Dunia Terus Berputar

Jumat, 11 Februari 2011

Play and Autism

In no evaluation has a child's meaningful use of language been above his/her cognitive play level...Unless the child possesses the cognitive prerequisites for the linguistic structures she/he is learning, she/he will not use them in actual interpersonal situations. Carol Westby (1980)

Carol Westby is, in our estimation, a brilliant woman who connected language use (aka pragmatic language--a huge deficit in our learners) in children with the development of their symbolic play skills. What she connected, in her assessment of children, is that children's ability to USE language coincides with the emergence of predictable symbolic play schemes. To put it roughly, children don't use language fully until they can play in symbolic ways. She proposed that simple stimulus response paradigms (read ABA without symbolic play development), aren't enough to build the symbolic cognitive skills necessary to promote your learner's full language development. Therefore, teaching language use and symbolic play skills should go hand in hand.

Other things we like about the Westby Scale: We like how she organized her information clearly and briefly by developmental level--the whole scale is two pages long. We like her explanation that play reflects cognitive consciousness (awareness of other's state of minds, etc). It seemed to lend itself to teaching theory of mind (TOM) skills at very early ages.

On a personal note, we have noticed that language development in our learners, including using words to request or demand, label and use of WH-questions (interrogative conversation) can precede symbolic play. Symbolic play and improved social attention skills has preceded acquisition of declarative conversational speech. Our experience has been that the acquistion of symbolic play skills has not in itself caused conversational speech to develop, but it has marked a level of social awareness that allowed teaching of declarative conversation (e.g. I like hotdogs. Not me, I like hamburgers.) to be successful.

Per usual, we are going to highlight what we feel are the most relevant points to be gained from evaluating the Westby Play Scale, and interpret them for you in as jargon-free language as possible. As always, we encourage you to read the original source and draw your own conclusions. The Westby Play Scale is found in the following journal: Westby, C.E. (1980). Assessment of cognitive and language abilities through play. Language, Speech, and Hearing Services in Schools, 11, 154-168, and on pages 303-305 in the book Behavioral Intervention for Young Children with Autism: A Manual for Parents and Professionals. Edited by Maurice, Green and Luce.

The Westby Play Scale (edited and interpreted for relevance)

