Play and Autism - contents

Play and Autism

contents

Introduction 3

Interview with Professor Melanie Nind 4

Research Articles Reviewed 11

1. Alone and in a Group: Ethnographic Research on Autistic Children’s Play 11

2. Mothers’ Reports of Play Dates and Observation of School Playground Behaviour of 13

Children having High-functioning Autism Spectrum Disorders

3. Description of a Mother's Play Guidance for her Child with Autism in the Process of 15

Playing by the Rules

4. Inclusion in Play: A Case Study of a Child with Autism in an Inclusive Nursery 18

5. Parents as Play Date Facilitators for Preschoolers with Autism 20

6. Picture Me Playing: Increasing Pretend Play Dialogue of Children with Autism 22

Spectrum Disorders

7. Qualities of Symbolic Play among Children With Autism: A Social-Development 24

Perspective

8. Relationships between the Responsiveness of Fathers and Mothers and the Object Play 26

Skills of Children with Autism Spectrum Disorders

9. e Role of High-Level Play as a Predictor of Social Functioning 27

10. e Impact of the Advancing Social-communication And Play (ASAP) Intervention 29

11. Symbolic Play of Preschoolers with Severe Communication Impairments with Autism 30

and Other Developmental Delays: More Similarities than Differences

12. e Relation between Social Engagement and Pretend Play in Autism 31

13. Play and Communication in Children with Autism Spectrum Disorder: 32

A Framework for Early Intervention

Conclusion 34

This is the ninth Research Bulletin produced byMiddletown Centre for Autism. The aim of theCentre’s Research Bulletin Series is to provideaccessible summaries of relevant peer-reviewedresearch articles. The current Bulletin contains 13summaries of articles related to play and autism,and commences with an interview with ProfessorMelanie Nind.

Melanie Nind BEd, Phd is Professor of Education at the University of Southampton. Her particular areas of

interest and expertise lie in the Telds of interactive and inclusive pedagogy, and inclusive research methods.

She also maintains a keen interest in inclusion, and gender, sexuality and disability rights issues within a broad

social justice framework, but is best known for her work on Intensive Interaction. She is editor of the

International Journal of Research and Method in Education and on the international advisory or editorial boards

for the Journal of Research in Special Educational Needs, European Journal of Special Needs Education, British

Journal of Learning Disabilities and Disability and Society.

Melanie began her teaching career in special schools as a teacher of students with severe and complex learning

difficulties and autism. She has also worked in further education where she has coordinated support for

students with learning difficulties and disabilities. In higher education she has worked as an Associate

Research Fellow in the Centre for Autism Studies at the University of Hertfordshire, as a Senior Lecturer in

Special Education at Oxford Brookes University, and at e Open University developing and teaching

undergraduate and postgraduate distance learning courses in inclusive education. She has been researching for

three decades and is currently a co-director of the ESRC National Centre for Research Methods.

Please note that the views represented in this document do not necessarily reflect the views of Middletown Centre forAutism. Reviewers have, where possible, used the original language of the article which may differ from UK andIreland usage and the usage of a range of terminologies for autism.

Introduction3

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1. What do educators mean by play andwhy is it important?

As educators, when we talk about play we tend to bereferring to an activity we see as integral tochildhood and to learning. Particularly in WesternEurope and Northern America, we are steeped incultures in which play is seen as a “good thing”, notjust in and of itself, but for fostering children’sdevelopment. Even within these cultures, educatorsare not a homogenous group, of course, and thesector we work in and the kind of training we haveundergone is likely to inUuence just what it is wemean by play. Early childhood educators, forinstance, are often highly committed to play as thebusiness of young children – their work – but alsowhat comes naturally to them. Tony Booth andcolleagues (2006) sum this up in the Index forInclusion (Early Years) when they assert that youngchildren are experts at play and that it is throughtheir play experiences that they learn.

Play has long been at the heart of early education,valued for being the way that children make sense ofthe world, get to know and enjoy it, and feel thatthey belong. Being included in play is about beingincluded in the social world of childhood. ere aremany examples of champions of early childhoodeducation seeking to protect the place of play in theearly years, where trends toward more formalisedcurricula have put this under threat. Specialeducators, by comparison, often have a view of playin which the instrumental value dominates over theintrinsic qualities of play, and in which certain kindsof play are valued over others. us, rather than aplay-based curriculum one is more likely to Tnd playtherapies and interventions designed to teach orenhance the play skills of children with autism andvarious impairments, not so much to enable thechild’s entitlement to play but as a vehicle toachieving other goals. is perspective has recentlycome under considerable criticism within disabilitystudies because it positions the play of the disabledchild as Uawed or lacking; Dan Goodley andKatherine Runswick-Cole (2010) and Jenene Burke(2012), for instance, offer powerful challenges.

My own view is that play is more than a collection of

AN INTERVIEW WITH MELANIE NIND

play skills or behaviours; it is about being playful in avariety of ways, shaped by sociocultural contexts andeveryday settings as well as individual dispositions. Itis important in its own right and it is important forchildren’s well-being and for their learning, for whatit offers in supporting children’s socialconnectedness. Yet there are not right and wrongways to play. If we are celebrating play we need tocelebrate the ways in which all children play andhave a concept of it that is expansive and inclusive.

2. Why do children with autism havedifficulties with some types of play?How do children display/communicate thisdifficulty?

Children with autism have difficulties with sometypes of play when a normative framework isapplied. ese difficulties can be continuouslyexposed by a research tradition in which the play ofchildren with autism has been compared with that ofmatched, non-disabled peers. Here, so-called playskills are assessed in what is presented as objectivetests of play with a focus on those areas of play thatare perceived to be lacking: joint attention andcomprehending pretence in particular. Diana Seach(2007) has argued that cognitive developmentaltheories have played a part in building up this deTcitorientation. ese research and theoreticalapproaches have inevitably orientated educatorstowards focusing on children’s deTcits rather thantheir strengths, which has led to the preoccupationwith therapeutic intervention to improve ornormalise their play skills. Ironically, at the sametime children with autism are often placed ineducational environments with structured, adult-ledphilosophies that provide them with feweropportunities to just play, without the holisticapproach that would be enabling.

At the level of individual play interactions, childrenwith autism sometimes do not play their part asexpected and as a result they may not stimulateplayful interactions in others. ere is, then, aninteraction between what children with autism bringand what the adults (or even other children aroundthem) bring, making play feel like an area of

Melanie Nind,Professor of Education,University of Southampton

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difficulty. Assessments of play skills or playfulnesscan turn this Uuid situation into more of a problemthan it is, but play-based assessment does not have toact in this way. It can also be used to get to knowchildren as people with preferences and personalitiesthat vary as their play contexts vary. I prefer to see afocus on supporting children’s right to play throughfocusing on the whole child in the context of thewhole curriculum, rather than focusing onremedying particular difficulties. When we observecarefully we can see that in some environmentschildren with autism have an ability to play thatchallenges assumptions of deTcits. I would not wishto negate the difficulties of individual children,merely put them into a context in which we can viewthem with a different lens.

3. Does this have an impact on theirdevelopment?

For me, as educators we cannot ignore the educativepotential of play; the potential for fosteringdevelopment in all children. is does not mean thatthe best way forward is to Tnd out what is broken ina child’s play repertoire and Tx it. It means that weneed to provide children with rich and varied playenvironments that work for them. It means that weneed to observe so that we can value the play thatdoes happen and the contexts that foster this. Itmeans that the adults in those play environmentsneed to be skilled supporters and mediators of play,and sometimes play partners. In all these ways playcan have the positive impact on children’sdevelopment that we know it can have.

4. Can children and young people withautism be taught to play?

is may depend on your model of teaching andlearning. When I think about this I do not have inmind telling a child how something is done, or someelaborate training programme to model and reinforcedistinct skills and behaviours. I have in mind theeducator’s role in creating an environment in whichlearning happens - often the outcome of a good mixof ethos, human and physical resources, activitiesand support. Fani eodorou found in her doctoral

research that adult intervention programmes mayactually reduce or impoverish children’s play witheach other, and the act of intervening in or removingindividual children from naturally occurring peerplay is not, as I see it, the way to teach play.

