Play intervention and Children with ASD. Prof. Karen Stagnitti Deakin University Amaze Conference 2014

Transcription

1 Play intervention and Children with ASD Prof. Karen Stagnitti Deakin University Amaze Conference 2014

2 Today s presentation Play is a powerful intervention Why children with ASD would benefit Pretend play Pretend play and children with ASD Learn to Play program Research and case studies

3 To be truly competent in the world children must be able to do more than repeat a string of facts they must understand more than laws governing the physical world.to exist successfully within the world requires an understanding of people Westby, 1991, p. 131

4 Understanding people Is gained through a child playing Children observe and imitate others Reproduce what they see in their play Experiment with social situations, emotions Self-initiate their own play = organising their brain (Ayres, 1972) and deeper learning Extend beyond the literal = problem solving Flexibility Cooperating and negotiating with others in play Play is safe, non-threatening Children do their own risk assessments within play

5 Why children with ASD would benefit Difficulties in play is a characteristic of children with ASD Play pretend play involves social competence, flexible thinking, symbols and stories, and socialemotional regulation Understanding a child s pretend play gives valuable information about how a child engages within their world Mostly play ability is not directly addressed in many interventions Building self-initiated play ability is EMPOWERING for a child

6 Pretend play Understanding a pretend scenario requires children to: Go beyond the literal Understand the imposed meaning Interact meaningfully with others in social interaction To see the invisible Understand context of a situation Self-initiate

7 Development of pretend play 12 months to 5 years

8 Play scripts Body Within the home Outside the home Fantasy characters from books, TV etc Anything can happen

9 Sequences of play actions Repetitive and illogical Simple, logical sequential actions Late 3 years play strategy Play over 2-3 days Play over 2-3 weeks

10 Object substitution Manipulate objects Use a physically similar looking object for intended object Use same object for 2 or more representations Use body and imaginary objects Use any object doesn t look anything like the represented

11 Social interaction Imitate others Observe others Associative play Cooperate and negotiate

12 Doll/teddy play Place doll in correct position Doll does things on their own Doll has emotions Doll has its own life

13 Role play Imitate others Observe others Imitate a characteristic of someone Short periods of time in role Several roles within a play scene Same role within the play scene

14 Embeds other types of play Pretend play as understood here embeds other types of play Children can impose pretend play on other play skills, such as gross motor play or fine motor play

15 Play scripts Sequences of play action Object substitution Social Role Play Doll/Teddy Body 1 pretend action Functional use of objects in home in and out of the home personally experienced but less frequent life events 2-3 similar actions. illogical simple, logical actions Detailed logical actions. Imitates a pretend action similar looking object Imitates object substitution 1 object = 2 functions Child asks for objects needed in play Carries out actions previously seen As above imitates others 1 action Child sits doll in chair The doll can do things 1 object = many uses Parallel play. Short Doll wakes up, an abstract doll Symbolic play Construction play Themes include TV, books, computer games etc. Child uses multiple logical play actions uses blocks to build a wall. As Above a play strategy Child uses body parts and imaginary objects Associative play Role play is fluid a doll s house. As above As above Doll is a character good, bad, naughty Socio-dramatic Or Dramatic play Thematic Fantastic play Sub-plots occur in play anything at all. a planned storyline sequences are preplanned organised, logical and have subplots. Complex storylines use an object with a distinct function Cooperative, negotiate several roles own character language As Above same role Doll live its own life Role play

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19 Narrative Story telling

20 Development Of Narrative Pretend play develops before narrative ability begins 2 years Children can tell a story about themselves. They tell stories before they can read. 2-3 years Children attempt fictional storytelling 3 years Children begin to develop narrative ability 3 5 years Children move from description of objects and events, to temporal sequencing of actions relevant to solving a problem Preschoolers can tell stories and their storytelling can be enhanced. School age Majority of children possess a basic repertoire of narrative abilities. 3rd grade Children tell complete stories 11 or 12 years of age children reach a peak in their ability to tell oral narratives. The average child has mastered story grammar.

