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PubMed2003

Behavioral approaches to promoting play.

A variety of techniques grounded in behavioral psychology, and more specifically in applied behavior analysis, have been established to increase and improve play skills in children with autistic spectrum disorders. This article introduces a set of efficacious methods, which range from highly structured techniques to more naturalistic strategies. It focuses on object play as other authors in the issue discuss social play in greater depth. Behavioral techniques that are reviewed include: discrete trial training, use of stereotyped behaviors to increase play skills, pivotal response training, reciprocal imitation training, differential reinforcement of appropriate behavior, in vivo modeling and play scripts, and video modeling. A discussion of expanding behavior techniques to teach more complex play as well as training in varied environments is also presented. References are provided to allow the reader to obtain more in-depth information about each technique.

Autistic Disorder↗

PubMed2003

Reflections on play: recollections from a mother and her son with Asperger syndrome.

This is a personal account of the play behaviors of an individual who has autism as remembered by himself and his mother. Jean-Paul Bovee explains the activities that were enjoyable for him and which were his play, although they were unusual and may not fit the typical definition of play. His mother, Dr Julie A. Donnelly, tells of her attempts to involve Jean-Paul in typical play and how important play is as a bridge to social skills and involvement with peers. Jean-Paul concludes that his play is a part of the unique individual he has become.

Adolescent↗

PubMed2005

Dysregulation of pretend play and communication development in children with autism.

We hypothesized that the difficulties of the child with autism originate from disorders of organization and regulation of actions according to environmental changes. Autism impoverishes general mental representation skills, which are the basis of symbolic play and the development of communication. Twenty-one children with autism were compared with 14 children with global intellectual impairment and 15 matched typically developing children, on both regulation of play activities and communication development. Regulation of play was very disordered in children with autism, with breaking off, dissociation and instability of actions. However, in directed play their actions were more structured and corresponded to a better developmental level. In addition, dysregulation was associated with delayed, heterogeneous development of communication skills. The results of this study are in line with our hypotheses and emphasize the role of symbolic play in differential diagnosis and the value of therapies based on regulation processes and symbolic play.

Autistic Disorder↗

PubMed1986

Unstructured play in hospital settings: an internal locus of control rationale.

Play reveals how well or poorly children are coping with stresses. Simultaneously, play can influence the balance between affect and cognition as well as between children and their environments. Play is a process by which children can control contingencies and affect outcomes. It is unstructured play that particularly permits children to control events, ideas, and relationships. This article provides a locus of control rationale for unstructured play in hospital settings and presents implications for adults' roles in young children's play that enhance internal perception of control.

Child↗

PubMed1988

From questions to answers: approaches to studying play in health care settings.

Although play has long been considered an important factor in humanizing health care environments for children, research investigating the role of play in pediatric settings has been limited, a condition that may be attributed to practitioners' unfamiliarity with techniques for studying play. Methods of conducting play research to provide systematic descriptions of play activities and to examine relationships between play and other factors are discussed.

Child↗

PubMed1988

The development of play for children in hospitals: British and European perspectives.

Play in hospitals has developed alongside of changes toward a more family-centered model of care. The recreational and educational role of play has been significantly extended toward a therapeutic purpose. This article considers the relationships between play workers and teachers, nurses and parents, and presents some European examples of the use of play in hospitals. Finally, problems encountered in the operation of play programs are discussed in the context of ensuring the viability of play in the hospital.

Child↗

PubMed1988

Enhancing dramatic play potential in hospitalized children.

Dramatic play is seldom seen in hospitalized children. It is hypothesized that children recapitulate the separation-individuation process during hospitalization and, thus, are not capable of dramatic play until the process of self-development is restored. This article discusses the functions of play with hospitalized children and focuses on: (a) the relevance of play to the child's sense of self; (b) the impact of illness and hospitalization on the child, with emphasis on regression to earlier stages of self-development and on the developing capacity for symbolic play; and (c) the remedial activities to move children forward developmentally so that they can use play's potential for therapeutic benefit.

Child↗

PubMed2002

Sex-typed toy play behavior correlates with the degree of prenatal androgen exposure assessed by CYP21 genotype in girls with congenital adrenal hyperplasia.

Previous studies have shown that girls with congenital adrenal hyperplasia (CAH), a syndrome resulting in overproduction of adrenal androgens from early fetal life, are behaviorally masculinized. We studied play with toys in a structured play situation and correlated the results with disease severity, assessed by CYP21 genotyping, and age at diagnosis. Girls with CAH played more with masculine toys than controls when playing alone. In addition, we could demonstrate a dose-response relationship between disease severity (i.e. degree of fetal androgen exposure) and degree of masculinization of behavior. The presence of a parent did not influence the CAH girls to play in a more masculine fashion. Four CAH girls with late diagnosis are also described. Three of the four girls played exclusively with one of the masculine toys, a constructional toy. Our results support the view that prenatal androgen exposure has a direct organizational effect on the human brain to determine certain aspects of sex-typed behavior.

