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How play impacts speech & language development

Kara Cooper, M.A., CCC-SLP

January 15, 2011

Parent/Therapist Goals…Typical goals often expressed by parents to the speech therapist…

Goal #1: Get the child to communicate (preferably to talk)

Goal #2 :Get the child intomainstream schools

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How do we achieve our goal(s)? Practice, practice, practice!!!

Problem: What should we practice?

Make learning fun and interesting Think back to your favorite moments.

Key: What drives someone to learn something? Interest typically arises from previous pleasurable

experiences. Painful experiences in order to avoid reoccurrence.

How can one practice, learn, and have fun? Answer: PLAY!!!

What else can my child get out of “play”?

PLAY facilitates development in the following areas.. Language

Receptive Expressive

Communication Turn-taking Joint Attention Requesting/manding

Cognitive Attention Memory Executive Function

(Ex., Problem-Solving)

Visual Visual spatial awareness

Motor Gross Motor Fine Motor Coordination Planning & Sequencing Imitations skills

Psychosocial Interpersonal

engagement Affect

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Are there different kinds of play?YES! Types of play include…

Exploratory play Physical Play Constructive play Co-operative Play Symbolic/Imaginative & Role Play

*It is important to note that while these forms of play may be defined separately, they often are interdependent.

Play Hierarchy

Role/Imaginary/Sym

bolic Play

Functional/Representational (symbolic) play; cooperative

play

Physical

Exploratory

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Exploratory Play(Cooke & Williams, 1995)

Exploratory play- involves a child playing with various objects and learning they can make things happen.Basically, learning cause-effect, as well as

learning of distinguishing features and properties of objects.

Aids in teaching the child that people and objects exist apart from themselves. It involves motor, perceptual, and cognitive skills (Cooke & Williams, 1995).

Exploratory Play: Visual Activities• Face Play- make different facial expressions using props (Ex., hats, jewelry,

glasses, etc…)• Press toys that result in a visual output.• Hang mobiles or make your own using wire coat-hanger and scraps of

materials (Note: mobile display should be changed frequently)• Play “Peek-a-Boo”; switch it up by popping out from behind a piece of

furniture.• Finger-play puppets and drawing faces on finger tips with washable

markers. • Hold object/toy in front of child until he/she is looking, then move it to the

left followed by to the right (Note: may be necessary to assist the child in moving head in the appropriate direction). As the child improves, increase speed and alternate direction (Ex. of items to use: balloons, puppets, paper chains, etc…)

• Pull toys: pretend dog or cart attached to string.• Skittles/bowling: Idea is to demonstrate cause-effect of rolling ball and

knocking down objects (Note: can perform without ball using one’s own hand). May use a variety of objects to knock down: toilet paper tubes, blocks, boxes piled-up, stacking cups etc…

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Exploratory Play: Auditory Activities• Whenever possible, allow the child to see what

he/she hears. This will facilitate sensory processing and integration of both visual and auditory input. Show and talk about the different sounds (Examples, running water, crumpling paper, stirring spoon in cup, etc…).

• Voice play: alter pitch (high-low), vocal intensity (loud-soft), prosody (humming and singing). It may be best for the child to be placed on your lap to view your face.

• Expose child to noise-producing toys (Ex., squeeze/musical toys, ring bell, etc…) and have him/her listen.

• Encourage the child to engage in these activities. If required, help physically assist the child to activate sound-producing items.

Exploratory Play: Touch/Feel Activities Encourage child to explore your hands and face, as

well as his/her own body.• Engage in “finger play” (Ex., tickle palm with fingers,

“This Little Piggy”, etc…).• Make a “feel” sensory box using an old shoe box (so

child cannot see inside) and cut a hole on top. Fill the box with items that have different textures (Ex., rough, smooth, bumpy, sticky, hard, heavy, light, etc…) and have the child reach in, “feel”, and pick out an item. Describe features of the item the child selected.

• Utilize “Touch-and-Feel” books, as well as commercial “Activity Centers”, with the child.

• Hide toys in sandbox.

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Exploratory Play: Smell & Taste Place items close to the child’s nose for him/her

to smell different items (Ex., different foods, smell of baby powder, soap, etc…). *Note: Use caution if your child “mouths” objects.

Have the child eat small bites of different types of food (Ex., sweet vs. salty).

Utilize scratch-and-sniff books.

