Play in Orphanages Vikas Taneja 1, R.S. Bed and J.M. Puliyel

1Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, Department of Pediatrics, St. Stephen" s Hospital, Delhi, India.

Abstract . Objectives: This paper attempts to validate the programme of structured play lasting 90 minutes a day, for use in orphanages, to check if it can be replicated in other orphanages, with similar results. Methods : A 2-week workshop on the structured play scheme was conducted at the Missionaries of Charity Orphanage in Delhi, the venue of the original project. 15 MOC sisters from 6 centers attended the workshop. The authors selected the MOC orphanage at Chandigarh to track the benefits of the programme. The development quotient of all the residents between the ages of 6 months - 3 years was assessed by a pediatric-clinical-psychologist using the Development Assessment Scale for Indian Infants (DAS II) scale. A reassessment of all these children was done again 3 months after initiating the programme of structured play here. Results: The mean motor and mental scores at the orphanage in Chandigarh before the start of the intervention were 57.9 and 58.2 respectively. Post intervention assessments showed a rise of 23 points in both the scores. Conclusion: The development of children in orphanages nses dramatically after initiating a programme of play. The pre-intervention development scores is similar to that in a pilot study and the benefits after play was also similar. The play programme can be easily replicated in other orphanages with similar results. [Indian d Pediatr 2004; 71 (4) : 297-299] E-mail: puliyel@vsnLcom.

Key words : Play; Development; Orphanages

The authors have previously demonstrated that a short, daily session of structured play can significantly improve the development of children in an orphanage. This project ca l led the "No t by Bread Alone Projec t" has been pub l i shed in the UK journa l Child: Care, Health and Development. 1 Ha v ing d e m o n s t r a t e d r emarkab le improvement in the development of children, it was felt that this programme of structured play could be used in o the r o r p h a n a g e s as well. The p resen t s t u d y was undertaken with the objective to see whether the results of this pilot s tudy could be replicated in other orphanages.

MATERIALS AND METHODS

The Missionaries of Charity center in Chandigarh was taken up as the index. This MOC center was selected, as it was relat ively close to Delhi and convenient for the au t ho r s to m o n i t o r the p r o g r a m m e . A clinical psychologis t did the assessments both before and 3 months after the intervention. She used the DASII scale 2 (the Indian adapta t ion of the Bailey's Scale of Infant D e v e l o p m e n t ) for mak ing the assessments . The o r p h a n a g e at C h a n d i g a r h has normal as wel l as physically handicapped children. Play was initiated such that all the children between the ages of 6 months and 3 years were included, regardless of their handicap. As the tes t ing in s t rumen t is not va l ida ted in h a n d i c a p p e d

Reprint requests : Dr. J.M. Puliyel, Department of Pediatrics, St. Stephen's Hospital, Tis Hazari, Delhi-110054 Fax No : 91-11-23932412

children, the pre and post intervention assessments were done in children without any physical handicap (n = 19). The p r o g r a m m e of p lay which was i m p l e m e n t e d is reproduced with permission of Child: Care , Health & Development (Table 1). The play therapist from the pilot study started the play programme. 1 Student's t test was used to calculate the p value for the difference between the pre and post intervention mean motor and mental scores.

RESULTS

Table 2 shows the pre and post intervention assessments of chi ldren at Missionaries of Char i ty o rphanage in Chandigarh. 19 children were assessed for their motor and mental scores both before and 3 months after the intervent ion. The mean motor and mental quot ients before the start of the intervention were 57.9 (SD - 16.6) and 58.2 (SD - 16.4) respect ively . Post in te rven t ion assessments showed a rise of 23 points in both quotients and this rise was statistically significant (p<0001).

