Welcome to the Webinar on Evidence-Based Tools for Teaching Play to Children with Special Needs

• The webinar will begin at 1:30 PM CST. • There will be minimal audio before the webinar begins. • Please run the audio setup wizard to make sure your speakers work. – You will not need to test your microphone! (Skip microphone setup)

Audio Setup Wizard Evidence-Based Tools for Teaching Play to Children with Special Needs

Robert E. Daniels, Ph.D. Licensed Clinical Psychologist www.DrRobDaniels.com Today’s Presenter

Robert E. Daniels, Ph.D. Licensed Clinical Psychologist Executive Director, Chicago Children’s Clinic www.DrRobDaniels.com Today’s Moderators

Maria Matticks Consultant Early Intervention Training Program

Michaelene M. Ostrosky Head and Goldstick Family Scholar, Special Education, University of Illinois

Alissa Jones Research Specialist Early Intervention Training Program Survey & Certificate

This webinar has ILLINOIS EI credit as well as ILLINOIS STATE LICENSURE* credit *OT, PT, SLP, SW, Nutrition/Dietitian

complete survey to get certificate Look for “unique” email AFTER the webinar with the survey from LUCY GIMBLE ([email protected])

If you joined as a group, each individual will need to complete the unique survey for credit Chat

Move the column

Rollover the top or right side border to resize the chat box.

type in this box—lower left side of screen Who do we have participating in this webinar today?

A. Parent/caregiver B. Early Interventionist C. CFC Staff D. Administrators E. Other If you are an early interventionist, what is you primary discipline?

A. Developmental Therapist B. Speech/Language Pathologist C. Physical Therapist D. Occupational Therapist E. Other (identify in chat box) Learning Objectives

Identify evidence-based strategies to improve play skills in children aged 0-3

Identify methods of assessment and progress monitoring of play skills Play is:

• Intrinsically motivated • Freely chosen • Pleasurable • Non-literal • Actively engaged Why Teach Play?

Play has immediate benefits, such as cardiovascular fitness, and long-term benefits, including a sense of morality and learning how to learn

Play develops neural pathways in the brain

Play is an effective teaching strategy both in school and out

A review of more than 40 studies concludes that play enhances early development by at least 33%

Toy play at age 18 months is related to the child’s intelligence at age 3 years Conceptual Foundations

Behaviorism Laws of Behavior Conceptual Foundations

Behaviorism Laws of Behavior

PRT Pivotal Response Treatment Conceptual Foundations

Behaviorism Laws of Behavior

PRT Pivotal Response Treatment

PBS Social Validity Classical Conditioning

During a typical month of services, how often is the child’s parent/guardian present (regardless of participation)? A. Rarely B. No more than once a month C. Once or twice a month D. Almost every session E. Every session the parent/guardian is present

During sessions in which the parent/guardian is present, what percentage of the time are they active participants? A. Rarely B. About 25% of the time C. About 50% of the time D. About 75% of the time E. The parent/guardian is always actively participating

Paradigm Shift Infant Play

Primarily Sensorimotor Emerging Social/Language play Emerging Cause & Effect play

KEY STRATEGIES: 1. Infant-Directed Speech 2. “Motionese.” 3. Gestures Play with Classical Conditioning

Unconditioned Stimuli Conditioned Stimuli

“Preferred Stimuli” that naturally “Neutral Stimuli:” Those actions result in joy and laughter the caregiver uses to engage the • Intrinsically motivated infant that would normally result • Freely chosen in joy and laughter, but currently • Enjoyable do not. • Choose only 1 “neutral stimulus” at a Present these once/10s to infant time for 5-7 minutes.

Take a 5-10 minute walk Play with Classical Conditioning

Unconditioned Stimuli Conditioned Stimuli

“Preferred Stimuli” that naturally “Neutral Stimuli:” Those actions result in joy and laughter the caregiver uses to engage the • Intrinsically motivated infant that would normally result • Freely chosen in joy and laughter, but currently • Enjoyable do not. • Choose only 1 “neutral stimulus” at a Present these once/10s to infant time for 5-7 minutes.

Take a 5-10 minute walk Play with Classical Conditioning

Unconditioned Stimuli Conditioned Stimuli

“Preferred Stimuli” that naturally “Neutral Stimuli:” Those actions result in joy and laughter the caregiver uses to engage the • Intrinsically motivated infant that would normally result • Freely chosen in joy and laughter, but currently • Enjoyable do not. • Choose only 1 “neutral stimulus” at a Present these once/10s to infant time for 5-7 minutes.

