PLAY AND CHILDREN WITH DISABILITIES

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PLAY AND CHILDREN WITH DISABILITIES

• Children with disabilities may engage in play differently than their peers without disabilities. Consequently, quality of play depends on the following:

1. The disability or combination of disabling factors.2. The opportunity for play.3. The accessibility of toys.4. A modified play environment.5. The presence of peers and adults to facilitate and encourage play.

• Disabilities can be classified in terms of the following:

1. Intellectual impairment, physical disabilities, and emotional disorders (Rubin, Fein & Vanderberg, 1983)

2. Developmental and developmental delay.

3. Children at risk for development (children who can become disabled without intervention).

THE NATURE OF DISABLITIES

PHYSICAL DISABILITIES

Children with Physical Disabilities can have Hearing impairment. Depending on type of malfunction

to the ear or nerves, impairment may range from mild to severe; temporary or permanent.

Visual impairment. Variation in range of impairment due to premature birth, injury, or medical causes.

Motor impairment. Variations range from physical restrictions of limbs, hand, trunk control, mobility, and strength. Generally caused by:

1) Spina Bifida2) Cerebral Palsy3) Muscular Dystrophy

Spina Bifida

• Develops when spinal cord is not fully developed and has an opening that impedes protection of the cord.

• Significant impairment causesLoss of bowel and bladder controlBone DeformitiesMotor ImpairmentParalysis Hydrocephalus.

A condition in which spinal fluids collects in the brain. If left untreated can result in retardation and seizures. Condition commonly treated by surgically implanting a tube into brain which allows fluid to drain and blood to circulate properly.

Cerebral Palsy

• Most common type of orthopedic impairment leading to a neuromuscular disability.

• Results from injury to brain before or during birth.

• Children (mild to moderate) are able to walk and use other motor movements with some awkwardness; however, children (severe) often have other disabilities (mental retardation and have little or no mobility).

• Muscular Dystrophy– Results in progressive degeneration of the voluntary muscle of the arms and

legs.

– Symptoms (can appear in children as young a 3 years of age)Appearance of awkwardnessWalking on tiptoesSevere curvature of the spineOther postural abnormalities

– Although there can be periods of remission, gradually the child loses the ability to walk and early death is possible.

AT- RISK CHILDREN

• At-risk Children. Children’s experience with Biological or Environmental factors that may result in developmental delays or disabilities.

• Biological Risk Factors– Children have biological history that can result in later developmental problems– Children at-risk include

a) Premature babies.b) Children born to mothers who have German measles while pregnant or complications during

labor.c) Low birth weight babies.d) Children who accidentally ingest toxic substance during infancy and toddlers years.

• Environmental Risk Factors – Can be at risk because of the environment in which they lived before and after birth.

– These risk factors result from the mothers living in substandard or deprived environments.

– Early identification of at-risk child is essential so that intervention earlier on can be provided.

DEVELOPEMNTAL DELAYS

• COGNITIVE DELAY– Child with cognitive or mental retardation is unable to use

thinking skills to the level that is characteristic of normal development.

– A child with Downs Syndrome experiences cognitive delays that result in mental retardation

– ADHD

• Language Delay– Difficulty in articulating or expressing language. Speech

deficit that limits verbalization, such as stuttering or inability to utter sounds correctly.

– Immature use of language.– Limited vocabulary.

Emotional and Behavioral Disorders

• Exhibit deviation from age appropriate behavior that can cause them to be very aggressive or very withdrawn. Leading to behavioral problems such as:– Aggression.– Academic disability.– Anxiety.– Depression.

• Behavioral deviation can be caused by– Psychological causes – Bereavement due to loss of a

parent through divorce or death.– Environmental causes – Parenting methods of child

management, Teacher management strategies.– Psychological causes – Genetic factors.

A. Autism

• Children with autism experience severe emotional disturbance. Noticeable as early as 2½ years of age.