I would encourage educators to focus on theopportunities for play that they offer and their rolewithin these. We can certainly plan for play. We cango back to the sensible argument that what is neededis a balance of the teaching and learning suited to allchildren (common pedagogy), that suited to childrenwith speciTc/impairment-related difficulties (speciTcpedagogy), and that suited to the unique individual(individual pedagogy). is focuses us Trst on whatchildren on the autistic spectrum share with allchildren, including (as Rita Jordon would remind us)the need to be emotionally engaged in learning,hence the regular play opportunities. But it alsoprompts us to consider where they might needsomething extra. is means tuning in to the childand to what we can do to assist, while retaining as faras possible the spontaneity and intrinsic pleasure ofplay. Teaching play must not equate to taking overthe play agenda and seizing control from the child.

5. How can practitioners and parentsunlock the motivation for play and movelearning forward? Are there key strategies?

It follows from everything I have already said thatmotivation for play needs to come from followingthe child’s lead. We need to create settings in whichbeing playful is irresistible, and keep an open mindabout what form that play might take. Once we havecreated carefully considered contexts for play weneed to allow children to be active meaning-makerswithin those contexts, often intervening as little aspossible in the Uow of children’s playful interactions.Supporting the motivation to play can mean beingnon-directive and optimally facilitative, with supportbeing most effective when adults follow the leadgiven by children, enabling them to enjoyparticipating in an activity they show an interest in,and avoiding styles of interaction in which wedominate. Based on Teldwork in which one childwith autism was observed being optimally supported

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by very skilled practitioners, we concluded thatadults helpfully adopt roles as supporters ormediators of play or as active play partners.Supporting play is likely to mean enabling it tohappen and observing, perhaps offering anoccasional commentary to children’s activity, butencouraging familiar playful rituals in which childrengain conTdence. A mediating role is morepurposefully interventionist, yet still intervening nomore than is needed; most often this will be in theface of real or potential breakdown in playfulexchanges or to provide minimal, timely assistance.As supporting, possibly mediating adults we need tomake ourselves available to children - in quietproximity to their play - ready to be drawn in as aresource if needed. Sometimes the play will be withus, when we need to take on the role of active playpartner. In this case we need to learn to readchildren’s cues and intentions, however idiosyncratic,and support the establishment of reciprocity andmutual fun. We have to relax into play and genuinelyenjoy it. We need to act with spontaneity, but retainour ability to reUect, in the moment, on how tooptimise play interactions. All of this is helpedenormously by supportive cultures where there is anethos of valuing play and playfulness.

6. Should we support and modify solitaryplay to encourage inclusion with theirpeers?

If we value the social world then obviously we wantto open it up to all children, to foster their inclusionin social activities and playful interactions. is isbest helped by creating the right environment andadopting the roles I have described. We might wantto create situations in which play is happeningalongside children with autism, coaxing them in, orwe might need to be their play partners ourselvessometimes. is might be separate to children’ssolitary play, or it might mean joining in with theirsolitary play. I would not use the language ofmodifying play as it creates all the wrongexpectations, and it devalues the child and whateverthe play activity is that is important to them.

I am largely convinced by the argument that children

AN INTERVIEW WITH MELANIE NIND

make the best play partners for each other - that theycan create and sustain mutual interest that is rich andundirected. e accompanying argument is that theshared interest is usually more authentic than whenadults attempt to establish mutual play withchildren. We can act as a play partner andsimultaneously and intuitively model how to play,but to perform these roles we need to let go of someof our other roles, particularly “being in charge”.

Being social is something I aspire to for all children.If that necessitates adults being play partners ratherthan other children, then we are still opening up thesocial world, and we may have a vital role to playhere. rough social play we come to enjoy spendingtime together, making sense of things together, andso playing with other children is central to children’ssocial inclusion. I would work hard to facilitate this,starting with creating social play opportunities.

7. How does the regulation of sensoryinput influence play scenarios andengagement?

We are sensory beings and play is a sensoryexperience. For some children with autism typicalplay environments like playgrounds and paddlingpools can be overwhelming on the senses andthereby interfere with play. We need to get to knowchildren and what environments suit them best.Play-based assessment can even be a means forgetting to know them holistically and to know whatthey can do in what optimally supportive socialsituations. Toni Linder’s (1993) transdisciplinaryplay-based assessment, which involves a teamobserving the child in unstructured and structuredplay, in play with other children and with parents,and in various environments, can shed light on thesensory features that are facilitative or detrimental toplay. Understanding children’s responses to thesensory world can inform our planning for play.Phoebe Caldwell & Jane Horwood (2008) are goodon this theme in relation to those individuals withautism who experience sensory distress. eyrecommend combining the approaches of IntensiveInteraction and Sensory Integration, thus bringingtogether tuning in to the whole person andawareness of sensory overload.

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8. The advent of technology is potentially amotivating means of play engagement forthe child with autism. It has its benefits, butdoes it also have disadvantages?

is is not something I have much experience ofmyself. e technology I am wed to is the videocamera and the role video can play in helping us toreUect on play interactions and our own role inthem. Beyond that, the answer I could give, based onwhat I do know, is that if some form of technology iswhat is interesting and engaging for a child withautism, then we would be foolish to ignore itspotential for playfulness and play interactions. I alsoknow that there is enthusiasm for the potential of thetechnology of virtual reality to offer a vehicle forchildren with autism to engage in simulations ofreal-world social situations and learn about themwithout being threatened by them. us a childmight engage in virtual play with virtual children ina controlled way, learning about the social whileavoiding the social! ere might be potential for realchildren playing collaboratively in this way, and theremight be motivating elements. My colleague atSouthampton, Sarah Parsons, has research experienceof this, but she also warns of over-optimismregarding the role virtual environments are as yetable to play in supporting real-world, especially non-rule-bound, social abilities (Parsons & Cobb, 2011).My own view is that there is plenty of potential inthe ready availability of everyday children, adults andsocial situations, and that we have the ability tomake play safe and motivating without the need forsuch technology. We need to be careful not todisempower ourselves, or to de-value the humanresource of the children in our classrooms, familiesand neighbourhoods.

Bibliography

Booth, T., Ainscow, M. and Kingston, D. (2006).Index for Inclusion: Developing Play, Learning andParticipation in Early Years and Childcare. Bristol:Centre for Studies on Inclusive Education (CSIE).

Burke, J. (2012). Some Kids Climb Up; Some KidsClimb Down: Culturally ConstructedPlay-Worlds of Children with Impairments.Disability & Society, 27 (7), p. 965-981.

Caldwell, P. and Horwood, J. (2008).Using Intensive Interaction and Sensory Integration: AHandbook for ose who Support People with SevereAutistic Spectrum Disorder. London: Jessica Kingsley.

Goodley, D. and Runswick-Cole, K. (2010).Emancipating Play: Dis/abled Children,Development and Deconstruction.Disability and Society, 25, p. 499-512.

Jordan, R. (2007) Social Inclusion and the educationof children with Autism Spectrum Disorder(Unpublished). A speech at International EuropeanCongress 1 September 2007.

Lewis, A. and Norwich, B. (2005). Special Teachingfor Special Children? Pedagogies for Inclusion.Maidenhead: Open University Press.

Linder, T. W. (1993). Transdisciplinary Play-BasedAssessment: A Functional Approach to Working withYoung Children. Baltimore: Paul H. BrookesPublishing Co.

Nind, M., Flewitt, R. and eodorou, F. (in press).Play and Inclusion, In: Cologon, K. (ed.)A Good Start: Inclusion in the Early Years. Oxford:Oxford University Press.

Nind, M. and Hewett, D. (2005). Access toCommunication: Developing the Basics ofCommunication with People with Severe LearningDifficulties through Intensive Interaction.(2nd edn). London: David Fulton.

Parsons, S. and Cobb, S. (2011). State-of-the-art ofVirtual Reality Technologies for Childrenon the Autism Spectrum. European Journal of SpecialNeeds Education, 26 (3), p. 355-366.

Seach, D. (2007). Interactive Play for Children withAutism. London: Routledge.

eodorou, F. and Nind, M. (2010). Inclusion inPlay: A Case Study of a Child with Autism in anInclusive Nursery. Journal of Research in SpecialEducational Needs, 10 (2), p. 99-106.

Trevarthen, C., Aitken, K., Papoudi, D. and Robarts,J. (1996). Children with Autism: Diagnosis andInterventions to Meet their Needs. London: DavidFulton.

