Pediatric Services Pediatric Services: An intervention team serving children with developmental delays.

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The following information was presented at a developmental conference by Mary Owen Ed. Specialist in Santa Barbara in 1998. The training covered the topics of developing play and social skills in Pre-School children with special needs. It was a well rounded presentation with broad applicability.
-Julie Loe

The Effect of Disabilities on Play Skills

A disability, handicapping condition, or delay can affect how a child plays, the kinds of play the child engages in, and the child's ability to use play as an avenue to learning and generalizing new skills or concepts. Although experiential background, personality. environment, and gender also affect how play skills develop, how children approach play, and the learning that the child takes from the play activity, children with disabilities will have distinct differences in their play. They may even need to be taught specific play skills before they can begin to learn through play.

The child may need to be taught such adaptations as how to get to materials or how to ask another child to play.

Physical Disabilities: Physical disabilities may affect the child's play in a variety of ways, depending on how the disability restricts movement. The child may have difficulty moving to the materials or areas available for play. She may have difficulty manipulating materials in a constructive or meaningful way. Certain conditions, such as cerebral palsy, may also restrict the use of speech.

Cognitive Disabilities: Delays or impairments in cognitive functioning may also delay the development of play skills. Children may need many opportunities to imitate and learn specific play skills before they are ready to put skills to work in the more generalized nature of play. They may also find it difficult to engage in high levels of socio-dramatic play because of difficulty thinking abstractly. Children with cognitive delays may also engage in more exploratory behaviors than in direct play behaviors.

Communication Disabilities: Difficulties with speech and/or language may inhibit the child's ability to enter into or initiate play with others, explain or comment about her own play, or play with the effects of words and language. The child may have trouble being understood by other children and adults and this may limit her/his ability to express desire for play materials or dislike of a play activity ("I don't wanna") Because language is closely related to cognition, problems with communication may interfere with ability to describe, extend, or control play with others.

Sensory Disabilities: Children with sensory problems such as visual or hearing impairments may experience a variety of play problems. Orientation to play areas and materials can be a major difficulty for the child with limited vision. This child may also lack exploratory or imitative skills. She may not understand the use of materials or objects because of limited experience in watching models or in manipulating objects. Early object exploration techniques, such as putting things in the mouth, may be observed. Hearing impaired children may lack language and speech skills and, thus. may have problems similar to the child with communications difficulties. These children also may not be able to respond to initiations by others and may be perceived by other children as not wanting to play. Opportunities for social play may be limited by this lack of responsiveness.

Social, Emotional and Behavioral Disabilities: Children's behavior often interferes with engagement in play and with the development of play skills. Constant withdrawal from others or from materials and activities restricts the child from social play and from manipulation of objects. Aggressiveness may limit the types of activities that the child is invited to join in by others and may lead to misuse and destruction of materials. Many children may have difficulty using pay as a tool for generalizing skills because of their focus on repetitive or stereotypic use of materials. Other children may have difficulty concentrating on specific pay activities long enough for real involvement to occur. Some children may be extremely fearful of new things and may be unwilling to risk exploration of materials with differing textures, size, or functions. The development of interactive play skills in handicapped children, which moves from being adult oriented to object or toy oriented to peer oriented can inhibit the development of social interactions with peers and delay the sequence of social play development.

Medical Disabilities: Health problems may be serious enough to hinder the development of play skills or inhibit the use of play learning new skills. A child whose movement is restricted by a health condition such as severe cardiac problems or asthma may tire easily and may engage in motor play in only very limited ways. Children who have been hospitalized frequently may lack the ability to initiate social or play interaction with other children. New techniques in care and programming for hospitalized children which focus on opportunities for learning, play, and interaction within the care setting are beginning to address the lack of stimulation in medical settings for young children.

Because most disabilities can have an impact on more than one area of development, it is important to be aware of individual differences in the development and use of play skills. Careful observation of children's interactions with objects and with people will provide a better picture of how a child's disability affects her/his play.

Cultural and Social Class Issues: There is some debate regarding whether culture and social class affect play in a negative way. Smilansky, in her 1968 studies, found distinct differences in the imaginative play and use of language in play between children from low income and children from middle income homes. Other studies corroborate these findings and also discover that the quality or level of dramatic play is lower among low-income children. Later studies, however, by Golomb (1979) and Stern, Bragdon, and Gordon (1976) have failed to confirm these findings.

Other studies have noted differences in the development of play skills across cultures or ethnic groups. For example, fantasy and imaginative play are virtually absent in some societies such as Russian and East African, but very rich and diversified in others such as New Zealand and Okinawa. (Johnson, et al. 1987.)

Culture and socio-economic status are variables that affect the availability of materials, space for play, and adult encouragement and modeling, which influence, in turn, play behavior and development.

From 'Play', by Mary Perkins (Region X RAP Coordinator), Portland State University RAP Raosource. Volume 5, #1. Adapted and distributed in Region III by Region III RAP, May 1990.

Typical development of object and social play

Play reflects a child's understanding of both the physical world and their social world. Play typically follows a development progression:

Simple to complex

Self to other

Concrete to abstract

Types of Play w/objects/toys

Sensory-motor play

Exploratory play

Representational play

Replica (theme) play

Coordinated symbolic play

Type of Social Play

Solitary play

Parallel play

On-looker play

Associative play (common focus)

Cooperative play (common goal play)

Strategies to support play with toys and objects

Play reflects a child's understanding of both the physical world and their social world. Two of the most important types of play to encourage in young children are replica play and coordinated symbolic play.