Take a 5-10 minute walk Play with Classical Conditioning

Unconditioned Stimuli Conditioned Stimuli

“Preferred Stimuli” that naturally “Neutral Stimuli:” Those actions result in joy and laughter the caregiver uses to engage the • Intrinsically motivated infant that would normally result • Freely chosen in joy and laughter, but currently • Enjoyable do not. • Choose only 1 “neutral stimulus” at a Present these once/10s to infant time for 5-7 minutes.

Take a 5-10 minute walk Play with Classical Conditioning

Unconditioned Stimuli Conditioned Stimuli

“Preferred Stimuli” that naturally “Neutral Stimuli:” Those actions result in joy and laughter the caregiver uses to engage the • Intrinsically motivated infant that would normally result • Freely chosen in joy and laughter, but currently • Enjoyable do not. • Choose only 1 “neutral stimulus” at a Present these once/10s to infant time for 5-7 minutes.

Take a 5-10 minute walk Infant Play PRT

Baseline Intervention

Video 5 minutes of parent-child Once child is displaying positive affect interaction for 3 consecutive sequences: • Smiling, laughing, kissing/hugging, &/or Create list of preferred and neutral momentary eye contact stimuli/activities Intersperse neutral activity/stimulus Discuss with caregiver in 1 out of every 5 trials until it spontaneously elicits positive affect Present only preferred on 3 consecutive sequences. stimuli/activities • 1/10sec for 5-7 minutes Add next neutral stimulus/activity • 5-10 minute break Infant Play PRT

Baseline Intervention

Video 5 minutes of parent-child Once child is displaying positive affect interaction for 3 consecutive sequences: • Smiling, laughing, kissing/hugging, &/or Create list of preferred and neutral momentary eye contact stimuli/activities Intersperse neutral activity/stimulus Discuss with caregiver in 1 out of every 5 trials until it spontaneously elicits positive affect Present only preferred on 3 consecutive sequences. stimuli/activities • 1/10sec for 5-7 minutes Add next neutral stimulus/activity • 5-10 minute break Infant Play PRT

Baseline Intervention

Video 5 minutes of parent-child Once child is displaying positive affect interaction for 3 consecutive sequences: • Smiling, laughing, kissing/hugging, &/or Create list of preferred and neutral momentary eye contact stimuli/activities Intersperse neutral activity/stimulus Discuss with caregiver in 1 out of every 5 trials until it spontaneously elicits positive affect Present only preferred on 3 consecutive sequences. stimuli/activities • 1/10sec for 5-7 minutes Add next neutral stimulus/activity • 5-10 minute break Infant Play PRT

Baseline Intervention

Video 5 minutes of parent-child Once child is displaying positive affect interaction for 3 consecutive sequences: • Smiling, laughing, kissing/hugging, &/or Create list of preferred and neutral momentary eye contact stimuli/activities Intersperse neutral activity/stimulus Discuss with caregiver in 1 out of every 5 trials until it spontaneously elicits positive affect Present only preferred on 3 consecutive sequences. stimuli/activities • 1/10sec for 5-7 minutes Add next neutral stimulus/activity • 5-10 minute break Infant Play PRT

Baseline Intervention

Video 5 minutes of parent-child Once child is displaying positive affect interaction for 3 consecutive sequences: • Smiling, laughing, kissing/hugging, &/or Create list of preferred and neutral momentary eye contact stimuli/activities Intersperse neutral activity/stimulus Discuss with caregiver in 1 out of every 5 trials until it spontaneously elicits positive affect Present only preferred on 3 consecutive sequences. stimuli/activities • 1/10sec for 5-7 minutes Add next neutral stimulus/activity • 5-10 minute break Infant Play PRT

Baseline Intervention

Video 5 minutes of parent-child Once child is displaying positive affect interaction for 3 consecutive sequences: • Smiling, laughing, kissing/hugging, &/or Create list of preferred and neutral momentary eye contact stimuli/activities Intersperse neutral activity/stimulus Discuss with caregiver in 1 out of every 5 trials until it spontaneously elicits positive affect Present only preferred on 3 consecutive sequences. stimuli/activities • 1/10sec for 5-7 minutes Add next neutral stimulus/activity • 5-10 minute break Infant Play PRT

