Engaging Students with Autism Through Functional Play

Engaging Students with Autism Through Functional Play: A Literature Review
Jennifer Zellner
Georgia Southern University
Introduction
Review of Literature
Imagine having a student in your class that doesn’t pay attention to other people. He always seems to be in his own world, playing by himself and doesn’t notice the other students playing around him and when you try to get his attention, he doesn’t seem to hear you. When trying to play with him he stares off into space or won’t stop lining up his toys long enough to look up at you. Per the doctor, his hearing checks out and he is fine, but he still shows no interest in acknowledging when someone is talking to him or trying to show him something. No matter what you do or how hard you try, you can’t get him to pay attention to anything, play with anyone or anything and he always seems to be tuned out. If he isn’t engaging in self-stimulatory behaviors, or inappropriately play with a toy, then he is completely unengaged. How can you teach a student like this? Can you teach him anything? You can’t even get him to respond to his own name! Establishing engagement and providing students with the necessary play skills is the first thing teachers must do because without this, the student will have a hard time learning how to engage in functionally appropriate play.

Being able to engage in activities that involve playing with toys and objects is important for children. Play is conceptualized as being a fundamental component of early childhood that contributes to the social-emotional and cognitive development of children, in education and learning (Piaget 1951 as cited in Lifter et al., 2011 and Kossyvaki ; Papoudi, 2016). Play allows children to display what they know and what they are currently thinking about. It is through play that children spend a majority of their time developing knowledge, learning to interact, exploring, and actively discovering the world around them. According to Lifter et al. (2011), “If play is an expression of what children already know, then an evaluation of children’s play behaviors can be used for an assessment of knowledge. If play is an activity for learning, then interventions in play can be used to help children learn.”
Types of Play
Many different types of play have been targeted for study by researchers. Jennifer Frey and Ann Kaiser (2011) study the emergence of three different types of play during the toddler and preschool years of children with disabilities. In their review article made of up past research articles on play, Sunhwa Jung and Diane Sainato (2013) examined six different types of play. Some of the most common types of play are object (nonfunctional) play, functional play, and symbolic (pretend) play. The sequence of these types of play reflects the emergent cognitive abilities of children’s representations of actions, objects, and events in their environment (Frey & Kaiser, 2011).

As children develop over time, their play skills should also normally progress, and increasingly become more important and more complex. Beginning with the nonfunctional play of objects, which consists of mouthing and banging toys to displaying simple, repetitive actions with an object. This type of play gradually transforms into functional play around one year of age. Functional play is where a child appropriately manipulates and plays with toys in ways that they are functionally intended (Wilson et al., 2017). Pushing a toy car, stacking blocks, and shaking a maraca are some examples of functional play. The next and final stage is symbolic, or pretend, play. Symbolic play is where the child uses an object in different ways as if it were something else such as, using a fork as a comb, pretending a baby doll is crying, and pretending to drive a car through a pretend carwash (Jung & Sainato, 2013).
As they continue to progress, almost all typically developing children will take part in these types of play. Unlike their typically developing peers, children with autism have trouble engaging in play. When targeting play skills as an intervention for children with autism, it is important to start from the beginning of the developmental sequence of play and build your way up. Since functional play is considered to be the basis for where a child begins playing with toys appropriately, this is a good starting play for an intervention and will provide children with autism the foundation of appropriate functional play in which they can continue to build upon.
For functional play to be considered such a simple skill, it is unknown why children with autism experience such difficulty when engaging in functional play, how many children with autism are struggling with functional play, and what the children are doing when they are not showing signs of being unengaged from functional play or any other type toy play. Observations has been conducted of children with autism playing and several other behaviors have been documented influencing play in children with autism.

Challenges in Play for Children with Autism
Students with autism’s ability to demonstrate and acquire appropriate functional play skills has been proven to be limited. One challenge that students with autism face is engaging in the act of stereotypical behaviors such as, self-stimulatory and repetitive behaviors rather than functional play. challenge children with autism face with engaging in functional play is their tendency to spend more time in an unengaged state (e.g., sitting and staring off into space) than spontaneously engage themselves an any type of play activity. Finally, children with autism are challenged with a lack of understanding on how to play with new toys in new ways, independently and appropriately, without prior instruction being provided. Various research studies have identified all three of these behaviors as challenges faced by children with autism when engaging in functional play.

