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PlayinChildrenwithASD
Aplanforyourlearning...
What• Define play & the characteristics of play in children with ASD• Describe narrative play therapy
How
• Review what we know about play in the literature• View videos• Complete a small group activity related to selecting a play strategy to
support a child with ASD
Why
• Increase your understanding of play & its relationship to JA, language & theory of mind
• Apply your knowledge to the assessment and intervention of play in children with ASD
Take-homeMessage1. Play is the “recreation” of young children2. Children with autism need to be taught play skills 3. Play development is fluid4. Play evolves into recreation
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Whatis‘Play’?
• A context in which children learn and practice other skills (Boucher, 1990; Naber et al., 2008)
• Social & language skills (Boutot et al., 2005)
• Use of speech & communication (Fekonja et al., 2005)
•Motor skills• Literacy and math skills• Critical to children’s quality of life
CharacteristicsofPlay
• Pleasurable• Involves active engagement• Intrinsically motivated • Flexible
Playdevelopment...
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1.SolitaryPlay:playingalone
2.OnlookerPlay:watchesothersplay;doesnotjoinin.
3.ParallelPlay:sidebysidewithdifferenttoysoractivities
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4.AssociativePlay:playwithothersandsharestoys
5.CooperativePlay:playingtogetherinstructuredgames
6.SymbolicPlay:useofobjectstorepresentsomethingentirelydifferent.
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7.ImaginativePlay:dramaticandpretendplay
PlaydevelopmentisfluidSolitary “Play” Parallel “Play”
Associative “Play”
ConsideringtheDSM-5CharacteristicsforASD...
1. Deficits in social emotional reciprocity• Abnormal social approach• Failure of normal back and forth conversation• Reduced sharing of interests, emotions or affect• Failure to initiate or respond to social interaction
2. Deficits in nonverbal communicative behaviors• Poorly integrated verbal & nonverbal communication• Abnormalities in eye contact and body language• Deficits in understanding and use of gestures• Lack of facial expressions and nonverbal communication
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3. Deficits in developing, maintaining and understanding relationships
• Difficulties adjusting behavior to suit various social contexts• Difficulties in sharing imaginative play • Difficulties making friends• Absence of interest in peers
4. Restricted, repetitive patterns of behavior, interests, or activities
• Stereotyped or repetitive motor movements, use of objects, or speech
• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
• Highly restricted, fixated interest that are abnormal in intensity or focus
• Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment
ASDCharacteristics(DSM-5)
WhymightPlayDevelopmentbeimpactedbyASDcharacteristics?
Characteristics Example of impact
Minimally verbal Difficult to ask a child to play
PlayinchildrenwithASD...Development• ⇓ pretend play: frequency, complexity, novelty &
spontaneity (Baron-Cohen, 1987; Bernabei et al., 1999; Rutherford et al., 2007; Wing et al., 1977)
• ⇓ symbolic play: >routine & <spontaneous (Williams, 2003)
Variety• ⇑ Repetitive & stereotyped play (Mundy et al., 1986; Sigman & Ungerer, 1982)
• ⇓ Variety of object selection (Van Berkerlaer-Onnes, 2003)
• ⇓ Variety of play (Sigman & Ungerer, 1984; Williams et al., 2001)
• Problems generating play ideas ~ praxis (Jarrold et al., , 1996)
è Remains in older children who have less varied recreation (Hilton et al., 2009; Potvin et al., 2011)
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Nature of play• ⇓ time in functional play (Lewis & Boucher, 1988; Jarrold et al., 1996)
• ⇓ appropriate object use (Freeman et al., 1984)
• Prefer touch & taste more to visual exploration (Williams, 2003) or preoccupied in visual exploration of single object (Freeman et al., 1979)
PlayinchildrenwithASD...
RelationshipsbetweenPlay,Language,Cognition&ToM
• Joint attention predicts pretend play (Rutherford et al., 2007)
• Pretend play & ToM (Leslie, 1987; Rutherford et al., 2007)
• Language & symbolic play emerge concurrently (Gould, 1986; Spencer, 1996; Stanley & Konstantareas, 2007)
• Non-verbal cognitive ability & expressive language are related to symbolic play (Stanley & Konstantareas, 2007)
AssessingPlayDevelopmentWhattoconsiderwiththosewithASD???
• Does the child know how to play?• Does the child go for what is familiar &
only act upon objects in a familiar way?• Is play the child�s first choice for an
activity?• Does the child require a routine & comfort
with knowing what to do?
