Lash McCoy
Lash McCoy
Lash McCoy
and
Patricia McCoy, MA, CCC-SLP
Website: www.marshall.edu/coe/atc
4
WHAT IS PLAY?
• Play is the universal language of childhood.
5
DEVELOPMENT OF PLAY
6
TYPES OF PLAY
9
HOW PLAY DIFFERS IN AUTISM (CONT.)
• Some children with autism do not give any
indication that they want to play with other
children; this may indicate that they prefer to
play alone or it may be that they do not have
the social or communicative skills to seek out
play interactions with others.
• Solitary play in children with autism is often
accompanied by a strong resistance to those
who attempt to participate or disrupt their
patterns or rituals.
10
HOW PLAY DIFFERS IN AUTISM (CONT.)
• The play skills of children with autism serve
as a window into what they understand.
• Using a computer
• Watching videos
• Looking at books
• Completing puzzles
• Using fine motor manipulatives
• Playing physical games
12
Playground
0%
40%
Solitary Play
60% Parallel Play
Interacting
*
BLOCKS
Blocks Area
0%
34%
Solitary Play
Parallel Play
66%
Interacting
WHY TEACH CHILDREN WITH AUTISM HOW
TO PLAY?
15
WHY TEACH CHILDREN WITH AUTISM HOW TO
PLAY? (CONT.)
16
WHY TEACH CHILDREN WITH AUTISM HOW
TO PLAY? (CONT.)
17
• Research has shown:
• that the predictability of interactions with adults
serves to increase the communicative
effectiveness of children with autism.
• peers are less likely to adapt their communication
styles. (Although peers can be taught to adapt
their behavior to be play partners for children with
autism.)
• during peer play sessions, the social
responsiveness of children with autism improved
when they were able to predict the sequence of
events involved in the play activity.
18
JOINT ATTENTION (JA) AND PLAY
19
• To be effective learners, children with
autism need to find meaning in everyday
interactions.
*
20
• Classroom teachers may not be
familiar with the prerequisite skills for
the development of preliteracy skills.
21
WHEN TEACHING JOINT ATTENTION THE SLP
SHOULD:
• Use preferred objects/toys
• Take the child’s lead in the play interaction
• Pay attention and comment on what the child
is doing
• Make your presence more obvious. Choose
to do things you know he will find interesting
to attract his attention.
22
• If he is standing in front of you with a
toy, react as if he is showing it to you.
Show interest and talk about it.
23
SUMMARY: TEACHING JOINT ATTENTION
• Imitate what the child is doing with the toy.
• Take the toy, comment on it, and wait for
them to reach for it.
• Use toys that need help such as placing a
favorite item in a container with a tight lid.
• Interact with toys at eye level so that the
child can shift their gaze between the toy and
your face.
24
WHY DOES IT MATTER?
26
PLAY AND SPEECH THERAPY
• Observing/evaluating play skills is an important part
of the initial assessment phase.
28
SLP’S ROLE (CONTINUED)
29
DELIVERY MODELS
Should lead to increased active engagement
Should build independence in natural learning
environments
Should facilitate peer-mediated learning
Should provide services that are connected with
functional and meaningful outcomes
30
EBP COMPENDIUM GUIDELINES
Six kinds of interventions should have
priority:
• Functional, spontaneous communication
• Social instruction
• Teaching of play skills
• Other instruction aimed at goals for cognitive
development
• Interventions to address problem behaviors
• Functional academic skills
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AND FINALLY…..
32
WHAT LANGUAGE SKILLS DO WE EXPECT TO DEVELOP
THROUGH PLAY?
• Attention getting
• Imitation
• Expressing emotions
• Negotiating
• Commenting
• Group play
33
HOW DO WE START?
FIRST STEPS
• Observing
• Waiting
• Listening
34
FIRST STEPS (CONT)
• Observing
35
FIRST STEPS (CONT)
• Waiting
36
FIRST STEPS (CONT)
• Listening
37
REMEMBER..
