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Longitudinal assessment of play and adaptive behavior in young children with developmental disabilities
Pergamon
Research in Developmental Disabilities, Vol. 20, No. 2, pp. 147–162, 1999 Copyright © 1999 Elsevier Science Ltd Printed in the USA. All rights reserved 0891-4222/99/$–see front matter
PII S0891-4222(98)00038-9
Longitudinal Assessment of Play and Adaptive Behavior in Young Children with Developmental Disabilities Jeff Sigafoos The University of Sydney and Children’s Hospital Education Research Institute (CHERI)
Donna Roberts–Pennell and Diane Graves The University of Queensland
Deficits in appropriate play have been widely documented among children with developmental disabilities. However, there has been little research on the development of play or the relation between play and adaptive behavior in such children. The present study involved a longitudinal assessment of play and adaptive behavior among 13 preschool children with developmental disabilities. Children were assessed every 6 months over a 3-year period. Assessments included standardized ratings of adaptive behavior and videotape observations during unstructured free-play times in the preschool classroom. Adaptive behavior increased by almost one standard deviation from the first to the last round of data collection. Appropriate play was observed during approximately 20% of each 30-min observation and showed little overall change over 3 years of study. Observed play was primarily functional (57%) and exploratory (28%) with less constructive (5%) and pretend (10%) play. Adaptive behavior scores were not Preparation of this manuscript was supported by a grant from the Australian Research Council. Previous versions of this paper were presented at the 23rd Annual Meeting of The Association for the Study of Play, April 2–3, 1997, Washington, DC, and at the XVth Biennial Meeting of the International Society for the Study of Behavioural Development, July 1– 4, 1998, Berne, Switzerland. Address correspondence to: Jeff Sigafoos, Children’s Hospital Education Research Institute (CHERI), The New Children’s Hospital, P.O. Box 3515, Parramatta, NSW 2124, Australia. E-mail: [email protected]
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consistently correlated with the amount or type of play. The results suggest little overall relation between appropriate play and other major domains of adaptive behavior. Implications for play-based assessment and intervention in early childhood special education are discussed. © 1999 Elsevier Science Ltd
Developmental disabilities, such as autism and mental retardation, are associated with serious delays in general psychosocial development (Baroff, 1991; Hersen & Van Hasselt, 1990). By definition, children with developmental disabilities exhibit substantial deficits in one or more areas of adaptive functioning. For example, deficits are often found in communication, self-care, social, and leisure skills (Matson & Mulick, 1991). In addition to substantial deficits in adaptive behavior, many children with developmental disabilities exhibit serious problem behaviors, such as frequent aggression, self-injury, or extreme tantrums (Duker, van Druenen, Jol, & Oud, 1986; Luiselli, Matson, & Singh, 1992). The combination of behavioral deficits and excesses represents a severe disadvantage that limits participation in many aspects of daily life in the home, school, and community. The behavioural deficits and excesses associated with developmental disabilities no doubt stem in part from neurologically based difficulties in learning. In particular, learning via more incidental and social learning processes (e.g., instruction following, imitation) appears particularly problematic for children with developmental disabilities (Remington, 1996). In contrast to normally developing children who acquire many skills by following instructions, observing others, and by incidental contact with the environment, children with development disabilities seem to require intensive and systematic instruction to learn many basic skills (Green, 1996; Schopler & Mesibov, 1994; Snell, 1987). However, little is known about how much or what types of skills might be acquired via less structured and more incidental learning opportunities. For example, would such children show any development in play-related behaviors within the relatively unstructured free-play periods that occur in most preschool classrooms? The impact of disrupted learning processes is often manifest dramatically in the play of children with developmental disabilities. Whereas the vast majority of normally developing children readily acquire sophisticated play skills without deliberate or systematic instruction (Garvey, 1991; Moyles, 1994; Sutton– Smith, 1976), young children with developmental disabilities often have considerable problems related to play (Quinn & Rubin, 1984; Malone & Stoneman, 1995). Indeed, inappropriate play is a defining characteristic of autism (American Psychiatric Association, 1994) and deficits in the amount and type of play have long been noted among children with developmental disabilities (Baron– Cohen, 1987; Horne & Philleo, 1942; Li, 1981; Stahmer, 1995). Play is likely the dominant activity in the daily life of most children in Western societies (Sutton–Smith, 1976). Play is also an important component in
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early childhood education programs (Bredekamp & Rosengrant, 1992). The attention given to play does indeed appear justified. Considerable evidence suggests that play contributes greatly to the child’s overall development (Moyles, 1994; Pepler & Rubin, 1982). More specifically, play is often the catalyst for the acquisition of important social, motor, and cognitive skills (Scales, Almy, Nicolopoulou, & Ervin–Tripp, 1991). Given the importance of play to psychosocial development and the ubiquity of play in early childhood and early childhood education, deficits in play-related skills will no doubt have serious negative consequences for the child’s overall development. To ameliorate such deficits and provide more effective early childhood special education, it is therefore necessary to better understand the development of play and the relation between play and other areas of adaptive behavior in children with developmental disabilities. Despite the pervasive and often rather obvious deficits in play among children with developmental disabilities, play-based assessment and intervention has been relatively neglected in early childhood special education (Hanline & Fox, 1993). A review of the literature by Malone and Langone (1994), for example, identified only 11 intervention studies focused on teaching appropriate toy play to children with mental retardation. In these studies, the teaching goals or strategies were rarely linked to prior assessment information and this could hamper intervention efforts. Although additional studies involving children with autism have been conducted (e.g., Lewis & Boucher, 1995; Tardif et al., 1995; Stahmer, 1995), the literature on this topic is not large and many important issues remain to be investigated. In particular, data on the assessment and development of play in children with the most severe disabilities are limited. Although children with mild to moderate disabilities have been shown to display considerable deficits in pretend, imaginative, or symbolic play, some of these children seem to have fewer problems using toys in a functional manner (Jarrold, Boucher, & Smith, 1993; Malone & Langone, 1998). Though it is likely that children with more severe disabilities would also show substantial deficits in pretend, imaginative, or symbolic play, it is unclear if these children can be expected to show any appreciable development in what might be considered less advanced types of play, such as exploratory, functional, or constructive play. In addition, the relation between play and other areas of adaptive behavior (e.g., self-care, motor, communication, and social skills) has not been established for children with severe disabilities. It is therefore unknown if programs which focus on teaching functional adaptive behaviors would impact on play-related behaviors to any significant degree. Given that early childhood special education programs typically adopt functional curricula models that focus on teaching adaptive behavior (Hanline & Fox, 1993), it is important to determine if there is any relation between general adaptive behavior and play-related skills among children with developmental disabilities. To this end, the present study involved the longitudinal assessment of play
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TABLE 1 Number of Children with Each Diagnosis Number of Children
Diagnosis Autism Chromosome 5 abnormality C.H.A.R.G.E. Syndrome Developmental delay/(unknown etiology) Down Syndrome Lennox-Gastaut Syndrome Partial Agenisis of corpus collosum Periventricular Leukomalacia
4 1 1 3 1 1 1 1
and adaptive behavior among 13 children with severe disabilities. Assessments were conducted every 6 months over a 3-year period. Play was assessed by observing each child during unstructured free-play periods in the preschool classroom. Analysis of the actual play behavior was likely to yield a valid measure of the child’s existing amount and type of play. This analysis might also reveal particular problem areas for the child or indicate the type of play that should be targeted for intervention. Comparison of the observed play behavior to a standardized metric of adaptive behavior was used to establish the relation between play and other skills and areas of development. METHOD Participants and Settings Participants were 13 preschool children with developmental disabilities. The sample had 10 boys and 3 girls. The over-representation of boys was expected given that many of the disorders reflected in the sample (e.g., autism) are more common in boys than girls. At the beginning of this study, the children ranged from 35 to 55 months (mean age 5 47 months). All lived at home and attended center-based early childhood special education preschools for children with developmental disabilities. Diagnoses varied (see Table 1), but all had severe developmental delays. Generally, the center-based programs that these children attended operated from 4 to 6 hr per day with the children in this study usually attending at least 3 days per week. Many of the children had secondary placements for 1 or 2 days per week in other preschool or child-care centers. However, all of the assessments and observations associated with this study were conducted in the early childhood special education centers, which constituted each child’s primary placement. Within these centers, the children were typically grouped in classrooms of four to six children. Classrooms were staffed by a teacher and one or two teaching assistants. Related services were provided by speech and
