Teaching Play to Children with Autism

1. Teaching Play to Children with Autism

2. How Do Kids Learn to Play?(Weiss & Harris, 2001) • TD kids begin to imitate and are interested in other children even before turning 1 year old • Stages of Socialization in Play • Solitary Play – Child plays by self • Parallel Play – Child plays near another child, may show interest or occasionally exchange toys, but not really interactive • Associative Play – Several children are engaged in the same play and interact with one another. They share equipment or toys, but each child goes her own way • Cooperative Play – Children work together toward common goal or share a fantasy theme that requires mutual exchange to build scenario • Different pattern of development in kids with autism: • Repetitive and stereotyped play with toys • Difficulties learning imitation and learning through observation • Difficulties with pretend play

3. Teaching Procedures for Promoting Play(Stahmer, Ingersoll, & Carter, 2003) • Discrete Trial Training • Break down skill and use massed trials; highly structured • Using Stereotypy • Perseverative themes are used to teach play • PRT • Clear instructions, child choice, interspersal, direct/naturalistic reinforcement, reinforcement of attempts, turn taking • Reciprocal Imitation Training (RIT) • Developed to teach spontaneous imitation, but has been shown to result in collateral pretend play and joint attention • Therapist imitates actions and vocalizations of the child, labels what he is doing, and then begins interspersing models and reinforcing imitation • http://video.google.com/videoplay?docid=-1854885981808209926&q=%22joint+attention%22&total=13&start=0&num=10&so=0&type=search&plindex=2 • DRA • Self-Management Training • Useful for teaching the child to play when he is alone • In Vivo Modeling, Video Modeling, and Play Scripts • http://www.neccautismplay.com/curriculum.html

4. Pretend Play and Autism(Jarrold, 2003) • DSM-IV-TR criteria for autistic disorder • Under Communication domain…Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level • Pretend Play: “using one object to stand for another or invoking the presence of nonexistent objects or object properties” (p. 385) • Why do children with autism not engage in pretend play? • They can’t? • It isn’t reinforcing? • Children of same age with MR engage in flexible pretend play • Some children with autism do engage in some pretend play on their own, but typically stereotypic • But are they really pretending? • Does pretending mean just the action of using materials to “stand in” for other materials? • Or does it require an “awareness” that nonexistent properties are represented? • One way to measure might be to assess novel pretend acts and different pretend acts with the same objects

5. Peer Interactions & Play(Bass & Mulick, 2007; McConnell, 2006) • In free play situations, children with autism are more likely to • Play alone • Observe others from a distance • Engage in problem behavior • They DO interact with peers, but they • Make and receive fewer social initiations • Respond to fewer initiations • Engage in shorter bursts of interaction • Exhibit irregular eye contact • Inverse relation between a child’s rates of stereotypy/SIB and social interaction • Just putting children with more competent peers is not enough • Peers may misinterpret/ not reinforce/ may punish attempts at interaction • May result in further isolation for a child with autism • Using peers and siblings as “therapists” to initiate, prompt, and reinforce social interactions • Reduce dependence on adult prompts • Increase generalization • Doesn’t require additional phase of training • Natural and realistic models for language and behavior • You should arrange for this even if you don’t plan on using peers in your teaching!

6. Peer Modeling • Peer serves as model for engaging in an inappropriate behavior • In vivo or video model • Target learner and peer sit in proximity to each other • Peer emits behavior (with or without teacher instruction) • Teacher may provide reinforcement for peer • Teacher prompts target learner to imitate behavior • Teacher reinforces correct response • Teacher fades prompts • Teacher differentially reinforces prompted and unprompted responses

7. Peer Modeling with an Activity Schedule

8. Peer Modeling with an Activity Schedule • Learner A has activity schedule in front of him or her with pages with pictures/text instruction of responses to engage in • Learner A turns to page 1, gets any necessary materials, and performs action on page 1 • Learner B gets any needed matching materials and imitates action • Teacher provides reinforcement for both learners – edible in cup or token • Learner A turns the page and models the next action • When the schedule is completed, learners switch roles between playing model and imitator • May incorporate learners delivering reinforcement for each other

9. Bass & Mulick (2007) • Strain, Odom, Goldstein, and colleagues have developed a line of research on peer-mediated techniques • Protocol for training TD peers (“confederates”) • TD peers role play with adults until mastery • Adults model stereotypy and resistant behaviors typical of children with autism • Peers are taught to initiate, prompt, reinforce • Training conducted in the context of play activities in the natural environment • TD peers are prompted to interact with target children, activities, and materials • Visual cues (posters of skills) • TD peers receive reinforcement at first - systematically faded • Ringing bell, praise, happy face tokens (exchange for tangibles) • Increases in initiations and responses to initiations • Larger effects on responses • Limitations…

10. Limitations of the Strain ProtocolBass & Mulick (2007) • Implementation is complex • Requires socially skilled TD peers • Adults must train peers, control reinforcement, and record data • Possible teacher-prompt dependency • Inconsistent results with generalization • Inability to increase more advanced social behavior • Most research on pre-school age children • No recent replications in today’s schools

11. Strategies with “Preliminary Support”Bass & Mulick (2007) • Integrated Play Group (IPG) • Peer Buddy • Group-oriented Contingencies • Siblings as Change Agents