Exploratory Play: Cause/Effect

Encourage banging of objects. Give the child a wooden spoon and have him/her bang different objects (Ex., banging a pan vs. a pillow will feel different; banging empty containers vs. full ones will sound different). Use commercial products involving toy hammer and peg board.

Have child “hammer” the pegs/nails into the board until they fall out or “disappear”.

Play with musical instruments (I.e., teach the child how to make sounds; when child is able allow him/her to make their own sounds/music).

Engage the child in playing with pop-up toys (Ex., “Jack-in-the-Box”) and pop-up picture books (I.e., pull tab and picture pop up or moves; lift curtain and see hidden picture).

Toy cars: push a car and it moves. Can make it go up, down, or drive into the pocket of a shirt.

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Exploratory Play: Manipulative Activities Activities that involve development of size and

spatial concepts (Ex., placing small toys in and out of containers, fitting objects/toys together, etc…)

Insert puzzles with pictures of real objects.

Shape sorters (start with 3-4 holes)

Big push-in beads that connect together.

Physical Play • Physical play- is play that

involves physical contact or movement.

• It aids in the development and refinement of gross motor skills, as well as initiation and coordination.

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Physical Play: Activities Bounce child on lap Swing/rock child in arms. Have the child move arms and legs up, down, and in circular

motion (physically assist as needed). Play “See-Saw”: have child lay on back with knees bent, raise

and lower child by his/her hands. Have child walk to his food, drink, and toys. Stand in front of child with small distance between both of you

and call child’s name with arms stretched out; as child walks toward you and within arms reach, gently grab and lift him/her up in your arms.

Pretend to be a “horse” and have the child sit on your back and crawl on knees.

Play “Chase” and “Obstacle” games (Ex., Chase each other going through a play tunnel, around/under the table, in/out of boxes, etc…)

Physical Play Activities (continued) Utilize staircase, playground, trampolines, and/or bounce house “Tac Tracks” for more advanced skills. Have the child follow laid out

footprints (from laminated paper) creating twists and turns Movement to music (Ex., “Wheels on the Bus”, “Row, Row, Row Your

Boat”; dance; musical chairs with placing an item on each chair for motivational purposes).

Play “Simon Says” or “Hide and Seek” Activities involving balance such as

riding bikes or balance boards. Play sports like basketball, hockey,

cricket, football/soccer, etc… Bean bag toss, bowling/skittles,

play “catch”

*If unsure what activities may be most developmentally appropriate, consult your child’s occupational and/or physical therapist.

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Constructive Play Constructive play- involves putting or

connecting things together in order to have an end product. It incorporates integration of motor and sensory skills, as well as storing visual information and retrieving it from memory.

Learns his/her effect on objects, as well as their effect on each other.

Builds hand-eye coordination. Develops concept formation: shape, color,

texture, size, and weight. “Concept formation and memory skills are

important to the development of verbal language” (Cooke & Williams, 1995).

Constructive Play: Activities Push-in beads: may create jewelry Stacking toys Jigsaw puzzles Threading toys Building towers with blocks or

various materials (Ex., egg cartons, milk container, toilet paper tubes, etc…) For added fun: knock them down

Play with interlocking blocks (Ex., “Legos”) and construct buildings, cars, trains, etc… start with simple moving to complex.

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Co-operative Play Co-operative play- playing with other children or

individuals. Co-operative play can aid in teaching “social referencing”, as well as building joint attention skills. (Notbohm & Zysk, 2004). Social referencing is when one refers to a

source for information (Ex., Is it safe?, Is it dangerous?)

Joint attention involves visually attending to a communication partner, shifting eye gaze between objects and people, and/or sharing emotional states with another person for the purpose of sharing experiences.

Co-operative/Social Play: Activities Have child crawl through a tunnel and wait at the

other end with face just inside the end of the tunnel (as a reference point) or perform “peek-a-boo”.

Do floor puzzles or build block towers together.

Roll ball back-and-forth, playing “catch” or passing balloon.

Blowing bubbles: One blows the bubbles, the other pops them.

Play “Hide-n-Seek”, “Simon Says”, or chase games.

Board Games (Ex., Candyland, Chutes/Snakes & Ladders, Hi-Ho Cherry O, Memory)

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Symbolic/Imaginative/Role Play Symbolic play-pretending to perform “real” actions

with toys/objects; or where objects represent represent another (Ex., a banana is substituted as a phone).

Imaginative and Role play- involves acting out one’s own experiences.