Adrenal Hyperplasia, Congenital↗

PubMed2006

Chromium on the hands of children after playing in playgrounds built from chromated copper arsenate (CCA)-treated wood.

Children's exposure to arsenic and chromium from playground equipment constructed with chromated copper arsenate (CCA)-treated wood is a potential concern because of children's hand-to-mouth activity. However, there exists no direct measure of Cr levels on the hands of children after playing in such playgrounds. In this study we measured both soluble and total Cr on the hands of 139 children playing in playgrounds, eight of which were constructed with CCA-treated wood and eight of which were not. Children's age and duration of play were recorded. The hands of each child were washed after play with 150 mL deionized water, which was collected in a bag and subsequently underwent analysis of Cr and 20 other elements, using inductively coupled plasma mass spectrometry. Total average Cr on the hands of 63 children who played in CCA playgrounds was 1,112 +/- 1,089 ng (median, 688; range 78-5,875). Total average Cr on the hands of 64 children who played in non-CCA playgrounds was 652 +/- 586 ng (median, 492; range 61-3,377). The difference between the two groups is statistically significant (p < 0.01). Cr levels were highly correlated to both Cu (r = 0.672) and As (r = 0.736) levels in CCA playgrounds (p < or = 0.01), but not non-CCA playgrounds (r = 0.252 and 0.486 for Cu and As, respectively). Principal-component analysis indicates that Cr, Cu, and As are more closely grouped together in CCA than in non-CCA playgrounds. These results suggest that the elevated levels of Cr and As on children's hands are due to direct contact with CCA wood.

Arsenates↗

PubMed1989

Relationship between imaginative play and language development in hearing-impaired children.

The relationship between imaginative play and language development was investigated in a group of 20 severely and profoundly hearing-impaired children between the ages of 3 and 6. Each child was videotaped in a 60-minute session interacting with the investigator and playing with three sets of toys: a miniature house, barn, and garage. Analysis of the subjects' language revealed that 15 were operating in Brown's (1973) Stage 1, one in Stage 3, and four in Stage 5. Play was analyzed along three dimensions: (a) percentage of time engaged in imaginative play; (b) use of planned pretend; and (c) use of story line. A significant relationship was found between imaginative play and language development. Results revealed no relationship between imaginative play and chronological age. Correspondences were found between language development and use of planned pretend and story line.

Age Factors↗

PubMed1992

Teaching children with autism appropriate play in unsupervised environments using a self-management treatment package.

The present study used a self-management treatment package to teach 3 children with autism, who exhibited inappropriate play behaviors, to play appropriately in the absence of a treatment provider. After self-management training, generalization and maintenance of the behavior change were assessed. Because of the detrimental effects of self-stimulation (arm flapping, spinning toys, twirling, etc.) on learning, the relationship between self-stimulatory behaviors and appropriate play was measured. Results indicated that the children learned to exhibit appropriate play skills in unsupervised settings, appropriate play skills generalized to new settings, and 2 of the children maintained their gains at 1-month follow-up. In addition, self-stimulatory behaviors decreased as appropriate play increased. Treatment implications of these findings are discussed.

Autistic Disorder↗

PubMed2002

The effects of magnitude and quality of reinforcement on choice responding during play activities.

Three boys with autism participated in a study of the effects of magnitude and quality of reinforcement on choice responding. Two concurrent response alternatives were arranged: (a) to play in an area where a peer or sibling was located, or (b) to play in an area where there was no peer or sibling. During one condition, the magnitude (i.e., duration of access to toys) or quality (level of preference) of reinforcement provided for both responses was equal. During the other condition, the magnitude or quality of reinforcement was relatively greater for choosing the play area where the peer or sibling was located than the area where the peer or sibling was not located. Results showed that after repeated exposure to the unequal magnitude or quality condition, the participant increasingly allocated his responses to the play area where the peer or sibling was located. For 2 participants, this pattern of responding was maintained in the subsequent equal magnitude or quality condition. Overall, the analysis suggests that the dimensions of magnitude and quality of reinforcement can be arranged to influence choice responding in favor of playing near a peer or sibling rather than playing alone.

Attention↗

PubMed2004

Increasing pretend toy play of toddlers with disabilities in an inclusive setting.

UNLABELLED: We evaluated a program for increasing pretend toy play of 2-year-old children with disabilities in an inclusive classroom. Classroom personnel implemented the program, which involved choices of classroom centers containing toys that tend to occasion pretend play in toddlers without disabilities, along with prompting and praise. Increases occurred in independent pretend-play rates among all 5 participating toddlers. Results are discussed regarding the importance of promoting toy play of very young children with disabilities that is similar to the type of play of their nondisabled peers, and the need to identify critical program components that are applicable in inclusive settings. DESCRIPTORS: pretend play, young children with disabilities

Child Behavior↗

PubMed1990

Effects of prenatal ethanol exposure on juvenile play-fighting and postpubertal aggression in rats.