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RESEARCH AIMS

is research aimed to study the social interactionand play of children with autism, and the role of theadult in developing play skills. e researchersexpected the children with autism to encountersigniTcant challenges in:

■ Learning how to play and socialise with theirpeers

■ Entering the play arena■ Listening and catering to others■ Arousing and maintaining the interest of others■ Ending the play.

e uses of play as a learning tool in both academicand social Telds were also highlighted by theresearchers.

RESEARCH METHOD

Forty-Tve children (11 girls and 34 boys) withautism in 11 groups were observed, withdocumented written notes and videotapes, inorganised and free play situations.

■ Twelve children were under 6 years of age■ Eighteen were between 6 and 11 years■ Fifteen were aged between 12 and 16 years.

e study addressed the question, “How do childrenwith autism play?” and sought to answer thisthrough analysis of the lone and group play activitiesof children with autism.

RESEARCH FINDINGS

Lone Play

In the majority of situations, the children withautism played alone without paying attention toother children and engaged in:■ Sensomotoric practice play, manipulating and

arranging items

■ Imitation, re-enacting the play of adults ratherthan peers

■ Simple functional play, with the preferred toyof choice being a car

■ Imaginative play. Although the children used thetoys in what appeared to be imaginative playscenarios, some may have been re-enactmentsfrom previous experience, playing in a mannerthat follows a story.

Group Play

ere appeared to be differences between playingtogether, creative action, cooperation, interactionand directing the action. e children who hadgreater language skills were more able to interactwith their peers. One child tended to be dominant,controlling the play, with the others followingimaginative play in such situations.

Television, video, music video, computer or the PlayStation were all popular forms of introducing sharedactivity. e children also engaged in rough-and-tumble play scenarios, appearing to enjoy them, butit became apparent that the children with autism haddifficulty discriminating when this moved toinappropriate and harmful behaviour.

IMPLICATIONS FOR PRACTICE(by the authors)

■ If there is a route to open the social world ofchildren with autism, then teachers, parents andallied health professionals need access to methodsto support the child on an individualised basis.

■ When children with autism are playing, we mustbe aware that there may be a logical pattern orstory to the play and that the child may bederiving some form of comfort. e child mayalso engage at particular times within the re-enactment, which could be opportunities for newlearning.

Research Paper

Alone and in a Group: Ethnographic Research on AutisticChildren’s Play

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■ As the child frequently re-enacts the play of anadult, a structured approach, with a scriptdesigned to support social interaction, can beused to develop opportunities for groupactivities.

■ Adults and peers may be used to teach morecomplicated play skills, yet focused repetitionand practice will be needed to allow the child tomaster the skill.

■ Use the motivator of television, video, musicvideo, computer or the Play Station to initiategroup play experiences, as the children actuallysupported one another as they discussed andguided the play.

■ Vigilance is needed when children engage inrough-and-tumble play, as the children may notbe able to see or interpret how another is feeling,when this is then changing to play that is hurtinganother. However, as rough-and-tumble playappears to be appealing and important forchildren with autism, the children may need tobe speciTcally taught a safe place and safe way ofengagement.

■ Children with autism will engage in functionalplay during unstructured times, yet thedevelopment to symbolic functional play may bedependent on cognitive and communicationskills.

■ e children’s play may be controlled by theircompulsion for repetition, sensory needs andpersonal interest, refelective of lone sensomotoricrather than group play activities. Having saidthat, novelty or the introduction of a motivatorcan interrupt lone play for engagement in agroup activity. Having a memorable experienceseems crucial for encouraging play progression.

Full Reference

Kangas, S., Määttä, K. and Uusiautti, S. (2011).Alone and in a Group: EthnographicResearch on Autistic Children’s Play. InternationalJournal of Play, 1 (1), p. 37-50.

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RESEARCH AIMS

Children with Asperger’s syndrome or high-functioning autism have been observed to initiateand reciprocate peer interactions much lessfrequently than peer-matched children withdevelopmental disabilities. Play dates, which arepopular in our society among neurotypical children,are thought to be an important contributing factorto the formation and maintenance of friendships.e current study set out to assess the relationshipbetween play date frequency and amount of conUict,with peer interaction observed on the schoolplayground. It was hypothesised that children withautism who experienced less conUict and morefrequent play dates would have more friends atschool and this would be reUected in more positivepeer interaction in the playground.

RESEARCH METHOD

Twenty-seven boys and four girls and their familiesparticipated in the study. Twenty-nine of theparticipants were in mainstream education and twowere in special education placements.

Parents were asked to complete the Autism SpectrumScreening Questionnaire, the Social SkillsResponsiveness Scale, the Quality of PlayQuestionnaire and the ConUict Scale. Children’sinteractions were also observed in playgroundsituations and their behaviour was coded to allow forquantitative analysis.

RESEARCH FINDINGS

e hypothesis that children with less conUict andmore frequent play dates would have more positivepeer interaction in the playground was partiallyconTrmed. e frequency of play dates, but notconUict on play dates, was related to rates of peerinteractions in the playground. It was also found that

children with autism who had more play dates in theirhome tended to engage for longer time in mutualbehaviours such as offering of objects, conversing andjoint attention. Importantly, they also received morepositive responses to their overtures from peers.

Results revealed that the frequency of play dates wasmost important in predicting joint engagement andpositive responses to overtures from peers, and theserelationships remained highly signiTcant even afteraccounting for other demographic, general social andcognitive variables, including verbal IQ.

It is noteworthy that the most important contributionof play dates to the development of friendship was theirpersistence rather than their quality; it would appearfrom these results that even play dates that werecharacterised by higher levels of conUict and lowerquality of interactions still fostered more interaction inthe playground.


Increasing the frequency and quality of play dates forchildren with autism may be an important outcome ofschool-based social skills training and may result in theformation and maintenance of best friendships. is isimportant as authors have found that where a childwith autism has a “best friendship” with a neurotypicalchild, the friendship has been found to be more durableand stable and both children have been found todisplay higher levels of goal-oriented social behavioursand positive affect.

Additionally, friends in mixed dyads were moreresponsive to one another, showed higher levels ofpositive social orientation and cohesion, anddemonstrated a more complex level of coordinated playthat those in non-mixed dyads.

As a consequences of these Tndings, it seems crucialthat parents are supported by the professionals working

Research Paper cont.

Mothers’ Reports of Play Dates and Observation of SchoolPlayground Behaviour of Children having High-functioning AutismSpectrum Disorders

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with their child to organise play dates that are heldoutside of the school day.

Full Reference

Frankel, F. D., Gorospe, C. M., Chang, Y. and Sugar,C. A. (2011). Mothers’ Reports of PlayDates and Observation of School PlaygroundBehaviour of Children having High-functioningAutism Spectrum Disorders. Journal of ChildPsychology and Psychiatry, 52, p. 571-579.

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RESEARCH AIMS

e purpose of this study was to provide adescription of the strategies employed by a mother ofa child with autism during games activities withtypically developing peers, to help support the childwith necessary social skills.

RESEARCH METHOD

is was a qualitative single-subject case study. eparticipants were a mother and her nine-year-old sonwith autism, one brother, and three typicallydeveloping peers. e participants were determinedvia a purposeful sampling technique.

e study was carried out in the family home and atthe children’s park. e researcher took part in thestudy as “participant observer”. e mother gave theresearcher the role of “teacher”. e brother wasinstructed to participate in the playgroup as a playpartner, in the same way as the peers and the childwith autism.

Data were collected using Teld notes, interviews,audio- and videotape recording during normalinteractions between the mother and her child.FFiigguurree 11

RESEARCH FINDINGS

In order to examine the interactions of the motherwith her child, the mother created a group of Tvepeople for her child to play hide-and-seek, tag, andother games with. e game of hide-and-seek, forexample, was played in a park near the child’s home.Video recordings of the game were examined. eanalysis of the recordings showed that the mother used13 verbal and seven non-verbal communicationstrategies during the game (Figure 1). How the motherused the strategies was as important as the kind andfrequency of the strategies.

e methods by which the mother used these strategiesare explained under the headings of:

Mother’s contributione mother determined the child’s play preferences and play initiations, made environmental arrangements, guided the participation process, found playmates and invited them to play.