• More common in boys than girls and is believed to be a biological problem that occurs during prenatal stages of development.

• Behavior exhibited includes– Head banging.– Extremely delayed expressive language.– Echolalia speech.– Stereotypical body movements.

• Children with Autism– Can seem to be insensitive to sound and events around them.

– Have difficulty in socially interacting with others.

– Fail to recognize that outside world is different from self.

– Often experience mental retardation as well.

(B) Abused & Neglected Children

• Children can be abused emotionally, physically, sexually, and through neglect. Frequently children who are abused experience more than one form of abuse.

• Abused children are aggressive and use inappropriate social behavior; they are equally likely to be withdrawn and passive.

• Aggressive children can be – Disruptive.– Antisocial.

• Children who have been sexually abused might use inappropriate sexual behavior in social interaction with peers.

• Physically abused children might wear clothing that is seasonally inappropriate to cover signs of abuse.

• Neglected children might be dressed inappropriately or in dirty clothes. Generally, because they have received minimal care and supervision.

Children with Multiple disabilities

• Children with disabilities frequently have combination of conditions.– Example. Children with visual impairments can also have hearing

impairments, mental retardation with unusual and hearing impairments.– Cognitive delay or mental retardation can have language delay or

communication disorder.– Behavior disorder can also experience language abnormalities or

cognitive delay.

• It is important to understand the nature of disabilities in order to understand how these conditions and variations from normal development affect how children play.

• Easier to understand the limitation of children with physical disability and how their play is affected than children with behavior or mental disabilities.

• Providing play opportunity is more challenging in case of multiple disabilities.

DISABILITIES AND PLAY

• It is difficult to study the play of children with disabilities.

1) Handicapping condition involves a wide range of disabilities, therefore it can be difficult to determine the cause of play differences.

2) Studies are flawed because they have failed to separate the developmental differences from differences caused by disabling condition.

3) Different researchers from different profession might be studying play for different purpose and with different results.

4) Some researches are conducted with individual children and do not consider the effect of peer relationship or behavior in a group setting.

Children With Visual Impairments

• CHARACTERISTICS OF PLAY Troster and Bambring (1994) summarized significant difference between the

play of sighted children and blind children. Blind children do the following1) Explore their surrounding and the objects in their surrounds less often.2) As infants and preschoolers, frequently engage in solitary play that is repetitive and

stereotyped.3) Exhibit less spontaneous play; far more than sighted children, they have to be taught how to

play.4) Do not or only rarely imitate the routine activities of the caregiver.5) Play less frequently with stuffed animals and dolls and rarely engage in animism.6) Play less frequently with peers and usually direct their play towards adults.7) Exhibit clear delay in the development of symbolic play and role play.8) Engage in play that contains fewer aggressive elements.

Children with visual impairments often have developmental delays in other domains of development that could easily affect their play skills.

Overprotection or fear of danger might result in limited attempts to engage in play.

Tend to ask more questions of adults in an effort to further their understanding of the environment.

Have obstacles interpreting nonverbal communication that can impede interacting with sighted children

Differences in cognitive play i.e., use hands, feet and other parts of the body in object kind of plays.

Lack of interest in exploring toys in the environment might be due to lack of experience and tendency to be more interested in their bodies than the environment.

Presiler & Palmer (1989) found them to be more interested in environmental elements that opened and closed e.g., doors.

Adults should not only provide a variety of real objects for play but also assist children in the symbolic use of the objects.

Toys should be selected to encourage symbolic representation e.g., dolls & wooden trucks.

Adults can provide experience with objects , which sighted children can acquire automatically.

Adults can support play by providing the opportunity to explore in a safe & familiar environments.

Partially sighted children need opportunities for motor play so that they can develop the same abilities as their sighted peers.

Adults can assist children in becoming autonomous and independent in play. Assist them in developing social interaction with other children.

Guide them to use more imagination and fantasy so their play can be enhanced with sighted peers.