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SENSORY/EXPLORATORY PLAY
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SENSORY/EXPLORATORY PLAY
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SENSORY/EXPLORATORY PLAY
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NONFUNCTIONAL PLAY
• Using a toy/object in an
unconventional way such as lining up
objects, banging blocks instead of
building.
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NONFUNCTIONAL PLAY
– Attending to people
– Imitating actions
– Turn taking
44
FUNCTIONAL/CONSTRUCTIVE PLAY
45
FUNCTIONAL/CONSTRUCTIVE PLAY
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FUNCTIONAL/CONSTRUCTIVE PLAY
– Imitating words
– Following verbal directions
– Making requests
(signs/pictures/words)
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POTENTIAL THERAPY GOALS
To intentionally interact and communicate for a variety of
reasons.
48
POTENTIAL THERAPY GOALS (CONT)
Appropriately initiate social interactions with
peers and adults.
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OBJECTIVES
Managing Attention:
• Shift attention between people, activities, and
toys
• Pay attention to routine changes
• Increasing awareness of a play partner
• Awareness of, and interest in, playful social
interaction.
50
OBJECTIVES (CONT)
Communication:
• Understand and use a set of important
words and phrases (scripted language)
• Understand pictures as representing
activities, emotions, or people.
• Follows 1-2 step directives during play.
51
OBJECTIVES (CONT)
52
OBJECTIVES (CONT)
Call to others
Greet others
Request help
53
OBJECTIVES (CONT)
54
OBJECTIVES (CONT)
Emotional Regulation
• To stay emotionally regulated when others
say “NO”
• To stay emotionally regulated with the
unexpected happens
• To persist when appropriate
55
OBJECTIVES (CONT)
56
OBJECTIVES (CONT)
57
OBJECTIVES (CONT)
Cooperation:
• To follow routines within games and activities
• To communicate the desire to end an activity
• To take turns
• To move with others/in response to others
58
OBJECTIVES (CONT)
Play:
• To use toys in an intended way
• To use toys in a variety of ways
• To follow routines within games or activities
• To add new ideas to play, as inspired
• To join into play activities
59
WHAT RESOURCES DO I NEED?
• Play activities that are useful for building play skills
include (Quill, 2000):
60
WHAT RESOURCES DO I NEED? (CONT.)
Music activities
61
RESOURCES (CONT.)
62
WHAT ABOUT MATERIALS?
63
MATERIALS MAY INCLUDE:
64
MATERIALS MAY INCLUDE:
65
MATERIALS MAY INCLUDE:
66
THE PEER BUDDY SYSTEM
67
THE PEER BUDDY SYSTEM
The peer buddy system can be reinforced through
the use of tangible rewards such as stickers. If the
child with autism stays with his buddy for the
allotted amount of time he and his buddy will
receive a reward. Additionally, staff can set up a
“buddy” table. The “buddy” table will consist of
items/activities that are reinforcing to the child with
autism. The child must find a friend to play at the
table with in order to gain access to the
items/activities
68
MEET ZACHARY
A case study
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SEVERAL INITIAL PARENTAL CONCERNS
Making friends
Vocalizing at school
Finding a “friend”
SOCIAL SKILLS
Observations in after-school care to identify peers as
playmates
Collect baseline data for spontaneous verbal interactions
with peers and adults
Suggestions to after-school caregivers to encourage peer
interactions
Play dates scheduled at home
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31-03-2012
BASELINE DATA
SPONTANEOUS VERBAL INTERACTIONS
Observations conducted on 3 occasions
Baseline data collected on greetings, spontaneous
interactions with peers, interactions with adult
caregivers, and ease of transitions
Settings
Gym, snack time, computer time, playground
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31-03-2012
20
18
16
14
Spontaneous Interactions
12
10
0
15-1 15-2 15-3 15-4 15-5 15-6 15-7 15-8 15-9 15-10 15-11 15-12 15-13 15-14 15-15 15-16
15-Minute Periods
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31-03-2012
BASELINE DATA-INTERPRETATION
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31-03-2012
INTERVENTION
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31-03-2012
90
80
70
60
Interactions
50
40
Directed play
30
20
10
0
15-1 15-2 15-3 15-4 15-5 15-6 15-7 15-8 15-9 15-10 15-11 15-12 15-13 15-14 15-15 15-16 15-17 15-18 15-19 15-20 15-21
15 Minute Period
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31-03-2012
