Enhancing Pretend Play Skills in Preschoolers With Autism ......Enhancing Pretend Play Skills in...

Enhancing Pretend Play Skills in Preschoolers with Autism Spectrum DisordersBy Linda R. Watson

Case Studies by ASHA Professional Development 1

Enhancing Pretend PlaySkills in Preschoolers WithAutism Spectrum Disorder

Linda R. Watson, EdD, CCC-SLP

University of North Carolina at Chapel Hill

[email protected]

Speaker Disclosure

• Financial

– Professor at University of North Carolina atChapel Hill

– Research grant funding from the Institute ofEducation Sciences

– Financial compensation from ASHA for thispresentation

• Nonfinancial

– Lead author of the Advancing Social-Communication and Play Interventionmanual/materials



Why Pretend Play IsImportant

Object Play

“…consists of spontaneous,naturally occurring activitieswith objects that engageattention and interest”

(Lifter, Mason, & Barton, 2011)



Incorporating object substitution,pretend objects, or role play

SymbolicPlay

Relating objects to one another insimple ways

Relational Play

Conventional social uses ofobjects in play

FunctionalPlay

Exploring objectsExploratory Play

(Lifter, 2000; Casby, 2003)

Development of Play

Why is pretend play important forchildren with ASD?

Correlatedconcurrentlywith languagedevelopment,imitation,cognitive andsocial deficits(Ingersoll & Meyer, 2011;Manning & Wainwright, 2010;Thiemann-Bourque, Brady, &Fleming, 2012; Stone & Yoder,2001)

Correlatedlongitudinallywith languagegains(Stone & Yoder, 2001; Sigman& Ruskin, 1999; Smith, Mirenda,& Zaidman-Zait, 2007)



Correlatedconcurrentlywith languagedevelopment,imitation,cognitive andsocial deficits(Ingersoll & Meyer, 2011;Manning & Wainwright, 2010;Thiemann-Bourque, Brady, &Fleming, 2012; Stone & Yoder,2001)

Correlatedlongitudinallywith languagegains(Stone & Yoder, 2001; Sigman& Ruskin, 1999; Smith, Mirenda,& Zaidman-Zait, 2007)

Symbolic playOR jointattentioninterventionswith moreintentionalcomm. andbetterlanguage 1year later vs.control(Kasari, Freeman, & Paparella,2006; Kasari et al., 2008)



Preschool language skills have long beenrecognized as good predictors for long-term outcomes in individuals with ASD

(Billstedt, Gillberg, & Gillberg, 2005; DeMyer et al., 1973; Venter, Lord, & Schopler, 1992)

But how could pretend play contribute tobetter language?

?



Possible Processes Linking Pretend Play toLanguage Development in ASD

Some “interaction” variablescorrelated with children’s pretend

play include:

Caregiverresponsiveness

(Campbell et al., 2016)

Caregivercognitive

stimulation(Campbell et al., 2016)

Caregiver-childengagement(Campbell et al., 2016;

Hobson et al., 2013, 2015)

Transactional effects betweenchild’s pretend play and

caregiver behaviors

“Bi-directionalfeedback loop”

(Campbell et al., 2016; Lieberman & Yoder,2012)

Pretend play = goodcontext for scaffolding

social skills(Hobson et al., 2015)

Possible Processes Linking Pretend Play toLanguage Development in ASD



Pause…

Write down a few sentences thatyou could use to explain to a child’sparent why you are recommendingpretend play goals as part of thetreatment plan for a preschoolerwith ASD

Pretend PlayAssessment & GoalIdentification



Play Hierarchy (truncated)

© University of North Carolina at Chapel Hill, 2011

(Watson et al., 2011)

We assume a child has mastered a level inthe ASAP hierarchies if the childdemonstrates three different, unpromptedexamples of the behavior during theschool day

Mastery:The Rule of



Devon

3 years old

Self-containedclassroomsetting

Speaks in 1–2word utterances

How Does Devon Play?



How Does Devon Play?

How Does Devon Play in a DifferentContext?



•Cut with knife

•Pushed car alongpath

•Demonstratedtool use(hammer,screwdriver)

Child playswith toys infunctionalor “simple”pretendways

F1

•Fed dog

Childincludes adoll/actionfigure insimplepretendplay withtoys

F3

•Pretended thetool was anairplane

•Pretendedbaseball was icecream

Child usesone toy/object torepresent orstand foranother

S4

Emerging skills (prompted)Mastery





Pause…

Which play goal or goalswould you choose for Devon?

