The Early Play Program

Transcription

1 The Early Play Program APAC 9 th September 2015 Presented by Genevieve Johnsson 1

2 Early Social Communication and Play Skills in Children with Autism Early social communication skills including the use of eye gaze, facial expression, and pointing (joint attention), as well as imitation and social turn taking are thought to be pivotal skills for social and language development (Charman et al., 2003; Kwisthout, Vogt, Haselager, & Dijkstra, 2008; Murray et al., 2008; Whalen, Schreibman, & Ingersoll, 2006) Deficits in these skills are possible early indicators of an Autism Spectrum Disorder (ASD) (Cornew, Dobkins, Akshoomoff, McCleery, & Carver, 2012) 2

3 Early Social Communication and Play Skills in Children with Autism Joint attention, imitation and object play have also been found to be strongly associated with: language ability at three-five years of age in children with ASD. (Thurm, Lord, Lee & Newschaffer, 2007; Toth, Munson, Meltzoff & Dawson, 2006) intellectual functioning at three-seven years of age. (Poon, Watson, Baranek, & Poe, 2012). 3

4 Parent-Mediated Programs Although parents appeared to have an instinctive grasp of how to mediate learning for their children they needed guidance on the meaning and importance of joint attention for future language and social development Schertz & Odom, 2007, p

5 Parent-Mediated Programs PMP s can allow intervention to begin early, involve consistent handling and ensures that the intervention is enhancing the child s earliest social relationships - their care givers (Diggle, McConachie, & Randle, 2003) PMP s have been found to have a positive improvement on parent emotional wellbeing (Brookman-Frazee, 2004; Soloman et al., 2014). 5

6 What is the Early Play Program? The Early Play Program is an 8+ session manualised home-based family program focussing on developing early social communication and play skills in children with autism. 6

7 Early pretend play Understanding a child s interests Teaching turn taking Encouraging imitation Encouraging functional play skills Early Play Program Focus Areas Encouraging joint attention Encouraging communication through visual supports Encouraging communication through people games 7

8 What does each focus area involve? Each intervention focus area has a session plan including discussion points teaching strategies activity sheet video exercises recommended homework information sheet for preschool/childcare 8

9 How do sessions run? Review homework and past sessions Introduce new focus area Model strategies Ask parents to practice in session (video if possible) Write all strategies in manual for parents to remember and practice 9

10 Early Play Program Research Questions Does participation in the Building Blocks Early Play program lead to; an increase in the child s social-emotional development? an increase in the child s early social communication and play skills (joint attention, imitation, behavioural requesting, turn taking and functional play)? an increase in parenting involvement, confidence, and emotional wellbeing? Are parents satisfied with the Building Blocks Early Play program? 10

11 Research Pilot: Participants 7 children; 6 males, 1 female (aged months) Formal diagnosis of Autism Spectrum Disorder Met at least 3 of the following criteria: prefer to play on their own and may become upset or move away when others try to play with them rarely bring toys to show others for shared enjoyment rarely point out things to others of interest e.g. plane in the sky have difficulty imitating another person s actions avoid eye contact when others attempt to play with them (based on parent report of the Building Blocks Play Skills checklist) 11

12 Research Pilot: Assessments Child Measures Early Social Communication Scales (ESCS, Mundy et al., 2003) Greenspan Social Emotional Growth Chart (SEGC, Greenspan, 2004) Early Social Communication Skills - Parent Report (developed by researchers based on ESCS, Mundy et al., 2003) Parent Measures Parenting Relationship Questionnaire Preschool (PRQ, Kamphaus & Reynolds, 2006) Family Quality of Life Survey (FQOL, Hoffman, Marquis, Poston, Summers, & Turnbull., 2006) Parent Satisfaction Questionnaire (PSQ, developed by researchers) 12

13 Research Pilot: Procedure Pre-Assessment Conducted at Aspect schools and offices ESCS, SEGC, PRQ, FQOL Early Play Program Intervention 8 x fortnightly intervention sessions conducted within family homes Post-Assessment Conducted at Aspect schools and offices ESCS, SEGC, ESCS (Parent report) PRQ, FQOL, PSQ 6 month Follow-up Conducted at Aspect schools and offices ESCS, SEGC, PRQ, FQOL 13

14 Research Results Significant changes in children s social emotional development (W(7) = 0, p <.01, Greenspan s Social Emotional Growth Chart) Significant improvements in response to joint attention and social interaction (W(5) = 0, p <.05, Early Social Communication Scales) Significant improvements in parenting involvement and parent emotional wellbeing (W(5) = 0, p <.05, Parenting Relationship Questionnaire and Family Quality of Life Survey) 14