Imaginative play begins with imitation skills. It is important to remember: ALL words are symbols!!!

“Children need to think in symbols before they can make sense of language” (Lynch & Kidd, 1999, p.23-24; Cooper, Moodley, & Reynell, 1974 as cited in Cooke & Williams, 1999).

One of the most important forms of play in relation to language development.

Symbolic/Imaginative/ Role Play: Activities May start with matching “real” objects-to-objects, followed by real

objects to toy objects, then objects to pictures. Take everyday objects and “pretend” to perform actions with

them (Ex., take an empty cup and pretend to drink from it; take bowl and spoon and pretend to eat).

Have a tea party- use real or pretend food (or even cut-out pictures of food) and have the child serve everyone (include stuffed animals or dolls). Another example, “Birthday Party”.

Play “dolls”: dress, wash, and feed them. Have the child walk the “baby” (doll) in a stroller and put them to bed (or have the child make a bed from a box)

Miniature toy play: play “Animals”-make animal sounds (or even talk to each other), use blocks and make animal pens, have the animals eat, drink, run, jump; and/or put the animals on a toy train and take them to the circus.

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Symbolic/Imaginative/Role Play: Activities Play “Peek-a-Boo” or “Hide-and-Seek” using puppets. Toy cars- make car sounds (Ex., vroom, beep-beep, etc…), pretend to

drive the car and have it stop and go, or even have it go to the “car wash”.

Use old materials and make a pretend animal or transports (Ex., string beads or toilet paper tubes together and make it a “snake”).

Role Play Activities:• Dress-up- use various clothes and props. Ideas for dress-up include:

policeman, doctor, cowboy, chef, ballerina, animal, superhero, queen, pirate, etc…)

• Play “Shop”- can use empty cans or pretend food, fake money, grocery bags, cash register/till, etc… Re-enact the routine of “shopping”.

• Other pretend play ideas include playing school, playing house, playing doctor, playing construction, etc…

• Play puppets with each having their own characters and voices and make up a story.

• Act out stories.

Free Play

Free play-involves the child playing on his/her own

Guidelines: Supervision

Activities: anything the child independently does or plays with on his/her own.

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Benefit of “Free Play” Free play is an important part of play. It allows

the child to play independently and “talk to themselves”. This is not for communication, but rather helps the child work out sound patterns in their brain (Lynch & Kidd, 1999).

It offers the child a chance to practice skills already acquired and experiment with new or different ones.

Anything else? Everyday experiences and routines heavily

contribute to the development of imaginary/role play and language ( Interdisciplinary Council on Developmental & Learning Disorders (2008), Lynch & Kidd (1999), Cooke & Williams (1991).

First and foremost, follow the child’s lead in what he/she likes to play with and build on that. If the child doesn’t appear to play at all with anything,

start exploring with him/her. Set up different types of activites (Ex., Water play, sand

play, etc…).

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YOUR role during play ALWAYS SUPERVISE and EXERCISE SAFETY!!! Model and modify activities to child’s developmental level

(as needed). Use a wide variety of different objects & toys that provide

rich sensory experiences (Ex., visual, auditory, tactile, smell, and/or taste).

Consider child’s sensory profile & current health condition. Follow child’s lead/interests!!!

Imitate their actions If your child shows repetitive interest in only a few activities,

expand his/her repertoire to include other activities for development. Allow access to their previous interests, but either limit the amount of exposure or add to it.

Verbal instruction = child’s comprehension level. *May help to provide visual supports.

Activity duration = child’s attention span.

YOUR role during play (cont.) Give verbal praise & keep it fun! Never force the child to play!!! Present toys in a different way or change play routines mid-stream to

maintain attention, as well expand object function. Additionally, it makes the child refer to “YOU” as a social reference.

Provide lots of various experiences for the child to re-enact during play. Utilize more home-made items rather than store bought items to stimulate

more creative thinking skills. Frequently model various behaviors and language during play to help the

child imitate and build off those behaviors. If child becomes stuck in a routine, provide other interesting suggestions to help the child engage in other schemes.

Demonstrate turn-taking skills during play. ALWAYS talk about what you are doing during play! Use natural reinforcers vs. unnatural reinforcers. Encourage “Theory of Mind” skills by showing emotional states during play

and discussing them, as well as engaging in pretend/imaginative play (as suggested by Notbohm & Zysk, 2004).

Break activities into subcomponents, starting at child’s level of difficulty. Provide physical assist as needed, fade as soon as possible.