Mastered

Emerging

Emerging


Play Hierarchy (truncated) (Watson et al., 2011)



SupportingPretend PlayDevelopmentin ChildrenWith ASD

15 hours of directone-to-oneintervention

Kasari et al. studies

10 hours of parentcoaching

24 hours of parentcoaching

Intervention Intensity

Strongest evidence for impacton children’s later language



One-to-one for 40 min/weekacross school year

At least three classroom groupactivities per day, each with atleast three instructionalopportunities

Intervention Intensity

15 hours of directone-to-oneintervention

SEWing ItAll Up




Childincludes adoll/actionfigure in simplepretend playwith toys

F3 Objective Child will include adoll/action figure in simplepretend play with toys

Materials Doll/action figure,grooming supplies such ascombs, brushes, toy razor,toothbrush, etc.

SEW Setting it up

Grooming activity (one-to-one)

Devon’s Play Goal

Engaging the child

Childincludes adoll/actionfigure in simplepretend playwith toys

Devon’s Play Goal

Arrangement Have child in close proximity toteacher and materials

Activity Tell the child that the doll needs toget ready for work/school

See if the child will brush/comb thedoll’s hair, pretend to shave it, brushits teeth, etc.

Demonstrate the actions or promptif the child doesn’t direct actionstoward the doll

F3

SEWGrooming activity (one-to-one)



Three different, unprompted examplesof the behavior during the session orschool day

SEW Wrap-up

Demonstrated mastery

SEW Wrap-up

Demonstrated progress

If no progress in ~2 weeks, review interventionactivities – is the child interested and engaged?

Back up a stepIf no, returnto hierarchyand trydifferentactivities orstrategies Go to a higher-level goal if you

have seen evidence it isemerging

Go across the row to a differentgoal on the same row



Pause…

If Devonhadmasteredthe F3 playgoal, wherewould yougo next?

If Devon had beenworking on the F3play goal for 2weeks and shownno progress, wherewould you gonext?


Emerging

No progress

Mastered





Emerging

Mastered



Emerging

No progress




Play Intervention: One-to-One

Play Intervention: Small Group



Pause…

Design another activity

– Either for one-to-one intervention or asmall group that would provideopportunities to address Devon’s F3 playgoal

Use materialsand activities

that are ofhigh interest to

child(Lydon, Healy, & Leader,

2011; Porter, 2012;Stahmer, 1995; Wolfberg

et al., 2015)

Use naturalreinforcers

(Lydon, Healy, & Leader,2011; Stahmer, 1995)

“Mirroredpacing” –

imitation ofchild’s

appropriateand functionalplay, timed tooccur when

child isfocused on

the play act, &within child’sline of view(Gulsrud et al., 2016)

Naturalisticteaching –imitation ofactions on

objects(Ingersoll & Schreibman,

2006)

Empirically Supported Strategies(Jung & Sainato, 2013)



Follow-indirectives –more likely

than follow-incomments tobe followed

by childengaging infunctional

play(Bottema-Beutel et al.,

under review)

Scaffolding bydemonstrating

andprompting(Lang et al., 2009)

Videomodeling,including

point-of-viewvideo

modeling(Lydon, Healy, & Leader,

2011; Sani-Bozkurt & Ozen,2015)

Empirically Supported Strategies(Jung & Sainato, 2013)

Pause…

Review your activity

– Did you incorporate any of theseevidence-based strategies?

– Which of these strategies could you use?



Research links pretend play to later language andcommunication in young children with ASD

Pretend play may trigger transactional processes thatsupport language and communication learning

Developmental sequences of pretend play skillsprovide useful guidelines for intervention content

Varied, easily implemented strategies can enhancepretend play in young children with ASD

Evidence-based practice requires that we collect “localdata” on our clients’ progress to help guide decision-making

Have funplaying!



ASHA STRATEGIC OBJECTIVES

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OBJECTIVE #3: Enhance the generation, publication,knowledge translation, and implementation of clinicalresearch.

OUTCOME: ASHA has enhanced the generation,publication, knowledge translation, andimplementation of clinical research.

More information at www.asha.org/About/Strategic-Pathway/

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