21 Pretend Play and Narrative Developm ent Understanding narrative intrinsically relates to a child s ability to forward think or predict what will happen. That is, children understand what the character s plans are and what is going to happen. Problem solving in the narrative gives children exposure to divergent problem solving skills.

22 Social interaction Social interaction is significantly related to elaborate pretend play Social disruption is negatively related to symbolic play particularly object substitution Social disconnection is negatively related to elaborate symbolic play

23 Pretend play and the brain

24 Pretend play overlaps with TOMM (Whitehead et al., 2009) Medial prefrontal cortex (ToMM, mentalising, emotion) Temporo-parietal junction Inferior frontal gyrus Posterior superior temporal sulcus (ToMM, emotional gestures) Anterior medial prefrontal cortex Temporal poles (ToMM, emotional gestures) Amygala Right posterior superior temporal sulcus Ventrolateral prefrontal areas (narrative) Orbitomedial prefrontal cortex (narrative) Posterior cingulate (role play, narrative) Inferior parietal and dorsolaterial frontal (role play, narrative)

25 Pretend play overlaps with narrative (Whitehead et al., 2009) Medial prefrontal cortex (ToMM, mentalising, emotion) Temporo-parietal junction Inferior frontal gyrus Posterior superior temporal sulcus (ToMM, emotional gestures) Anterior medial prefrontal cortex Temporal poles (ToMM, emotional gestures) Amygala Right posterior superior temporal sulcus Ventrolateral prefrontal areas (narrative) Orbitomedial prefrontal cortex (narrative) Posterior cingulate (role play, narrative) Inferior parietal and dorsolaterial frontal (role play, narrative)

26 Children with ASD - play deficits Children do not change easily from one activity to another they lack flexibility and adaptability. Doll play usually not played with in a representational way Play action sequences are poor or limited Linked to poor narrative Object substitutions may be present but usually only associated with 1 action chunking templates may be observed child may or may not imitate experimentation with objects may be the main form of play Repetition of play actions Seeing only the literal meaning Do not understand the play of their peers

27 Learn to Play program Stimulates the brain

28 Learn to Play program Learn to Play Program designed to increase the spontaneous initiation of pretend play Developmentally based program Suitable for children from months developmental age Successful if children have focused attention, meaningful 1 word, or gesture at 18 months level or higher It is a DYNAMIC INTERACTIVE PROGRAM

29 Learn to Play with children with ASD begin with structure start on the child s pretend play developmental level shift the child s attention by interrupting and/or challenging the play (eg, you move their parked car) use protodeclarative pointing (i.e., the toy is over there and you point as you say it) use emotions associated with the play e.g., scared, happy, tired, sad, surprised focus on developing logical, sequential sequences of play actions only use play scripts that the child has had some life experience of you will need to repeat play scenes but also use a variety of play scenes from the same developmental level remove structure as the child begins to initiate play

30 Establish the child s developmental play age Sequences of action Object substitution Social Play themes Role play Child s developmental level of pretend play Doll/Teddy

31 General Overview of Model Child s developmental level of pretend play Choose developmentally appropriate play activities Repeat Play activity Use emotions Have fun Variety of activities Amount of toys & objects Allow opportunity for child to initiate Challenge child

32 To begin Level 1: 18mths-2.5 years Repeat x 3 Variety on same level More play ideas 5 activities per 1 hour session Limited amount of toys & Objects Emphasis on engaging the child encouraging the child to imitate Developmental level across 6 developmental skills Challenge When child Is ready

33 When children begin to add one action to the play Repeat x 2 Variety on same level More play ideas 3 activities per 1 hour session Expand amount of toys & Objects Extend sequences Developmental level across 6 developmental skills Challenge Challenge

34 Challenge with problems to narrative Variety of play themes And Ability to add 1 activity per 1 hour session Expand amount of toys & Objects Extend sequences Developmental level across 6 developmental skills Expand

