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Teaching Play to Children with Autism. 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

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how do kids learn to play weiss harris 2001
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
teaching procedures for promoting play stahmer ingersoll carter 2003
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
pretend play and autism jarrold 2003
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
peer interactions play bass mulick 2007 mcconnell 2006
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!
peer modeling
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
peer modeling with an activity schedule
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
bass mulick 2007
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…
limitations of the strain protocol bass mulick 2007
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
strategies with preliminary support bass mulick 2007
Strategies with “Preliminary Support”Bass & Mulick (2007)
  • Integrated Play Group (IPG)
  • Peer Buddy
  • Group-oriented Contingencies
  • Siblings as Change Agents



a curriculum for teaching play weiss harris 2001
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…
pretend play weiss harris 2001
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…
macdonald et al 2005
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
ingersoll and schreibman 2006
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
ingersoll and schreibman 200624
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)
ingersoll and schreibman 200625
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?
  • 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.