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occupational therapists on a regular basis. The educational programs in the centers generally consisted of individual and small group instruction based around an individualized education plan (IEP). IEPs tended to focus on teaching adaptive behaviors (e.g., self-care, motor, communication, and social skills) and pre-academic skills (attending, matching, imitation). Although the programs mainly involved structured teaching sessions, at least one period of 30 to 40 min per day was reserved for unstructured free play in each classroom. The children had been selected for an early intervention research project in Brisbane, Australia. Criteria for selection in the project included a diagnosis of intellectual disability, autism, or other developmental delay/disability of a severe nature; aged between 24 and 60 months; and limited or no expressive speech. To confirm the presence of severe communication impairment, children were initially screened using the second edition of the Bzoch and League (1991) Receptive-Expressive Emergent Language Scale (REEL-2). The REEL-2 provides a reliable estimate of receptive and expressive language ability (Sigafoos & Pennell, 1995). For the purpose of the present study, assessments were completed by parents. The results from this screening indicated that all of the children in the present study had severe delays in both receptive and expressive language ability with age equivalents averaging less than 15 months. Originally, 16 children had been selected, but 3 children were subsequently withdrawn due to incomplete data. For two of these three children, incomplete data sets resulted from numerous and lengthy periods of hospitalization over the 3 years of the study. The third child was removed because the classroom teacher decided to withdraw from the project for unknown reasons after the second year of data collection.
Procedural Overview Each child was assessed at 6 monthly intervals over a 3-year period. For each of the six rounds of data collection, a standardized assessment of adaptive behavior was completed by the child’s teacher. In addition, a 30-min videotape was made of each child during unstructured play time in the preschool classroom. During these times the child typically had free access to a variety of toys and there was minimal teacher intrusion. Occasionally, however, the teacher provided some instruction or assistance to the child or the child was part of an organized small play group. The videotapes provided a naturalistic observation of existing play time routines that were typical of and common to each classroom. Videotapes were coded for the amount and type of play. Visual and statistical analyses of the data were conducted. Visual analysis involved plotting the means for adaptive behavior and amount and type of play to show overall developmental trends. In addition, Pearson’s correlation coefficients were calculated to determine the relation between adaptive behavior and amount and type of play.
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Assessment of adaptive behavior. Adaptive behavior was assessed with the Topeka Association for Retarded Citizens Assessment System (TARC; Sailor & Mix, 1975). The TARC is a third-party rating scale containing 26 items in four domains. The four domains are Self-Help, Motor, Communication, and Social Skills. For example, one item from the Motor Skills domain asks the rater to indicate the child’s involvement in fine motor activities. For this item, fine motor ability is rated on a 6-point scale ranging from (1) Destroys materials unless supervised, to (6) Actively and creatively uses materials without help or urging most of the time. Similarly, one item from the Social Skills domain asks about interactions with peers, with scores ranging from (1) Actively seeks inappropriate interaction, to (5) Interacts appropriately most of the time, with words or actions. This device was selected because it is reliable and valid for young children with severe disabilities, is most discriminative at the lowest levels of functioning, and is sensitive to small changes in adaptive functioning (Sailor & Mix, 1975). This device was also selected because the TARC is relatively easy for parents and teachers to complete compared to other adaptive behavior scales. In addition, the TARC was developed with a standardization sample of 283 institutionalized children (3 to 16 years of age) with severe disabilities. This makes the device highly appropriate for use in the present study. The TARC yields an overall standard score with a mean of 50 and a standard deviation of 20. An overall standard score of 70, for example, would indicate adaptive functioning that was one standard deviation above the mean when compared to the standardization sample. Videotapes. Videotapes were analyzed to determine the percentage of intervals with appropriate play, inappropriate behavior, and nonplay. Each 30-min videotape was divided into 60 30-s intervals. For each 30-s interval, the presence or absence of the target behaviors was recorded. Occurrence was scored if any instance of the target behaviors occurred at any time during the interval. Nonoccurrence was scored if the interval elapsed without an instance of the target behavior. Appropriate play was rather broadly defined. It included any independent use of a toy in a manner for which it was intended (e.g., rolling a truck along the floor, putting pieces into a puzzle). In many cases, the child may have merely been holding a toy. This was counted as appropriate play. Appropriate play also included participation in any game or leisure activity. For example, if the teacher approached and attempted to engage the child in a game of peek-a-boo, any appropriate attention to the adult or actual participation on the child’s part was counted as appropriate play. It is important to consider that this rather broad definition may have inflated the amount of play observed. However, given the severe nature of each child’s disability, we anticipated relatively low rates of play and therefore decided to develop a broad definition to include participation in any play-related activity and even relatively basic exploratory play, such as holding a toy. Inappropriate behavior consisted of any act of aggression or property destruction (e.g., hitting, kicking others, throwing,
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or smashing a toy), self-injury (e.g., head-banging, face-slapping) or tantrums lasting 5 s or more (e.g., crying, yelling, throwing self to the floor). Stereotyped movements and stereotyped toy play were also counted as instances of inappropriate behavior. Stereotyped movements consisted of 5 s or more of body rocking, head weaving, finger flicking, or other stereotyped mannerism. Stereotyped toy play included use of a toy in an inappropriate repetitive manner, such as repeatedly spinning a doll or book on the floor, mouthing a toy, or turning over a toy truck and repeatedly spinning the wheels. If the child was not engaged in appropriate play or inappropriate behavior, their behavior was considered nonplay by default. Nonplay included instances when the child was off-task, passively waiting, or otherwise undirected or unoccupied. When appropriate play was observed, the type of play exhibited by the child was classified into one of four mutually exclusive categories, based on the predominant type of play observed during the interval. Definitions were based on those used by Malone and Langone (1998). Exploratory play was recorded if the child examined play materials in a visual, motor, or combined manner, as if deciding what to do with an item, or learning about the characteristics of the materials. Functional play involved a child using materials for play in a functional manner (e.g., bouncing a ball, rolling a truck, drawing with a crayon). For constructive play, a child had to put toys or materials together or organize the materials in some spatial manner (e.g., building a block tower, making a log cabin). Pretend play involved playing in a make-believe manner or role playing (e.g., talking into a toy telephone, pretending to be a superhero). Reliability For five of the six rounds of data collection, four of the videotapes were randomly selected and scored by an independent observer to obtain interobserver agreement. For the other round, only three videotapes were scored for reliability, because acceptable percentages of agreement had been obtained for the first five rounds. The results recorded by the independent observer were compared to those of the primary observer on an interval by interval basis. An agreement was scored if the two observers agreed on the presence or absence of appropriate play or inappropriate behaviors and, when appropriate play was observed, on the type of play. Any discrepancy between the two observers was counted as a disagreement. A percentage of agreement was calculated for each videotape using the formula: Agreements/(Agreement 1 Disagreements) 3 100%. Agreement on the amount of appropriate play and inappropriate behavior ranged from 60 to 100% with a mean of 92%. For type of play, agreement ranged from 70 to 100% with a mean of 89%. These results indicate an acceptable level of interobserver agreement on the scoring of the videotapes. To obtain inter-rater reliability on adaptive behavior scores, each child’s mother independently completed a TARC assessment at each of the six rounds of data collection. Pearson’s correlations were calculated between the parent and
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FIGURE 1. Mean overall standard scores from the TARC assessment and the mean percentage of intervals with appropriate play for each of the six rounds of data collection.