A Description of a Mother's Play Guidance for her Child with Autismin the Process of Playing by the Rules

Verbal communication strategies

Giving instructionWhisperingAsking questionMaking explanationRemindingApprovingVerbal promptingSelf-talkEncouragingComical actionGiving feedbackRewarding

Non-verbal communication strategies

Physical promptingModellingGestural promptingMaking eye contactTouchingWaitingUsing gestures and mimics

Mother monitoring play initiations and thepreferences of her child. Once the mother knew her child’s play preferences,games were planned accordingly. e mother alsoused what the child liked to do as a reward, in thiscase playing computer games and cycling.

e mother initially played with the child alone tomonitor play initiations in the hide-and-seek game.When it was apparent that the child was not meetingthe tasks of the game, the mother invited the child’sbrother to participate in the game. She then hid withthe child and jointly tried to Tnd his brother. A fewdays after the Trst hide-and-seek game the motherplayed the game again in her home, helping herchild to Tnd the other children when he was “it”.

Environmental arrangements. e mother used the slide unit in the park for thechildren’s hide-and-seek game. e street lamplocated near the playground was chosen as the homebase.

Finding playmates and inviting them to thegame.e mother found the friends to play with her childand invited them to play the game.

Mother’s process of guided participation. e mother participated and guided the children.is process of guided participation can be examinedunder the following three headings:

■ Social communication guidance.By participating in the game the mother guided her child’s initial interaction with his peers, responded to the subsequent interactions and helped sustain his interaction.

■ Scaffolding interactions. e child was supported by his mother accordingto his needs. rough giving instructions, acting as a model and providing verbal assistance, the child’s initiations increased and the mother withdrew her support; however, she never carriedout any independent application.

■ Play guidance. e mother played with her son to help him takepart in the game. She gave him reminders to helphim focus and to complete tasks in the game.

Mother’s contribution in making her childparticipate in a “play by the rules” gameHide-and-seek is a game with Tve aspects: startingthe game, counting out, hiding, being “it” andending the game. e mother’s guidance process inthese aspects, the strategies she used to make herchild participate in the game and the child’sparticipation process are explained through thedescriptions below.

Starting the game activities. At the beginning of the game the mother wanted thechildren to gather in the playground and greet eachother. She guided them in planning the game andremembering the rules. To assist the child in thegreeting aspect, the mother attracted her child’sattention by touching him and asking him thequestion, “Did you say hello to your friends?” toremind him to greet his friends.

Counting out and choosing “it”. e children were gathered around. e motherchose one of the other children to count out. echild sang out a counting-out song whilst pointingto each child. When the child with autism was “it”the mother pulled her child to her chest (touching),getting his attention and making him wait. After theother children told him he was “it” his motherexplained he was “it” and directed him towards thehome base using physical prompts.

Hiding. e child’s activities consisted of Tnding a place tohide, waiting in that place, controlling home baseand tagging home base. For example, when the childhad to hide the mother told her son that they had tohide. e child waited and looked at his mother. emother then grabbed his arm and walked with himbehind the trees. e child crouched down when shetouched his shoulders and pointed for him to sit. Shealso gave him verbal instructions to hide quietly bywhispering, and then asked him to verify whether heunderstood what they were doing.

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Being “it”. When it was her child’s turn to count out, themother used a sign clue to get him to close his eyesand reminded him to count by saying “one”. Whenhe had completed his counting his mother attractedhis attention by grabbing the child’s right shoulder(touching) and saying “let’s seek now” (givinginstruction). When the child went in the wrongdirection, his mother called out his name to get hisattention, then called him near her by givinginstruction.

Ending the game of hide-and-seek. In the process of ending the game, planning theactivities of another game and saying goodbye werecarried out. e child’s mother grabbed his shoulderfrom behind and leaned slightly towards him. emother reminded the child to say goodbye by askinghim the question “Did you say goodbye?” emother also helped to make plans for arranginganother appointment for the day after. After thechild had said goodbye the mother gave her approvalby saying “Ok, let’s go”. She waved at the otherchildren (modelling).

An examination of the video recordings revealed thatthe sequence of how the mother took part in playactivities with her child showed similarities to that ofthe integrated playgroups model. In this study noinstructions were given to the mother. e child withautism and the mother have no educationalexperience about the integrated playgroups model. Itis thought that this model could be an easilyapplicable one.

is research was not aimed at observing the increasein the participation rate of the child at play or theusage of verbal expression. e gradual withdrawal ofthe mother’s guidance in the play and going back toverbal guidance while counting and being the personwho looks for others hiding in the game can beinterpreted as a way of increasing the child’sparticipation in play. A child with autism can learnhow to play games.

e data examined in this study revealed that amother having a child with autism acts as a guideduring games and uses verbal and non-verbal

interaction strategies in this guidance process. Indoing so she contributes to the process ofparticipation in the games by the child with autismand in the child’s social interaction with his peers.


If adopting the integrated playgroups model theresearch highlights that:

■ It is important before starting to engage in play the abilities and interests of the child should be observed and interpreted. e play environment and play materials should be prepared, and friends found and invited to play.

■ Skills should be taught in natural environments that are full of peers who have social capabilities and where children often display difficulties in social skills, such as in the home, at school and insocial areas.

■ Playgroups should consist of familiar children, siblings, at least three people, at most Tve people,and there should be more peers who have social competences in the group as this has been shownto help children with autism to improve their social skills.

■ e role of the adult should be to determine what the child can do independently and offer guidance to assist the child to participate in an activity that the child cannot do independently. e adult should then act as a support to assist the child’s performance in the play activity.

■ e authors also recognise that in future research,a child’s acquisition of play skills with the guidance of the mother could be examined by carrying out experimental studies. Further research could also examine the interactions of the children in the playgroup with each other using qualitative research methods.

Full Reference

Ökcun, M. C. and Akçin, N. (2012). A Descriptionof a Mother’s Play Guidance for her Child withAutism in the Process of Playing by the Rules.Journal of Research in Special Educational Needs, 12(2), p. 96-106.

■ Teacher as mediator – intervening in the face of potential misunderstanding or exclusion.

■ Teacher as active play partner – acting as a role model while engaged in the play scenario. e skilled exponent can be both playmate and facilitator.


■ When a child wishes to engage in an interaction with a peer, he/she may not have the necessary skills and in such an instance an adult should provide the child with autism with the necessary vocabulary and commentary.

■ e adult can motivate, engage and maintain attention by modelling the acceptable format of the play using the appropriate pedagogical interactions and framing. Children with autism rely on the adult to provide the opportunities and the resources to enhance interactions and learning.

■ Without over-interference the adult may have to explain the expectation of the play scenario on anindividual basis to the child with autism. If he/she does not know the rules of the play, he/she cannot be expected to learn them without speciTc guidance.

■ Such explanations must also be carried out in a timely fashion to ensure that others do not become frustrated when the child with autism does not comply with the rules and expectations of the play.

■ Children with autism learn from observing, modelling and interacting with their peers. However, teachers may have to teach the rudiments of the play activities to ensure understanding and inclusion. is direct involvement can lead to sustained attention, more shared experiences, and greater

18

Inclusion in Play: A Case Study of a Child with Autism in an InclusiveNursery

RESEARCH AIMS

is ethnographic case study aimed to understandand describe the play of a child with autism in anaturalistic early years setting. It discusses the playinteraction of a child and the strategies adopted byher teachers to facilitate her successful inclusion. eauthors hold the view that the promotion of play as avehicle for social interaction and learning is centralto support teachers to provide for successfulinclusion and the subsequent beneTts for all in thisclassroom environment. Teachers must plan theirpractice to ensure the inclusion of children withautism.

RESEARCH METHOD

e study was conducted in an early years settingthat aims to meet the educational needs of 50children between the ages of three and Tve years,coming from a diverse range of ethnic backgroundsin an urban setting. e focus was a girl with autismdescribed as being intelligent, computer-wise andhaving a keen interest in the character “omas theTank Engine”. Data derived from Teld and videoobservations, Teld notes of brief jottings, directquotations and episodes of dialogue and interviewswere collected in week-long blocks across a six-month period. e study observed the child withautism and her play but did not compare the child toher typically developing peers.

RESEARCH FINDINGS

e case study concluded that teachers attempting toensure successful inclusion facilitated the child byoperating in three distinct capacities:

■ Teacher as supporter - supporting the children’s play by modelling cooperative involvement whilst offering occasional commentary. To aid inclusion, the teacher asks the child a direct question and gives her a role within the play.

19


opportunities for learning and cognitive development.

