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Teaching Play to Children with Autism


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 ... – PowerPoint PPT presentation

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Title: Teaching Play to Children with Autism

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
  • 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
  • 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)
  • Discrete Trial Training
  • Break down skill and use massed trials highly
  • 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
  • http//video.google.com/videoplay?docid-185488598
  • DRA
  • Self-Management Training
  • Useful for teaching the child to play when he is
  • In Vivo Modeling, Video Modeling, and Play
  • http//www.neccautismplay.com/curriculum.html

Pretend Play and Autism (Jarrold, 2003)
  • DSM-IV-TR criteria for autistic disorder
  • Under Communication domainLack 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
  • They cant?
  • It isnt 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
  • 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)
  • 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 childs 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
  • Using peers and siblings as therapists to
    initiate, prompt, and reinforce social
  • Reduce dependence on adult prompts
  • Increase generalization
  • Doesnt require additional phase of training
  • Natural and realistic models for language and
  • You should arrange for this even if you dont
    plan on using peers in your teaching!

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
  • Peer emits behavior (with or without teacher
  • Teacher may provide reinforcement for peer
  • Teacher prompts target learner to imitate
  • 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
  • When the schedule is completed, learners switch
    roles between playing model and imitator
  • May incorporate learners delivering reinforcement
    for each other

Bass Mulick (2007)
  • Strain, Odom, Goldstein, and colleagues have
    developed a line of research on peer-mediated
  • 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
  • Larger effects on responses
  • Limitations

Limitations of the Strain Protocol Bass Mulick
  • 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
  • Most research on pre-school age children
  • No recent replications in todays schools

Strategies with Preliminary Support Bass
Mulick (2007)
  • Integrated Play Group (IPG)
  • Peer Buddy
  • Group-oriented Contingencies
  • Siblings as Change Agents

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Developmental Play Assessment (Lifter, 2000)
Developmental Play Assessment (Lifter, 2000)
A Curriculum for Teaching Play (Weiss Harris,
  • 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
  • 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 Imitation
  • After 2-step imitation mastered
  • Choose objects that are interesting to child, but
    not objects that he only engages in stereotypy
  • 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
  • Lets 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 childs play You play and Ill
    tell a story
  • Have the child narrate your play Ill 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)
  • 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
  • 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
  • Its 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
  • Lack of generalization across therapists/settings?
  • Response under control of Do this whats 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
  • 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 childs interest
  • Gen novel toys not used in tx
  • Design MBD across participants
  • Eight 20-min sessions per week

Ingersoll and Schreibman (2006)
  • Baseline
  • Therapist attempted to gain child attention and
    modeled action and verbal model with toy (about
  • 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
  • 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

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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Ingersoll and Schreibman (2006)
  • 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
  • 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.
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