January 24, 2018 | Author: Anonymous | Category: Arts & Humanities, Performing Arts, Drama
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Marisa Lobo Biddappa M.A. M.Phil.

WHAT IS PLAY? Play is a natural medium of a child’s expression. It refers to any activity engaged in for the enjoyment it gives without consideration of the end result.

DEFINITION OF PLAY Play is pleasurable and enjoyable Play has no goal imposed on it from outside Play is spontaneous and voluntary Play involves some active engagement on the part of the player Garvey 1977


• • • • • • • • •

Play follows a predictable pattern of development Play is influenced by culture and tradition Play becomes more social as the child grows Number of playmates decrease with age Number of play activities decrease with age Play becomes more gender based as the child grows Play becomes more organized as the child grows Play turns from active to passive as the child grows Play is predictive of a child’s adjustment

CONTRIBUTIONS OF PLAY Physical Development

Communication Skills

Dev. of motor skills, muscles, exercise Outlet for surplus energy

Encourages communication Initiate communication

Outlet for Pent up Emotions

Interaction & Socialization

Outlet for release of tensions due to restrictions placed by environment

Learn to interact, establish relationships sort problems

Outlet for Needs and Desires

Source of Learning

Needs and desires can be achieved in play e.g. leadership

By exploring, manipulating, experimenting they learns new things

Stimulant to Creativity

Dev. of Self Insight

Through experimentation they discover new things that they can transfer to the outside world

Learn what their capabilities are More realistic concept of self

Age and Sex Appropriate Roles

Moral Standards and Values

Learn to accept app. age and sex role Learn to belong to a group

Learn what is right and wrong Taking turns, fairness Enjoying victory, accepting defeat

Dev. of Desirable Personality Traits Learn to be cooperative, truthful, fair, good sports, tolerant and fun to be with


Active Play

Passive Play (Amusements)

Actively participates in the activity Building blocks, running, playing a game

Derives pleasure with minimal expenditure of energy watching others play, reading, watching television

STAGES IN PLAY • Explorative Play - Sensory – Motor - 3months – 6 months • Imitative Play – 9 months • Independent Play - Functional and Parallel Play – 9 months – 2 years • Pretend Play – 2 years – 2 years 6 months • Peer Play - Reciprocal Play – 2 years 9months – 3 years • Cooperative Play – 3 years 6 months – 4 years

• Group Play - rule based games – 5 years • Organized Sport – 8 years







• Difficulty in both expressing and understanding the content of speech – verbal and non – verbal • Difficulty in relating experiences • Difficulty in pragmatic speech i.e. functional communication – real dialogue where two people have a two way conversation, relate incidents, give interpretations of it , where two sets of impressions are tuned → common behaviour

PROBLEMS IN SOCIALIZATION • Difficulty in understanding the social world • Difficulty in understanding the thoughts, feelings and intentions of others,

• An unwillingness to allow others to share experiences - Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people → Lack of social or emotional reciprocity • Difficulty in understanding non - verbal cues – facial expression, tone of voice, etc. • Difficulty in imitation, interaction and joint attention • Failure to develop peer relationships app. to developmental level

The physical approach

The social approach

A ‘chew on, shake, explore’ world Regularity Cause-effect Activity Exploring oneself through action activity) Exploring behaviour (manipulating the object) Processing information Cognitive – perceptual Concrete The effect Realization (understanding function)

A ‘communicating with’ world Regularity Intention Activity Exploring oneself through (sensorimotor mirroring (sharing and attuning emotions) Playing behaviour (relating to the object) Processing information Emotional – empathetic Abstract – dynamic The effect Experience (understanding context)

Beyer, and Gammeltoft,2000

PROBLEMS IN IMAGINATION • Difficulty in understanding the meaning of imaginary situations, often leading to repetitive, obsessive behaviour that means something only to the child • Difficulty in forming flexible scripts and tend to be dependent on events occurring in the same way every time → unexpected events may throw the child off this familiar and inflexible script – internal images of well known daily routines • Need to establish stable perceptual images as they find it difficult to see beyond the things they see or hear → ‘echo like’ behaviour i.e. same behaviour and rituals performed again and again- Stereotyped Behaviour • Persistent preoccupation with parts of objects