Stage I: 9 to 12 months
PLAY:
Travel to get what want, stop mouthing everything. Finds toy hidden under scarf.
LANGUAGE:
Some appropriate toy use with performance words (woo-woo, sound effects, etc).
Communication Skills: Request AND command (implies child directing others--already some control over their environment)
Stage II: 13-17 months:
PLAY:
Purposeful exploration of toys--discovers how they operate via trial and error. Variety of motor schema with toys. HANDS TOY TO ADULT IF UNABLE TO OPERATE (this, in my opinion, represents an early TOM awareness that others may possess skills they lack--good target to teach).
LANGUAGE:
Context dependent single words (says car when riding in car, but doesn't label car when asked). Words come and go in vocabulary (this is NORMAL children). Uses language in the following ways: Request, command, call attention to self, establish interaction, greet, protest and label. At this stage (note the age), a child begins to ask for help, even if by gesture. According to Westby, this indicates that a child understands that adults are agents who can act on objects. Again, I think that cognitive awareness is directly related to TOM.
Stage III: 17-19 months:
PLAY:
autosymbolic play--child pretends to fall asleep, or pretends to drink from a cup, or eat with a spoon. Playfulness/awareness of pretending emerge in relation to self. Uses tool to reach toy (e.g. Stick). Uses most common objects and toys appropriately. Finds toys invisibly hidden ( put object in box, and dump out under a scarf).
LANGUAGE:
Functional and semantic development in language with the following uses demonstrated: 1. Recurrence (Again, Again!) 2. Existence (Here I am!) 3. Nonexistence (I am not!) 4. Rejection (No!) 5. Denial (Wasn't me.) 6. Agent and object (Billy took train.) 7. Action or state (Billy is hitting.) 8. Location (In the kitchen) 9. Object or person associated with object or location. (Mommy's in the kitchen). Additionally, there is a rapid growth in number of words USED. Will NOT refer to ABSENT situations (correlate this with request for things absent?)
Note: We attempted to interpret these language uses (all example in parentheses are our interpretation of these uses, but we fear we may have misinterpreted Westby's intent. If any SLP would care to define these for us more clearly, or give more relevant examples, please contact us.
Stage IV: 19- 22 months:
PLAY:
symbolic play extends beyond self. E.g. Play with dolls--brushes doll's hair, feeds toy, puts doll to bed. Combines TWO toys in pretend play--e.g. Puts spoon in pan, pours from pitcher to cup.
LANGUAGE:
Begins to use possessives, (my , mine). NO word endings. Makes reference to objects and people NOT present (which acc. To Westby indicates consolidated sensorimotor concepts and internalized action schemas--a reflection of cognitive acheivement).
Stage V: 24 months:
PLAY:
pretends at activities of others--re-presents his daily experiences (play house, play acts as mommy, daddy, baby). Uses objects that are realistic and close to life size (won't use miniature action figures yet, apparently). Short events--no true sequences, except perhaps short, self-limiting ones such as puts food in pan, stirs and eats. BLOCK PLAY--consists of stacking and knocking down. Sand and water play consists of filling, pouring and dumping (now THAT takes some pressure off!). Child does NOT build representational structures. Blocks are not integrated into pretend play.
LANGUAGE:
All the same pragmatic language functions now extend to phrases and short sentences. Word endings: ING appears on words, plurals and possessives. Language functions extend to PRETEND, sharing information and questioning (NOTE--not answering questions--ACTIVELY questioning).
Stage VI: 2 1/2 years:
PLAY:
Represents events less frequently experienced or observed, particularly impressive or traumatic events--1. Doctor-nurse-sick child 2. Teacher-child 3. Store-shopping. Events are still short and isolated. Realistic props still required. Roles shift quickly. Parallel play predominates.
LANGUAGE:
Responds appropriately to the following WH questions in context: What, who, whose, where, what...do, ASKS WH questions, Responds to WHY questions inappropriately, except for well known routines. , ASKS why, but often inappropriately and does not attend to answer. TOM: child can use language to selectively analyze perception as seen by ASKING and ANSWERING WH- questions. Before age three, use of size occurs with respect to selves versus comparative.
STAGE VII: 3 years old:
PLAY:
relates pretend schemas in a sequence. (EG. Mix cake, bake it, serve it, wash dishes.) Sequence evolves unplanned (we'd of course need to teach this, requiring some planning on our part.) This demonstrates a cognitive basis for using past tense and future aspect (TIME). Still dependent on realistic props. Associative play increases. Reenact old play scenarios with new outcomes (spontaneous improvisation) that reflect what child would have LIKED to have happen in scenario (eg. Doll hides at doctor's office, refusing to be examined).
LANGUAGE:
Past tense (I ate, I walked) describing past events. Future aspect: I'm going to, etc.
Stage VIII: 3 to 3 1/2:
PLAY:
Carries out play of earlier stages with doll house and fisher-price style toys ( less realistic props--reflects child's ability to take another person's perspective --TOM). Blocks are used to make enclosures. One object is used to represent another (row of chairs is bus) aka play is not stimulus bound. Uses doll or puppet as participant in play--doll is a friend now and has own personality (TOM).
LANGUAGE:
Marked increase in descriptive attributes--reflects emerging understanding of perception (TOM). Concepts emerge in speech: shapes, size, colors, texture, spatial relationships (DO WE EMPHASIZE THESE TOO EARLY?). Gives dialogue to puppets and dolls. Metalinguistic language: "HE SAID...", Uses indirect requests "Mommy lets me have cookies for breakfast.", Changes speech dependent on listener (definite TOM).
Stage IX: 3 1/2 to 4 years:
PLAY:
Begins to problem solve events not experienced (e.g. Child builds enclosure for circus animals and needs a roof. Looking at several objects, rejects some without trying by reasoning too big, small, heavy, etc. Plans ahead. Hypothesizes "what would happen IF...". Uses Dolls and puppets to act out scenes. Builds 3 dimensional structures with blocks that represent actual objects seen.
LANGUAGE:
Conceptualizes "this should", "this would", "This won't" "If I do this, then.." "This is big enough, but it's too heavy". Verbalizes intentions by using "can, may , might, could , would, will" and conjunctions: "and, but, if, so, because." These are emerging skills, not competent skills (that takes until age 10-12 in typical children). Begins to respond appropriately to why and how questions that require reasoning about perception.
Stage X: 5 years:
PLAY:
Plans a sequence of pretend events and organizes needs in advance--both objects and children. Can coordinate simultaneous events. E.g. Plan his role in a play situation and decide what others will be doing as well. No longer dependent on realistic props, can rely fully on imagination to set scenes. Full cooperative play seen.
LANGUAGE:
Planning coordinated events reflects the cognitive attainment of relative and subordinate clauses that relate two or more prepositions to each other. Uses relational terms such as "then, when, first, next, last, while, before and after", but doesn't develop full competence with usage until 10-12 years of age (typical children).

