Development of Playfulness in Children with Low Executive Functions: The Role of Parental Playfulness and Parental Playtime with Their Child

Children with low executive functions (EFs) are described as having lower levels of playfulness, the quality of children's play, compared to children with EFs within the normal range. However, how playfulness in children with low EFs develops over time remains unclear. Additionally, little is known about how parental playfulness and parental playtime with their child affect these developmental trajectories in children with low EFs. To address these research gaps, we measured playfulness in 62 children with low EFs and 62 children with EFs within the normal range aged 3 to 6 years at three time points over 2 years. We used the Children's Playfulness Scale, which captures multi-informant perspectives from parents and teachers. Moreover, the parents of children with low EFs reported their own playfulness and their playtime with their children at T1. Repeated-measures hierarchical linear models indicated significantly lower levels of playfulness in the children with low EFs than in the controls, with no significant changes observed over 2 years in either group. In the children with low EFs, we found a significant positive relationship between parental playfulness at T1 and children's playfulness 2 years later but a significant negative relationship between parental playtime at T1 and children's playfulness 2 years later. These results prompt a broad discussion on potential implications for the enhancement of playfulness in children with low EFs within the family environment.

Influence of Ideational Praxis on the Development of Play and Adaptive Behavior of Children with Autism Spectrum Disorder: A Comparative Analysis

BACKGROUND

Traditionally, assessment of praxis skills in children with ASD has focused on the evaluation of aspects related to the planning and execution of actions. This study aimed to evaluate the ideational abilities of children with ASD and analyze possible relationships with the development of play and adaptive behaviors.

METHODS

40 children between 4 to 6 years (TD = 20; ASD = 20) were evaluated with the Test of Ideational Praxis, the Revised Knox Preschool Play Scale, and the Adaptive Behavior Assessment System II.

RESULTS

Statistically significant relationships were obtained between ideational praxis and play skills development (r = 0.649; p = 0.01), adaptive leisure behavior (r = 0.338; p = 0.04) and social adaptive behavior (r = 0.319; p = 0.04). Results of multiple linear regression models found a linear relationship between ideational praxis and play development (p = 0.005) and adaptive leisure skills (p = 0.004), but not with social interaction skills (p > 0.05).

CONCLUSIONS

Objective evaluation with a specific ideational praxis assessment facilitates understanding of the ideational abilities and widens understanding of praxis skills and their impact on play and adaptive behaviors in children with ASD.

Expectations and Assumptions: Examining the Influence of Staff Culture on a Novel School-Based Intervention to Enable Risky Play for Children with Disabilities

Risky play is challenging, exciting play with the possibility of physical, social, or emotional harm. Through risky play, children learn, develop, and experience wellbeing. Children with disabilities have fewer opportunities than their typically developing peers to engage in this beneficial type of play. Our team designed a novel, school-based intervention to address this disparity; however, our intervention yielded unexpected quantitative results. In the present study, we qualitatively examined divergent results at two of the five schools that participated in the intervention. Specifically, we aimed to explore how staff culture (i.e., shared beliefs, values, and practices) influenced the intervention. To explore this relationship, we employed a retrospective, qualitative, multiple case study. We used thematic analysis of evaluative interviews with staff members to elucidate the cultures at each school. Then, we used cross-case analysis to understand the relationships between aspects of staff culture and the intervention's implementation and results. We found that staff cultures around play, risk, disability influenced the way, and the extent to which, staff were willing to let go and allowed children to engage in risky play. Adults' beliefs about the purpose of play and recess, as well as their expectations for children with disabilities, particularly influenced the intervention. Furthermore, when the assumptions of the intervention and the staff culture did not align, the intervention could not succeed. The results of this study highlight the importance of (1) evaluating each schools' unique staff culture before implementing play-focused interventions and (2) tailoring interventions to meet the needs of individual schools.

Play profiles of children with HIV/Aids: A comparative study

INTRODUCTION

Despite play being widely used in occupational therapy practice as a means and ends in intervention, no research has explored how the play of children with HIV/AIDS is affected. Therefore, the specific processes through which play can be used in therapy with children with HIV/AIDS remains underexplored, especially in low resourced settings. This study aims to compare the level of playfulness of children with HIV/AIDS to that of age and gender matched typically developing children living in the same low resourced community.

METHODS

The Test of Playfulness (ToP) was used to examine the differences and similarities of play between children aged 4-7 years who are typically developing children (n = 52) and children with HIV/AIDS who receive antiretroviral treatment (n = 44). Each child was video recorded playing with a familiar playmate both indoors and outdoors. The videos were scored by two independent raters who were blinded to all aspects of the study. Scores were subjected to Rasch analysis to calculate interval level measure scores. Independent t-tests were used to compare differences between the means of the groups.

RESULTS

Typically developing children scored significantly higher when playing outdoors, as compared to children with HIV [t (94) = 3.57, p = .001]. There was no significant difference between mean measure scores for indoor play when comparing typically developing children and children with HIV. Children who are HIV positive scored significantly lower than typically developing children on items related to the ability to suspend reality and framing in both indoor and outdoor environments.