To encourage interaction with sighted peers, to start with include one peer and then gradually increase to more.

Teachers can help sighted children to understand the nature of visual impairments and encourage them to play with visually impaired children.

Children with Hearing Impairments

Characteristics of Play• Children with hearing impairments are less affected in their play than

children with usual impairments.• There is delay in language, which results in less interest in make-

believe play or fantasy play than hearing peers.• Engage less often in socio-dramatic play.• Use less symbolism of objects than children with normal hearing

ability

• Social interaction with hearing children can be facilitated by using sign language or by lip reading.

• According to Parten(1932) parallel play can be observed more often in the self contained setting for hearing impaired children.

• Associative play more common in integrated setting in a study conducted by Esposito & Koorland (1989).

Children with Motor Impairments

Characteristics of Play– Complex because there are many kinds of motor impairments

and severity varies from child to child.

– The most significant limitation is in play that involves physical activity.

– Indoor play is least affected because some of the activities do not require gross motor skills.

– By using wheel chairs and other physical assistance devices, children with mobility problems can be included in games and other play activities with minimum adaptations.

– Unless other disabling conditions, social interactions are affected only to extent that children without disabilities are guided in accepting the child’s limitation and can modify their play to include the child.

• Positioning Equipment – Is equipment that can provide support and proper positioning that permits children to carry out daily self care activities and engage in play, e.g. car seats, prone standers, stroller, toilet seat.

• Equipment permits the child with weak muscle support to be placed in setting position and also provide mobility for some children or at a minimum makes it possible for children to use their hands to play with objects.

• Lack of mobility or limitations in mobility makes it difficult for the child to participate in outdoor play with peers who are not disabled.

• The environment should be made accessible to children with motor impairment.

• An issue in school settings is inclusion of children with motor impairments in sports and other physical activities with their peers who are not disabled.

• The American with Disabilities Act ensures the rights of people with disabilities to be encompassed in all aspects of community life, including participation in physical activities and integrated settings.

• Teachers, physical education coaches and sports leaders must find ways to adapt and accommodate to provide support on an individual basis.

• Remove barriers to participation in physical activities.

• Burkour (1998) suggests the following to include children with disabilities in youth sports– Skill assessment/task analysis – clearly identify all of the physical,

sensory, learning, communication, socialization skills needed to be successful.

– Focus on maximizing abilities – utilize individual strengths.

– Ask everyone for accommodation ideas – the child, family, teachers, therapists, and other children should be asked to come up with most unobtrusive adaptations.

The Role of Adults

Characteristics of Play

– Play of at-risk children can be described in terms of sensor-motor practice play, symbolic play and social play.

– The play of sensor-motor play of at-risk children develops similar to that of non-risk, but if play indicates differences, it can give early indications of a possible delay or handicapping condition

• Ex. Narrow range of sensorimotor activities might be found to be unusually impaired or autistic or have motor impairment.

– Level of symbolic play with play objects is affected in sensory impaired, mentally retarded and autistic children who show less ability to use complex transformations in their play.

– Interactive adult-child social play routines can be impaired in children with reversal, motor, cognitive, or emotional impairments.

– Children born to teenage mothers can have delays in social play because the mothers may have fewer social support systems, and are less knowledgeable about parenting.

– Children who develop poor social interactions with adults may also experience delays and distortions in social play interactions with peers.

The Role of Adults

• Children found to be at risk for development or a disability are generally served through interventions to enhance development and minimize the risk of handicapping conditions.

• Services might be provided directly with the child, indirectly through parents and other adult caregivers or both.

• In case of child who has an early diagnosis of a disabling condition, both the child and care giving adults receive intervention services. Parent also receives help in how to enhance the child’s development and to compensate for limiting physical or mental conditions

• In case of children who are at risk for environmental causes, such as those whose mothers exposed them to drugs or alcohol during prenatal stage, decisions have to be made about appropriate environment for the child; whether the mother can provide a healthy environment.