Baseline Intervention

Video 5 minutes of parent-child Once child is displaying positive affect interaction for 3 consecutive sequences: • Smiling, laughing, kissing/hugging, &/or Create list of preferred and neutral momentary eye contact stimuli/activities Intersperse neutral activity/stimulus Discuss with caregiver in 1 out of every 5 trials until it spontaneously elicits positive affect Present only preferred on 3 consecutive sequences. stimuli/activities • 1/10sec for 5-7 minutes Add next neutral stimulus/activity • 5-10 minute break Koegel, L. K., A. K. Singh, R. L. Koegel, J. R. Hollingsworth, and J. Bradshaw. “Assessing and Improving Early Social Engagement in Infants.” Journal of Positive Behavior Interventions 16, no. 2 (April 1, 2014): 69–80. doi:10.1177/1098300713482977.

Switch it up

• Play with infant using only favorite activities • Infants have short attention spans! • Change activities frequently • Learn when infant becomes bored • Goal is to sustain social engagement for as long as possible

Switch it up

• Play with infant using only favorite Activity Duration activities Itsy-Bitsy Spider 15 seconds • Infants have short attention spans! Peek-a-boo 25 seconds • Change activities frequently Tickling 10 seconds • Learn when infant becomes bored Raspberry lips 15 seconds • Goal is to sustain social engagement for Repeat 3x as long as possible

Mix-In Activities

• When they are engaged after 3 sets of play with favorites, time for a “Mix-In.” • Result in motivation for the social interaction, not just the activity • Increases engagement in other neutral activities, not just favorites

Mix-In Activities

• When they are engaged after 3 sets of play with favorites, time for a “Mix-In.” • Result in motivation for the social interaction, not just the activity • Increases engagement in other neutral activities, not just favorites

Activity Duration Type of Activity Itsy-Bitsy Spider 15 seconds Favorite Peek-a-boo 25 seconds Favorite Nibble on fingers/toes 10 seconds Mix-In Tickling 10 seconds Favorite Raspberry lips 15 seconds Favorite Repeat 3x

Socialization & Communication Types of Play

Social/language Cause and effect Sensory play Constructive play play play

Rough and Representational Symbolic play Dramatic play tumble play play Common Play Issues for Children with Autism

– Ritualistic – Repetitive – Nonfunctional – Isolated – Apparently not motivated

Using PRT to Teach Play to Toddlers and Preschoolers

Specific Strategies Each type of play is demonstrated at each stage of development

Sensorimotor Play Symbolic Play • Done for enjoyment or physical sensation • Use of substitute objects • Spinning balls • A block is a cookie • Banging balls • Giving objects pretend attributes • Block building • The pan is “hot” • Imitation begins • Pantomime • Actions can be purposeful and goal directed • Pretending to shovel without any object • Active experimentation available Play Development Progression

Relational Play Sociodramatic Play

• Actions toward self • Child is pretending to be someone else • Actions toward others/dolls • Repeating the same action (feeding • Pretends with objects or without several dolls) objects

• Sequencing Actions • Pretends through dolls • Doll in car, car gets gas, drive car

• Dolls doing the action • Doll cooks the food, doll walks, etc.

A B C A B C

Opportunity: Present a desired toy A B C

Behavior: Opportunity: Child reaches/ Present a desired toy Demonstrates join attention A B C

Behavior: Opportunity: Response reinforced: Child reaches/ Present a desired toy Child given desired toy Demonstrates join attention

Antecedent Behavior Consequence

A: Present/Shake bell A: Shake different bell A: Shake first bell B: Joint Attention B. Imitation B: Crawl/Joint Attention C: Infant obtains bell C. Shared enjoyment C: Obtain bell/Shared Enjoyment Variables that increase motivation to respond

Reinforcing Stimulus attempts variation

Child- Natural preferred reinforcers activities Motivation: What you reinforce matters

Reinforce Success • Motivation Decreases • # attempts at responding • Affect

Reinforce Attempts • Motivation Increases • # attempts • Affect • # correct responses Principles of PRT

Antecedents Consequences (Presenting the opportunity) (responding)

Attention Contingent Reinforcement

Maintenance skills Reinforcement of Attempts

Shared control Direct & Natural Reinforcement (child choice, turn taking)

Multiple cues (discriminations) Embedded Social Interaction Example: Child Playing with Cup

Caregiver follows child’s lead and comments on cup play (gain attention) Example: Child Playing with Cup