Stereotypyical behaviors are identified as self-stimulatory, restrictive, and repetitive actions. Some of these behaviors include hand flapping, lining up toys, flapping or dangling items in front of face, and being overly interested in a particular toy or object. Lang et al. (2010) implies that stereotypical behaviors are challenging for children with autism because when compared to typically developing peers of the same mental age, children with autism demonstrate less appropriate play behaviors. Since stereotypy behaviors significantly reduce children’s engagement in functional play, the also challenge the effectiveness of using interventions to teach play skills, making them important to target.

Lang et al. (2010) conducted a study observing the amount of time four different children with autism spent engaging in stereotypical behaviors compared to the time they spent engaging in functional play. Results found that nearly all the children spent so much time displaying stereotypical behaviors that it prevented them from engaging in functional play completely. Stereotypy occurred in the first child for 77% of the time with no time spent engaged in functional play. The second child engaged in stereotypy for 54% of the time and spent 29% engaged in functional play. The third child spent 98% of time engaged in stereotypy and none in functional play, while stereotypy occurred in the fourth child for 48% of the time and 26% of the time was spent engaged in functional play (Lang et al., 2010). Stereotypy behaviors once again were proven to negatively impact student engagement in demonstrating functional play skills.

Another challenging behavior children with autism demonstrate is their ability to remain completely in an unengaged state or participate only as an onlooker. In a study conducted by Connie Wong and Connie Kasari (2014), the functional play skills of children with autism were compared to those of children with other developmental delays. During this study, most functional play for both groups occurred during unstructured activities. Students with autism initiated fewer acts of functional play in unstructured settings than students with other developmental delays but engaged in more functional play during structured activities. Results of the findings indicated that children with autism spent 37% of their time in an unengaged state, show difficulties initiating engagement with other people, and spent most of their time engaging in functional levels of plays than any other level.

When trying to improve the functional play skills of children with autism, it is important to discuss the challenges they face when manipulating new toys or objects in play. Direct instruction is typically used to teach children with autism new skills, when practicing generalization of skills, and to reduce their engagement in stereotypy behaviors, when learning skills in other areas. It is possible that children with autism may need to learn how to play with new toys through direct instruction, so that their skills in functional play will not be limited. In a study by Laura McGill (2011), one child with Down’s Syndrome and five children with autism were observed over a 9-minute play session measuring the “extent to which each participant a) engaged with the toys; b) demonstrated play behaviors that followed an apparent sequence; and c) generated novel play actions.” Only two children with autism were shown to have only demonstrated examples of integrated functional play for less than one instance per session. The children with autism spent an average of 41% of time engaging in any functional types of functional play, with an average of 4.2 displayed acts of functional play per child during the session. The child with Down’s Syndrome spent 65% of their time engaged in functional play and displayed 26 acts of functional play during the session. Results from these findings suggest that to help further develop functional play skills, it is imperative that intervention strategies introduce new ways to manipulate and play with toys for children with autism.
Children with autism have been proven to show significant deficits in functional play when not provided with prior instructions on how to play and left to their own accord. Research has identified stereotypy behavior, unengaged behaviors, and difficulty integrating new actions into play as challenges limiting functional play in children with autism. It is important to find intervention strategies that will be beneficial to children with autism and effective in improving their functional play skills. Interventions have the potential to have positives effects on the increase of functional play skills in children with autism if they can adequately and successfully target all three of the challenging behaviors.
Methodology
ParticipantsThis research will be conducted in the Jumpstart Preschool Intervention (PSI) classroom located at Port Wentworth Elementary, a pre-k through second grade public school in Georgia. Four children with autism, enrolled in the Jumpstart PSI classroom, will be the participants in this study.
The Jumpstart PSI classroom these four students are enrolled in contains 6 students, 5 boys and one girl, and a special education teacher along with 2 paraprofessionals. The class consists of students ranging in age from four to five; two students are four years old and four students are five years old. Regarding ethnicity, one student is Asian, three students are African American, and two students are Hispanic. Two out of the six children also live in a home where two languages are spoken. All six students in the class are diagnosed with autism and speech and language impairments. Instructional strategies within the class include evidence-based instruction, plus methods of ABA.