• Children might be served in a foster home or placed with a relative.

• Care giver at risk for environmental causes also needs intervention service and support if they are to engage in appropriate adult-child interaction to meet the child’s needs.

• Play has a significant role for development in at risk children.

• Provider of intervention services needs to include play in the curriculum for children at risk for delay as well as children with diagnosed disabilities.

• Parents and other care givers at home need to know how to use play with children and how to enhance the child’s ability to play.

• Child’s need to play and purpose for play should be the major focus for play activities.

• Bergen cautions that play for at risk children should have the same purpose as for children who are not at risk and do not have a disability

Developmental Delay

Children with Cognitive Delay & Mental Retardation

Characteristics of play

Literature on play of children with cognitive delay is limited when compared to other types of disabilities

• Reasons:• Research has been done with individual children and limited to the

study of their play with objects.

• Most of the research done is medical in nature.

• Research results have been inaccurate in that the researchers seemed to be unaware of the nature of the early development that includes individual differences in rate of development in children without developmental delays.

Findings

• Play of children with cognitive delay is less sophisticated and more functional than play of children with cognitive delay and requires more structure (Beckman & Kohl, 1987; Mindes, 1982; Weiner, Tilton & Ottinger, 1969).

• Play of children with cognitive delay is similar to that of children without cognitive delay and is developmentally appropriate (Switzky, Ludwig Haywood, 1979; Weiner & Weiner, 1974).

• Differences in findings might be because of lack of control for toy familiarity in some studies and the differences in context for the studies (Malone & Stoneman, 1990; Rubin & Quinn, 1984).

• When equated with mental age, children with cognitive disabilities do not differ from normal children in some characteristics of play.

• Nor do they differ in their preference from unstructured activities vs. structured activities.

• Prefer child centered or child initiated activities to adult-directed activities.

The Role of Adults

• Adults use play with intervention with children with cognitive delay as an assessment tool to identify specific delays that need intervention.

• As a strategy, that can be used in intervention programs.• The Value of social play between adults and infants and toddles is

also valuable for children with cognitive delay or mental retardation.• Techniques used with children with cognitive delay are adapted to

use a range from very directive to playful strategies.

• Strategies are both taught to parents and used by care givers in intervention programs and they are taught to be playful and responsive to their children.

• Modeling by adults is used to demonstrate symbolic play roles, with more structured coaching used for children who are severely impaired.

• It is natural for adults to be more directive in play with children with cognitive delay than with non-delayed peers.

• Integration of skills teaching into play sometimes can improve play and development.

• Free play can also facilitate development especially when adapted toys and play environments facilitate social interaction between children.

• The challenge for adult provider of intervention for children with cognitive delay or mental retardation is to affirm the child’s ability and interest in engaging in play.

CHILDREN WITH LANGUAGE DELAY AND COMMUNICATION DISORDERS

• CHARATERISTICS OF PLAY Children with speech impairments did engage in make-believe play, but

occurred less often and was of less mature level of play than play of children without speech delays.

Children with language impairments are capable of engaging in object substitutions and object transformations.

They exhibit symbolic play less frequently than their peers with typical language development.

Language- impaired children use less complexity in their play activities as they grow older.

Children with communication disorder in group settings interact more with adults than peers, are less likely to respond to peer initiation for play , and tend to ignored more often by peers.

• THE ROLE OF ADULTS Children with language impairments benefit from playing in integrated

settings.

They can be taught, how to communicate and interact with other children.

Adults working with children with language delays and disorders need to be skilled in ho to provide language intervention within play.

Adults can serve as a facilitator of communication between children at play without directing the play activities.

Can encourage the child with language delay to use verbalization and model appropriate language.

Modeling of language in socio-dramatic play can also guide the child with language delay in how to engage in more sophisticated play.

CHILDREN WITH AUTISM

• CHARACTERISTIC OF PLAY Autistic children's pattern of development is distorted.

Play patterns of these children are also different from children with other types of disabilities.

