a difference between the way women and men bond socially," LeGoff said. "Women tend to make friends by exposure. They share personal information with each other quicker and directly, face to face. ... With men, they'll get together because of a joint activity, and there will be this trickle of information. Slowly, over time, they get to know each other."
The Lego Group founded the Lego Foundation in 1986, a research arm that seeks to "redefine play" around the world. The group has partnered with UNICEF to create early childhood development programs around the world, and it sent materials and pedagogical experts to war and refugee zones in Ukraine and Iraq. Recently, it began piloting Lego Braille bricks as a way to increase Braille literacy.
"We are aware of the Lego-based therapy, and we regularly get letters from parents and children -- especially autistic children -- who thank Lego for bringing the brick to the world," said Stine Storm, new ventures project manager at the Lego Foundation. "It's had so many good benefits in terms of focusing and relaxing and concentration. We know that many autistic children are attracted to the bricks, to our building instructions, and to the system of it -- to building in a very structured way."
But Storm stops short of endorsing Lego-based therapy for autistic children, citing a need for more research and longitudinal studies. LeGoff conducted a short-term study in 2004 -- the first of its type -- which showed significant improvement in social competence within a 24-week span.
In 2006, LeGoff completed another, more-long-term study, this time using three years' worth of data to measure the social interaction of 60 LEGO-therapy participants. These gains were compared to a control group of 57 patients, who received "mental health, educational and other therapeutic services of comparable form and intensity." On the Vineland Adaptive Behavior Socialization Domain (VABS–SD), used to measure and test for social competence, the control group increased approximately 10 points from where it had started three years prior, whereas the LEGO-therapy group gained approximately 20 points -- nearly twice the former's gain.
A major study -- unaffiliated with LeGoff -- is currently under way in the UK and will compare "usual care" versus Lego-based therapy for 240 ASD-diagnosed children (aged seven to 15) in a school setting. The goal is to determine the clinical and cost-effectiveness of Lego-based therapy groups, and the researchers hope to present their findings in 2020.
"We are monitoring what's out there and we are certainly aware, but we haven't made any decisions on our goals, if any," Storm said.
LeGoff continues to teach, train and lecture about Lego-based therapy in places as far-flung as Buenos Aires, Argentina; Santiago, Chile; Helsinki; and Kuala Lumpur, Malaysia. In 2017, LeGoff estimated that Lego-based therapy was being piloted or used in 22 countries.