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31-03-2012
Facilitated Play with Peers
50
45
40
35
Verbal Interactionss
30
25
20
15
10
0
Christmas 1/19/2009 1/19/2009 1/19/2009 2/18/2009 2/18/2009 2/18/2009 4/15/2009 4/15/2009 4/15/2009 5/6/2009 5/6/2009 5/6/2009
Break
15 Min. Period
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31-03-2012
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31-03-2012
DATA SUMMARY
Baseline observational data collection:
spontaneous verbalizations = 19% of
observed time
Following play interventions: spontaneous
verbalizations= 49% of observed time
Responses following intervention:
appeared age appropriate
included both conversational reciprocity and
turn-taking while playing a two-person game
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31-03-2012
COMMUNICATION
Team members modeled greetings and used
verbal prompts to encourage responses
A social story was used to enable Zack to tell
others that he was hurt or in pain
Eye-contact was addressed during directed play
interventions, in the classroom, and at home
A social story was used to ask for help, and use
words to express “I don’t know”
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31-03-2012
QUALITY OF LIFE
84
31-03-2012
85
QUALITY OF LIFE (CONT.)
87
INTERVENTION STRATEGIES
• A visual support will be beneficial to help the child
with autism understand the play activity.
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INTERVENTION STRATEGIES
89
COOPERATIVE PLAY INTERVENTION
STRATEGIES
• When facilitating cooperative play, it is
important to remember to begin with adult-
child play dynamic and then bring in one child
to the play session, with the adult serving as
the facilitator.
90
COOPERATIVE PLAY INTERVENTION STRATEGIES
(CONT.)
• Select activities in which the children share a common
activity and work toward a common goal.
• Select activities that are motivating and reinforcing to the
child with autism.
• Select activities that do not require direct observation.
• Select activities that emphasize nonverbal responses and
limit the requirements for verbal interaction.
91
COOPERATIVE PLAY INTERVENTION STRATEGIES
(CONT.)
• Examples:
• Two children share a bin of blocks and take
turns building a tower.
• Two children play with play dough using a
play dough press or cookie cutter. When one
child has pressed or cut his play dough, then
he gives it to the other child.
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PLANNING FOR SOCIAL PLAY INTERVENTION
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INTERVENTION STRATEGIES FOR SOCIAL
PLAY INTERACTIONS
• Where to begin:
– Identify the social behaviors that are most important to
the play situation.
– The communication messages should mirror the
messages of the same-age peers: For example, the
typically developing 4 year-old may not say, “John, would
you like to play with me?” Instead they may say, “Come
on!” or “Look here.”
– Use a social script to teach what to say.
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SOCIAL SCRIPTS
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INTERVENTION STRATEGIES FOR SOCIAL
PLAY INTERACTIONS
• Example: A child has difficulty asking peers
if he can join in their "ball-tag" game at
recess. He will run into the group, take the
ball and then run away. The script would
read:
– Zachary - “I want to play"
– Guys - “O.K., Zach, wait for your turn."
– Zachary - "O.K.”
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SUMMARY
• Children with autism have deficits in play skills that impact
their social and communication skills, their cognitive and
emotional development, and their imagination and creativity.
• For children with autism, play skill development cannot be
left to chance. Play skills must be taught like any other skill.
• Play skills objectives should be part of IFSP and IEP
development and a data collection system should be in
place to assess improvement (or lack of) in these skills.
97
SOME TIPS TO GET STARTED
• Assess your child’s level of play development
• Structure your environment to support play opportunities
• Prepare materials/toys needed to engage in a variety of play activities
• Develop needed supports such as visual cues, scripts, labels
• Use multiple, short sessions throughout the child’s day to address
specific play skills (Always try to stop the session before the child
becomes tired or loses interest)
• Play activities should always stop on a positive note
• Get on the child’s level (physically and mentally!)
• HAVE FUN!