" A cognitively based orientation to language acquisition implies that language training can never do more than assist the child in expressing what he/she already understands"

"remediation should provide experiences to facilitate development of the cognitive sensorimotor or preoperational symbolic abilities rather than emphasizing language skills"

"Directive adult-led teaching has been shown actually to retard, rather than facilitate progress"

" In no evaluation has a child's meaningful use of language been above his/her cognitive play level"

" Unless the child possesses the cognitive prerequisites for the linguistic structures she/he is learning, she/he will not use them in actual interpersonal situations."

The following is contributed by Mareile Koenig, SLP:

If you are interested in reading more about the relationship between play and language, consider chapter 7 (by Carol Westby) in the following book:

IW. O. Haynes & B. B. Shulman (1998) (Eds.) Communication Development: Foundations, Processes, and Clinical Applications. Baltimore: Williams and Wilkins.

This book would also be available at university libraries. Westby's chapter ("The Development of Play") contains a chart that is an extension of the Symbolic Play Scale. It illustrates correlated developments in the following areas for ages 18 months to 6 years:

Props used in symbolic play
Themes expressed in symbolic play
Organization of pretend episodes
Roles that are assumed by children as they mature
The kind of language that is used during successive levels of play

Teaching Tips for Children and Adults with Autism

Good teachers helped me to achieve success. I was able to overcome autism because I had good teachers. At age 2 1/2 I was placed in a structured nursery school with experienced teachers. From an early age I was taught to have good manners and to behave at the dinner table. Children with autism need to have a structured day, and teachers who know how to be firm but gentle.

Between the ages of 2 1/4 and 5 my day was structured, and I was not allowed to tune out. I had 45 minutes of one-to-one speech therapy five days a week, and my mother hired a nanny who spent three to four hours a day playing games with me and my sister. She taught 'turn taking' during play activities. When we made a snowman, she had me roll the bottom ball; and then my sister had to make the next part. At mealtimes, every-body ate together; and I was not allowed to do any "stims." The only time I was allowed to revert back to autistic behavior was during a one-hour rest period after lunch. The combination of the nursery school, speech therapy, play activities, and "miss manners" meals added up to 40 hours a week, where my brain was kept connected to the world.