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• Elicit varied play through prompting & modeling in multiple context• Unstructured situations• Independent play• Peer play• Home, school & community
• Complete a Play Preference Inventory (Wolfberg, 1995)• Child�s play preferences• Peers’ play preferences
• Use a Play Observation Diary (Van Hoorn, et al., 1993)• Record spontaneous & guided play• Identify the learning & social contexts for play
ObservingPlay
AssessingPlay
• In your videotaped observations, look for . . . (Howlin et al., 1999)• Sensory motor play (simple toy manipulation)• Emerging functional play (conventional use without pretense)• Established functional play (more than 3 tx in 10 minutes)• Emerging pretend play (object substitution, attribution of pretend properties
& use of imaginary objects/events)• Established pretend play (demonstrates 3 or more examples)
• Westby Symbolic Play Scale Checklist (1980, 1988)• Transdisciplinary Play-Based Assessment (Linder, 1993, 2008)• Infant-Preschool Play Assessment Scale (I-PAS) (Flagler)
SampleofWestbySymbolicPlayScaleActivity Explanation Language Observed Play Observed Other Comments
Place desirable toy under a scarf or blanket; if no response; partially hide the object’
Place desirable object away from child and see how child retrieves it
Have a pull string toy available for child to pull
Bangs toys appropriately
Mouths toys
___No true language or may
have words that are associated
with actions (e.g., _________)
Exhibits the following
communicative functions:
____Request
____Command
STAGE I (9-12 months)
___Awareness that objects
exist when not seen; finds toys
hidden under scarf
___Means-end behavior;
crawls or walks to get what he
wants; pulls string toys
___Does not mouth or bang all
toys—some used appropriately
Watch what the child does with available toys; note how she explore the toys
Look at trial & error
What motor schemes are noted
Hands wind-up toy or some other toy to get the adult’s help
___Context dependent single
words (e.g., uses ‘car’ when
riding in a car but not when
sees a car; words come & go
Exhibits the following
communicative functions:
___Request ___Personal
___Command
___Interactional
___Protesting ___Greeting
___Label ___Response
STAGE II (13-17 months)
__Purposeful exploration of
toys; discovers operation of
toys through trial & error; uses
variety of motoric schemas
__Hands toy to adult if unable
to operate
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Infant-PreschoolPlayAssessmentScale(I-PAS,Flagler)
• Criterion reference• Teachers, clinicians & other clinicians can systematically observe
children at play• Developmentally sequenced from birth to 5• Examines play in contexts where you can observe the following:• Communication• Cognition• Sensorimotor• Fine motor• Social-emotional
TransdisciplinaryPlay-basedAssessmentandIntervention
StrategiestoSupportPlayDevelopmentinASD
Watch and make a list of the strategies mentioned: https://www.youtube.com/watch?v=X0nlSluF33w
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Time Delay to Teach Social Play Skills (Liber et al., 2008)
GOALS• Appropriate play with toys• Initiation with peers• Requesting peer assistance
SOCIAL PLAY INTERACTIONS • Use peer�s name• Turn shoulders or face towards peers• Make a statement, request or ask a question of peer
Strategies to Support Play Development
What’s Time Delay?
§National Professional Development Center (http://autismpdc.fpg.unc.edu/)
§Evidence-Based Practices§Autism Internet Modules (FREE!!!)(http://www.autisminternetmodules.org/mod_intro.php?mod_id=49)
Visual scripts in inclusive playgroups (Ganz & Flores, 2008, 2010)
• Choose theme, prepare setting and materials• Choose social & language learning objectives for child• Base script on child�s reading, language abilities & attention• Teach script one-on-one to child• Develop peer instruction cards & teach them to typically
developing peers• Implement script during playgroups, provides frequent
opportunity to practice social skillsWhat are Visual Scripts?(http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/Scripting_factsheet.pdf/)
Research Evidence for Structured Play Groups(http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/Structured_Play_Groups_factsheet.pdf)
Strategies to Support Play Development
• Virtual reality to facilitate pretend play (Herrera et al, 2008)
http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/Technology_Aided_Instruction_factsheet.pdf
• Picture Me Playing (Murdock & Hobbs, 2011)
• Social Stories to improve game play skills (Quirmbachat al., 2009)
• Interpersonal Synchrony “intervention” (Landa et al., 2010)
• Peer-mediated intervention (Petursdottir et al., 2007)
Strategies to Support Play Development
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Integrated Play Groups (Wolfberg, 1995; Zercher et al., 2001)
FEATURES• Well designed play spaces• Play materials with interactive potential• Consistent schedule & routine• Focus on competence• Guided participation• Developmentally appropriate peer partners• Immersion in natural settings
Strategies to Support Play Development
StrategiestoSupportPlayDevelopment
INTEGRATED PLAYGROUPS• At least 5 children, 2 with ASD & 3-5 TD• Meet 2+ times a week for 30-60 minutes• Adult interventionist is play facilitator• Interventionist monitors play initiations &
scaffolds interactions• Can support the play of older elementary
children (Schuler & Wolfberg, 2000; Wolfberg, 1995)
Whataretheparentsdoingtosupportasocialplayroutine?