Autistic children do not generally engage in symbolic play. They lack make- believe in their play because they lack basic representational skills.

They lack in symbolic play because of 1) Lack of motivation.2) Poor social context.3) Level of repetitive language skills.4) Lack peer interaction in play.

Autistic children tend to engage in repetitive and stereotyped manipulation in toy and object play.

They are less likely to use toys appropriately or engage in complex toy play.

Few autistic children play similarly to children with cognitive delay and normal children.

• THE ROLE OF ADULTS New intervention strategies are used which are more child oriented and

focus in planned environments and opportunity to play wit peers in a group.

According to Wolf-berg & Schuler’s Integrated play Group Model, The play opportunities should have eight components:

1) Natural Integrated Settings.

2) Well- Designed Play Space.

3) Selection of Play Materials.

4) A consistent Schedule & Routine.

5) Balanced Play Group.

6) Focus on Child Competence.

7) Guided Participation.

8) Full Immersion in Play.

Abused & Neglected Children

Characteristics of Play• There are some indicators that abused and neglected children play

differently from their peers, who are not experienced in abuse.

• Type of abuse can also affect play behavior differently.

A study comparing abused children with control group found the following differences (Hughes, 1998)

• Abused children played in less mature ways both socially and cognitively.

• Engaged in less play overall.• Involved in themselves, and less often in group and parallel play.• Used the play materials in less imaginative and more stereotyped ways.• Fantasy themes are more imitative and less creative.• They repeatedly played out domestic scenes.

• Sexually abused children had an absence of fantasy play suggesting a need to occupy the present.

• Sexually abused children have been found to be more passive, but they are not necessarily antisocial or negative.

• Sexually abused children are more focused on sexual features of anatomically correct dolls.

• Play themes of physically abused children were more action oriented to include fights, wars, and sudden disasters.

• Physically abused children tend to be disruptive and uncommunicative and are antisocial.

• Their play is characterized as fantasy, aggressive and chaotic.

Role of Adults

• Teachers role would seem to be to guide children in ways to play appropriately and expanding socio-dramatic play to include many types of themes.

• Teacher needs to be aware of the differences in play behavior and alert to the possibility that the child had been experiencing abuse.

THE ROLE OF THE ENVIRONMENT

Influences of Inclusion Classrooms in Children’s Play• A major goad of intervention programs is to help children with

disabilities develop social competence.• Social interaction is seen as a way for children with disabilities to

overcome long delay and to acquire developmental skills.• Social play is also perceived to benefit children who involved

themselves with less complex form of play as a result of a disability.

• Children with disabilities are not as involved or accepted as children who are developing typically. Also they receive initial opportunities for social play less often and have fewer reciprocal friendships and less involved in higher levels of social play.

• Children with typical development have positive attitudes towards children with disabilities.

• Peer mediated activities in inclusion classrooms were found to – Increase peer interaction.– Children with disability benefited both academically and socially.

• Children with disabilities can benefit from inclusion in mixed age classroom. They achieved more sophistication in play with toys in mixed age classrooms.

• Teacher’s attitude in inclusion classroom can have an effect on successful social relationships. Teachers with positive attitudes have a positive effect on para-professional time and direct time with children with disabilities, and the social competence of children without disabilities.

• Teachers training can be a factor, as can be specific teaching behaviors that are supportive of play.

Adapted Play Environments• Environments that serve a large number of children must include modifications for all types of disabilities.

• The environment needs to be predictable so that they can play with confidence

• The American with Disabilities Act (ADA) aims to “ensure that people with disabilities have access to employment, public accommodation, commercial facilities, government services, transportation, and telecommunications.”

Regulatory Negotiation Committee on Accessibility Guidelines for Play Facilities are as follows

– Be based on children’s anthropometric dimensions and other resource information.

– Be base on children with disabilities using a variety of assistive devices.

– Provide opportunity of use by children who have a variety of abilities.

