Teaching play to children with autism
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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 l.jpg
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

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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

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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

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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!

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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

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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

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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…

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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

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Strategies with “Preliminary Support”Bass & Mulick (2007)

  • Integrated Play Group (IPG)

  • Peer Buddy

  • Group-oriented Contingencies

  • Siblings as Change Agents

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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…

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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…

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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

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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

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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)

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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?

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  • 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.