PROBLEMS WITH SENSORY PROCESSING Difficulty in sensory processing - in the areas of visual, auditory, tactile, taste, olfactory and vestibular processing → avoiding eye contact, oversensitivity to certain vivid colours, sounds, textures, being picky eaters, resistance to being held or cuddled, throwing head back without any sense of what may be behind it Difficulty in filtering out the variety of sensory input they are bombarded with

OBSERVATIONS OF PLAY AMONG CHILDREN WITH AUTISM Kanner in1943 first observed the limited ability of play that characterizes those with Autism. Three explanations as to why children with ASD do not play: Difficulty with lower levels of play i.e. manipulation (stacking) and relational play (waving). They have limited experiences in these categories because of their lack of curiosity and need to explore → Repetitive, persistent behaviour and self stimulatory use of proximal senses(sucking, licking etc). Cognitive theory- impairment in the child’s representational thought, the ability to form and manipulate symbols. Conative theory- suggests that elicited play of children with Autism is less impaired than their spontaneous play. This implies that children with Autism can pretend, but do not do so spontaneously, perhaps because of repeated failures. Roeyers and van Berckelaer –Onnes,1994

Very few children with Autism use symbolic play, Wing, 1970 and the few who showed signs of symbolic play, played in a very stereotypical manner -Wing and Gould,1979.

Production of pretense in children with Autism has been assessed under two general setting conditions: (a) unstructured, spontaneous conditions, and (b) structured, prompted, or elicited conditions. All studies show an impairment in the production of

pretend play in children with Autism (in comparison to mental - aged matched controls) in unstructured, spontaneous conditions . (Baron- Cohen, 1987; Lewis & Boucher, 1988; Riguet, Taylor, Benaroya, & Klein, 1981; Sigman & Ungerer, 1984).

After general or specific prompts are given, children with Autism tend to produce some pretend play, although in many studies the group differences remain . (Riguet et al., 1981; Sigman & Ungerer, 1984)

‘Theory of Mind’ hypothesis was introduced, Baron-Cohen, Leslie and Frith,1985.It showed the link between the child’s ability to pretend play and his potential ability to understand his own behaviour as well as other people’s.

According to Leslie's (1987) theory pretend play involves metarepresentation,(deliberate disregard for reality, where the child is simultaneously aware of a real situation and creates an image of it being something else) the cognitive basis of the young child's developing theory of mind—both of which are impaired in Autism -Jarrold,


Smith, & Boucher, 1994)

Lewis and Boucher (1988) suggested that since prompting increases the amount of both

functional and pretend play, this supports either a generativity or a motivational deficit theory, and that the production of pretend acts per se (and presumably the accompanying representational thinking) is not impaired in Autism.

Children with Autism have problems in generating pretend play rather than in the mechanics of pretence itself. They can play if highly structured or if prompts are used. They also found that child with ASD had impaired levels of functional play Jarrold, Boucher and Smith, 1996

Sensory motor play dominates beyond the verbal mental age, at which it normally declines for a child without Autism Jordan and Libby, 1997

Child with Autism show a lack of spontaneous play in free settings, not because of a complete inability to play, but may be due at least in part to the fact that they find play difficult, so they experience repeated task failure. This in turn leads to frustration and a pervasive lack of motivation to play Stahmer,1999

The difficulty that children with ASD in pretend play arises from difficulties they have in both the fluid organization of thought processes and in communicating these thoughts to others . Sherratt, 1999

Play in children with Autism is repetitive. Wolberg 1999

Children with Autism did not normally engage in elaborated functional play and produced fewer different actions than control groups like kids with Down’s Syndrome and typical kids. Their play is impoverished e.g. Placing a spoon in a pot but not stirring it). Williams, Reddy and Costell,2001

HYPOTHESES Motivational Hypotheses

Competence Hypotheses

Do not understand pretend play

do not use pretend play

Lack emotional involvement

unable to form images

Do poorly in free play situations

unable to attribute an actual

Better in structured situations

mental life with its own wishes and imagination to a toy

Emotional component

cognitive component

WHY IS PLAY DIFFICULT? • Communication difficulties • Problems with meaning • Difficulty accepting direction from an adult • Problems with imitation, interaction and joint attention • Problems with generalization of skills

• Problems with flexibility • Problems with imagination • Problems with sensory processing