13. Dave Kelly

14. Developmental Play Assessment (Lifter, 2000)

15. Developmental Play Assessment (Lifter, 2000)

16. A Curriculum for Teaching Play(Weiss & Harris, 2001) • Toy Manipulation – Include more than 1 action with each object • 1 Step • 2 Step – both logical and illogical • Parallel Play – sit near someone else and play • Parent – same set of toys • Other child – start with different sets & preferred; later identical sets of toys • Video Modeling – should be able to imitate 1 step in vivo first; teach up to 3 step • Cooperative Play • Ball Play • Basic – teach to imitate different actions with different kinds of balls • With Receptive Commands • Reciprocal – rolling, kicking, throwing back and forth • Basic Sport Skills – make a basket • Play Stations – activity centers set up at different locations around a room • Art center, block center, animals/barn center, puzzles, train set • Start after 4-step imitation • Sustained Independent Play – Activity Schedules • Pretend Play…

17. Pretend Play(Weiss & Harris, 2001) • Pretend Imitation • After 2-step imitation mastered • Choose objects that are interesting to child, but not objects that he only engages in stereotypy with • Teach 1 step pretend – some with objects and some without; move to 2, 3, 4 step • Pretend Receptive Actions • “Pretend you are ________” (e.g., sleeping, feeding the doll) • Have several objects available so child has to choose one • Teach 1 step and increase to multi-step • Pretend Representational Play • “Pretend this is a ____________” (e.g., the banana is a phone) • Pretend Joint Imaginary Play • “Let’s pretend that ______________” and child and you each have an equal role • Each sequence 4-8 min long and each person describes his activities as he goes along • Prompt with video, auditory, written scripts and/or pictures • Play Narration • Narrate the child’s play – “You play and I’ll tell a story” • Have the child narrate your play – “I’ll play and you tell a story” • Have the child narrate his own play – “You play and you tell a story” • Play flowchart…

18. MacDonald et al. (2005) • Purpose – to evaluate effectiveness of video modeling in teaching long sequences of pretend play to children with autism • Participants – 2 boys with autism, ages 4 and 7 • Method • Toys – 3 sets with 7 objects/characters to manipulate (town, house, ship) • Scripts • Child was taught to manipulate and speak for characters • Each script had 16 scripts and 14 actions • Procedure • Baseline – given toys without video • Intervention • Child was shown video of adult playing with the toys and saying the script • 2 times consecutively • “It’s time to play” and brought child to materials for 4 min • No reinforcement or prompting • Mastery Probes – identical to baseline • Follow-up – maintenance after mastery without video; identical to baseline • Data collection – scripted and unscripted actions; scripted vocalizations • Design: Multiple Baseline Probe Design across play sets

23. Ingersoll and Schreibman (2006) • Background • Relationship between imitation and development of language, play, and JA • Discrete trial format for teaching imitation – limitations? • Lack of generalization across therapists/settings??? • Response under control of “Do this” – what’s the proper stimulus control for imitating? • Imitation not automatically reinforcing • Not taught in natural context • Purpose – Evaluate effects of Reciprocal Imitation Training (RIT) on object imitation and collateral changes in language, pretend play, and JA • Participants – 5 children with autism ages 2-3, limited imitation in play • Setting • Training – floor of treatment room • Gen – different room • Materials • 5 sets of identical toys in each session – varied each session (total over 50) • “Based on child’s interest” • Gen – novel toys not used in tx • Design – MBD across participants • Eight 20-min sessions per week

24. Ingersoll and Schreibman (2006) • Baseline • Therapist attempted to gain child attention and modeled action and verbal model with toy (about 1/min) • Familiar and novel actions; used toy child was and was not already engaged with • Action/verbal pair given up to 3 times • Verbal models varied across actions • No feedback • Gen probes – setting, materials, therapist • Treatment • 5 phases (2 weeks each phase) • Phase 1: No actions modeled • Phase 2: familiar actions modeled with same toy • Phase 3: familiar and novel actions with same toy • Phase 4: add familiar actions with different toy • Phase 5: familiar and novel actions with same and different toys • Naturalistic techniques • Contingent imitation – therapist imitated all child actions and vocs • Provided running commentary of child and therapist actions • Beginning in Phase 2, interspersed asking child to imitate • Reinforcement – praise and continued access to toy • Physical prompt after 3 models (followed by praise)

25. Ingersoll and Schreibman (2006) • Post-treatment and 1-month follow-up: Identical to baseline • Three to five 10-min post-tx sessions • 3 generalization sessions • Treatment Integrity? • DVs • First 10-min of each session of the day and all gen sessions • %age of actions imitated • %age of intervals with language and joint attention– partial interval recording • Frequency of play • Pre and post assessments • IOA? • Social Validity?

31. Ingersoll and Schreibman (2006)

32. References • Bass, J.D., Mulick, J.A. (2007). Social play skill enhancement of children with autism using peers and siblings as therapists. Psychology in the Schools, 44, 727-735. • Ingersoll, B., Schreibman, L. (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: Effects on language, pretend play, and joint attention. Journal of Autism and Developmental Disorders, 36, 487-505. • Jarrold, C. (2003). A review of research into pretend play in autism. Autism, 7, 379-390. • Lifter, K. (2000). Linking assessment to intervention for children with developmental disabilities or at-risk for developmental delay: The developmental play assessment (DPA) instrument. In K. Gitlin-Weiner, A. Sandgrund, & C. Schafer (Eds.), Play diagnosis and assessment (2nd ed., pp 228-261). New York: John Wiley and Sons. • MacDonald, R., Clark, M., Garrigan, E., & Vangala, M. (2005). Using video modeling to teach pretend play to children with autism. Behavioral Interventions, 20, 225-238. • McConnell, S. R. (2006). Interventions to facilitate social interaction for young children with autism: Review of available research and recommendations for educational intervention and future research. Journal of Autism and Developmental Disorders, 32, 351-413. • Stahmer, A.C., Ingersoll, B., & Carter, C. (2003). Behavioral approaches to promoting play. Autism, 7, 401-413. • Weiss, M.J., & Harris, S.L. (2001). Reaching out, joining in. Bethesda, MD: Woodbine House.