To have been chosen for this study, all students must: 1) have an autism diagnosis; 2) be enrolled in the Jumpstart PSI program at PWES; and, 3) demonstrate difficulties when independently engaging in functional play based on classroom observations and compared to peers within the same Jumpstart PSI program. These four students meet all the criteria and show the most potential for growth in the area of functional play skills out of all the students in the Jumpstart PSI program.

Participant 1. ZS is a four year and six-month old African American male who has been attending school for nine months. ZS was given the diagnosis of autism at four years old. He receives services in the Jumpstart PSI classroom and receives two thirty-minute individual pull-out speech sessions and one thirty-minute integrated (push-in) group speech sessions per week. When ZS first began school, he was non-verbal, but now makes word approximations spontaneously, imitates words upon request, and spells out his first and last name. ZS has difficulty staying seated, attending to tasks, making eye contact, responding to his name, playing appropriately with toys, and communicating his wants and needs effectively. ZS engages in frequent self-stimulatory behaviors such as humming repetitively, chewing on small items and strings, lining objects up, and holding his hands over his ears.
Participant 2. JT is a five year and four-month old Hispanic male who has been part of the Jumpstart PSI classroom for 9 months. JT was given the diagnosis of autism and receives speech therapy. JT receives two thirty-minute individual pull-out speech sessions and one thirty-minute integrated (push-in) group speech sessions per week. JT is a non-verbal student that engages in frequent destructive, disruptive and attention seeking behaviors (pulling stuff off the walls, taking off shoes and socks, pushing over bookshelves, screaming when he does not get his way, and climbing on furniture). JT has difficulty staying seated, attending to tasks, appropriately manipulating and playing with toys, and communicating his wants and needs effectively He also engages in self-stimulatory behaviors such as shaking his head side to side repeatedly, flapping arms, mouthing objects, spinning in the chair, and making repetitive humming sounds.

Participant 3. EPW is a five year and four-month old African American male student with an autism diagnosis. EPW has been receiving services in a Jumpstart PSI classroom for nine months. EPW receives services in the Jumpstart PSI classroom for 4 days a week. EPW receives two thirty-minute individual pull-out speech sessions and one thirty-minute integrated (push-in) group speech sessions per week. EPW is a verbal student who struggles with following directions, attending to tasks for more than five minutes, playing with toys appropriately, and communicating effectively with teachers and peers. EPW also commonly engages in repetitive motions with his hands, toys or objects while also scripting television shows or YouTube videos.
Participant 4. JR is a five year and seven-month old African American female student with an autism diagnosis. JR has been participating in the Jumpstart PSI classroom for nine months. JR receives two thirty-minute individual pull-out speech sessions and one thirty-minute integrated (push-in) group speech sessions per week. When JR first began school, she was non-verbal, but now makes word approximations spontaneously and sings songs. JR has difficulty staying seated for more than five minutes, attending to tasks, playing appropriately with toys, and communicating her wants and needs effectively. V also engages in self-stimulatory behaviors throughout the day including spinning around in circles, lining objects up, and vocal stereotyping.
Procedure
Baseline data will be collected on all four students for two weeks. During these two weeks, each student will be observed once for thirty minutes during group free play, in the students’ Jumpstart PSI classroom. Toys will be laid out on the blue carpet and play table. During student observations, teachers and paraprofessionals will not provide directions, prompting, or positive reinforcement to that student. Play materials will vary depending on the students’ interest. Data will be collected at one-minute intervals using the sheet below. Functional play will be recorded as it occurs, meaning when the student is playing with toys in ways that they are meant to be played with. For example, functional play may include pushing cars, inserting shapes into a shape sorter, and building with blocks. For each minute the student is not observed engaging in functional play, describe the student’s actions occurring at that time under the column titled “other.” Some actions that may be listed under “other” include, but are not limited to, staring unengaged, hand flapping, spinning, mouthing objects, lining up toys, or screaming.
After baseline data is collected, the intervention will be implemented for 5 weeks. Each student will receive instruction on functional play with a specific toy through discrete trial training. The special education preschool teacher, who has five years of experience using methods of ABA, will provide discrete trial training to each of the four students. Discrete trial training will be administered in a one-on-one setting and depending on the play activity, will be at either the blue carpet or the play table.