■ Teachers have the opportunity to teach appropriate interactions with consideration and cooperation when immersed in the play situation.

■ e use of a collaborative and supportive curriculum framework assisted the teacher and other staff members to include, and the child to be included.

■ e strategies used by the setting were supportiveof all of the children, all-inclusive, contextually and culturally appropriate, and not seen as explicitly “autism-speciTc” approaches – good practice can be just that, good practice.

Full Reference

eodorou, F. and Nind, M. (2010). Inclusion inPlay: A Case Study of a Child with Autism in anInclusive Nursery. Journal of Research in SpecialEducational Needs, 10 (2), p. 99-106.

RESEARCH AIMS

Although most social play interventions have beendesigned and implemented in school settings,research suggests that typically developing childrenoften invite friends to play at home. To date therehas been little research to examine the home playdate as a potential intervention context for childrenwith autism.

e aims of this study were to assess the effectivenessof parent-implemented contextually supported playdates.

RESEARCH METHOD

Two boys with autism, their mothers and twoplaymates were recruited for the study through anagency providing early intervention services tochildren with autism. Children with autism wereincluded in the study if they:

■ Were aged between four and six years with a diagnosis of autism from a medical professional

■ Were able to understand English as their Trst language and had a receptive language age equivalent of at least three years

■ Were engaged primarily in parallel play with peers

■ Were able to remain independently engaged withpreferred play activities for at least 10 minutes at a time

■ Had access to a regular peer play partner who was no more than three years younger or older and had no identiTed social, cognitive or behavioural problems

■ Had a parent who agreed to the time commitment required for play date facilitator training. Children with autism were excluded if they engaged in serious peer-directed problem behaviour in peer play situations.

e two parents were taught how to designcooperative play arrangements to facilitate social

interactions between their children with autism andtheir typically developing peers. Play dates occurredin each family’s home across a variety of natural playsettings. Materials for the play dates varied accordingto the interests of the children and the play dateactivity. Materials were supplied by the parent exceptfor a few special toys that were provided by theresearcher.

To prepare for implementation, each parent receivedinstructions on how to host a contextually supportedplay date that involved:

■ Mutually reinforcing activities – activities that were motivating to both the child with autism and the peer.

■ Cooperative arrangements – activities that encouraged the participation of both children, i.e. coaching child-child interactions only as needed.

e primary dependent variable measured in thisstudy was the percentage of 30-second intervalsduring which the children with autism engaged insynchronous reciprocal interactions (SRIs) for themajority (i.e. at least 16 seconds) of the interval. AnSRI began when a child made a verbal statement orquestion, eye contact, facial expression orgesture/action that was directed toward the otherchild and was related to engagement in a jointactivity. If the child with autism was prompted bythe parent to make any of these, the subsequent SRIwas not counted. An SRI ended as soon as eitherchild stopped participating in a cooperative motoract (e.g. one child pulling his hand off a spoon whentwo children were stirring together).

Secondary measures included affect ratings for thechildren with and without autism and parents, plus ameasure of social validity completed by the parentsimmediately following completion of the study andone year later. In addition, a follow-up survey relatedto parents’ use of the key play date strategies.

Two independent reversal designs were used todemonstrate functional relationships between parent-implemented, contextually supported play dates andan increase in synchronous reciprocal interactions inboth participants. All sessions were videotaped for data collection. A

20

Parents as Play Date Facilitators for Preschoolers with Autism

21


research assistant (RA) who was blind to thecondition she was coding was enlisted to observe thevideotapes and record occurrences of the targetbehaviours. e RA was provided with a scoringmanual containing operational deTnitions ofexamples and non-examples of target behaviours,and a scoring protocol. Training was provided untilthe RA achieved 90% accuracy over three practiceplay date activities that were not part of the study.e data were coded and scored from all videotapedsessions. Videotapes were also reviewed to examinethe parents’ ability to implement the interventionaccurately. For each activity, a checklist was used toevaluate the parents’ use of the 10 strategies thatwere presented during training. Each strategy wasscored as either correct or incorrect for each play datesession.

RESEARCH FINDINGS

e results of this study suggest that teachingparents/caregivers to support social play in theirhomes is both feasible and desirable. ere was asteady increase in the number of implementationstrategies used by both parents. Activities for bothchildren increased during this phase and there was animmediate and dramatic increase in synchronousreciprocal interactions (SRIs) for both children. Supplemental measures also indicated improvementsin child affect and an increase in the number ofsocial invitations (e.g. sleepovers, birthday parties)received by the children with autism over a one-yearfollow-up period.

Upon completion of the study both parents ratedtheir conTdence in their ability to plan and executeplay date strategies as very high. ey also felt thattheir children’s ability to participate in play dates hadincreased. Approximately one year after theintervention ended, none of the social validity scoreshad changed dramatically. Both parents continued torate the strategies as useful, displayed conTdence intheir ability to use them and continued to host playdates using the strategies they had been taught. eresults therefore suggest that parents can learn skillsto become skilled play date facilitators within theirown homes within a reasonable length of time.


Each approach to play is best suited to children withautism with speciTc skills proTles; however, there islittle information available to inform decisionsregarding this. Parents in the study found that usingmotivating material, avoiding distracting stimuli,providing only one of each item so the childrenneeded to share, and preparing materials in advanceall helped with implementing this type ofintervention.

e authors of the approach examined in the presentstudy recognise that it is more appropriate for thehome setting that involves only a few children and issupported by parents. It is the Trst time a studyinvolved teaching parents to conduct contextuallysupported play dates and to use preschool childrenwith autism and young school-aged children aspartners. Future research is therefore required toexplore the effectiveness of this intervention across avariety of settings and across a more varied group ofindividuals.

A limitation to this study is that the sample size wassmall involving participants with distinctivecharacteristics. Future research would also be neededto replicate the training procedures with manydifferent types of parents and with children ofvarying ages, backgrounds and abilities, and toexamine the relative effectiveness of variousapproaches for supporting children with autism ofvarious ages and abilities.

is study did not anticipate the importance ofparent-to-peer prompting during the interventionand therefore did not assess the frequency of parentprompts across the videotapes. Future researchshould include a speciTc measure of this componentto determine its importance as part of the overalltraining aspect of the study.

Full Reference

Jull, S. and Mirenda, P. (2010). Parents as Play DateFacilitators for Preschoolers with Autism. Journal of Positive Behaviour Interventions, 13(1), p. 17-30.

RESEARCH AIMS

is study examined the effectiveness of the PictureMe Playing intervention for increasing the playdialogue (PD) of preschool children with autismduring pretend play opportunities with typical peers.

Picture Me Playing is a pictorially enhanced, script-based intervention targeting character role playthrough a narrative vignette.

e following research questions were investigated:

1. Would the intervention group exhibit greatergains in PD than the comparison group?

2. After both groups received the intervention would the participants demonstrate increases in their ability to produce PD with peers while playing with the trained toy?

3. Would the participants demonstrate increasesin scripted as well as unscripted utterances?

RESEARCH METHOD

e study was conducted at a private comprehensivetreatment centre for children with autism. Twelvechildren were selected and parental permission given.Children were aged between 55 months and 75months and had a diagnosis of autism or pervasivedevelopmental disorder - not otherwise speciTed(PDDNOS). e children were all able to followgroup-directed instructions as well as comply withand attend to group activities. Eight typicallydeveloping peers, four from each classroom, alsotook part in the study but were not targeted orassessed. ey simply acted as communicativepartners.

Attendees from two of the preschool classrooms wereassigned to comparison and intervention groupsbased on which class they attended. Each groupconsisted of 6 children with ASD (Tve males and onefemale) and four typically developing peers (2 males

and 2 females). Prearranged schedules and roles werein place prior to the intervention for this study.

Prior to the baseline observations, a toy survey wascompleted by caregivers of each child in order tochoose materials that were of equal familiarity andskill to each child. e Picture Me Playing story wasonly used during the intervention and was notavailable to the participants during data collection.

Baseline measures were taken for all the participantsdivided into the two groups of six. One group wasrandomly selected to receive the intervention duringthe Trst condition. e second group served as thecomparison group.