teacher ratings to estimate inter-rater reliability. Across the six rounds of data collection, correlation coefficients ranged from .71 to .90 with mean of .80. All correlations were significant at p , .01. The high and significant positive correlations between parent and teacher ratings suggest the TARC provided a reliable estimate of adaptive functioning.
RESULTS Figure 1 shows the mean overall standard scores from the TARC assessment (open bars) and the mean percentage of intervals with appropriate play (hashed bars). Note that the scale in Figure 1 ranges from 0 to 50. Mean overall standard scores from the TARC for each project month ranged from 26.06 at the start of the project to 42.17 at the final round of data collection. Recall that the TARC yields an overall standard score with a mean of 50 and a standard deviation of 20. Thus, the increase from the first to the last round of data collection represents a mean overall gain of almost one standard deviation. Visual analysis indicates the largest gain from the fifth to sixth round of data collection. Although overall mean scores increased at assessment every 6 months, the scores for individual children varied. This is evidenced by the fact that the standard deviations for the means shown in Figure 1 ranged from 12.85 to 19.27 with a mean standard deviation of 16.51.
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TABLE 2 Correlations between TARC Scores and Amount of Appropriate Play for Each Project Month Project Month 0 6 12 18 24 30
Pearson’s r
p-value
.62 .42 .30 .16 .44 .61
.02 .14 .31 .59 .12 .02
The mean percentage of intervals with appropriate play for each project month ranged from 14.01% to 24.36% with an overall mean of 19.57%. Visual inspection shows no major trends in these data. With the exception of the relatively lower percentages for the second and third rounds of data collection, appropriate play occurred during roughly one-fifth of each 30-min observation. As with the TARC scores, there was variability around the means for appropriate play shown in Figure 1; with the standard deviations ranging from 15.91 to 27.75 with a mean overall standard deviation of 19.90. The percentage of intervals with inappropriate behavior from each project month ranged from 11.75% to 19.37% with an overall mean of 15.46%. By default, the percentage of intervals in nonplay across the six rounds ranged from 61.42% to 73.53% with an overall mean of 65.06%. As these figures show, the vast majority of the observed time was spent in nonplay behavior which included off-task, passively waiting, and other undirected activity. Table 2 shows the Pearson’s correlation coefficients between the overall standard scores from the TARC and the percentage of intervals with appropriate play for each round of data collection. The correlations obtained could be described as moderate to low. Two of these correlations were significant at p , .05. To determine if there was any relation between the amount of appropriate play and particular subdomains of adaptive behavior, Pearson’s correlation coefficients were also calculated using scores from each of the four subdomains of the TARC. Table 3 shows the resulting correlations. Again, the correlations were generally moderate to low. However, significant correlations ( p , .05) were obtained in three instances. Specifically, significant and positive correlations were obtained between the amount of appropriate play and scores from the Self-help and Motor domain at the final round of data collection and in the Communication domain at the initial round of data collection. Figure 2 shows the breakdown by type of play for each of the six rounds of data collection. That is, when appropriate play was observed, Figure 2 shows what percentage of that play was exploratory, functional, constructive, and
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TABLE 3 Correlations between Scores from Each of the Four Subscales of the TARC and the Amount of Appropriate Play for Each Project Month TARC Subscale Project Month 0 6 12 18 24 30 a
Self-Help
Motor
Communication
Social
.51 .47 .10 .09 .48 .68a
.61 .57 .34 .18 .54 .69a
.79a .37 .26 .13 .44 .38
.53 .05 .35 .14 .16 .39
Significant at p 5 .05 or less.
pretend. The distribution of play by type was fairly consistent across the six rounds of data collection. Overall, the mean percentage of intervals with functional play was (57%) followed by exploratory (28%), pretend (10%), and constructive play (5%). As with the amount of play (Figure 1), visual inspection shows no major trends in the data shown in Figure 2. To determine if there was any relation between the type of play and TARC scores, Pearson’s correlation coefficients were again calculated. Table 4 shows
FIGURE 2. Percentage of appropriate play that was classified as exploratory, functional, constructive, or pretend for each of the six rounds of data collection.
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TABLE 4 Correlations between TARC Scores and Type of Play for Each Project Month Type of Play Project Month 0 6 12 18 24 30 a
Exploratory
Functional
Constructive
Pretend
2.04 2.32 2.19 2.30 2.08 2.05
.20 .35 2.08 .20 .56a .63a
.01 .30 2.14 2.39 .14 .23
.55a 2.05 .29 .31 2.32 .02
Significant at p 5 .05 or less.
the resulting correlations. These correlations were generally low. However, significant correlations ( p , .05) were obtained in three instances. Specifically, significant and positive correlations were obtained between TARC scores and percentage of intervals with functional play at the fifth and sixth rounds of data collection. In addition, there was a significant positive correlation between TARC scores and percentage of intervals with pretend play at the first round of data collection.
