Idea Transcript
Play intervention and Children with ASD Prof. Karen Stagnitti Deakin University Amaze Conference 2014
Karen Stagnitti (c) July 2014
Play is a powerful intervention Why children with ASD would benefit
Today’s presentation
Pretend play Pretend play and children with ASD Learn to Play program Research and case studies
Karen Stagnitti (c) July 2014
“To be truly competent in the world
children must be able to do more than repeat a string of facts…they must understand more than laws governing the physical world….To exist successfully within the world requires an understanding of people…” Westby, 1991, p. 131
Karen Stagnitti (c) July 2014
Is gained through a child playing Children observe and imitate others Reproduce what they see in their play Experiment with social situations, emotions
Understanding people
Self-initiate their own play = organising their brain (Ayres, 1972) and deeper learning Extend beyond the literal = problem solving Flexibility Cooperating and negotiating with others in play Play is safe, non-threatening Children do their own risk assessments within play
Karen Stagnitti (c) July 2014
Difficulties in play is a characteristic of children with ASD
Why children with ASD would benefit
Play – pretend play – involves social competence, flexible thinking, symbols and stories, and socialemotional regulation Understanding a child’s pretend play gives valuable information about how a child engages within their world Mostly play ability is not directly addressed in many interventions Building self-initiated play ability is EMPOWERING for a child
Karen Stagnitti (c) July 2014
Understanding a pretend scenario requires children to:
Pretend play
Go beyond the literal Understand the imposed meaning Interact meaningfully with others in social interaction To ‘see’ the ‘invisible’ Understand context of a situation Self-initiate
Karen Stagnitti (c) July 2014
Development of pretend play 12 months to 5 years
Karen Stagnitti (c) July 2014
Body Within the home
Play scripts
Outside the home Fantasy – characters from books, TV etc Anything can happen
Karen Stagnitti (c) July 2014
Repetitive and illogical
Sequences of play actions
Simple, logical sequential actions Late 3 years – play strategy Play over 2-3 days Play over 2-3 weeks
Karen Stagnitti (c) July 2014
Manipulate objects
Object substitution
Use a physically similar looking object for intended object Use same object for 2 or more representations Use body and imaginary objects Use any object – doesn’t look anything like the represented
Karen Stagnitti (c) July 2014
Imitate others
Social interaction
Observe others Associative play Cooperate and negotiate
Karen Stagnitti (c) July 2014
Place doll in correct position
Doll/teddy play
Doll does things on their own Doll has emotions Doll has its own life
Karen Stagnitti (c) July 2014
Imitate others Observe others Imitate a characteristic of someone
Role play
Short periods of time in role Several roles within a play scene Same role within the play scene
Karen Stagnitti (c) July 2014
Embeds other types of play
Pretend play – as understood here – embeds other types of play Children can impose pretend play on other play skills, such as gross motor play or fine motor play
Karen Stagnitti (c) July 2014
Play scripts
Thematic Fantastic play
Sequences of play action
Object substitution
Social
Role Play
Body
1 pretend action
Functional use of objects
Imitates a pretend action
in home
2-3 similar actions. illogical
similar looking object
Imitates object substitution
in and out of the home
simple, logical actions
1 object = 2 functions
imitates others Child asks for objects needed in play
The doll can do things
personally Detailed logical experienced but less actions. frequent life events
1 object = many uses
Parallel play.
Short
Doll wakes up, an abstract doll
Themes include TV, Child uses multiple books, computer logical play actions games etc.
uses blocks to build a wall.
Associative play
Role play is fluid
a doll’s house.
As Above
a play strategy
Child uses body parts and imaginary objects
As above
As above
Doll is a character – good, bad, naughty
Sub-plots occur in play
a planned storyline
use an object with a distinct function
Cooperative, negotiate
several roles
own character
anything at all.
sequences are prelanguage planned organised, logical and have subplots. Complex storylines
As Above
same role
Doll live its own life
Karen Stagnitti (c) July 2014
Carries out actions previously seen As above
Doll/Teddy
1 action
Child sits doll in chair
Symbolic play
Construction play
Socio-dramatic Or Dramatic play
Role play
Karen Stagnitti (c) July 2014
Karen Stagnitti (c) July 2014
Karen Stagnitti (c) July 2014
Narrative Story telling
Karen Stagnitti (c) July 2014
Pretend play develops before narrative ability begins
Development Of Narrative
2 years – Children can tell a story about themselves. They tell stories before they can read. 2-3 years – Children attempt fictional storytelling 3 years – Children begin to develop narrative ability 3 – 5 years – Children move from description of objects and events, to temporal sequencing of actions relevant to solving a problem Preschoolers can tell stories and their storytelling can be enhanced. School age – Majority of children possess a basic repertoire of narrative abilities. 3rd grade – Children tell complete stories 11 or 12 years of age – children reach a peak in their ability to tell oral narratives. The average child has mastered story grammar.