35 Learn to Play You give power to the child You have an idea of where to start and introduce a play idea You watch the reaction of the child You are usually on the floor not a table You supply the exact toys /materials you need You only add or change the play direction if it instigated by the child. You are not secure in total control, although you are monitoring all the time where the play is going

36 General Principles Start on the child s level Repeat play activity (Minimum 3 times >++) If child not coping either, lower developmental level or remove some of the toys Allow opportunity for the child to initiate ideas in the play scene. Work on several skills at once. Allow for challenge in the activities by introducing an activity from a higher developmental level.

37 Neurplastic principles 1. focussed attention 2. starting simple = where the child s development is 3. repetition with variation 4. pretend play, language and social skills fire together 5. use of symbols = higher abstract thought 6. play is relevant to a child s daily life = meaningful 7. You play with your child (seeking) 8. Child-initiated (neuroplastic principles from Diodge, 2010)

38 Power of Learn to Play Generalise to home and early childhood settings HAPPY Increase in language Increase in social turn-taking 7 sessions 2 years of sessions

39 Research Study 1

40 2006 Multiple case study design 4 children diagnosed with ASD Offered fortnightly sessions for 3 months Resulted in 6-7 sessions Honours student Siobhan Merchant

41 Analysed for Important Markers in Pretend Play Stagnitti, K. & Casey, S. (2011). The Learn to Play program con bambinis con autismo: practical considerations and evidence. Autismo Oggi, 20, (in Italian) Papers Analysed for Process of Learn to Play Stagnitti, K. (2009). The Learn to Play program. In K. Stagnitti & R. Cooper (eds). Play as therapy: assessment and therapeutic interventions. Jessica Kingsley Publishers: London.

42 3 of the 4 children reached Freedom in Play in 7 sessions. Major findings Freedom in Play = able to attach emotion and character to the dolls showing attention to detail being flexible in play increasing control of the play seeing the potential for the play materials Increased use of language. None of the Freedom in Play attributes were noted in the first session. Initially, EI workers were pessimistic about any improvements.

43 Pretend Play Ability Pretend play markers Attributing a property Reference to an absent object Initiate one action Asking for objects for play Attention to detail Initiating a sequence of actions Representation Object substitution Attributed an emotion to themselves Attributed emotions and character to a doll Increasing ability to decentre Understood potential for use of the play materials Pretend play related behaviours Social play turn taking Following emotional engagement child increased control of the play Increased language utterances Flexible in play Changes seen in EI settings Freedom in Play

44 Parent program Parents reported increase in play knowledge Parents reported increase in valuing play Parents reported of all the therapy yours is the most effective because I see the change at home

45 Benefits of Learn to Play After 3 months increase in: child s language child s ability to play independently time engaged in self-initiated play child s use of symbols in play child s ability to interact with others child s ability to initiate play ideas greater flexibility in coping with new play ideas

46 Specialist school 1 group with a play program (Learn to Play) 1 group comparison (no play) O Connor, C. & Stagnitti, K. (2011). Play, Behaviour, Language and Social Skills: The Comparison of a Play and a Non-Play Intervention within a Specialist School Setting. Research in Developmental Disabilities, 32,

47 Began with only 1 action (feed doll a doll using a spoon), no symbols in play. Elaborate symbolic play ability 2.5% Bill Finished responding to dolls as if real, sequences up to 15 minutes, use of symbols in play, enjoyment playing Elaborate symbolic play 40%. Spontaneous object substitution = 3. Writing books over Christmas 2010

48 Development continued after the program

49 Ned 6 year old boy ID and autism Language but no pretend play First session: working hard to engage him By 8 weeks in, mother reported his ability to selfinitiate play at home. After program finished on pretend play level at 2.5 years. Play at home with his sister for 2 hours at a time. Language improved. 4 years later he has come back play skills remained on level but didn t move He is beginning to increase in focus and follow through

50 thankyou Question?