Many people with autism are visual thinkers. I think in pictures. I do not think in language. All my thoughts are like videotapes running in my imagination. Pictures are my first language, and words are my second language. Nouns were the easiest words to learn because I could make a picture in my mind of the word. To learn words like "up" or "down," the teacher should demonstrate them to the child. For example, take a toy airplane and say "up" as you make the airplane takeoff from a desk. Some children will learn better if cards with the words "up" and "down" are attached to the toy airplane. The "up" card is attached when the plane takes off. The "down" card is attached when it lands.
Avoid long strings of verbal instructions. People with autism have problems with remembering the sequence. If the child can read, write the instructions down on a piece of paper. I am unable to remember sequences. If I ask for directions at a gas station, I can only remember three steps. Directions with more than three steps have to be written down. I also have difficulty remembering phone numbers because I cannot make a picture in my mind.
Many children with autism are good at drawing, art and computer programming. These talent areas should be encouraged. I think there needs to be much more emphasis on developing the child's talents. Talents can be turned into skills that can be used for future employment.
Many autistic children get fixated on one subject such as trains or maps. The best way to deal with fixations is to use them to motivate school work. If the child likes trains, then use trains to teach reading and math. Read a book about a train and do math problems with trains. For example, calculate how long it takes for a train to go between New York and Washington.
Use concrete visual methods to teach number concepts. My parents gave me a math toy which helped me to learn numbers. It consisted of a set of blocks which had a different length and a different color for the numbers one through ten. With this I learned how to add and subtract. To learn fractions my teacher had a wooden apple that was cut up into four pieces and a wooden pear that was cut in half. From this I learned the concept of quarters and halves.
I had the worst handwriting in my class. Many autistic children have problems with motor control in their hands. Neat handwriting is sometimes very hard. This can totally frustrate the child. To reduce frustration and help the child to enjoy writing, let him type on the computer. Typing is often much easier.
Some autistic children will learn reading more easily with phonics, and others will learn best by memorizing whole words. I learned with phonics. My mother taught me the phonics rules and then had me sound out my words. Children with lots of echolalia will often learn best if flash cards and picture books are used so that the whole words are associated with pictures. It is important to have the picture and the printed word on the same side of the card. When teaching nouns the child must hear you speak the word and view the picture and printed word simultaneously. An example of teaching a verb would be to hold a card that says "jump," and you would jump up and down while saying "jump."
When I was a child, loud sounds like the school bell hurt my ears like a dentist drill hitting a nerve. Children with autism need to be protected from sounds that hurt their ears. The sounds that will cause the most problems are school bells, PA systems, buzzers on the score board in the gym, and the sound of chairs scraping on the floor. In many cases the child will be able to tolerate the bell or buzzer if it is muffled slightly by stuffing it with tissues or duct tape. Scraping chairs can be silenced by placing slit tennis balls on the ends of the legs or installing carpet. A child may fear a certain room because he is afraid he may be suddenly subjected to squealing microphone feedback from the PA system. The fear of a dreaded sound can cause bad behavior. If a child covers his ears, it is an indicator that a certain sound hurts his ears. Sometimes sound sensitivity to a particular sound, such as the fire alarm, can be desensitized by recording the sound on a tape recorder. This will allow the child to initiate the sound and gradually increase its volume. The child must have control of playback of the sound.
Some autistic people are bothered by visual distractions and fluorescent lights. They can see the flicker of the 60-cycle electricity. To avoid this problem, place the child's desk near the window or try to avoid using fluorescent lights. If the lights cannot be avoided, use the newest bulbs you can get. New bulbs flicker less. The flickering of fluorescent lights can also be reduced by putting a lamp with an old-fashioned incandescent light bulb next to the child's desk.
Some hyperactive autistic children who fidget all the time will often be calmer if they are given a padded weighted vest to wear. Pressure from the garment helps to calm the nervous system. I was greatly calmed by pressure. For best results, the vest should be worn for twenty minutes and then taken off for a few minutes. This prevents the nervous system from adapting to it.
Some individuals with autism will respond better and have improved eye contact and speech if the teacher interacts with them while they are swinging on a swing or rolled up in a mat. Sensory input from swinging or pressure from the mat sometimes helps to improve speech. Swinging should always be done as a fun game. It must NEVER be forced.
Some children and adults can sing better than they can speak. They may respond better if words and sentences are sung to them. Some children with extreme sound sensitivity will respond better if the teacher talks to them in a low whisper.
Some nonverbal children and adults cannot process visual and auditory input at the same time. They are mono-channel. They cannot see and hear at the same time. They should not be asked to look and listen at the same time. They should be given either a visual task or an auditory task. Their immature nervous system is not able to process simultaneous visual and auditory input.