CONCLUSIONS

Children with HIV/AIDS exhibited lower levels of playfulness when compared to typically developing children. This study provides insight on the play profiles of children with HIV/AIDS, highlighting play deficits and differences between indoor and outdoor play. Occupational therapy can play a significant role in promoting playfulness in children with HIV/AIDS.

A Feasibility RCT Evaluating a Play-Informed, Caregiver-Implemented, Home-Based Intervention to Improve the Play of Children Who Are HIV Positive

Background/aim

In South Africa, contextual factors have been identified as barriers to outdoor, unstructured play. The human immunodeficiency virus (HIV) and resulting progressive HIV encephalopathy (PHE) is a pandemic in this area, associated with development delays that are not addressed by highly active antiretroviral treatment (HAART). This study aimed to describe the playfulness in children with HIV and PHE on HAART living in challenging socioeconomic areas in South Africa aged 6 months to 8 years and to evaluate the feasibility and preliminary effectiveness of a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for improving play.

Methods

A feasibility randomized control trial allowed for comparison of PICIHBI and conventional one-on-one occupational therapy interventions. Children were filmed playing pre-, mid-, and postintervention, using the Test of Playfulness (ToP) to assess playfulness. The PICIHBI comprised of 10 monthly sessions facilitated by an occupational therapist, involving group discussions with caregivers and periods of experiential play.

Results

Twenty-four children with HIV and/or PHE were randomized into one of the two intervention groups. Overall, the group (n = 24) had a median score of 0 (lowest item score) on nine of 24 ToP items and only had a median score of 3 (highest score) on two items. Pre- to postintervention overall ToP scores improved marginally for the PICIHBI group (n = 12) and the conventional group (n = 12). Between-group differences were not significant. The PICIHBI group demonstrated a significant increase in one ToP item score at midassessment. No significant ToP item changes were found in the conventional group.

Conclusion

Children with HIV were found to have the most difficulty on ToP items relating to the play elements of internal control and freedom from constraints of reality. The PICIHBI did not significantly improve children's play and was not more effective than the conventional intervention. Considerations for feasibility and effectiveness, including barriers to attendance, are discussed.

Play, Playfulness, and Self-Efficacy: Parental Experiences with Children on the Autism Spectrum

Background

Play serves as an essential medium for parent-child interaction; however, engaging children with ASD through play can be a challenge for parents.

Purpose

The purpose of this phenomenological study was to explore the perspectives of parents with children on the autism spectrum regarding play experiences and self-efficacy during play encounters.

Method

Semistructured interviews were administered to 8 parents of children 3–7 years of age with ASD. The analysis was guided by the constant comparison method.

Findings

Parental narratives denoted playful experiences reflecting components of Skard and Bundy's model of playfulness. The facilitation of framing and suspension of reality were generally more challenging than facilitating intrinsic motivation and internal control. Participants associated self-efficacy during play with their perceived ability to interact with their child and with positive emotions experienced during play. Fathers generally derived a greater sense of self-efficacy from play encounters than mothers, and this was explained by differences in fathers' and mothers' motivations for playing. Mothers were motivated to play for outcome-oriented reasons (e.g., promote the child's progress) whereas fathers' motivations depicted greater emotional emphasis, reflecting a better match between motivation and perceived indicators of efficacy during play.

Conclusion

The results suggest that a good match between motivation for playing and perceived indicators of efficacy during play is important for a parental sense of self-efficacy. Occupational therapists should utilize coaching strategies to increase parents' understanding of play and playfulness and how they can affect a sense of parental self-efficacy.

The play skills of children with high-functioning autism spectrum disorder in peer-to-peer interactions with their classmates: A multiple case study design

BACKGROUND/AIM

Children with ASD are known to have lower play skills than their typically developing peers. However, the play skills of children with ASD are rarely investigated using observational measures in the context of their everyday peer-to-peer play interactions. To explore the play skills of children with ASD and their aged matched classmates during a peer-to-peer play interaction.

METHODS

Using convenience sampling, four children with ASD (5-11 years) attending mainstream schools were recruited for this multiple case design study. Each child with ASD was paired with one of their aged matched typically developing classmates. Children's play skills were measured using the Test of Playfulness (ToP). Additional case data were collected through teacher-reported social skills and behaviours. Rasch analysis was utilised to convert raw ToP scores into an interval level overall score for each child. Children's individual ToP item scores, social skills and behaviours are presented by case.

RESULTS

The two children with ASD who had the highest ToP scores, also had the highest teacher-reported social skills. All children with ASD had greatest difficulty on ToP items reflecting suspension of reality and framing. Two children with ASD had higher ToP scores than their classmate. In these two cases, the classmates had similar play skills of children with ASD.