Data were collected in a quiet office within thecentre on two separate days, to limit the inUuence ofa participant’s individual mood on a given day. Adultprompting was not permitted with the exception ofending problematic or dangerous behaviour. Eachinteraction was video recorded and timed with astopwatch. In the baseline and intervention phases,the children were given the opportunity to interactwith the target toy (castle set) during two Tve-minute sessions occurring on separate days.Different peers were utilised to avoid the possibilitythat a particularly engaging or inhibiting peer mightskew the performance of an individual child. epeers participating in data collection also served asthe peers participating in the group intervention andeach child participated in data collection with at leastone same-sex peer. Data from only two play sessionswere added together, resulting in the amount of PDexhibited by each participant.

Transcriptions were coded in order to determinewhether participants would directly repeat thescripted utterances or if increases would be noted innovel, unscripted utterances.

Social validity questionnaires were distributed toparticipating families. Respondents were asked torate play skills on a three-point scale. Additional

22

Picture Me Playing: Increasing Pretend Play Dialogue of Childrenwith Autism Spectrum Disorders

23


questions required the respondent to agree ordisagree on a scale of whether they had observedbehavioural changes in the children.

RESEARCH FINDINGS

Results of this study indicate that the Picture MePlaying intervention was effective for increasing thePD of the children with autism during interactiveplay activities with typically developing peers.SigniTcant differences were displayed between theintervention and comparison groups and for thewithin-subjects comparisons following introductionof the intervention to the comparison group.Participants were able to generalise the increasedlevels of PD to a novel toy. A signiTcant 60% of thepost-intervention PD was coded as unscripted, novelutterances, indicating that the children were notstrictly following the scripts provided. Overall theparticipants demonstrated high levels of appropriatedialogue across the study and reduced the level ofinappropriate utterances by 4% after participating inthe intervention.

With regard to the children’s ability to maintain theirlevel of PD with an untrained toy, post-interventiondata were compared to generalisation data in order toevaluate whether there was a reduction in PDbetween the trained and untrained toys whenscripted utterances were not provided. Resultsindicated no signiTcant difference, demonstratingthat the level of PD was maintained fromintervention to generalisation.

Results of this study are consistent with previousstudies indicating that children with autism canincrease pretend play behaviours followingintervention. e Picture Me Playing interventionallowed children to engage in high levels of pretendplay with no adult prompting, and to maintain thelearned skill when only provided with a basic playstructure.


is research highlighted a number of implicationsfor practice:

■ Peers are a critical component of research focusing on child-to-child interaction. is study provided some evidence for the effectiveness of anintegrated playgroup. ere is no need to speciTcally train peers to prompt or cue children with autism.

■ It is essential to provide speciTc and direct instruction, even scripted dialogue, to children with autism; it is just as important to provide intervention in the natural environment during meaningful communicative interactions.

■ e Picture Me Playing intervention, because of its visual strategy, could be incorporated as an independent learning centre in a preschool classroom.

■ Results of the study are limited due to the small sample size and the lack of random group structure. Ideally, an additional generalisation condition should be implemented to mirror the baseline condition. us, baseline to generalisation comparisons from this study should be interpreted with caution. Emphasis in this study is, however, more appropriately placed on comparisons between post-intervention and generalisation data. Future research could repeat and extend these Tndings using both older and younger participants, and children with lower verbal ability.

Full Reference

Murdock, L. C. and Hobbs, J. Q. (2011). Picture MePlaying: Increasing Pretend Play Dialogue of Children withAutism Spectrum Disorders. Journal of Autism andDevelopmental Disorders, 41, p. 870-878.

RESEARCH AIMS

is study’s aim was to determine if children withautism engaged in less playful pretend play. isinvolves self-conscious awareness of pretending, andthe symbolic representation of the materialsprovided. It hoped to gain insight into the nature ofthe play amongst children by paying close attentionto those qualities of symbolic representational playthat might derive from and reUect speciTc aspects ofsocial engagement. e assumption made at thebeginning of the research was that children withautism display a limited capacity for creativesymbolic play.

RESEARCH METHODS

e study tested pretend play activities in 16 boyswith autism between the ages of 7:1 and 13:9 years,and 16 children (11 boys and 5 girls) between theages of 7:10 and 12:3 years who did not have autism,but did have a learning difficulty or a developmentaldelay. All children were matched through verbalability ascertained using the British PictureVocabulary Scales (BPVS).

e children were tested individually and this wasvideotaped for future reference and rating by anindependent clinician, who was not given any insightinto diagnosis, through two play scenarios: DollCondition and School Condition. e test consistedof:

1. Play without modelling – spontaneous play with the instruction, “Use these things to make up a story”

2. Modelled play, with the tester describing all of his actions.

e tester commented, encouraged and talked withthe children, yet did not participate in the play. echildren’s interactions were then rated in the six areasof:■ Attribution of symbolic meaning to play objects

■ Potential for Uexible use of objects

■ Self-awareness

■ Investment in symbolic meanings

■ Creativity

■ Fun.

RESEARCH FINDINGS

e study found that the playful pretend play ofchildren with autism, in both the spontaneous andmodelled interaction, was distinctive due todifficulties in the lack of awareness of self in creatingmeanings, investment in symbolic meanings,creativity and fun, which may be deemed as essentialand reUective of normative social and creative playdevelopment.

Children with autism demonstrated relativecompetence and ability with the mechanics ofpretend play, yet experienced difficulty with theexpression of this playfulness. Children with autismmatched their peers in terms of inventing imaginaryobjects, making one item represent another andUexibility in using the play objects. e childrenwith autism appeared to engage more conTdentlyand creatively when the play had been modelled,particularly when using the toys for more than onepurpose, and to illustrate the playfulness that can beachieved.


■ Children with autism can play and can engage in symbolic play activities. ey may simply be less emotionally expressive, and may be so in a manner that is difficult to recognise.

■ We may not realise what exactly is at the heart of their pretend play experience. erefore close attention must be given to the child’s expression of motivation and engagement in an array of playopportunities and situations.

■ Children with autism have difficulty with overt, easily recognised means of self-expression, the useof verbal and non-verbal communication, and practitioners may have to look for more subtle indicators. We cannot categorically state from

24

Qualities of Symbolic Play among Children With Autism: A Social-Development Perspective

25


observation whether the child is discriminating through his or her facial or bodily expressions.

■ As the child with autism experiences difficulty reading his or her own self-expression, he or she may have difficulty discerning the enjoyment andengagement of another, which may inUuence the development of perspective taking and interpersonal engagement.

■ Modelling play may be a suitable introduction toan activity for children with autism and may allow them to see a range of functions for particular toys and resources.

■ e fun experienced by a child with autism may also be indicated in an unusual manner. As practitioners, we may have to look more closely to see if the child is having a positive experience.

■ As practitioners, we must foster creativity in symbolic play by offering opportunities for joint engagement and negotiation with a range of partners.

■ More research is needed in the full curricular areaand leisure activity of play across other age rangesand developmental levels. is study asserts that the researchers have much still to learn on the quality of the child with autism’s play.

Full Reference

Hobson, R. P., Lee, A. and Hobson, J. A. (2008).Qualities of Symbolic Play among Children WithAutism: A Social-Development Perspective. Journalof Autism and Developmental Disorders, 39, p. 12-22.

RESEARCH AIMS

■ To research differences in levels of object play demonstrated by children engaged in both free play and play with their mothers and fathers

■ To investigate concurrent relationships between the levels of object play demonstrated by childrenwith autism and the verbal and play responsiveness of their mothers and fathers.

RESEARCH METHOD

Parents conTrmed their child’s diagnosis of autismand completed demographic questionnaires. Inaddition, assessments were completed regarding non-verbal quotients as well as receptive and expressivelanguage skill levels. Subsequently three 15-minutefree play observations involving mother and child,father and child and free play were conducted andanalysed.

RESEARCH FINDINGS

Children were found to engage in more relationalplay (stacking objects, sorting objects and “putin”/“take out” type activities) in play with theirmothers than in either free play or in play with theirfathers. is suggests that the play interactions withmothers mirror the quality of play interactions ofmothers and typically developing children. However,children with autism fail to develop functional andsymbolic (higher levels) of object play in comparisonto typically developing peers and doing so is linkedto better developmental outcomes. erefore,targeting higher levels of play may be particularlyimportant for play intervention delivered by mothersof children with autism.

e study found a strong connection between parentverbal responsiveness and higher levels of object playfor children with autism. For both parents the use ofverbal responses was linked with their child engaging

in a higher level of object play. ere was aparticularly strong correlation in play interactionswith fathers. ere are a number of interpretations ofthis Tnding:

■ Fathers’ use of responsive play behaviours may stimulate more frequent child play at the symbolic level

■ Fathers may use more responsive play behaviours with their children who can engage in symbolic levels of play

■ Fathers do not use as many responsive play behaviours if their children engage only in lower-level object play

■ Fathers’ responsive behaviours may encourage more symbolic child play, especially for children who are developmentally ready to engage in symbolic-level play.