In older nonverbal children and adults touch is often their most reliable sense. It is often easier for them to feel. Letters can be taught by letting them feel plastic letters. They can learn their daily schedule by feeling objects a few minutes before a scheduled activity. For example, fifteen minutes before lunch give the person a spoon to hold. Let them hold a toy car a few minutes before going in the car.
Some children and adults with autism will learn more easily if the computer key-board is placed close to the screen. This enables the individual to simultaneously see the keyboard and screen. Some individuals have difficulty remembering if they have to look up after they have hit a key on the keyboard.
Nonverbal children and adults will find it easier to associate words with pictures if they see the printed word and a picture on a flashcard. Some individuals do not under-stand line drawings, so it is recommended to work with real objects and photos first. The picture and the word must be on the same side of the card.
Some autistic individuals do not know that speech is used for communication. Language learning can be facilitated if language exercises promote communication. If the child asks for a cup, then give him a cup. If the child asks for a plate, when he wants a cup, give him a plate. The individual needs to learn that when he says words, concrete things happen. It is easier for an individual with autism to learn that their words are wrong if the incorrect word resulted in the incorrect object.
Many individuals with autism have difficulty using a computer mouse. Try a roller ball (or tracking ball) pointing device that has a separate button for clicking. Autistics with motor control problems in their hands find it very difficult to hold the mouse still during clicking.
Children who have difficulty understanding speech have a hard time differentiating between hard consonant sounds such as 'D' in dog and 'L' in log. My speech teacher helped me to learn to hear these sounds by stretching out and enunciating hard consonant sounds. Even though the child may have passed a pure tone hearing test he may still have difficulty hearing hard consonants. Children who talk in vowel sounds are not hearing consonants.
Several parents have informed me that using the closed captions on the television helped their child to learn to read. The child was able to read the captions and match the printed works with spoken speech. Recording a favorite program with captions on a tape would be helpful because the tape can be played over and over again and stopped.
Some autistic individuals do not understand that a computer mouse moves the arrow on the screen. They may learn more easily if a paper arrow that looks EXACTLY like the arrow on the screen is taped to the mouse.
Children and adults with visual processing problems can see flicker on TV type computer monitors. They can sometimes see better on laptops and flat panel displays which have less flicker.
Children and adults who fear escalators often have visual processing problems. They fear the escalator because they cannot determine when to get on or off. These individuals may also not be able to tolerate fluorescent lights. The Irlen colored glasses may be helpful for them.
Individuals with visual processing problems often find it easier to read if black print is printed on colored paper to reduce contrast. Try light tan, light blue, gray, or light green paper. Experiment with different colors. Avoid bright yellow--it may hurt the individual's eyes. Irlen colored glasses may also make reading easier. (Click here to visit the Irlen Institute's web site.)
Teaching generalization is often a problem for children with autism. To teach a child to generalize the principle of not running across the street, it must be taught in many different locations. If he is taught in only one location, the child will think that the rule only applies to one specific place.
A common problem is that a child may be able to use the toilet correctly at home but refuses to use it at school. This may be due to a failure to recognize the toilet. Hilde de Clereq from Belgium discovered that an autistic child may use a small non-relevant detail to recognize an object such as a toilet. It takes detective work to find that detail. In one case a boy would only use the toilet at home that had a black seat. His parents and teacher were able to get him to use the toilet at school by covering its white seat with black tape. The tape was then gradually removed and toilets with white seats were now recognized as toilets.
Sequencing is very difficult for individuals with severe autism. Sometimes they do not understand when a task is presented as a series of steps. An occupational therapist successfully taught a nonverbal autistic child to use a playground slide by walking his body through climbing the ladder and going down the slide. It must be taught by touch and motor rather than showing him visually. Putting on shoes can be taught in a similar manner. The teacher should put her hands on top of the child’s hands and move the child’s hands over his foot so he feels and understands the shape of his foot. The next step is feeling the inside and the outside of a slip-on shoe. To put the shoe on, the teacher guides the child’s hands to the shoe and, using the hand-over-hand method, slides the shoe onto the child’s foot. This enables the child to feel the entire task of putting on his shoe.
Fussy eating is a common problem. In some cases the child may be fixated on a detail that identifies a certain food. Hilde de Clerq found that one child only ate Chiquita bananas because he fixated on the labels. Other fruit such as apples and oranges were readily accepted when Chiquita labels were put on them. Try putting different but similar foods in the cereal box or another package of a favorite food. Another mother had success by putting a homemade hamburger with a wheat free bun in a McDonald’s package.