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Please visit…

Video samples of play in children with Autism at www.youtube.com “Floortime with my 4 yr. old son” “Hunter DIR Floortime Therapy” Robby’s Shapes

What the research shows… “Improvements in receptive and expressive communication have been found to

prevent problem behaviors and maintain reductions of these behaviors” as reported by the National Research Council [NRC], 2001 in Woods & Wetherby (2003), p. 181.

Children with ASD have particular difficulty acquiring 2 core communication and social skills: Joint attention and symbol use (reported by Wetherby, Prizant, & Shuler (2000) In Woods & Wetherby, p.181.

“Accumulated data suggest that the failure to acquire gestural joint attention may be both a critical milestone that impairs language development and an important target for early communication intervention” (Whetherby & Woods, 2003, p.181).

As reported by Dawson & Adams (as cited in Wetherby & Woods, 2003, p.181-182), children with ASD show significant deficits in symbolic play and imaginary play skills. However, children with ASD show similar or higher levels on constructive play compared to typical developing children.

Whetherby study (1998) found children who showed a greater ability to coordinate attention and affect were more likely to communicate for social purposes, use a larger range of conventional gestures, and have a higher rate of communicating (p.182).

Play is important for the development of language. It facilitates in the development of the prerequisites necessary for language development which include: listening, observation, imitation, concept formation and symbolic understanding (Cooke & Williams, 1995).

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Further Research… Many children with language delay often have other

deficits, such as sensory and/or cognitive deficits (Robertson & Weismer, 1999).

Charman et. al (1997) study found lack of joint attention and pretend play skills to be among the best factors in discriminating between autism and other developmental disabilities.

Both Marwick & MacKay (2005) and Lyytinen et. Al (1997)found play skills involving other-directed pretence(Ex., doll, caregiver) most strongly correlated with language understanding and use. Additionally, the earlier the child demonstrated symbolic play skills the higher the language scores were.

Marwick & MacKay (2004) found after being enrolled in 14 weekly joint-play sessions with an an adult play partner, children with autism showed improvements developments in the areas of : engagement, communication, and shared interpersonal understanding.

Stay tuned…

In September 2009, the National Institute of Health (NIH) awarded a $1.85 million dollar grant for a 3 year research study on play-based early intervention program for autism titled: “Play and Language for Autistic Youngsters (P.L.A.Y)”.

On-going research is being conducted by the New England Center for Children (NECC) regarding the use of “video modeling” for teaching imaginary play in children with autism.

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Last note…

“Now we know the brain grows most rapidly in the early years as an outgrowth of interactions with caregivers. So every word in our language has to be lived first to understand it”.

– Dr. Stanley Greenspan, M.D. (2008)

References Charman, T., Baren-Cohen, S., Swettenham, J., & Cox, A. (1997). Infants with Autism: An

Investigation of Empathy, Pretend Play, Joint Attention, and Imitation. Developmental Psychology, 37 (5), 781-789.

Cooke, J. & Williams, D. (1995). Working with Children’s Language. Oxfordshire: Winslow Press.

Lynch, C. & Kidd, J. (1999). Early Communication Skills: Language and Play, pp. 23-35. United Kingdom.

Lynch, C. & Kidd, J. (1999). Early Communication Skills: Pre-Verbal Skills, pp.3-20. United Kingdom.

Lyytinen, P., Poikkeus, A.M., & Laakso, M.L. (1997). Language and Symbolic Play in Toddlers. International Journal of Behavioral Development, 21 (2), 289-302.

Marwick, H. & Mackay, G. (2005). Joint-Imaginative Play With ‘Representational Others’ in Pre-school Children With Autism. Available from www.isec2005.org.uk/isec/abtracts/papers_m/marwick_h_2.shtml

Robertson, S.B., & Weismer, S. E. (1999). Effects of Treatment on Linguistic and Social Skills in Toddlers with Delayed Language Development. Journal of Speech, Language and Hearing Research, 42, 1234-1248.

Woods, J.J. & Wetherby, A.M. (Jul 2003). Early Identification of and Intervention for Infants and Toddlers Who Are at Risk for Autism Spectrum Disorder. Language, Speech, and Hearing Services in Schools, 34, 180-193.

Greenspan, S.I. (2008). Floortime:What It Really Is and What It Isn’t. Available fromwww.icdl.com/dirFloortime/overview/documentsWhatFloortimeisandisnot.pdf