However, there is no evidence in this study tosuggest whether fathers’ responsive play fosters childsymbolic play, or vice versa, or both.


is research indicates that object play skills mayincrease play development and have long-termbeneTts for joint attention and languagedevelopment for young children with autism.Targeting parental responsiveness to children’s playmay be a useful intervention strategy for youngchildren with autism.

Full Reference

Flippin, M. and Watson, L. R. (2011). Relationshipsbetween the Responsiveness of Fathers and Mothersand the Object Play Skills of Children with AutismSpectrum Disorders. Journal of Early Intervention,33, p. 220-234.

26

Relationships between the Responsiveness of Fathers and Mothers andthe Object Play Skills of Children with Autism Spectrum Disorders

27


RESEARCH AIMS

It is established that children with autism engage lessin imaginative play than their typically developingpeers.

e research aimed to examine the play and socialabilities of high functioning children with adiagnosis of autism (HFA) and compare theseabilities with those of a group of children with adiagnosis of developmental language disorder(DLD). It was hypothesised that the children with adiagnosis of high functioning autism would produceless developed forms of play than their DLD peers.

RESEARCH METHODS

e sample consisted of 30 children with a diagnosisof high functioning autism and 33 age- (7-9 years)and gender-matched peers.

e children were observed and videoed over a 25-minute period, during which they were presentedwith a puzzle box. eir play was observed for 10minutes with this and then in a 15-minuteunstructured play session with an unfamiliar adult.e adult was non-directive for the Trst Tve minutesof the play session but then became increasinglydirective to elicit age-appropriate play.

e child’s play and social functioning was thencoded from the 25-minute video.

RESEARCH FINDINGS

e children with autism demonstrated impairedplay skills and there were differences between thegroups in the area of symbolic play, functional playand in overall play. None of these differences wassigniTcant and the researchers concluded that neitherthe children with autism nor their DLD peers wereengaging in this kind of play at a high level.

e signiTcant differences between the groups werein the areas of engaging in rule-based play and

engaging in conversation. e children with autismscored signiTcantly lower than the DLD group inboth of these areas. Rule-bound game playing andsuccessfully participating in a conversation bothrequire the child to have an understanding of turn-taking, and this may be impaired in children withautism.

Another interesting Tnding was in the area of overallsocial rating. As expected, the children with autismscored signiTcantly lower than their DLD peers inthe early part of the play session. However, as theplay session continued the children with autismbecame more socially engaged and the differencesbecame non-signiTcant by the end of the encounter.is appears to be correlated with the degree ofdirection by the adult, and it would appear thatsocial engagement of the children with autismincreased as the adult became more directive andinvolved.

e Tnal notable Tnding was a relationship betweenplay and social functioning; the authors report playto be a signiTcant predictor of social function. eresearchers suggest that play could be a usefulmethod of increasing or improving the quality ofsocial functioning.


e research has a number of useful points forpractitioners:

■ ere tends to be a relationship between social engagement and play; professionals working withyounger children can use play as a way of engaging the child and for addressing any social impairment.

■ e research indicated that the child’s initial social difficulty decreased with the amount of engagement from the adult involved in directing the play. is suggests that guided one-to-one engagement may be a useful way of working withchildren who have impairments in play and social interactions.

The Role of High-Level Play as a Predictor of Social Functioning

28

■ e relationship between play and social engagement requires much more teasing out; the research addressed only those children said to be highly functioning, within a narrow age frame and within a relatively small sample. Future research with a larger and more representative sample size could focus in on mapping the broader correlations and potential causations between social engagement and play.

Full Reference

Manning, M. and Wainwright, L. (2010). e Role ofHigh-Level Play as a Predictor of Social Functioning.Journal of Autism and Developmental Disorders, 40, p. 523-533.

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RESEARCH AIMS

is research aimed to determine the impact of theAdvancing Social-communication And Playintervention (ASAP) on the play skills of threechildren with an average age of 4.2 years. All of thechildren presented with limited and impairedlanguage skills and identiTed needs in socialcommunication and play.

RESEARCH METHODS

e ASAP intervention is designed to target socialcommunication and play of children with autism ina preschool setting. e intervention targets 20social-communication objectives across the areas ofsocial interaction, requesting and joint attention, and21 play objectives across the areas of exploratory,relational, functional and symbolic play.

Following assessment to determine the level ofintervention, ASAP is delivered on a one-to-one basisfor 40 minutes once a week, and daily in 10-15-minute group instruction sessions to promotegeneralisation. e success of the programme isjudged by the frequency of spontaneous socialcommunication or play, speciTcally threeunprompted occurrences of targeted behaviours inone day.

e children were then observed in the school settingand their social communication and play behaviourswere recorded and coded.

RESEARCH FINDINGS

All of the children demonstrated increases in bothsocial communication and pretend play followingthe full implementation of the ASAP programme.For the single case design data, the strongestincreases were observed during one-to-one settings.However, they were also observable in group settings,but these increases were more variable. For socialvalidity, the results of an analysis of variance

(ANOVA) on the pre- and post-intervention dataindicated that all three children had signiTcantincreases in their social communication and playbehaviours.


e ASAP was an effective intervention to increasesocial communication and play for this small groupof children. e Tndings were variable across one-to-one and group settings.

e research supports the use of this programme andpractitioners may Tnd it a useful tool for guidingindividualised plans for children to assist thedevelopment of their social communication and playskills. It is worth noting that the intervention wasmost effective in a one-to-one setting andpractitioners should consider the need to workindividually with children prior to implementinggroup work. A Tnal observation is that the researchwas conducted on a very small group of children, allof whom were being educated in an autism-speciTcclassroom, and these factors might impact on theresults.

Full Reference

Dykstra, J., Boyd, B., Watson, L., Crais, E. andBaranek, G. (2012). e Impact of the AdvancingSocial-Communication and Play Intervention onPreschoolers with Autism Spectrum Disorder.Autism, 16 (1), p. 27-44.

The Impact of the Advancing Social-communication And Play(ASAP) Intervention

30

Symbolic Play of Preschoolers with Severe CommunicationImpairments with Autism and Other Developmental Delays: More Similarities than DifferencesRESEARCH AIMS

Research into the symbolic play of children withautism in comparison to developmentally delayedpeers has been equivocal. e majority of researchconTrms that children with autism have difficultieswith symbolic play and also limited functional play.Children with autism demonstrated less interest indolls and shorter play sequences than children withDown’s syndrome.

e researchers also highlight the relationshipbetween symbolic play, language and cognitive skills.Relationships have been identiTed between wordusage and symbolic play, and also later languagedevelopment and levels of symbolic play.

e researchers aimed to determine the differences, ifany, between a group of children with autism and agroup of children with developmental delay insymbolic play. ey hypothesised that the childrenwith autism would present with more limitedsymbolic play.

ey also wanted to determine the relationship, ifany, between measures of play and non-verbal andcommunication measures. ey hypothesised thatmeasures of cognitive ability and communicationwould be congruent with measures of play.

RESEARCH METHOD

e sample consisted of 35 children with autism and38 children with developmental delay. e averageage was 49.5 months. All of the children had adiagnosed learning difficulty as well ascommunication impairments.

e researchers used the Developmental PlayAssessment, which measures play ability over eightlevels and 15 categories. e children were observedin play situations, and their engagement in play wasmeasured and coded by observers.

e children were also assessed for their cognitiveand language abilities using a standardised measureof learning for preschoolers.

RESEARCH FINDINGS

e research Tndings indicated no signiTcantdifferences between the two groups of children inlevels of play or in expressed interest in playing withdifferent toys. e groups were similar in theiremergence and mastery of symbolic play, althoughthis was the least observed type of play for all of thechildren. e diversity and functional symbolic playwas not signiTcantly impaired in the children withautism in comparison to their developmentallydelayed peers. e most common type of play acrossboth the groups was functional play, and a few of thechildren across both groups engaged in low levels ofsymbolic play.

e researchers’ second hypothesis, that there wouldbe correlations between play, language andcognition, was supported. ere were highcorrelations between play, language and cognitivemeasures indicating that play is commensurate withthese measures

IMPLICATIONS FOR PRACTICE

Although the researchers’ hypotheses were not allborne out by the research Tndings, the research doeshave some useful elements for current practitioners.e importance of play in children acrossdevelopmental abilities is worthy of note. oseliving and working with children with autism andother developmental delays should note theimportance of play in their lives and promote playand play opportunities with children.