When Your Child With Special Needs Goes to School

Your child deserves appropriate care at school. Working with your child’s care team can help your child stay healthy at school. Your child’s care team may include your child’s doctor, school nurse, principal, teacher and others. Plan ahead with them before your child goes to school. Don’t be afraid to ask questions or share ideas to get the help your child needs.

Before your child goes to school, talk with your child’s care team about:

When your child will be ready for school
Expectations for your child’s care and treatment at school
Your child’s pain, discomfort, or energy level at school
If your child will need to miss school, have a hard time concentrating or difficulty learning skills
What supplies, equipment or adaptations your child may need at school, like crutches, a wheelchair or g-tube feedings
How your school nurse or school can help you, and what services they provide
Transportation for your child to and from school (be sure to talk with your child's bus driver)

Prepare for school:

Gather any medicines and forms needed for school
Create an emergency plan and list of phone numbers for you, your child’s care team and other contacts
Fill out and distribute your child's

Once your child has entered school, be sure to keep updated on:

New behaviors or feelings your child may have, and the need for counseling
Changes in your child’s activities, like gym class, lunch, outdoor recess, where to sit in class and field trips

How to Teach Phonemic Awareness to a Dyslexic Child

You can easily kill the enjoyment of reading if a child struggles with reading; and it is especially true for an Dyslexic who experience failure everyday.

The names of the letters are what we say in the alphabet. But each letter also has a sound which it usually makes. This is the sound that you hear at the beginning of these words: apple begins with ‘a’, burger begins with ‘b’, and so on. It is easier for a dyslexic child to learn the sounds of letters first, and then later on when they are confident in reading, learn the letter names. It can be quit confusing and overwhelming for a child to learn the sound and letter name together and then know which one to use when reading.
The single sounds they have learned will sometimes help them with the first sound of an unknown word. E.g. there is a ‘t’ at the start of ‘television’ helps them to guess it, although they obviously cannot sound out all the letters. They may see that the new word begins with a ‘t’, and notice that there is a television in the picture on the page. This will allow them to make a sensible guess, which is an intelligent response. However, be sure to tell them the word very quickly if they have not guessed it within a few seconds.
In general, the sounding out of new words should be kept as an exercise or a game separate from reading for pleasure. If he stop to sound out every new word that is in the text, it will become difficult for the child to follow the story and enjoy the development of the story line.

Reading a fiction book with a dyslexic child should always be for pleasure. Looking at the pictures in the book and discuss with them what they think is going to happen next. Ask him if he enjoys the book and enjoy identifying with the main character of the book. Also let them choose the kind of book they want to read next.

Reading for pleasure – the golden rule

The golden rule of reading is to tell the child the words they do not know straight away. Reading books must be for pleasure and you can easily kill this enjoyment if you stop and let a child say the sounds of each letter when they meet an unknown word.
By telling the words to the child straight away, will increase the enjoyment of the story for both, making the child want to read with you again. The words you tell him will be repeated in the story anyway, or you can read the book again from the beginning another day, when the child will notice that he can read words that you had to tell them last time!
Signs that reading is not enjoyable to the child
Frustration, tears and a parent or tutor who cannot understand why the child cannot read an apparently simple word, will make reading not enjoyable to the child. There are many apparently simple words, but e.g. the ‘a’ sound in ‘are’ is different from the ‘a’ sound in ‘apple’ which the child already knows. This can be quit frustrating and confusing for a child.