↓ Lack of varied , spontaneous make believe play or social imitative play appropriate to developmental level DSM IV Tr

WHY IS JOINT PLAY DIFFICULT? • Problems in imitation, interaction and joint attention • Difficulty accepting direction from others and the resulting ‘exposure anxiety’ that this can cause • Problems with flexibility e.g. set way of playing e.g. lining up cars • Problems with imagination e.g. no pretend play • Problems with meaning- difficulty imagining that items can represent other things e.g. a stick could be an airplane • Problems with generalization – applying a skill learnt to a different context • Difficulty in both understanding and expressing language • Problems with sensory processing- sensory overload - not being able to filter out input and focus on the activity at hand

WHY IS TURN-TAKING DIFFICULT? In order to take turns we need to: • Be able to share the same material • Be aware that the other person is part of the game • Be aware that they are integral to the game

• Judge when it is our turn and be patient • Be aware of what they are doing • Try ultimately to predict what they are thinking and what they might do next

STUDIES ON PLAY AS INTERVENTION • Children's ability to use language coincides with the emergence of predictable symbolic play schemes. Children don't use language fully until they can play in symbolic ways. Carol Westby,1980. • Play has had a very small role in the education and treatment of children with ASD. Wolberg,1999

• Symbolic pretend play has much to offer in the remediation of the core difficulties that are experienced by children with ASD, as it offers a rich and meaningful environment for the manipulation of symbolic representations, which is something

these children find difficult. Sheratt,1999

• Symbolic pretend play may result in learning and changes to the brain, develops flexibility of thought, develops social skills they often lack by opportunities that create a shared understanding of pleasure experienced in play episodes. Sheratt and Peters, 2002 • Make believe play can develop thought flexibility and reduce conceptual fragmentation in children with ASD. If play is taught it may help to reduce repetitive, rigid behavioural problems and encourage communication and interaction. Sherratt and Peter, 2002

• Play Project shows that the bond between parent and child can be used to bring children through a once- hidden doorway into the warmth of a relationship. 50% of the children improve significantly, 25% show moderate improvement and 25% (usually with other physical or developmental problems) show little improvement. The logic is simple: rather than force a child to join the world, parents are taught to enter the child’s world and, over time, to become a trusted guide to the outside. Solomon , 2007 Play Project

A pilot randomized controlled trial of DIR/Floortime™ parent training intervention was designed by Pajareyan and Nopmaneejumruslers,2011 to test the efficacy of adding home-based Developmental, Individual-Difference, Relationship-Based (DIR)/Floortime™ intervention to the routine care of preschool children with ASD. Measures of functional, emotional development and symptom severity were taken. It was found that after the parents added home-based DIR/Floortime™ intervention at an average of 15.2 hours/week for three months, the intervention group made significantly greater gains in all three measures employed in the study: Functional Emotional Assessment Scale (FEAS), Childhood Autism Rating Scale and the Functional Emotional Questionnaires. This study confirms the positive results obtained by a previous DIR pilot study. Solomon et al., 2007

A study was conducted for 102 pre-school children diagnosed with an ASD at age 2 who attended an inclusive toddler program

(described by Stahmer and Ingersoll, 2004)

until age 3.

Outcomes on standardized developmental assessments indicate significant improvement, in developmental level, adaptive behavior and communication. Thirty-one of the children

(31%) were functioning in the typically developing range when they exited the program at age 3, after an average of 8 months of intervention. Predictors of positive outcomes included length of time in the program, level of words and gestures used at entry and higher externalizing and lower internalizing behavior CBCL scores at entry. Stahmer, Akshoomoff and Cunningham, 2011.

PLAY BASED INTERVENTION Play skills interventions may be implemented using non-directive or directive approaches. Nondirective teaching aims at a wide range of play skills, including play-related communication and social interaction. A directive teaching style focuses on specific play techniques, e.g.the functional use of toys. This may include teaching skills in isolation in the following sequence: 1. Select a motivating toy. 2. Observe other children using the toy to determine appropriate use of the toy. 3. Give the toy to the child. 4. Observe the child interact with the toy. 5. Prompt the child to interact with the toy in an appropriate manner. 6. Provide physical prompts(e.g., put your hand on the child’s hand and direct the use of the toy) to show the child how the toy works. 7. Model the desired behavior using the toy or ask another child to model the use of the toy. 8. Proceed to a more intrusive prompt, if needed. Stop if the child is using the toy in an acceptable manner. 9. Provide verbal prompts or direction to the child while he or she is using the toy (e.g., “Push the car to Pat”). 10. Positive reinforcement (e.g., verbal praise, identified reinforcers) should be implemented along with the prompting and used to reinforce the desired play behaviors. Terpstra, Higgins, and Pierce, 2002