Working on play skills may also have a positiveimpact on the future development of language, andthe researchers conTrm that there is a relationshipbetween play and current and future language andcognitive abilities.

Full Reference

iemann-Bourque, K., Brady, N. and Fleming, K.(2012). Symbolic Play of Preschoolers with SevereCommunication Impairments with Autism andOther Developmental Delays: More Similarities thanDifferences. Journal of Autism and DevelopmentalDisorders, 42, p. 863-873.

31

RESEARCH AIMS

To study the individual differences in socialinteraction and communication, symbolic play, andlanguage among children diagnosed with autism,autistic spectrum disorder (ASD) and those with adevelopmental disorder (DD).

RESEARCH METHODS

ree groups of children between 2.11 years and 9.8years with a verbal mental age (VMA) of at least 15months were all tested on the Autism DiagnosticOberservational Schedule-General (ADOS-G) andthe Test of Pretend Play (ToPP).

e groups were divided as follows:

■ Children with a previous clinical diagnosis of autism conTrmed on the ADOS

■ Children with ASD who had received a diagnosisof social communication disorder and met some of the criteria for autism

■ Children with DD.

e hypothesis was that children with autism woulddisplay a relative absence of play features and thatthis reUects their underlying social-developmentalimpairment.

RESEARCH FINDINGS

On the composite measure of playfulness on theToPP, children with autism were given signiTcantlylower scores across the items (e.g. investment,creativity and fun) than participants with DD.

Across the three groups, the degree of children’scommunication/social interaction impairments onthe ADOS was associated with lower scores forplayful pretence. is indicates that socialcommunication impairments explained some of thevariance in quality of playful pretence, beyond theability to play as assessed.

e correlation between individual differences incommunication/social interaction impairment onthe ADOS and playful pretence scores on the ToPPwas only signiTcant for the children with autism.e most severe cases of communication and socialinteraction disorder were correlated with those moreseverely impaired in playful pretence skills.

Children with autism tend to show impairment inplayful pretence skills even when they have themechanics of symbolic play and when other qualitiesof play, as matched by the ToPP, are similar.

Impairments in social communication skills areassociated with limitations in play quality even whenformal play skills (assessed by the ToPP) areaccounted for.

e play of children with autism may befundamentally different from that of other children.

e social communicative nature of the play oftypically developing children is founded uponengagement with other people and the world. ereis a mechanical component to the symbolic playdisplayed by children with autism. e lack ofplayfulness may be an indicator of how socialcommunication skills contribute to the nature ofsymbolic play in typical children.“ey are tell-talesigns that the child is engaged in a…grounded process ofsymbolic meaning-making that seems relatively limitedamong children with autism.”

Full Reference

Hobson, A., Hobson, R., Malik, S., Bargiot,K. andCalo, S. (2013). e Relation between Social Engagement and Pretend Play in Autism.British Journal of Developmental Psychology, 31, p. 114-127.

The Relation between Social Engagement and Pretend Play inAutism

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Play and Communication in Children with Autism SpectrumDisorder: A Framework for Early Intervention

RESEARCH AIMS

is review of concurrent and longitundal studiesfound an association between object play andintentional communication in children with autism,with the authors stating that a theoretical frameworkis needed as a means of devising a model forconceptualising intervention involving play andcommunication in children with autism. e reviewfound four questions to be addressed:

1. Is there a positive association between object play and intentional communication in young children with autism?

2. Are there positive associations between speciTc categories of object play (i.e. non-symbolic and symbolic play) and intentional communication (i.e. non-verbal intentional communication and expressive language) within the population with autism?

3. Is the relationship among these aspects of development signiTcant and even after controlling for other probable explanations for the relationship?

4. For those with autism, is there evidence that this association is causal, and if so, in what direction?

RESEARCH METHOD

Meta-analytic and narrative reviews were conductedto examine the association between object play andintentional communication, with a range ofinclusionary and exclusionary criteria set. Twelvereports were Tnally identiTed as examining theassociation between the two and in relation tochildren with autism.

RESEARCH FINDINGS

Ten of the identiTed studies reported concurrentassociations between intentional communication andobject play in children with autism while Tveexamined longitudinal associations, with severalreporting both concurrent and longitudinalcorrelations. Findings included a suggestion that anincrease in object play causes an increase in non-verbal intentional communication, and that such anincrease in turn can cause an increase in symbolic

play. However, greater research is needed todetermine if the inUuence is greater between theassociation of non-verbal intentional communicationincreasing symbolic play or if symbolic play leads togreater non-verbal intentional communication.

Associations were found between non-verbalintentional communication and symbolic play aswell as a correlation between expressive language andsymbolic play. e authors have suggested that inorder to develop symbolic play, particularly as it hasits roots in the social context, the child must beafforded a range of opportunities whereby he or sheis interacting with and becoming aware of people,objects and actions in his or her environment, as ameans of assimilating the information. It is assumedby the authors that through such repeatedinteractions, the child’s attention to all within his orher environment will support development.


■ In order to develop expressive language with children with autism, the authors claim that there is a pathway to follow, with play as the medium to deliver development.

■ Acquiring and achieving Uuency within each areaof non-symbolic play, non-verbal intentional communication, symbolic play, and eventually expressive language are interrelated and interdependent. With each aspect, the educator must build towards acquisition and generalisation until Uuency is achieved.

■ At the beginning, the child with autism may need a stepping-stones approach before full engagement in a joint action routine, a foundational interaction pattern or framework, can be established. For example, this may includebuilding from “peek-a-boo” and “pat-a-cake”, to getting used to an interactive reciprocal game with an adult, to eventually partaking in a joint object-based play in a social environment. e reciprocity attained through play is a forerunner for the reciprocity needed for expressive communication.

■ Choice of play objects and actions must be individualised to meet each child’s stage of play development while cognisance is given to

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chronological age. e level of social communication skills of each child must also be attained as a means of informing the goal and content of the play offered. e play can then be differentiated as the child develops, with the objects having more than one function. is diversity can be supportive of the child’s opportunity to develop greater language and engagement.

■ Opportunities to practice newly acquired non-symbolic play skills are thought to lead to Uuency, which may result in generalisation of play actions across context. Use of generalised play actions can increase non-symbolic play skills, which can be supportive of turn-taking, a skill many children with autism Tnd difficult. As non-symbolic play is generalised, non-verbal intentional communication is introduced, and with this change comes learning.

■ is practice and communication development grows to include non-verbal intentional communication; once Uuency is established, the child’s symbolic play skills can evolve and with this their expressive language.

■ is format of building on already attained skills will form the basis of other intervention planningand implementation to maximise functional use of skills and ultimately to optimise developmental and lifelong outcomes.

Full Reference

Lieberman, R. G. and Yoder, P. (2012). Play andCommunication in Children with Autism SpectrumDisorder: A Framework for Early Intervention.Journal of Early Intervention, 34, p. 82-103.

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The quotation “The work of the child isplay” is generally attributed to JeanPiaget; this current Research Bulletincertainly provides evidence of this.

e articles summarised demonstrate the importanceof play in the social and communicativedevelopment of the child.

Using novel and enjoyable media such as computers,music or TV can promote group play and addressthe child with autism’s preference for playing alone.However, the child with autism may not have thesocial skills to understand the boundaries of rough-and-tumble play, and group play should bemonitored.

Both parents and teachers have a role in promotingand facilitating play skills, and also in supporting themaintenance of play once initiated. e promotionof play skills should be recognised as an opportunityto foster not just play but also social andcommunication skills.

e Centre’s tenth Research Bulletin is on the area ofAutism and Inclusion, comments on currentBulletins and suggestions for future Bulletins arealways welcome; please contact [email protected]

CONCLUSION

The Centre trusts that you have found this ResearchBulletin informative. It would be appreciated if youwould take a few minutes to provide the Centre withfeedback in relation to this bulletin by clicking on thesurvey link below.

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