DISCUSSION As a group, the children in this study showed an overall improvement of nearly one standard deviation in teacher ratings of adaptive behavior over a 3-year period. Of course, while ratings of adaptive behavior increased, the children would still be described as having significant deficits in adaptive behavior. The gains in adaptive behavior must be considered in light of the relatively low level of adaptive functioning among these children at the beginning of the study. Despite the increase in adaptive behavior, there was no appreciable change in the amount or type of play over the same period of time. Correlations between adaptive behavior scores and the amount and type of play were mainly nonsignificant. Overall, these data suggest little development in the children’s play and little relation between play and other areas of adaptive behavioral development. In addition to the finding that there were no appreciable changes in play over the 3 years of the study, considerable deficits in play remained evident. On average, only about 6 min of appropriate play was observed in each 30-min observation period. Most of the appropriate play observed was functional and exploratory with very little constructive or pretend play. For the remaining 24 min of each observation, the children engaged in nonplay and inappropriate behavior. For example, one child spent most of her time passively sitting on the floor or mouthing objects. Another child engaged in frequent stereotypic move-
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ments and self-injury. A third child tended to sit near toys, but either did not touch them or used them inappropriately (e.g., repeatedly spinning a book on the floor). These examples illustrate the range of nonplay and inappropriate behaviors that were observed. These results are consistent with descriptions of play in children with developmental disabilities. Such children have been found to engage in low rates of play and their play is mainly exploratory and functional (Li, 1981; Johnson & Ershler, 1985). It appears that though children with developmental disabilities can be expected to develop exploratory and functional play, they may need deliberate and systematic instruction to increase the amount of appropriate play during unstructured free play times and direct intervention to teach constructive and pretend play. Perhaps the best venue to accomplish these objectives is to provide direct instruction in the context of play and at times when play occurs in the natural environment. The unstructured play opportunities provided to the children in this study did not appear to provide sufficient structure nor instruction to increase either the amount or variety of play. Inappropriate behavior was almost as frequent as appropriate play. As these behaviors were frequent during unstructured play times, an interesting practical question is whether intervention to teach appropriate play skills would produce collateral reductions in problematic and inappropriate behaviors. While there is some support for this indirect approach to the management of problem behaviors (Favell, McGimsey, & Schell, 1982), more research is needed to establish the relation between deficits in play and the presence of inappropriate behavior in children with developmental disabilities. On the theoretical side, these results lend support to questions raised by Smith, Takhvar, Gore, and Vollstedt (1985) about the proper location of constructive play in the developmental sequence. Generally, pretend play is considered more developmentally advanced than constructive play. However, our results indicate more pretend than constructive play. Future research should therefore focus on the development of these two types of play and the relation between constructive and pretend play. Play is a major activity in the daily life of most children in Western societies (Sutton–Smith, 1976). Play is also an important component in early childhood education programs (Bredekamp & Rosengrant, 1992). In this study, unstructured play time appeared to be used as a break from teaching and appeared to be conceptualized by teachers as a reward for the children. Such arrangements might be appropriate for children with sufficient skills to play appropriately and independently. These arrangements would also seem appropriate for children who are likely to learn by incidental contact with play materials and from mere exposure to play opportunities. However, this type of unstructured play does not appear to be appropriate in early childhood special education programs for children with significant disabilities. There is growing recognition among early childhood special educators that for children with significant disabilities, play needs to be used as the opportunity to teach a variety of functional adaptive
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skills (Hanline & Fox, 1993). In addition, our results suggest that for some children, it appears that play itself is unlikely to increase or develop in the context of unstructured arrangements typical of the classrooms observed in the present study. The implication is that unstructured play times may need to be replaced by structured play opportunities during which children are deliberately and explicitly taught a range of play skills. The settings observed in the present study were early childhood special education programs. Arguably, the goal of these programs should be to prepare children for entry into inclusive regular classrooms. Adequate preparation will require that these children learn to play appropriately, and for more than 6 min at a time, because such skills will be required in typical classrooms. Again this argument lends support to the suggestion that there is a need to structure play times to teach play skills, as well as ensure the availability of appropriate peer models and play materials. The functional curricula typical of preschool programs for children with developmental disabilities focus primarily on the development of adaptive behaviors, such as those measured in this study using the TARC Assessment System. However, this focus seems unlikely to lead to significant improvement in play. In the present study, the development of play appeared to stagnate at a functional level, even though adaptive behavior continued to improve. These trends could indicate that the development of constructive and pretend play was particularly difficult for these children. Alternatively it could be that materials and arrangements in the classrooms were not conducive to constructive or pretend play. Perhaps different materials or arrangements would have produced increases in the types and amounts of play. Additional research would be needed to clarify this issue, but it does highlight a limitation of the present research. The results of the present study should be interpreted with caution owing to several additional limitations in the scope and design of the research. First, data were only collected in the preschool setting. It would seem important to look at multiple settings because Malone and Stoneman (1995) found that children with mental retardation engaged in more play and more sophisticated play at home compared to school. However, play is clearly an important part of school, especially for young children and so it is important to study play in school settings. Nonetheless, information from settings where play is better, may provide useful guidelines as to how to boost it in other settings. Another limitation was the small group of children. This limitation is offset somewhat by repeated measures every 6 months over a 3-year period. Nonetheless, these results should be viewed as preliminary. A third limitation is that we looked at type of play only in terms of exploratory, functional, constructive, and pretend. Though it seemed useful to analyze play in terms of other aspects (e.g., solitary, parallel, or collaborative play), the children in this sample showed almost no parallel or collaborative play. Perhaps this was because they attended segregated programs and their only possible playmates also had severe deficits in play skills. If these children had been integrated into regular early childhood
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programs, then they would have had greater opportunities to interact and play with nonhandicapped peers, which may have facilitated the development of their play skills. Future research could examine play development in children with severe disabilities attending regular preschools. A fourth limitation is that the study did not include a control group. However, there is considerable evidence that the play of children with developmental disabilities tends to be oriented towards play with objects, is more functional, involves fewer combinations of toys, and is less creative than that of normally developing children (Malone & Langone, 1994). Our results support and extend this research by focusing on the development of play over a 3-year period in existing early childhood special education classrooms that are typical of programs for young children with severe disabilities. There appear to be no other studies which have investigated the relation between adaptive behavior and play among children with severe disabilities using a longitudinal design. In summary, this study should be viewed as preliminary and descriptive in its attempt to provide a better understanding of the development of play and the relation between play and other areas of adaptive behavior. Still, the results from the study have considerable applied relevance to early childhood special education. In particular, this study highlights a need for developmentally appropriate play-based curricula and direct intervention strategies to teach and advance the play skills of children with developmental disabilities in these types of early childhood special education classrooms.