Replica (Theme) Play occurs when children recreate familiar situations with toys, for example, loading a toy school bus with dolls, driving it to school and having the "children" get off. This type of play helps children develop a sense of sequence and narrative important for language development and future literacy. Below are strategies to increase replica (theme) play: Provide high realism toys/objects and make visible.

The more realistic the toys/objects and the more familiar the real life experiences, the more easily the child should be able to replicate them into play themes. House play, shopping, riding the bus to school, setting up for snack at school, are all themes that can be easily replicated with simple, realistic props, such as dishes, pan, plastic food, used food boxes.

These theme "props" should be placed so they are visible, since many children at this play stage are not yet able to plan out the play theme, but rather, it unfolds based upon what is in the immediate environment. Thus, the toys available to support play themes should be organized and visibly displayed so that they can be easily incorporated into the play.

"Structured toys" are toys that provide a pre-designed theme such as the Fisher-Price Garage or toys that can be used in easily understood ways, such as the Brio Railroad Set. For example, it is more difficult to "imagine" and build a track and station out of basic blocks than to hook the Brio train tracks together and add the train and station.

Assist in maintaining focus on the play - "talking in the air". Adults can support play by providing comments that assists in maintaining focus on the play. Such commenting is sometimes called "talking in the air," in that the comments are made aloud, but without the expectation of a response from the child. For example, "The plane is flying all around." "Is that plane ever going to land?" The goal of this intervention is to assist in maintaining focus and expanding his play, rather than specifically directing his play.

Coordinated Symbolic Play occurs when the child uses something to 'pretend" something else, e.g., uses an object or action to represent something else. For example, pretending a pencil is a toothbrush or cupping hands and pretending to drink water. While symbolic play skills cannot be direct taught, the child who is almost ready to engage in this type play is likely to benefit from opportunities to play with this manner of thinking.

Model this "manner of thinking" . Adults (or peers with these skills) can model 'pretending" by miming an activity just done with a real object. For example, taking a drink from an imaginary cup just after pouring a juice into a real cup, or using on object to represent another by pretending a one-inch cube is ajar of mustard and putting in on a plastic hamburger.

Strategies to support social play skills

Many children benefit from adults to increase their social play skills. Two types of social play are parallel play and associative play.

Parallel Play is defined as: playing beside, but not with another in a similar activity or with similar materials; includes some imitation.

Associative Play is defined as: playing with another in a loosely structured, common focus activity.

The following are specific strategies to increase these social play skills: Provide opportunities for proximity.

For parallel play to occur children must be in proximity to one another and have access to similar type toys. Using furniture to create spaces that encourages proximity is a helpful intervention. Another is to identify toys and activities that support proximity such as water and sand tables. These types of toys/activities allow proximity and a common focus that encourages parallel play, imitation and taking-turns with objects.

Have enough toys. Having enough toys for all, and having enough of the same type toys, encourages parallel play.

Use adult as models, mediators and common focus creators. Adults should be available to both model and mediate simple reciprocal turn-taking during peer play. In addition, the strategy described as "talking in the air" can be utilized to create the common focus necessary for associative play.

"Talking in the air". Adults can support associative play by providing comments that assists in maintaining a common focus on the play. Such commenting is sometimes called "talking in the air," in that the comments are made aloud, but without the expectation of a response from the children. For example, "Both Billy and Andrew are flying planes. " Andrew's putting gas in his car. " The goal of this intervention is to assist in maintaining a common focus on the play, so that the children stay in a shared activity, rather than a parallel activity.

Stages of relating to others

Based upon the work of child psychiatrist Stanley Greenspan, M.D. more educators are becoming interested in learning about the developmental process, or stages. children go through as they learn to relate to others. Stanley Greenspan identifies four developmental stages:

1)Engagement

During this stage a child will follow you with her eyes, is eager for touch, shows emotion, responds to facial expression and engages, disengages and re-engages.

2)Two-Way Communication

During this stage a child responses to gestures and gestures in return, initiates interactions, points to desired objects, has joint reference and expresses a variety of feelings.

3)Shared Meanings

During this stage a child uses words and play to express feelings; engages in simple theme play that re-enacts care-taking themes and familiar activities.

4)Emotional Thinking

During this stage a child begins to distinguish what's real from what isn't, can follow rules and respond to limits, begins to connect feelings with behavior, and engages in more complex theme play.

Progression through these stages is dependent upon multiple developmental systems working together, including:

Cognitive

Language

Sensory

Affect

Motor

Greenspan proposes specific intervention strategies to assist children who are not progressing through the stages. He calls his strategies/program, Floor Time.

For more information: Greenspan, Stanley, (1990) Floor Time: Tuning In to Each Child (a videotape and training guide), Scholastic Inc.. ECE Division, NY. 1-800-325-6149. Greenspan, Stanley, "Reconsidering the Diagnosis and Treatment of Very Young Children with Autistic Spectrum or Pervasive Developmental Disorder," Zero to Three . vol. 13, no. 2. Oct./Nov. 1992.

Other useful resources

Drew Bledsoe of the New England Patriots has established the Drew Bledsoe Foundation Parenting With Dignity program. Bledsoe says of his success "my parents helped me the most to be what I am today" and his goal is to help other parents give their children the best possible start. For more information, see http://www.drewbledsoe.com/.

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Last modified: January 26, 2013