FLOORTIME The DIR/Floortime model is based on the idea that EMOTION is critical to the growth of the mind and brain. What is Floortime? • A specific technique where for 20 or more minutes you get down on

the floor with your child. • A general philosophy that characterizes all the interactions with the child, because all interactions have to incorporate the features of Floortime as well as the particular goals of that interaction, be it speech therapy, OT or a set of educational goals. Greenspan, 1998

Main emphasis • Following the child's lead • Joining the child's world and pull him into a shared world in order to help him master each of his Functional Emotional Developmental Capacities - fundamentals of relating, communicating, and thinking. Follow the child's lead means - Tune into his emotional world - Follow his emotions - What is of interest to your child? - What gives him pleasure? The ultimate goal is - 1.To help him to be an empathetic, creative, logical, reflective individual - 2. To help the child master his Functional Emotional Developmental Capacities – his basic social, emotional, intellectual, language, and academic abilities.

SIX CORE DEVELOPMENTAL CAPACITIES Six Core Developmental Capacities Attending

Using ideas Logically


6 Core Developmental Capacities

Using Ideas Creatively

Purposeful Communication

Problemsolving Interactions

Floortime involves this polarity, or this dialectic, or this tension between following the child’s lead, entering his world and pulling him into your own world, finding his pleasures and his joys. Then creating challenges that help the child move up to higher levels of relating, communicating, and thinking. That means paying attention to the child’s individual differences in terms of the way they process sounds and sights and movements and modulate sensations, and also paying attention to the family patterns and therapists to your own personalities so you know how you have to stretch to work with a particular child so you can enter their world and tailor your interactions to their nervous system. Greenspan, 1998

Play provides a medium through which children develop skills, experiment roles and interact with others, children with Autism are disadvantaged in their use of play for these purposes - Boucher - 1999


Structure - Helps the child to understand the sequence of skills, activities or ideas necessary towards attainment of an agreed goal. Systematically breaking a play activity into component parts, so that it is no longer a jumble of language, objects and actions that has no meaning for your child. Affect - There needs to be an inherent pleasure in play or it ceases to be play Interests - The child must have interest in manipulation of materials to make the play experience personally meaningful. Use something that has an inherent meaning to the child – string, bubbles, spinning top Non representational Materials - Strings, play dough etc. should be used in balance with representational materials (toy animals, dolls)

Continuity – There should be some expectation of the process in teaching pretend play to enable the children to switch into pretence Appropriate Language- Language and instructions should be kept simple and to the minimum Social Play- This may involve learning new skills from a more able player, gaining a desired object from someone else or sharing a sense of enjoyment from the actions of others

8 BASIC PRINCIPLES Warm and Friendly Alert to recognize feelings & reflect them back

Places necessary limits

Deep respect for the child’s ability

Does not attempt to direct the child’s action

Play Therapist

Accept child for what he is

Feeling of Permissiveness Does not hurry the child or the therapy

HOW DO WE TEACH CHILDREN WITH AUTISM TO PLAY? • Create the right environment • Confine play area to a specific place • Use only 3 - 4 items of play • Keep instructions simple and clear • Start with short periods of time • Use picture prompts to communicate

• Help them make choices • Use lot of positive reinforcements • Use items your child is interested in to start with

• Create a sense of shared play by letting him see that how he plays has a direct effect on how you play • Be aware that limiting his access to a toy he likes will increase his motivation to play with it • Be aware that direct and confrontational interactions may cause him anxiety • Develop a collection of techniques to use when he resists play

• Start with controlled indoor table top/carpet play, generalize it to other situations, theme based play • Be subtle and gently work on his ‘in-built’ aversion to sharing his experience of the world