– Support social interaction and encourage integration.

– Create challenges, not barriers.

– Provide advisory information to assist designers, operators, and owners, to effectively incorporate access into their designs. Information should be in an understandable format.

– Maintain safety consistent with ASTM requirements.

– Be reasonable in terms of cost relative to health.

– Address access for parents and caregivers.

– Provide access to elevated structures. Additional ground-level accessible play components may be required, depending on the type of vertical access provided to elevated structures.

Components of Play Environments

Ground level Components– Are different types of play components that can be entered and exited at ground level (e.g. swings, climbers, spring

rockers).– Recommendation suggests that children with disabilities have a choice of at least one of each different type of play

components.– Ground component should equal to 50% of total number of elevated play components.

Elevated Play Components

– Are part of a composite play structure and are entered above or below grade, e.g., slides, climbers, and activity panel.

– At least 50% of all elevated play components be accessible to children with disabilities.

Accessible Routes– Guidelines require that pathways be constructed of a material that is suitable for wheelchair and other mobile aids.

– At least one Accessible route be provided within the boundary of the playground and connect accessible play components including entry and exit points.

Ramps, Decks & Stationary Bridges– Access to elevated play components is provided through use of ramps, decks and stationary bridges.

– American with Disabilities Act Accessibility Guidelines (ADAAG) recommendations for ramps provides a ramp width of 60 inches or greater.

– Guidelines for handrails and transfer points where children can transfer themselves onto play equipment or be assisted by an adult to make the transfer are also specified.

THE ROLE OF TECHNOLOGY

ASSISTIVE TECHNOLOGY

• Technological advances in recent years have enhanced the possibilities for children with disabilities to be able to communicate, participate and engage in –play with their peers.

• These assistive devices are provided as the result of an evaluation of the technological needs of individual children and selection of the most appropriate devices that can be acquired or devised.

ADAPTED TOYS

• Assistive technology can be used to adapt toys for children with disabilities.

• Specially designed switches, control units, battery devices adapters and mounting system can be used with available toys to make them interesting and accessible.

• Battery – powered toys can be adapted for external switch control so the child can control the on and off operation of the toy.

• Switch control adaptation can be used for battery powered kitchen appliances, and action toys.

• Games can also be adapted with a control switch.

CREATIVITY & PLAY

• Assistive technology makes it possible for children with some types of disabilities to engage in creative activities.

• Types of adaptation makes it possible for children with disability to enjoy creative play.

• With careful planning, children with disabilities can be encouraged to engage in creative activities.

• PLAY - BASED ASSESMENT

– Understanding play variations resulting from disabling conditions can be helpful in understanding their needs for intervention.

– The appearance of or a delay in the play behavior can also be used to assess children.

– Earlier identification of children with delay or disabilities traditionally was done through standardized assessment.

– Recently play-based assessment with children with disabilities has gained popularity.

There are three approaches to play observations which are being currently used. These are

1. Nonstructured Assessment Purpose is to identify all behaviors that occur during a play session. Spontaneous play is observed in nonstructured play assessment. Play may be initiated by either the child or the caregiver.

2. Structured Assessment Focus on a previously designed set of play behavior. Procedure are established, as are the toys to used. Techniques employed by adults to initiate the play activities.

3. Tran disciplinary Assessments Included a team of evaluators who observe the child at a play concurrently. Each member of the team observes a different domain of developmental or for

a different purpose.

Observation are generally structured. May include planned adult interaction.

Suggested Videos

• They’re Just Kids: Excellent for anyone working with children with disabilities. Aquarius Health Care Videos. (Videotape E5641) (www.justkidsvideo.org). 26 minutes.– Aquarius Health Care Videos– 5 Powderhouse Lane– Sherborn, MA 01770– 508-651-2963

• Bringing Out the Best. Research Press. (Videotape E2169). 24 minutes.– Research Press– 2612 N. Mattis Ave.– Champaign, IL 61821– (217)352-3273