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Hersen, M., & Van Hasselt, V. B. (Ed.) (1990). Psychological Aspects of Developmental and Physical Disabilities: A Casebook. Newbury Park, CA: Sage. Horne, B. M., & Philleo, C. C. (1942). A comparative study of the spontaneous play activities of normal and mentally defective children. Journal of Genetic Psychology, 61, 33– 46. Jarrold, C., Boucher, J., & Smith, P. (1993). Symbolic play in autism: A review. Journal of Autism and Developmental Disorders, 23, 281–307. Johnson, J. E., & Ershler, J. L. (1985). Play of children with mental retardation. Topics in Early Childhood Special Education, 5, 69 – 82. Lewis, V., & Boucher, J. (1995). Generativity in the play of young people with autism. Journal of Autism and Developmental Disorders, 25, 105–121. Li, A. K. F. (1981). Play and the mentally retarded child. Mental Retardation, 19, 121–126. Luiselli, J. K., Matson, J. L., & Singh, N. N. (Eds.) (1992). Self-Injurious Behavior: Analysis, Assessment and Treatment. New York: Springer-Verlag. Malone, D. M., & Langone, J. (1994). Object-related play skills of youths with mental retardation: A review of single-subject design research. Remedial and Special Education, 15, 177–188. Malone, D. M., & Langone, J. (1998). Variability in the play of preschoolers with cognitive delays across different toy sets. International Journal of Disability, Development and Education, 45, 127142. Malone, D. M., & Stoneman, Z. (1995). Methodological issues in studying the toy play of young children with mental retardation. Topics in Early Childhood Special Education, 15, 459 – 487. Matson, J. L., & Mulick, J. A. (Eds.) (1991). Handbook of Mental Retardation (2nd ed.). New York: Pergamon. Moyles, J. R. (Ed.) (1994). The Excellence of Play. Buckingham, UK: Open University Press. Pepler, D. J., & Rubin, K. H. (Eds.) (1982). The Play of Children: Current Theory and Research. New York: Karger. Quinn, J. M., & Rubin, K. H. (1984). The play of handicapped children. In: T. D. Yawkey & A. D. Pelligrini (Eds.), Child’s Play: Developmental and Applied (pp. 63– 80). Hillsdale, NJ: Erlbaum. Remington, B. (1996). Assessing the occurrence of learning in children with profound intellectual disability: A conditioning approach. International Journal of Disability, Development and Education, 43, 101–118. Sailor, W., & Mix, B. (1975). The Topeka Association for Retarded Citizens Assessment System. Austin, TX: Pro-Ed. Scales, B., Almy, M., Nicolopoulou, A., & Ervin–Tripp, S. (Eds.) (1991). Play and the Social Context of Development in Early Care and Education. New York: Teachers College Press. Schopler, E., & Mesibov, G. B. (Eds.) (1994). Behavioral Issues in Autism. New York: Plenum. Sigafoos, J., & Pennell, D. (1995). Parent and teacher assessment of receptive and expressive language in preschool children with developmental disabilities. Education and Training in Mental Retardation and Developmental Disabilities, 30, 329 –335. Smith, P. K., Takhvar, M., Gore, N., & Vollstedt, R. (1985). Play in young children: Problems of definition, categorisation and measurement. Early Child Development and Care, 19, 25– 41. Snell, M. E. (Ed.) (1987). Systematic Instruction of Persons with Severe Handicaps (3rd ed.). Columbus, OH: Charles E. Merrill. Stahmer, A. C. (1995). Teaching symbolic play skills to children with autism using pivotal response training. Journal of Autism and Developmental Disorders, 25, 123–141. Sutton–Smith, B. (Ed.) (1976). The Psychology of Play. New York: Arno Press. Tardif, C., Plumet, M. H., Beaudichon, J., Walker, D., Bouvard, M., & Leboyer, M. (1995). Micro-analysis of social interactions between autistic children and normal adults in semistructured play situations. International Journal of Behavioral Development, 18, 727–747.
Research in Developmental Disabilities, Vol. 20, No. 2, pp. 147–162, 1999 Copyright © 1999 Elsevier Science Ltd Printed in the USA. All rights reserved 0891-4222/99/$–see front matter
PII S0891-4222(98)00038-9
Longitudinal Assessment of Play and Adaptive Behavior in Young Children with Developmental Disabilities Jeff Sigafoos The University of Sydney and Children’s Hospital Education Research Institute (CHERI)
Donna Roberts–Pennell and Diane Graves The University of Queensland
Deficits in appropriate play have been widely documented among children with developmental disabilities. However, there has been little research on the development of play or the relation between play and adaptive behavior in such children. The present study involved a longitudinal assessment of play and adaptive behavior among 13 preschool children with developmental disabilities. Children were assessed every 6 months over a 3-year period. Assessments included standardized ratings of adaptive behavior and videotape observations during unstructured free-play times in the preschool classroom. Adaptive behavior increased by almost one standard deviation from the first to the last round of data collection. Appropriate play was observed during approximately 20% of each 30-min observation and showed little overall change over 3 years of study. Observed play was primarily functional (57%) and exploratory (28%) with less constructive (5%) and pretend (10%) play. Adaptive behavior scores were not Preparation of this manuscript was supported by a grant from the Australian Research Council. Previous versions of this paper were presented at the 23rd Annual Meeting of The Association for the Study of Play, April 2–3, 1997, Washington, DC, and at the XVth Biennial Meeting of the International Society for the Study of Behavioural Development, July 1– 4, 1998, Berne, Switzerland. Address correspondence to: Jeff Sigafoos, Children’s Hospital Education Research Institute (CHERI), The New Children’s Hospital, P.O. Box 3515, Parramatta, NSW 2124, Australia. E-mail: [email protected]
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consistently correlated with the amount or type of play. The results suggest little overall relation between appropriate play and other major domains of adaptive behavior. Implications for play-based assessment and intervention in early childhood special education are discussed. © 1999 Elsevier Science Ltd
Developmental disabilities, such as autism and mental retardation, are associated with serious delays in general psychosocial development (Baroff, 1991; Hersen & Van Hasselt, 1990). By definition, children with developmental disabilities exhibit substantial deficits in one or more areas of adaptive functioning. For example, deficits are often found in communication, self-care, social, and leisure skills (Matson & Mulick, 1991). In addition to substantial deficits in adaptive behavior, many children with developmental disabilities exhibit serious problem behaviors, such as frequent aggression, self-injury, or extreme tantrums (Duker, van Druenen, Jol, & Oud, 1986; Luiselli, Matson, & Singh, 1992). The combination of behavioral deficits and excesses represents a severe disadvantage that limits participation in many aspects of daily life in the home, school, and community. The behavioural deficits and excesses associated with developmental disabilities no doubt stem in part from neurologically based difficulties in learning. In particular, learning via more incidental and social learning processes (e.g., instruction following, imitation) appears particularly problematic for children with developmental disabilities (Remington, 1996). In contrast to normally developing children who acquire many skills by following instructions, observing others, and by incidental contact with the environment, children with development disabilities seem to require intensive and systematic instruction to learn many basic skills (Green, 1996; Schopler & Mesibov, 1994; Snell, 1987). However, little is known about how much or what types of skills might be acquired via less structured and more incidental learning opportunities. For example, would such children show any development in play-related behaviors within the relatively unstructured free-play periods that occur in most preschool classrooms? The impact of disrupted learning processes is often manifest dramatically in the play of children with developmental disabilities. Whereas the vast majority of normally developing children readily acquire sophisticated play skills without deliberate or systematic instruction (Garvey, 1991; Moyles, 1994; Sutton– Smith, 1976), young children with developmental disabilities often have considerable problems related to play (Quinn & Rubin, 1984; Malone & Stoneman, 1995). Indeed, inappropriate play is a defining characteristic of autism (American Psychiatric Association, 1994) and deficits in the amount and type of play have long been noted among children with developmental disabilities (Baron– Cohen, 1987; Horne & Philleo, 1942; Li, 1981; Stahmer, 1995). Play is likely the dominant activity in the daily life of most children in Western societies (Sutton–Smith, 1976). Play is also an important component in