During one-on-one instruction, the special education teacher will follow specific steps for delivering instruction throughout the discrete trial training for all the students.

Step 1: Teacher will gain the student’s attention. Examples include, calling the student by name, tapping student on the shoulder, guiding student’s face towards teacher to make eye contact, or by asking “Are you ready?” Move on to step 2 once the teacher has the student’s attention.

Step 2: Teacher will present student with the necessary materials or toys, while delivering the direction or instruction, also known as SD, to the student. For example, “stack blocks,” “put in” referring to the shapes of the shape sorter, or “push car.”
Step 3: Teacher will wait up to seven seconds for the student’s response. If the student does not engage in the activity after the seven seconds, the teacher will deliver the verbal instruction for a second time. If student does not respond after another seven seconds, the teacher will use physical prompting to initiate the student’s engagement in the activity. Prompts will be faded as student begins to learn these new skills.
Step 4: The teacher will observe the student’s response to the activity, providing prompting when necessary. Most of the student’s targets will require students to engage in the activity for a specific amount of time, such as thirty seconds. The teacher will observe the student’s response to the activity for the designated amount of time and provide immediate prompting if the student stops playing, is not playing appropriately, or engaging in self-stimulatory behaviors during this time. The teacher can use prompts such as, physical prompting (hand-over-hand), modeling (demonstrating the targeted skill), or verbal prompting (telling them what to do).
Step 5: Teacher will record the student’s response. I = Independently completed task and P = Prompting
Step 6: Teacher will provide student with positive reinforcement when correctly engaging in the targeted skill. Highly motivating items such as candy or access to preferred activity or toy, should be delivered to student as positive reinforcement.
Step 7: Repeat steps 1 through 6 at least five more times for all students during discrete trial training.
Step 8: Students must independently engage in appropriate functional play for the targeted skill and time with 100% accuracy over three consecutive data collection days, for the skill to be mastered. Time spent engaged on the targeted skill will continue to increase after each level of mastery throughout the five weeks of intervention.

Throughout all five weeks of intervention, the teacher will continue observing the students during free group play, once a week for thirty-minutes, to measure the effectiveness of discrete trial training on the student’s abilities to demonstrate generalization of their new skills during free group play. Just like during baseline, teachers and paraprofessionals will not be allowed to provide the student being observed with directions, prompts, or positive reinforcement and will be conducted in the same setting using the same set of toys. Student’s behaviors will continue to be recorded in one-minute intervals using the same data sheet as used in baseline. At the end of the five weeks of intervention, the teacher will graph all seven data points from the interval time sheet to show student’s rate of progression of engaging in appropriate functional play using their newly learned skills.

Design
Data Collection Procedures
Data Analysis
Timeline
Ethical Considerations
References
Frey, J.R. ; Kaiser, A.P. (2011). The use of play expansions to increase the diversity and complexity of object play in young children with disabilities. Topics in Early Childhood Special Education, 31(2), 99-111.

Jung, S. ; Sainato, D.M. (2013). Teaching play skills to young children with autism. Journal of Intellectual and Developmental Disability, 38(1), 74-90.

Kossyvaki, L. ; Papoudi, D. (2016). A review of play interventions for children with autism at school. International Journal of Disability, Development, and Education, 63(1), 45-63.

Lang, R., O’Reilly, M., Sigafoos, J., Machalicek, W., Rispoli, M., Lancioni, G.E., Aguilar, J., & Fragale, C. (2010). The effects of an abolishing operation intervention component on play skills, challenging behavior, and stereotypy. Behavior Modification, 34(4), 267-289.

Lifter, K., Foster-Sanda, S., Arzamarski, C., Briesch, J., & McClure, E. (2011). Overview of play: It’s uses and importance in early intervention/early childhood special education. Infants ; Young Children, 24(3), 225-245.

Wilson, K.P., Carter, M.W., Wiener, H.L., DeRamus, M.L., Bulluck, J.C., Watson, L.R., Crais, E.R., ; Baranek, G.T. (2017). Object play in infants with autism spectrum disorder: A longitudinal retrospective video analysis. Autism and Developmental Language Impairments, 2, 1-12.

Wong, C. ; Kasari, C. (2012). Play and joint attention of children with autism in the preschool special education classroom. Journal of Autism and Developmental Disorders, 42(10), 2152-2161.