CONCLUSION

The play skills of children with ASD varied by case. Across the cases, teacher-reported social skills, classmate age and existence of friendship between children were all factors observed to influence play. These findings require replication and investigation in larger scale studies.

Theory of Mind Deficit is Associated with Pretend Play Performance, but not Playfulness, in Children with Autism Spectrum Disorder

Objective/Background

This study aimed to examine the relationships of theory of mind (ToM) to both pretend play and playfulness in children with autism spectrum disorder (ASD).

Methods

Twenty children with ASD aged between 3 years and 7.11 years were assessed with the ToM test, and then placed in a free play condition and a pretend play condition to assess pretend play and playfulness with the Child-Initiated Pretend Play Assessment and Test of Playfulness, respectively. In addition, the children's symptom severities of ASD and verbal abilities were also assessed with the Childhood Autism Rating Scale (CARS) and Receptive and Expressive Vocabulary Test—second edition, respectively.

Results

The results of the regression analysis confirmed that ToM significantly predicted pretend play variables, namely, Number of Object Substitutions (R² = .158, p = .002) and Number of Imitated Actions (R² = .175, p = .001), but not playfulness. The CARS score was a significant predictor of the Percentage of Elaborate Pretend Play Actions of pretend play (R² = .075, p = .034), as well as the internal control (R² = .125, p = .006) and framing (R² = .071, p = .039) variables of playfulness.

Conclusion

The findings support the idea that children with ASD who have better ToM might be able to develop better pretend play, but not better playfulness, which might be more strongly related to their autistic severity.

A Randomised Controlled Trial of a Play-Based Intervention to Improve the Social Play Skills of Children with Attention Deficit Hyperactivity Disorder (ADHD)

There is a need for effective interventions to address the social difficulties of children with ADHD. This randomised controlled trial examined the effectiveness of a play-based intervention for improving the social play skills of children with ADHD in peer-to-peer interactions. Children with ADHD (5 to 11 years) were randomised to an intervention-first (n = 15) or waitlist control-first group (n = 14). Participants allocated to the control-first group received the intervention after a 10-week wait period. Children invited a typically-developing playmate and parents of children with ADHD participated. The intervention involved: six clinic play-sessions, weekly home-modules and a one-month home follow up. The Test of Playfulness (ToP) was scored by a blinded rater. Parent reported treatment adherence was used to assess treatment fidelity. Between group statistics were used to compare the change of the intervention-first (10-week intervention period) and control-first (10-week wait period) groups. Once all children had received the intervention, repeated measures ANOVA, post hoc Least Significance Difference tests and Cohen’s-d were used to measure effect. Changes in ToP social items were analysed using Friedman’s ANOVA. Linear regression analyses were used to identify variables that predicted change. The control-first group did not change during the wait period. The change in the intervention-first group was significantly greater than the change in the control-first group (during the wait period). When the data from the two groups were combined, the mean ToP scores of the children with ADHD (n = 29) improved significantly following the intervention, with a large effect from pre to post intervention and from pre intervention to follow up. Children maintained treatment gains at follow up. All ToP social items improved significantly following the intervention. The findings support the use of play involving parent and peer mediated components to enhance the social play skills of children with ADHD.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000973617

Home Safety for Children with Autistic Spectrum Disorder: Local Authority Occupational Therapy Intervention

Introduction:

Health and social care agencies are encouraged to provide child-centred services that respond to needs that change over time. There is evidence that occupational therapists are concerned about how to respond to issues of harmful behaviour in the home environment whilst promoting child development. This study explored occupational therapists' experiences regarding harmful behaviour and the safety of children with Autistic Spectrum Disorder.

Method:

Seven community occupational therapists, employed by a local authority and working in social care, participated in two focus groups.

Findings:

An inductive thematic analysis identified five broad themes. These were: ‘assessment is complex’, ‘child development and the home environment’, ‘importance of family-centred services’, ‘the need for additional services’, and ‘management of the disabled facilities grant’.

Conclusion:

Local authority occupational therapists prioritize supporting families to keep children safe. It is necessary to adapt the home to reduce hazards and for alternative interventions to be made available to address behavioural and sensory needs. Services such as sensory integration are lacking, and where they are available access is difficult. It is common for disabled facilities grants to fund adaptations; however, management of grants could be improved to meet the needs of these children and their families.

A preliminary investigation of the relationship between sensory processing and social play in autism spectrum disorder

There are well-documented play deficits in autism beginning with infant object and social play. To create effective interventions, the predictors of play deficits in autism must be established. Individuals with autism spectrum disorder (ASD) frequently report sensory processing difficulties including poor praxis; however, these are potential predictors of play that have not been well studied. Using a data set of 162 individuals with ASD, this study examined the direct and indirect relationships between sensory processing and social play performance via structural equation modeling. The best fitting model suggested that sensory system functions predict praxis and play in combination, providing preliminary evidence that sensory functions are related to social play in combination with praxis in children with ASD. The findings suggest future avenues for research. [OTJR: Occupation, Participation and Health 2013;33(3):159-167.].