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early childhood education programs (Bredekamp & Rosengrant, 1992). The attention given to play does indeed appear justified. Considerable evidence suggests that play contributes greatly to the child’s overall development (Moyles, 1994; Pepler & Rubin, 1982). More specifically, play is often the catalyst for the acquisition of important social, motor, and cognitive skills (Scales, Almy, Nicolopoulou, & Ervin–Tripp, 1991). Given the importance of play to psychosocial development and the ubiquity of play in early childhood and early childhood education, deficits in play-related skills will no doubt have serious negative consequences for the child’s overall development. To ameliorate such deficits and provide more effective early childhood special education, it is therefore necessary to better understand the development of play and the relation between play and other areas of adaptive behavior in children with developmental disabilities. Despite the pervasive and often rather obvious deficits in play among children with developmental disabilities, play-based assessment and intervention has been relatively neglected in early childhood special education (Hanline & Fox, 1993). A review of the literature by Malone and Langone (1994), for example, identified only 11 intervention studies focused on teaching appropriate toy play to children with mental retardation. In these studies, the teaching goals or strategies were rarely linked to prior assessment information and this could hamper intervention efforts. Although additional studies involving children with autism have been conducted (e.g., Lewis & Boucher, 1995; Tardif et al., 1995; Stahmer, 1995), the literature on this topic is not large and many important issues remain to be investigated. In particular, data on the assessment and development of play in children with the most severe disabilities are limited. Although children with mild to moderate disabilities have been shown to display considerable deficits in pretend, imaginative, or symbolic play, some of these children seem to have fewer problems using toys in a functional manner (Jarrold, Boucher, & Smith, 1993; Malone & Langone, 1998). Though it is likely that children with more severe disabilities would also show substantial deficits in pretend, imaginative, or symbolic play, it is unclear if these children can be expected to show any appreciable development in what might be considered less advanced types of play, such as exploratory, functional, or constructive play. In addition, the relation between play and other areas of adaptive behavior (e.g., self-care, motor, communication, and social skills) has not been established for children with severe disabilities. It is therefore unknown if programs which focus on teaching functional adaptive behaviors would impact on play-related behaviors to any significant degree. Given that early childhood special education programs typically adopt functional curricula models that focus on teaching adaptive behavior (Hanline & Fox, 1993), it is important to determine if there is any relation between general adaptive behavior and play-related skills among children with developmental disabilities. To this end, the present study involved the longitudinal assessment of play
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TABLE 1 Number of Children with Each Diagnosis Number of Children
Diagnosis Autism Chromosome 5 abnormality C.H.A.R.G.E. Syndrome Developmental delay/(unknown etiology) Down Syndrome Lennox-Gastaut Syndrome Partial Agenisis of corpus collosum Periventricular Leukomalacia
4 1 1 3 1 1 1 1
and adaptive behavior among 13 children with severe disabilities. Assessments were conducted every 6 months over a 3-year period. Play was assessed by observing each child during unstructured free-play periods in the preschool classroom. Analysis of the actual play behavior was likely to yield a valid measure of the child’s existing amount and type of play. This analysis might also reveal particular problem areas for the child or indicate the type of play that should be targeted for intervention. Comparison of the observed play behavior to a standardized metric of adaptive behavior was used to establish the relation between play and other skills and areas of development. METHOD Participants and Settings Participants were 13 preschool children with developmental disabilities. The sample had 10 boys and 3 girls. The over-representation of boys was expected given that many of the disorders reflected in the sample (e.g., autism) are more common in boys than girls. At the beginning of this study, the children ranged from 35 to 55 months (mean age 5 47 months). All lived at home and attended center-based early childhood special education preschools for children with developmental disabilities. Diagnoses varied (see Table 1), but all had severe developmental delays. Generally, the center-based programs that these children attended operated from 4 to 6 hr per day with the children in this study usually attending at least 3 days per week. Many of the children had secondary placements for 1 or 2 days per week in other preschool or child-care centers. However, all of the assessments and observations associated with this study were conducted in the early childhood special education centers, which constituted each child’s primary placement. Within these centers, the children were typically grouped in classrooms of four to six children. Classrooms were staffed by a teacher and one or two teaching assistants. Related services were provided by speech and
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occupational therapists on a regular basis. The educational programs in the centers generally consisted of individual and small group instruction based around an individualized education plan (IEP). IEPs tended to focus on teaching adaptive behaviors (e.g., self-care, motor, communication, and social skills) and pre-academic skills (attending, matching, imitation). Although the programs mainly involved structured teaching sessions, at least one period of 30 to 40 min per day was reserved for unstructured free play in each classroom. The children had been selected for an early intervention research project in Brisbane, Australia. Criteria for selection in the project included a diagnosis of intellectual disability, autism, or other developmental delay/disability of a severe nature; aged between 24 and 60 months; and limited or no expressive speech. To confirm the presence of severe communication impairment, children were initially screened using the second edition of the Bzoch and League (1991) Receptive-Expressive Emergent Language Scale (REEL-2). The REEL-2 provides a reliable estimate of receptive and expressive language ability (Sigafoos & Pennell, 1995). For the purpose of the present study, assessments were completed by parents. The results from this screening indicated that all of the children in the present study had severe delays in both receptive and expressive language ability with age equivalents averaging less than 15 months. Originally, 16 children had been selected, but 3 children were subsequently withdrawn due to incomplete data. For two of these three children, incomplete data sets resulted from numerous and lengthy periods of hospitalization over the 3 years of the study. The third child was removed because the classroom teacher decided to withdraw from the project for unknown reasons after the second year of data collection.
Procedural Overview Each child was assessed at 6 monthly intervals over a 3-year period. For each of the six rounds of data collection, a standardized assessment of adaptive behavior was completed by the child’s teacher. In addition, a 30-min videotape was made of each child during unstructured play time in the preschool classroom. During these times the child typically had free access to a variety of toys and there was minimal teacher intrusion. Occasionally, however, the teacher provided some instruction or assistance to the child or the child was part of an organized small play group. The videotapes provided a naturalistic observation of existing play time routines that were typical of and common to each classroom. Videotapes were coded for the amount and type of play. Visual and statistical analyses of the data were conducted. Visual analysis involved plotting the means for adaptive behavior and amount and type of play to show overall developmental trends. In addition, Pearson’s correlation coefficients were calculated to determine the relation between adaptive behavior and amount and type of play.