HOW DO I START??? Have 4-5 boxes (different themes- Different sounds, shapes, water play, family, doctor etc.) which you can rotate every day because children with Autism • Have poor attention span • Will not know what toys are in the box • Have communication difficulties • Have problems in imagination • Varying toys brings in flexibility and prevents your child from getting obsessed on

having one item which he expects and needs to see every day

WHAT KIND OF TOYS SHOULD I USE? • Do not look at the age level- Know your child’s level, strengths and deficits • Cause and effect toys are good for motivating children with Autism • Items should not be frustrating for your child to use • Size should be one that your child can handle easily • Minimum amount of details visually-plain tea sets • Realistic items – Children with ASD tend to relate to them better

cooking set, dolls etc. • Puzzles, stacking boxes should be easy to fit • Reinforcers – The ones your child shows interest in or is obsessed with should be used as reinforcers – bubbles, spinning tops

HOW DO I PLAY? Be alert to his level of communication, readiness to interact, use the approach that is right for your child. Indirect parallel play with duplicate items the child enjoys, copy what he does no matter how inappropriate, copy the noises, change them, give gentle commentaries, stop to watch his reaction, respond to any signs that he wants to carry on. A game schedule with a clear indication of content and order will help. Content should be simple and motivating as the social aspect is so challenging.

SOME METHODS TO TEACH PLAY SKILLS Modelling Mirroring Play routines Play scripts Action songs Integrated play groups (Thomas & Smith, 2004)

Social narratives and visual sequences (Beyer & Gammeltoft, 2000; Sherratt, 1999) LEGO play and LEGO based interactive play groups (LeGoff, 2004, 2006) Peer trainers and peer examples (Bass & Mulick, 2007)

The play strategies should focus on the following :

• Play theme –Familiar routines (scripts) that evoke recognition and motivation e.g. morning routine • Attention, expectation and shared focus - setting the stage, play material . Child’s attention and interest are increased by integrating several senses – colour of the box, sound of things inside • Imitation and mirroring – identical sets of toys to inspire attention, and motivation , to imitate child’s actions, reinforce the child’s own initiative, adult can guide • Parallel play, dialogue in play – two sets of miniature objects (cooking set, dolls) • Scripts and social stories –story sequence in pictures corresponding to the toys. Child acts out the story with toys • Taking turns – Can use a hat initially to indicate whose turn it is • Games and rules in playing – taking turns to indicate and play with their choice of toy for a fixed time, proceed to games with a feely bag, ball games, simple board gamesDominoes, Picture Lotto See Beyer & Gammeltoft, 2000

WHAT WE CANNOT DO… • We cannot shout, scream or cajole the Autism out of our child • We cannot make him ‘join us back in our world’ by forcing our attention • We cannot allow our feelings of anger and hurt to express themselves • We cannot use the same behaviour strategies we might use on a non-Autistic child • We cannot use the same motivating strategies for good behaviour • We cannot expect that if we devote years to the ‘recovery’ of

our child that he will grow into an adult without Autism • We cannot compare our child to both his typical and ASD peers – his experience is unique

HOW TO REDUCE STRESS WHILE YOU PLAY • Understand your child and respect his unique experience • Structure - Use visual prompts to mentally prepare your child. Work on attaining one element of a particular play activity giving him a chance to interpret the activity and give it meaning • Motivation-Create situations that will motivate him to communicate with you – use reinforcers • Preparation – Plan out your activity and keep things ready before you start playing. • Individuality – Get into your child’s thinking, don’t pull him down a typical path of learning, find other pathways and meet him half way. Have goals and open your mind to all the possibilities that his potential may hold, but never lose sight of the individual he is.

• Communication and interaction - Make him know that his attempts at communication and interaction are successful for him • Indirect Learning- Be aware that direct confrontational interactions may cause him anxiety- use puppets and toys as a third party to talk to your child • Use music, rhymes and commentaries to help bring your child into the world • Be alert to times when your child is receptive or needs to pull back. Watch the triggers that cause him stress, watch for sensations that are interfering with his interactions that he cannot communicate to you • Bring out the child in you and enjoy what you are doing. Engage yourself in the activity as if it were purely for your own pleasure. • Make a schedule for yourself so that you have time for your child, your spouse and yourself – you need to de –stress!

Through play find an ‘emotional space’ that you can both occupy at the same time or some of the time with laughter and responsiveness.

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