DISCUSSION

The initial deve lopmen ta l assessments made by the clinical psychologist at Chandigarh, were similar to the pre in te rvent ion scores of the pilot s tudy pub l i shed earlier. This shows that the preintervention development quotient (DQ) in Chandigarh is as bad as preintervention DQ in Delhi suggesting that the low DQ of children in the

Indian Journal of Pediatrics, Volume 71--April, 2004 297

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Play in Orphanages

TABLE 2. Comparisons of Mean Motor and Mental Quotients in Children with Both Pre and Post Intervention Results

Variable (n) Mean Motor Mean Mental quotient quotient

(Standard (Standard deviation) dewatlon)

Pre-intervention 19 57.9 58 2 (16.6) (16 4)

Post-intervention 19 81.2 81.3 (12.6) (I1 4)

Difference 23.3 23 1 p-value < 0.0001 < 0.0001

Delhi o rphanage is not an isolated phenomenon . Thus in the absence of p lay , the m e a n d e v e l o p m e n t a l score of c h i l d r e n in o r p h a n a g e s is a r o u n d 60. This is a l so the f ind ing of others. 3,4

The sha rp rise in the m e a n m o t o r and men ta l scores over the first three mon ths was s imilar to the rise seen in the p i lo t s tudy . This s h o w s tha t the resul t s of the p i lo t s t u d y were the d i rec t resul t of the p l ay p r o g r a m m e and no t d u e to o the r e x t r a n e o u s factors. O the r r e sea rche r s h a v e a lso f o u n d tha t e a r l y s t i m u l a t i o n of in fan t s a n d chi ldren can boos t their d e v e l o p m e n t ? ,",7 The exper ience at C h a n d i g a r h s h o w s t ha t the p r o j e c t can be e a s i l y dup l i ca t ed in other centers.

In th is s t u d y the c l in ica l p s y c h o l o g i s t w h o d id the assessments was not involved wi th the p l ay p r o g r a m m e , so as to avo id errors due to observer bias. The remarkable s imi la r i ty wi th the scores seen in the pi lo t s t u d y (which deve lopmen t scoring was done by a pediatr ic ian who was no t b l i n d e d to the i n t e r v e n t i o n ) , is a r e f l ec t ion of the ve r sa t i l i t y of the a s s e s s m e n t i n s t r u m e n t be ing used . It a l so s u g g e s t s t h a t th i s is an o b j e c t i v e a s s e s s m e n t of ch i ld ren in the o rphanage

C O N C L U S I O N

The s c h e d u l e of the "Not b y Bread Alone Project" can accelerate the motor and mental deve lopmen t of chi ldren

in o r p h a n a g e s . In t h e a b s e n c e of a p r o g r a m m e to s t i m u l a t e c h i l d r e n t hey t end to have a d e v e l o p m e n t a l s c o r e a r o u n d 60. The s t r u c t u r e d p l a y s c h e d u l e , can improve these scores to near 90 over 3 months . The "Not by Bread Alone" project can be easi ly dup l i ca ted in other o rpha na ge s wi th the same benefits.

A c k n o w l e d g e m e n t

Ms. Ruchika Aggarwal, M.Sc. (Human Development and Family Studies), Child Development Specialist, Missionaries of Charity, 12, Commissioner's Lane, Delhi was involved in conducting the workshop on play and starting the play programme at the new center. She was also involved in the early versions of the write up of the project. The authors acknowledge that Ruchika would have qualified as a coauthor of this paper, but for the fact, that due to ewagration, she could not approve of the final version of the paper

Source of Support

The project was funded by the Indian Council of Medical Research, New Delhi.

REFERENCES

1. Taneja V, Sriram S, Ben RS, Sreenivas V, Aggarwal R, Kaur R, Puliyel JM. Not by Bread Alone Project: Impact of a Structured 90 minute per day Play Session on Development of Children m an Orphanage. Chdd: Care, Health and Development, 2002; 28: 95- 100.

2. Phatak P Manual for using Indian adaptation of Bayley's Scale of Infant Development; Based on Baroda Norms, Anand Agencies, Pune, India. 1995

3. Rutter M. Parent-child separation. Psychological effects on children ] C/hid Psychol and Psychiatry 1971, 12: 233.

4. Somen S A Study of Mental Health Status of Children in orphanages at Bangalore: Indian Journal of SoclaI Work 1986; 2: 137-145.

5. Broussard M. and Decarie T.G. The effects of three kinds of perceptual-social stimulation on the development of institutionalized infants. Early Child Care Dev 1971; 1:111

6. Sharma N (1989) Infant Stimulation-Documentation of Research in Delhi. New Delhi UNICEF.

7. Hunt JM, Mohandessi K, Ghodssi M, Akiyama M. The Psychological development of orphanage-reared infants: interventmns with outcomes (Tehran). Genettc Psychology MomNraphs 1976, 94. 177-226

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