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Assessment of adaptive behavior. Adaptive behavior was assessed with the Topeka Association for Retarded Citizens Assessment System (TARC; Sailor & Mix, 1975). The TARC is a third-party rating scale containing 26 items in four domains. The four domains are Self-Help, Motor, Communication, and Social Skills. For example, one item from the Motor Skills domain asks the rater to indicate the child’s involvement in fine motor activities. For this item, fine motor ability is rated on a 6-point scale ranging from (1) Destroys materials unless supervised, to (6) Actively and creatively uses materials without help or urging most of the time. Similarly, one item from the Social Skills domain asks about interactions with peers, with scores ranging from (1) Actively seeks inappropriate interaction, to (5) Interacts appropriately most of the time, with words or actions. This device was selected because it is reliable and valid for young children with severe disabilities, is most discriminative at the lowest levels of functioning, and is sensitive to small changes in adaptive functioning (Sailor & Mix, 1975). This device was also selected because the TARC is relatively easy for parents and teachers to complete compared to other adaptive behavior scales. In addition, the TARC was developed with a standardization sample of 283 institutionalized children (3 to 16 years of age) with severe disabilities. This makes the device highly appropriate for use in the present study. The TARC yields an overall standard score with a mean of 50 and a standard deviation of 20. An overall standard score of 70, for example, would indicate adaptive functioning that was one standard deviation above the mean when compared to the standardization sample. Videotapes. Videotapes were analyzed to determine the percentage of intervals with appropriate play, inappropriate behavior, and nonplay. Each 30-min videotape was divided into 60 30-s intervals. For each 30-s interval, the presence or absence of the target behaviors was recorded. Occurrence was scored if any instance of the target behaviors occurred at any time during the interval. Nonoccurrence was scored if the interval elapsed without an instance of the target behavior. Appropriate play was rather broadly defined. It included any independent use of a toy in a manner for which it was intended (e.g., rolling a truck along the floor, putting pieces into a puzzle). In many cases, the child may have merely been holding a toy. This was counted as appropriate play. Appropriate play also included participation in any game or leisure activity. For example, if the teacher approached and attempted to engage the child in a game of peek-a-boo, any appropriate attention to the adult or actual participation on the child’s part was counted as appropriate play. It is important to consider that this rather broad definition may have inflated the amount of play observed. However, given the severe nature of each child’s disability, we anticipated relatively low rates of play and therefore decided to develop a broad definition to include participation in any play-related activity and even relatively basic exploratory play, such as holding a toy. Inappropriate behavior consisted of any act of aggression or property destruction (e.g., hitting, kicking others, throwing,
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or smashing a toy), self-injury (e.g., head-banging, face-slapping) or tantrums lasting 5 s or more (e.g., crying, yelling, throwing self to the floor). Stereotyped movements and stereotyped toy play were also counted as instances of inappropriate behavior. Stereotyped movements consisted of 5 s or more of body rocking, head weaving, finger flicking, or other stereotyped mannerism. Stereotyped toy play included use of a toy in an inappropriate repetitive manner, such as repeatedly spinning a doll or book on the floor, mouthing a toy, or turning over a toy truck and repeatedly spinning the wheels. If the child was not engaged in appropriate play or inappropriate behavior, their behavior was considered nonplay by default. Nonplay included instances when the child was off-task, passively waiting, or otherwise undirected or unoccupied. When appropriate play was observed, the type of play exhibited by the child was classified into one of four mutually exclusive categories, based on the predominant type of play observed during the interval. Definitions were based on those used by Malone and Langone (1998). Exploratory play was recorded if the child examined play materials in a visual, motor, or combined manner, as if deciding what to do with an item, or learning about the characteristics of the materials. Functional play involved a child using materials for play in a functional manner (e.g., bouncing a ball, rolling a truck, drawing with a crayon). For constructive play, a child had to put toys or materials together or organize the materials in some spatial manner (e.g., building a block tower, making a log cabin). Pretend play involved playing in a make-believe manner or role playing (e.g., talking into a toy telephone, pretending to be a superhero). Reliability For five of the six rounds of data collection, four of the videotapes were randomly selected and scored by an independent observer to obtain interobserver agreement. For the other round, only three videotapes were scored for reliability, because acceptable percentages of agreement had been obtained for the first five rounds. The results recorded by the independent observer were compared to those of the primary observer on an interval by interval basis. An agreement was scored if the two observers agreed on the presence or absence of appropriate play or inappropriate behaviors and, when appropriate play was observed, on the type of play. Any discrepancy between the two observers was counted as a disagreement. A percentage of agreement was calculated for each videotape using the formula: Agreements/(Agreement 1 Disagreements) 3 100%. Agreement on the amount of appropriate play and inappropriate behavior ranged from 60 to 100% with a mean of 92%. For type of play, agreement ranged from 70 to 100% with a mean of 89%. These results indicate an acceptable level of interobserver agreement on the scoring of the videotapes. To obtain inter-rater reliability on adaptive behavior scores, each child’s mother independently completed a TARC assessment at each of the six rounds of data collection. Pearson’s correlations were calculated between the parent and
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FIGURE 1. Mean overall standard scores from the TARC assessment and the mean percentage of intervals with appropriate play for each of the six rounds of data collection.
teacher ratings to estimate inter-rater reliability. Across the six rounds of data collection, correlation coefficients ranged from .71 to .90 with mean of .80. All correlations were significant at p , .01. The high and significant positive correlations between parent and teacher ratings suggest the TARC provided a reliable estimate of adaptive functioning.
RESULTS Figure 1 shows the mean overall standard scores from the TARC assessment (open bars) and the mean percentage of intervals with appropriate play (hashed bars). Note that the scale in Figure 1 ranges from 0 to 50. Mean overall standard scores from the TARC for each project month ranged from 26.06 at the start of the project to 42.17 at the final round of data collection. Recall that the TARC yields an overall standard score with a mean of 50 and a standard deviation of 20. Thus, the increase from the first to the last round of data collection represents a mean overall gain of almost one standard deviation. Visual analysis indicates the largest gain from the fifth to sixth round of data collection. Although overall mean scores increased at assessment every 6 months, the scores for individual children varied. This is evidenced by the fact that the standard deviations for the means shown in Figure 1 ranged from 12.85 to 19.27 with a mean standard deviation of 16.51.
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TABLE 2 Correlations between TARC Scores and Amount of Appropriate Play for Each Project Month Project Month 0 6 12 18 24 30
Pearson’s r
p-value
.62 .42 .30 .16 .44 .61
.02 .14 .31 .59 .12 .02
The mean percentage of intervals with appropriate play for each project month ranged from 14.01% to 24.36% with an overall mean of 19.57%. Visual inspection shows no major trends in these data. With the exception of the relatively lower percentages for the second and third rounds of data collection, appropriate play occurred during roughly one-fifth of each 30-min observation. As with the TARC scores, there was variability around the means for appropriate play shown in Figure 1; with the standard deviations ranging from 15.91 to 27.75 with a mean overall standard deviation of 19.90. The percentage of intervals with inappropriate behavior from each project month ranged from 11.75% to 19.37% with an overall mean of 15.46%. By default, the percentage of intervals in nonplay across the six rounds ranged from 61.42% to 73.53% with an overall mean of 65.06%. As these figures show, the vast majority of the observed time was spent in nonplay behavior which included off-task, passively waiting, and other undirected activity. Table 2 shows the Pearson’s correlation coefficients between the overall standard scores from the TARC and the percentage of intervals with appropriate play for each round of data collection. The correlations obtained could be described as moderate to low. Two of these correlations were significant at p , .05. To determine if there was any relation between the amount of appropriate play and particular subdomains of adaptive behavior, Pearson’s correlation coefficients were also calculated using scores from each of the four subdomains of the TARC. Table 3 shows the resulting correlations. Again, the correlations were generally moderate to low. However, significant correlations ( p , .05) were obtained in three instances. Specifically, significant and positive correlations were obtained between the amount of appropriate play and scores from the Self-help and Motor domain at the final round of data collection and in the Communication domain at the initial round of data collection. Figure 2 shows the breakdown by type of play for each of the six rounds of data collection. That is, when appropriate play was observed, Figure 2 shows what percentage of that play was exploratory, functional, constructive, and
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TABLE 3 Correlations between Scores from Each of the Four Subscales of the TARC and the Amount of Appropriate Play for Each Project Month TARC Subscale Project Month 0 6 12 18 24 30 a
Self-Help
Motor
Communication
Social
.51 .47 .10 .09 .48 .68a
.61 .57 .34 .18 .54 .69a
.79a .37 .26 .13 .44 .38
.53 .05 .35 .14 .16 .39
Significant at p 5 .05 or less.
pretend. The distribution of play by type was fairly consistent across the six rounds of data collection. Overall, the mean percentage of intervals with functional play was (57%) followed by exploratory (28%), pretend (10%), and constructive play (5%). As with the amount of play (Figure 1), visual inspection shows no major trends in the data shown in Figure 2. To determine if there was any relation between the type of play and TARC scores, Pearson’s correlation coefficients were again calculated. Table 4 shows
FIGURE 2. Percentage of appropriate play that was classified as exploratory, functional, constructive, or pretend for each of the six rounds of data collection.