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From Steps to Independence, fourth edition. Copyright 2004 by Paul H. Brookes Publishing Co., Inc. all rights reserved
99
Play Skills Rating Scale: Sample Checklist
Child’s Name: ________________________________ Observation Date:____________________
Child’s Age:_______________________________ Observation time:____________________
Observed by: _______________________________ Location:__________________________
Circle the number which most closely describes the child’s play skills during this observation.
(Circle One)
Never Always
Appears to enjoy interacting with peers. 1 2 3 4 5
Able to enter play groups successfully. 1 2 3 4 5
Uses peers’ names 1 2 3 4 5
Communicates effectively with peers 1 2 3 4 5
Able to lead play effectively 1 2 3 4 5
Able to follow directions of others 1 2 3 4 5
Able to share materials appropriately 1 2 3 4 5
Able to solve social problems appropriately 1 2 3 4 5
Able to get attention from other children 1 2 3 4 5
Is accepted into play groups 1 2 3 4 5
Plays with a variety of children 1 2 3 4 5
Sought out by other children 1 2 3 4 5
Able to choose play activity 1 2 3 4 5
Appears engaged, involved 1 2 3 4 5
Play is appropriately complex 1 2 3 4 5
Shows enjoyment 1 2 3 4 5
Adds to play, has ideas about activity 1 2 3 4 5
Is creative in play 1 2 3 4 5
Appears comfortable with play 1 2 3 4 5
Interacts with make believe activities 1 2 3 4 5
Shows interest in different activities 1 2 3 4 5
Sustains play for appropriate period 1 2 3 4 5
100
OUR ROLE
• Understand the relationship between
language development, social skill
development, and play
• Consider more inclusive (“Push in”) services
• Help build independence in natural learning
environments
• Provide services that encourage functional
and meaningful outcomes
101
STRATEGIES DO PAY OFF
Baseline/Intervention Data for Peer Interaction During Play
33
35
30
25
20
15
6
10
0
Baseline Intervention
A PICTURE’S WORTH…
103
REFERENCES
• Beyer, J., & Gammeltoft, L., (2000). Autism and Play.
London: Jessica Kingsley Publishers.
104
REFERENCES (CONT.)
• Pei, C. (2000). Developing Play Skills in Pre-
Schoolers. ARC Newsletter, 3(4), 5-9.
105
REFERENCES AND SOURCES (CONT)
• American Speech-Language-Hearing Association
(Position statement, Compendium)
• www.centerforcreativeplay.org
• www.playsteps.com
• http://sites.google.com/site/autismgames/home (Tahirih
Bushey, MS CCC-SLP)
• Toys R Us (Toy Guide for “Differently Abled Children”)
• www.mousetrial.com
106
ADDITIONAL RESOURCES
www,asha.org/Publications/leader/2005/0509
27.htm
www.autisminternetmodules.org (OCALI)
www.centerforautism.com
www.fraser.org/tip_sheets/play_skills. PDF
www.teacch.com
107
A SCENARIO: WHAT CAN I DO?
108
ADAM (THROUGH THE STAGES)
109
ADAM (THROUGH THE STAGES)
Build a tower with blocks, build a bridge.
Sort the blocks into piles (color, shape).
Build a building.
Put the car on or in the building.
Push the car fast.
Make the car stop.
110
ADAM
• Representational/exploratory play
– Make a road and bridge. Drive the car over the
bridge
– Send the car over the edge of the table. Push
the car (with “zoom zoom”)
– Crash the two cars together (add crashing
noises)
– Make a ramp. Push the car over the ramp.
111
ADAM PLAYS
112
ADAM PLAYS
113
PRETENDING
114
ADAM PRETENDS
115
ADAM PRETENDS
116
PRETEND PLAY (CONT)
117
DESIGNING PLAY AREAS
• Size
• Provide enough space for the children to move
freely
• Avoid large open spaces as they can inhibit
social interactions and allow for the child with
autism to wander off and become segregated.
118
DESIGNING PLAY AREAS (CONT.)
• Boundaries
119
DESIGNING PLAY AREAS (CONT.)
• Organization:
120
DESIGNING PLAY AREAS (CONT.)