Karen Stagnitti (c) July 2014
Pretend Play and Narrative Developm ent
Understanding narrative intrinsically relates to a child’s ability to forward think or ‘predict’ what will happen. That is, children understand what the character’s plans are and what is going to happen. Problem solving in the narrative gives children exposure to divergent problem solving skills.
Karen Stagnitti (c) July 2014
Social interaction
Social interaction is significantly related to elaborate pretend play Social disruption is negatively related to symbolic play – particularly object substitution Social disconnection is negatively related to elaborate symbolic play
Karen Stagnitti (c) July 2014
Pretend play and the brain
Karen Stagnitti (c) July 2014
Medial prefrontal cortex (ToMM, mentalising, emotion) Temporo-parietal junction Inferior frontal gyrus
Pretend play – overlaps with TOMM (Whitehead et al., 2009)
Posterior superior temporal sulcus (ToMM, emotional gestures) Anterior medial prefrontal cortex Temporal poles (ToMM, emotional gestures) Amygala Right posterior superior temporal sulcus Ventrolateral prefrontal areas (narrative) Orbitomedial prefrontal cortex (narrative) Posterior cingulate (role play, narrative) Inferior parietal and dorsolaterial frontal (role play, narrative) Karen Stagnitti (c) July 2014
Medial prefrontal cortex (ToMM, mentalising, emotion) Temporo-parietal junction Inferior frontal gyrus
Pretend play – overlaps with narrative (Whitehead et al., 2009)
Posterior superior temporal sulcus (ToMM, emotional gestures) Anterior medial prefrontal cortex Temporal poles (ToMM, emotional gestures) Amygala Right posterior superior temporal sulcus Ventrolateral prefrontal areas (narrative) Orbitomedial prefrontal cortex (narrative) Posterior cingulate (role play, narrative) Inferior parietal and dorsolaterial frontal (role play, narrative) Karen Stagnitti (c) July 2014
Children with ASD - play deficits
Children do not change easily from one activity to another – they lack flexibility and adaptability. Doll play usually not played with in a representational way Play action sequences are poor or limited Linked to poor narrative Object substitutions may be present but usually only associated with 1 action ‘chunking templates’ may be observed child may or may not imitate experimentation with objects may be the main form of play Repetition of play actions Seeing only the literal meaning Do not understand the play of their peers
Karen Stagnitti (c) July 2014
Learn to Play program Stimulates the brain
Karen Stagnitti (c) July 2014
“Learn to Play” Program designed to increase the spontaneous initiation of pretend play
Learn to Play program
Developmentally based program Suitable for children from 12-18 months developmental age Successful if children have focused attention, meaningful 1 word, or gesture at 18 months level or higher It is a DYNAMIC INTERACTIVE PROGRAM
Karen Stagnitti (c) July 2014
begin with structure start on the child’s pretend play developmental level shift the child’s attention by interrupting and/or challenging the play (eg, you move their parked car)
Learn to Play with children with ASD
use protodeclarative pointing (i.e., the toy is over there and you point as you say it) use emotions associated with the play e.g., scared, happy, tired, sad, surprised focus on developing logical, sequential sequences of play actions only use play scripts that the child has had some life experience of you will need to repeat play scenes but also use a variety of play scenes from the same developmental level remove structure as the child begins to initiate play
Karen Stagnitti (c) July 2014
Establish the child’s developmental play age
Sequences of action
Object substitution Social
Role play
Play themes
Child’s developmental level of pretend play
Karen Stagnitti (c) July 2014
Doll/Teddy
General Overview of Model Child’s developmental level of pretend play
Choose developmentally appropriate play activities Use emotions Have fun
Repeat Play activity Variety of activities
Amount of toys & objects
Allow opportunity for child to initiate
Challenge child
Karen Stagnitti (c) July 2014
To begin
Level 1: Repeat x 3 18mths-2.5 years Emphasis on • engaging the child • encouraging the child to imitate
Variety on same level “More play ideas”
5 activities per Limited amount 1 hour session of toys & Objects
Developmental level across 6 developmental skills
Karen Stagnitti (c) July 2014
Challenge When child Is ready
When children begin to add one action to the play
Repeat x 2
Extend sequences
Variety on same level “More play ideas”
3 activities per 1 hour session
Expand amount of toys & Objects
Developmental level across 6 developmental skills
Challenge Challenge Karen Stagnitti (c) July 2014
Variety of play themes And Ability to add Challenge with problems to narrative Extend sequences
1 activity per 1 hour session
Developmental level across 6 developmental skills
Karen Stagnitti (c) July 2014
Expand amount of toys & Objects
Expand