15 Research Results Significantly decreased Somewhat decreased No change Somewhat increased Significantly increased Figure 1. Early Social Communication Skills Parent Report Joint Attention Imitation Behavioural Requesting Social Interaction Functional Toy Play 15

16 Research Results Strongly Disagree Mildly disagree Undecided Mildy agree Figure 2. Parent Intervention Satisfaction Strongly agree Learning Intervention effectiveness Materials Overall Satisfaction 16

17 Parent Feedback The best part was I came to know how to make my child enjoy the game Learning how to get my child to do things he normally would not do e.g. eye contact, playing with toys, group activity Learning to take simple opportunities of a few minutes to engage with my child in play and follow his lead rather than feel like I had to have ½ hour plus to devote each time One of the best parts is that it was home-based 17

18 Limitations Small sample size (low statistical power for repeated measures) Lack of assessment at pre-intervention of ASD severity rating and general developmental delay. Lack of control of other services children may be accessing and their potential impact on research outcomes. Difficulties with testing environment and standardisation for the Early Social Communication Scales. 18

19 Future studies Larger sample size Longer intervention period (by parent feedback) Conduct pre-assessment of autism severity and developmental profile e.g. using Autism Symptom Rating Scale and Developmental Profile 3 Collecting data on type and hours spent in other early intervention program Use video time sampling throughout the intervention period to measure early social communication skills in the natural environment 19

20 Conclusion Based on the initial data indicating improvements for both children and families as well as high levels of parent satisfaction, the Early Play Program shows promise as an effective and feasible intervention for young children with autism. 20

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22 References Brookman-Frazee, L. (2004). Using parent/clinician partnerships in parent education programs for children with autism. Journal of Positive Behavior Interventions, 6(4), Charman, T., Baron-Cohen, S., Swettenham, J., Baird, G., Drew, A., & Cox, A. (2003). Predicting language outcome in infants with autism and pervasive developmental disorder. International Journal of Language & Communication Disorders, 38(3), Cornew, L., Dobkins, K. R., Akshoomoff, N., McCleery, J. P., & Carver, L. J. (2012). Atypical social referencing in infant siblings of children with autism spectrum disorders, Journal of Autism and Developmental Disorders, 42, Diggle, T., McConachie, H. R., & Randle, V. R. (2003). Parent-mediated early intervention for young children with autism spectrum disorder. Cochrane Database System Review (1). Kwisthout, J., Vogt, P., Haselager, P., & Dijkstra, T. (2008). Joint attention and language evolution. Connection Science, 20, Murray, D. S., Creaghead, N. A., Manning-Courtney, P., Shear, P. K., Bean, J., & Prendeville, J. (2008). The relationship between joint attention and language in children with autism spectrum disorders. Focus on Autism and Other Developmental Disorders, 23(1),

23 References Poon, K. K., Watson, L. R., Baranek, G. T., & Poe, M. D. (2012). To what extent do joint attention, imitation, and object play behaviors in infancy predict later communication and intellectual functioning in ASD? Journal of Autism and Developmental Disorders, 42, Schertz, H. H. & Odom, S. L. (2007). Promoting Joint Attention in Toddlers with Autism:A Parent-Mediated Developmental Model. Journal of Autism and Developmental Disorders. 37: Solomon, R., Van Egeren, L. A., Mahoney, G. Quon Huber, M. S., & Zimmerman, P. (2014). PLAY Project Home Consultation Intervention Program for young children with autism spectrum disorders: A Randomized Controlled Trial. Journal of Developmental & Behavioural Pediatrics, 35(8), Thurm, A., Lord, C., Lee, L.C., & Newschaffer, C. (2007). Predictors of language acquisition in preschool children with autism spectrum disorders. Journal of Autism and Developmental Disorders. 37(9), Toth, K., Munson, J., Meltzoff, A.N., & Dawson, G. (2006). Early predictors of communication development in young children with autism spectrum disorder: joint attention, imitation, and toy play. Journal of Autism and Developmental Disorders. 36(8), Whalen, C., Schreibman, L., & Ingersoll, B. (2006). The collateral effects of joint attention training on social initiations, positive affect, imitation, and spontaneous speech for young children with autism. Journal of Autism and Developmental Disorders, 36,

24 Thank You 24