The effects of prenatal ethanol exposure on juvenile play-fighting and postpubertal aggressive behavior in rats were longitudinally assessed in the context of more conventionally applied physical and behavioral measures. Pregnant animals were treated with either 2 gm/kg/day ethanol or isocaloric sucrose over gestation Days 6-19. Reproduction and somatic variables included maternal weight over gestation, offspring weight over Days 1-90, and age at eye opening and incisor eruption. Behavioral variables consisted of negative geotaxis, olfactory discrimination, activity, juvenile play-fighting, and postpubertal aggression. Ethanol offspring had lower birth weights, but there was no significant prenatal treatment effect on subsequent offspring weights or on any other reproductive or somatic variable. Both male and female ethanol-exposed offspring exhibited more play-fighting responses when paired with same-sex controls. Postpubertal aggression levels were assessed in males only. Ethanol-exposed offspring were more aggressive than controls and there was a significant positive correlation between play-fighting and postpubertal aggression ranks. No other behavioral measures discriminated between prenatal treatment groups and none were significantly correlated with either play-fighting or postpubertal aggression rank. The results are consistent with the position that juvenile play-fighting and postpubertal aggression are subserved by common substrates. They also are consistent with predictions derived from the hypothesis concerning a response-inhibition deficit as an effect of prenatal ethanol exposure on behavior.

Aggression↗

PubMed1992

The assessment of symbolic play in young children: a prototype test.

In this paper it is argued that assessing symbolic play (defined as one object substituting for another, a property being attributed to an object which it does not have or an absent object being referred to as if present) is particularly useful for young children in whom language and/or play is not developing normally. A new test of symbolic play is described which assesses the child's ability to substitute her- or himself, a teddy or a non-representational object such as a piece of material for another object, to attribute a property to her- or himself or a teddy, and to refer to an absent object used by her- or himself or a teddy. The play may be modelled or instructed or the child may produce examples of her or his own. Some preliminary results from a group of 43 children are reported. It is concluded that this new test of symbolic play will provide clinicians working with children whose language and/or play is impaired with information of value in reaching a diagnosis and in understanding immediate treatment needs.

Child↗

PubMed1994

Validational data on the Warwick Symbolic Play Test.

This paper examines the validity of a recently developed test of symbolic play. The Warwick Symbolic Play Test (WSPT) was administered to 60 normal children, 30 girls and 30 boys aged 3-6 years. In addition the children's expressive and receptive language skills were assessed using the Renfrew Action Picture Test and the British Picture Vocabulary Scale respectively. Significant correlations were found between scores obtained on the play test and both language measures. Exploratory statistics indicated that, when age was taken into account, partial correlations between play and language remained moderate. Further analysis of the results also suggested that the relationship between play and language ability as measured by the tests was stronger for the younger children in the sample than for the older children. These results suggest that the WSPT may indeed be a useful assessment instrument, in conjunction with measures of functional play, for assessment of language ability, diagnosis and possible treatment of language disorders, especially for children under the developmental age of 5 years.

Child, Preschool↗

PubMed2003

Using role play to develop cultural competence.

Role play is a useful teaching strategy for nursing education. This strategy can simulate patient behaviors, as well as demonstrate nursing interventions that students must learn to be clinically competent. Role play is a dramatic technique that encourages participation to improvise behaviors that may be encountered in nurse-patient situations. Using this technique, participants may test behaviors and decisions in an experimental atmosphere without risk of negative effects in a relationship. Role play is useful in developing cultural competence because participants may experience diverse roles. Cultural competence is the ability to care for patients in a culturally sensitive and appropriate manner. In role play, students may participate as culturally diverse patients or as nurses encountering patients from different cultures. Various teaching strategies facilitate successful use of role play in the classroom, including defining a time frame, selected roles, specific objectives, references, and grading criteria. To optimize learning, the importance of exploration and analysis must be emphasized. Many benefits and potential problems accompany use of role play.

Attitude of Health Personnel↗

PubMed2005

[The effects of a folk play program on cognition, ADL, and problematic behavior in the elderly with dementia].

PURPOSE: This study was to develop and evaluate a folk play program as a nursing intervention for the elderly with dementia. METHOD: First, a folk play program was developed through a careful study of literature review and field-work. Second, a nonequivalent control group pre-post test was designed. The subjects of the study were the elderly with dementia staying in nursing homes; 15 were in an experimental group adopting a folk play program developed through this study, 18 in the control group on a gymnastics and walking program which is generally used. The 40 min. intervention was conducted 5 times a week for 4 weeks. RESULT: The folk play program improved the cognition(t=6.12, p<.001) and ADL(t=2.92, p=.014) and diminished the frequency of problematic behaviors significantly(t=-6.39, p<.001). There was a significant difference of cognition, ADL, and problematic behaviors between the control and the experimental group before and after the experiment(t=3.38, p=.002; t=2.05, p=.046; t=-7.74, p<.001). CONCLUSION: Compared with the gymnastics and walking program, the folk play program proved to be much more effective in the elderly with dementia in improving their cognition and ADL, as well as in diminishing their problematic behaviors. Therefore, a folk play program should be applied as an effective and practical Korean nursing intervention for the elderly with dementia.

Activities of Daily Living↗