You give power to the child You have an idea of where to start and introduce a play idea You watch the reaction of the child
Learn to Play
You are usually on the floor not a table You supply the exact toys /materials you need You only add or change the play direction if it instigated by the child. You are not ‘secure’ in total control, although you are monitoring all the time where the play is going
Karen Stagnitti (c) July 2014
Start on the child’s level Repeat play activity (Minimum 3 times >++)
General Principles
If child not coping either, lower developmental level or remove some of the toys Allow opportunity for the child to initiate ideas in the play scene. Work on several skills at once. Allow for challenge in the activities by introducing an activity from a higher developmental level. Karen Stagnitti (c) July 2014
1. focussed attention 2. starting simple = where the child’s development is 3. repetition with variation 4. pretend play, language and social skills ‘fire together’
Neurplastic principles
5. use of symbols = higher abstract thought 6. play is relevant to a child’s daily life = meaningful 7. You play with your child (seeking) 8. Child-initiated (neuroplastic principles from Diodge, 2010)
Karen Stagnitti (c) July 2014
Generalise to home and early childhood settings HAPPY
Power of Learn to Play
Increase in language Increase in social turn-taking 7 sessions 2 years of sessions
Karen Stagnitti (c) July 2014
Research Study 1
Karen Stagnitti (c) July 2014
Multiple case study design 4 children diagnosed with ASD
2006
Offered fortnightly sessions for 3 months Resulted in 6-7 sessions Honours student – Siobhan Merchant
Karen Stagnitti (c) July 2014
Analysed for Important Markers in Pretend Play Stagnitti, K. & Casey, S. (2011). The Learn to Play program con bambinis con autismo: practical considerations and evidence. Autismo Oggi, 20, 813. (in Italian)
Papers
Analysed for Process of Learn to Play Stagnitti, K. (2009). The Learn to Play program. In K. Stagnitti & R. Cooper (eds). Play as therapy: assessment and therapeutic interventions. Jessica Kingsley Publishers: London.
Karen Stagnitti (c) July 2014
3 of the 4 children reached “Freedom in Play” in 7 sessions. Freedom in Play =
Major findings
able to attach emotion and character to the dolls showing attention to detail being flexible in play increasing control of the play
seeing the potential for the play materials Increased use of language.
None of the ‘Freedom in Play’ attributes were noted in the first session. Initially, EI workers were pessimistic about any improvements. Karen Stagnitti (c) July 2014
Pretend Play Ability Pretend play markers Attributing a property Reference to an absent object
Representation
Object substitution Attributed an emotion to themselves
Pretend play related behaviours Social play – turn taking
Initiate one action
Attributed emotions and character to a doll
Asking for objects for play
Following emotional engagement child increased control of the play
Increasing ability to decentre
Attention to detail
Increased language utterances
Understood potential for use of the play materials
Flexible in play
Initiating a sequence of actions
Freedom in Play
Karen Stagnitti (c) July 2014
Changes seen in EI settings
Parent program
Parents reported increase in play knowledge Parents reported increase in valuing play Parents reported “of all the therapy…yours is the most effective because I see the change at home”
Karen Stagnitti (c) July 2014
After 3 months increase in: child’s language child’s ability to play independently
Benefits of Learn to Play
time engaged in self-initiated play child’s use of symbols in play child’s ability to interact with others child’s ability to initiate play ideas greater flexibility in coping with new play ideas
Karen Stagnitti (c) July 2014
1 group with a play program (Learn to Play)
Specialist school
1 group comparison (no play) O’Connor, C. & Stagnitti, K. (2011). Play, Behaviour, Language and Social Skills: The Comparison of a Play and a Non-Play Intervention within a Specialist School Setting. Research in Developmental Disabilities, 32, 1205-1211.
Karen Stagnitti (c) July 2014
Began with only 1 action (feed doll a doll using a spoon), no symbols in play. Elaborate symbolic play ability 2.5%
Bill
Finished responding to dolls as if real, sequences up to 15 minutes, use of symbols in play, enjoyment playing Elaborate symbolic play 40%. Spontaneous object substitution = 3. Writing books over Christmas 2010
Karen Stagnitti (c) July 2014
Development continued after the program
Karen Stagnitti (c) July 2014
6 year old boy ID and autism Language but no pretend play First session: working hard to engage him
Ned
By 8 weeks in, mother reported his ability to selfinitiate play at home. After program finished on pretend play level at 2.5 years. Play at home with his sister for 2 hours at a time. Language improved. 4 years later he has come back – play skills remained on level but didn’t move He is beginning to increase in focus and follow through
Karen Stagnitti (c) July 2014
thankyou Question?
Karen Stagnitti (c) July 2014