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TABLE 4 Correlations between TARC Scores and Type of Play for Each Project Month Type of Play Project Month 0 6 12 18 24 30 a
Exploratory
Functional
Constructive
Pretend
2.04 2.32 2.19 2.30 2.08 2.05
.20 .35 2.08 .20 .56a .63a
.01 .30 2.14 2.39 .14 .23
.55a 2.05 .29 .31 2.32 .02
Significant at p 5 .05 or less.
the resulting correlations. These correlations were generally low. However, significant correlations ( p , .05) were obtained in three instances. Specifically, significant and positive correlations were obtained between TARC scores and percentage of intervals with functional play at the fifth and sixth rounds of data collection. In addition, there was a significant positive correlation between TARC scores and percentage of intervals with pretend play at the first round of data collection.
DISCUSSION As a group, the children in this study showed an overall improvement of nearly one standard deviation in teacher ratings of adaptive behavior over a 3-year period. Of course, while ratings of adaptive behavior increased, the children would still be described as having significant deficits in adaptive behavior. The gains in adaptive behavior must be considered in light of the relatively low level of adaptive functioning among these children at the beginning of the study. Despite the increase in adaptive behavior, there was no appreciable change in the amount or type of play over the same period of time. Correlations between adaptive behavior scores and the amount and type of play were mainly nonsignificant. Overall, these data suggest little development in the children’s play and little relation between play and other areas of adaptive behavioral development. In addition to the finding that there were no appreciable changes in play over the 3 years of the study, considerable deficits in play remained evident. On average, only about 6 min of appropriate play was observed in each 30-min observation period. Most of the appropriate play observed was functional and exploratory with very little constructive or pretend play. For the remaining 24 min of each observation, the children engaged in nonplay and inappropriate behavior. For example, one child spent most of her time passively sitting on the floor or mouthing objects. Another child engaged in frequent stereotypic move-
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ments and self-injury. A third child tended to sit near toys, but either did not touch them or used them inappropriately (e.g., repeatedly spinning a book on the floor). These examples illustrate the range of nonplay and inappropriate behaviors that were observed. These results are consistent with descriptions of play in children with developmental disabilities. Such children have been found to engage in low rates of play and their play is mainly exploratory and functional (Li, 1981; Johnson & Ershler, 1985). It appears that though children with developmental disabilities can be expected to develop exploratory and functional play, they may need deliberate and systematic instruction to increase the amount of appropriate play during unstructured free play times and direct intervention to teach constructive and pretend play. Perhaps the best venue to accomplish these objectives is to provide direct instruction in the context of play and at times when play occurs in the natural environment. The unstructured play opportunities provided to the children in this study did not appear to provide sufficient structure nor instruction to increase either the amount or variety of play. Inappropriate behavior was almost as frequent as appropriate play. As these behaviors were frequent during unstructured play times, an interesting practical question is whether intervention to teach appropriate play skills would produce collateral reductions in problematic and inappropriate behaviors. While there is some support for this indirect approach to the management of problem behaviors (Favell, McGimsey, & Schell, 1982), more research is needed to establish the relation between deficits in play and the presence of inappropriate behavior in children with developmental disabilities. On the theoretical side, these results lend support to questions raised by Smith, Takhvar, Gore, and Vollstedt (1985) about the proper location of constructive play in the developmental sequence. Generally, pretend play is considered more developmentally advanced than constructive play. However, our results indicate more pretend than constructive play. Future research should therefore focus on the development of these two types of play and the relation between constructive and pretend play. Play is a major activity in the daily life of most children in Western societies (Sutton–Smith, 1976). Play is also an important component in early childhood education programs (Bredekamp & Rosengrant, 1992). In this study, unstructured play time appeared to be used as a break from teaching and appeared to be conceptualized by teachers as a reward for the children. Such arrangements might be appropriate for children with sufficient skills to play appropriately and independently. These arrangements would also seem appropriate for children who are likely to learn by incidental contact with play materials and from mere exposure to play opportunities. However, this type of unstructured play does not appear to be appropriate in early childhood special education programs for children with significant disabilities. There is growing recognition among early childhood special educators that for children with significant disabilities, play needs to be used as the opportunity to teach a variety of functional adaptive
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skills (Hanline & Fox, 1993). In addition, our results suggest that for some children, it appears that play itself is unlikely to increase or develop in the context of unstructured arrangements typical of the classrooms observed in the present study. The implication is that unstructured play times may need to be replaced by structured play opportunities during which children are deliberately and explicitly taught a range of play skills. The settings observed in the present study were early childhood special education programs. Arguably, the goal of these programs should be to prepare children for entry into inclusive regular classrooms. Adequate preparation will require that these children learn to play appropriately, and for more than 6 min at a time, because such skills will be required in typical classrooms. Again this argument lends support to the suggestion that there is a need to structure play times to teach play skills, as well as ensure the availability of appropriate peer models and play materials. The functional curricula typical of preschool programs for children with developmental disabilities focus primarily on the development of adaptive behaviors, such as those measured in this study using the TARC Assessment System. However, this focus seems unlikely to lead to significant improvement in play. In the present study, the development of play appeared to stagnate at a functional level, even though adaptive behavior continued to improve. These trends could indicate that the development of constructive and pretend play was particularly difficult for these children. Alternatively it could be that materials and arrangements in the classrooms were not conducive to constructive or pretend play. Perhaps different materials or arrangements would have produced increases in the types and amounts of play. Additional research would be needed to clarify this issue, but it does highlight a limitation of the present research. The results of the present study should be interpreted with caution owing to several additional limitations in the scope and design of the research. First, data were only collected in the preschool setting. It would seem important to look at multiple settings because Malone and Stoneman (1995) found that children with mental retardation engaged in more play and more sophisticated play at home compared to school. However, play is clearly an important part of school, especially for young children and so it is important to study play in school settings. Nonetheless, information from settings where play is better, may provide useful guidelines as to how to boost it in other settings. Another limitation was the small group of children. This limitation is offset somewhat by repeated measures every 6 months over a 3-year period. Nonetheless, these results should be viewed as preliminary. A third limitation is that we looked at type of play only in terms of exploratory, functional, constructive, and pretend. Though it seemed useful to analyze play in terms of other aspects (e.g., solitary, parallel, or collaborative play), the children in this sample showed almost no parallel or collaborative play. Perhaps this was because they attended segregated programs and their only possible playmates also had severe deficits in play skills. If these children had been integrated into regular early childhood
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programs, then they would have had greater opportunities to interact and play with nonhandicapped peers, which may have facilitated the development of their play skills. Future research could examine play development in children with severe disabilities attending regular preschools. A fourth limitation is that the study did not include a control group. However, there is considerable evidence that the play of children with developmental disabilities tends to be oriented towards play with objects, is more functional, involves fewer combinations of toys, and is less creative than that of normally developing children (Malone & Langone, 1994). Our results support and extend this research by focusing on the development of play over a 3-year period in existing early childhood special education classrooms that are typical of programs for young children with severe disabilities. There appear to be no other studies which have investigated the relation between adaptive behavior and play among children with severe disabilities using a longitudinal design. In summary, this study should be viewed as preliminary and descriptive in its attempt to provide a better understanding of the development of play and the relation between play and other areas of adaptive behavior. Still, the results from the study have considerable applied relevance to early childhood special education. In particular, this study highlights a need for developmentally appropriate play-based curricula and direct intervention strategies to teach and advance the play skills of children with developmental disabilities in these types of early childhood special education classrooms.
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