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Howisthefamilyfacilitatingtoyplaywiththeir3yearold?
WhatstrategiesistheClinicianusingtosupportthischild’splay?
WhatstrategiesistheClinicianusingtosupportthischild’splay?
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WhatstrategiesistheClinicianusingtosupportthischild’splay?
WhatstrategiesistheClinicianusingtosupportthischild’splay?
WhatstrategiesistheClinicianusingtosupportthischild’splay?
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Howistheclinicianincreasingflexibilityinplay?
NarrativePlayforChildrenwithASD(Densmore,2000)
NarrativePlayTherapy
• Teaches joint attention• Children follow a
sequence of symbolic play with peers• Occurs in natural settings • Language supported in
social contexts(Densmore, 2000)
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NarrativePlayTherapy• Introduce a story in small
sequential steps, using circles of communication• Model the language to
tell the story, share objects in play & experience play events with peers
NarrativePlayTherapy• GOAL 1=>Develop joint
attention• LEVEL 1
Peer partner learns to comment to child with ASDEXAMPLE:Prompt peer to say �Look!�& point to rising balloon
NarrativePlayTherapy• GOAL 1=>Develop joint
attention• LEVEL 2
Teach child with ASD to look at peer partner & to commentEXAMPLE:Prompt comments like �Cool!� or �Awesome!�
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NarrativePlayTherapy• GOAL 1=>Develop joint
attention• LEVEL 3
Ask children to take turns holding an object & prompt children to ask & answer questions of one anotherEXAMPLES:�Can I hold it?� �Should we let it go?� �Will it fly away?�
NarrativePlayTherapy• GOAL 1=>Develop joint
attention• LEVEL 4
Encourage children to initiate a back & forth exchange by modeling comments during their play using emotional expressionEXAMPLES:�Catch it, here it comes� or �Look out it�s going to fly away�
NarrativePlayTherapy• GOAL 1=>Develop joint
attention• LEVEL 5
Have children play independently & observe attempts at JA; praise the children for their actions & keep data on comments & gaze toward peerEXAMPLE:�I like the way you are looking at your friend.�
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NarrativePlayTherapy• GOAL 1=>Develop joint
attention• LEVEL 6
Prompt peer partner to move objects toward child with ASD & to verbally prompt & gesture to get the child with ASD to respond; use questions to > time engaged in commenting
EXAMPLES:�Do you want to hold it?� �Are you going to let it go?
NarrativePlayTherapy• GOAL 2=>Develop a sense of
story• LEVEL 7
Prompt child with ASD & peer partner to create a story around object of play
EXAMPLES:�Where do you think the balloon will go?� �Is it carrying a secret message?
NarrativePlayTherapy• GOAL 2=>Develop a sense of story• LEVEL 8
Introduce simple language; rephrase children�s comments to help develop the story; allow children to name characters
EXAMPLES:�David is riding the hot air balloon and lands in Alaska. He is so cold he decides to come home.�
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NarrativePlayTherapy• GOAL 2=>Develop a sense of story• LEVEL 9
Put narrative on the computer; have children add photos to create a book; take pictures of children acting out their story & add to the book
NarrativePlayTherapy• GOAL 2=>Develop a sense of story• LEVEL 10
Make videotape of play partners creating their story; allow children to watch the video & share this with the parents
NarrativePlayTherapy• GOAL 2=>Develop a sense of story• LEVELS 11 & 12
Identify other locations for supporting play with peers, narrating actions, modeling comments, rephrasing verbalizations & cuing the children to look at one another & their objects of play as well as making comments to create a story