• Limit Distractions:
121
PLANNING FOR INTERVENTION
• Play skill intervention should be planned and
progressive.
• Target one skill at a time.
• Build from simple to complex.
122
PLANNING FOR INTERVENTION (CONT.)
• The easiest play activities are comprised of the
following components:
– Closed ended:
• Closed ended play activities involve toys and
materials being used in a specific way, utilizing a fixed
sequence of steps.
123
PLANNING FOR INTERVENTION (CONT.)
– Examples of closed-ended activities can
include:
• books,
• physical games with a sequence such as hop scotch
or musical chairs
• puzzles,
• board games
• art projects with a pre-determined final product.
124
PLANNING FOR INTERVENTION (CONT.)
• The easiest play activities are comprised of the following
components:
125
PLANNING FOR INTERVENTION
• The most complex play activities are comprised of the
following components (these are the most difficult for
children with autism):
– Open ended:
involve toys and materials that are used in a
variety of ways.
no sequence of steps or no pre-determined
outcome or ending
sequence of events and the outcomes are
determined by the participants
126
EXAMPLES OF OPEN-ENDED TOYS
playing in a sandbox
playing dress up
– Lego's/blocks
– action figures/dolls
– any type of manipulative
127
PARALLEL PLAY WITH OPEN ENDED
TOYS
• Promoting parallel play with open ended
toys can be accomplished by giving each
child a colored mat on which to build with
Lego’s.
• The children have their defined building
spaces but the Lego blocks are shared
between the children.
128
LEGO TABLE
129
PARALLEL PLAY INTERVENTION
STRATEGIES
• The first goal should be to support the child in
sharing physical space with peers. Specifically, the
child has his/her own set of materials and plays in
proximity to peers.
130
PARALLEL PLAY INTERVENTION
STRATEGIES (CONT.)
• Set up similar materials in the same play
space.
• Choose materials and activities that naturally
lend themselves to parallel play such as
water tables, action figures, toy cars.
131
PARALLEL PLAY INTERVENTION STRATEGIES
(CONT.)
• Select activities that allow the child to play
independently with his own set of materials.
• Select activities that do not require direct
observation.
• Select items/activities that are motivating to
the child with autism.
132
PARALLEL PLAY INTERVENTION
STRATEGIES (CONT.)
• Examples:
– Each child has a place at the table defined with a
placemat or tray and a container of puzzle
pieces.
– Each child has his own road rug and set of cars.
133
COOPERATIVE PLAY AND THE BLOCKS AREA
134
COOPERATIVE PLAY IN THE ART AREA
135
COOPERATIVE PLAY IN THE WATER TABLE
• Example:
– Place a water wheel in the empty water table; set six cups of
water nest to it.
– One child stands by the water table and gives the cup of water to
the child with autism.
– The child with autism dumps the water over the water wheel.
– Play continues until all of the cups have been used; the children
switch places and use another six cups of water. (This activity can
also be solidified for turn taking and exchange of roles to occur
after every cup of water.)
136
COOPERATIVE PLAY IN UNSTRUCTURED
GROUPS AT THE WATER TABLE
• Example:
– Place a bucket in each corner of the water
table; fill the table with plastic fish.
– Each child uses his own fishnet to scoop
fish into one of the buckets.
137
SETTING THE STAGE FOR SOCIAL
PLAY IN THE HOUSE AREA
• Completely organize the kitchen area.
Have all the items in clearly marked bins.
• Make sure all items are accessible to the
children.
• Limit the number of children in the House
Corner.
138
FACILITATING PLAY IN THE HOUSE AREA
139
FACILITATING PLAY IN THE HOUSE
CORNER (CONT.)
• Example:
– Set up a grocery store with every item clearly
labeled.
– The adult says to the child “working” at the cash
register, “I need some food for my house can you
help me?”
– Once the child offers help, the adult can incorporate
another peer by saying, “My friend needs some
food. Can you help him, too?”
140
INCORPORATING INTERESTS IN THE
HOUSE AREA
141
INCORPORATING INTERESTS IN THE
HOUSE AREA (CONT.)
142