Caregiver follows child’s lead and comments on cup play (gain attention)

Use developmental relevance to decide the type of play to engage in with the cup • (e.g. put blocks in cup; child pretends to drink from cup; child gives doll drink) (acquisition or maintenance task) Example: Child Playing with Cup

Caregiver follows child’s lead and comments on cup play (gain attention) Use developmental relevance to decide the type of play to engage in with the cup • (e.g. put blocks in cup; child Increasing levels of pretends to drink from cup; child gives doll drink) (acquisition or support/guidance to obtain the maintenance task) appropriate response (Reinforce attempt or prompt higher level)

• Imitate the child’s play • Provide verbal instruction • Gestural prompting • Model appropriate play • Visual assistance • Physical guidance Example: Child Playing with Cup

Caregiver follows child’s lead and comments on cup play (gain attention) Use developmental relevance to decide the type of play to engage in with the cup Increasing levels of • (e.g. put blocks in cup; support/guidance to obtain child pretends to drink the appropriate response from cup; child gives doll (Reinforce attempt or Reward by allowing any drink) (acquisition or prompt higher level) type of play with the cup maintenance task) (direct and contingent • Imitate the child’s play reinforcement) • Provide verbal instruction • Gestural prompting • Model appropriate play • Visual assistance • Physical guidance A B C A B C

Opportunity: Present a desired toy A B C

Behavior: Opportunity: Child attempts to Present a desired toy communicate A B C

Behavior: Response reinforced: Opportunity: Child attempts to Motivating Present a desired toy communicate social interaction

Koegel, Robert L., Ty W. Vernon, and Lynn K. Koegel. “Improving Social Initiations in Young Children with Autism Using Reinforcers with Embedded Social Interactions.” Journal of Autism and Developmental Disorders 39, no. 9 (September 2009): 1240–51. doi:10.1007/s10803-009-0732-5.

Progress Monitoring & Assessment

Validity, Reliability Do you ever use video in your sessions?

Yes or No If your answer was yes, do you…

A. Review on your own B. Review with the family C. Review with a supervisor D. Review with family and supervisor

–

Affect Child & Parent

(list specifically) (list

– affect positive or contact eye in resulted that toys/activities distinct of # diversity: Play

– % of time engaged in disruptive behavior disruptive in engaged time of %

– % of time spent engaging in functional play functional in engaging spent time of %

• permissible are “Guesstimates” video: no If

Monitoring is almost impossible without video without impossible almost is Monitoring

integrated) vocalization,

–

contact, eye (gesture, communicate to attempted child which during intervals of %

– Social Smiling=smiling while looking at caregiver at looking while Smiling=smiling Social

–

Initiations/Minute #

–

Responsivity %

• With video: 10 minute video samples of interaction to measure: to interaction of samples video minute 10 video: With

–

Affect Child & Parent

(list specifically) (list

– affect positive or contact eye in resulted that toys/activities distinct of # diversity: Play

– % of time engaged in disruptive behavior disruptive in engaged time of %

– % of time spent engaging in functional play functional in engaging spent time of %

• permissible are “Guesstimates” video: no If

Monitoring is almost impossible without video without impossible almost is Monitoring

Parent & Child Affect Rating Scale

Negative (0-1) Neutral (2-3) Positive (4-5)

Does not appear to be decidedly happy or Adult appear discontent with the particularly unhappy. May smile or frown Smiles, laughs appropriately; seems to be ongoing activities; Seems to not be occasionally but overall, seems rather neutral enjoying self. enjoying self Happiness in this situation.

The adult shows little indication of Seems interested in interacting with the Not clear whether adult seems interested in wanting to interact with child, will child. Attempts to encourage child to the child. Occasionally, the adult may ask a ask few questions, if any, to the communicate. Tries to interact with child

Interest question or get the child's attention. child. by asking questions or making requests.

Adult does not seem either stressed or The adult seems relaxed; appears to feel Adult looks frustrated; seems tense; relaxed. The parents will correct child though comfortable interacting with the children. Exhibits little patience; Quick to

Stress the emotions of the adult are not obviously Will sometimes laugh, smile, or show correct child. negative nor positive. humor. Video Analysis of Play

10-Second Continuous Interval Maintains Interaction Initiates Conversation Initiates play 0:10 0:20 0:30 0:40 0:50 1:00

1. Maintains interactions: continued engagement in same verbal or nonverbal activity as peer. During intervals of peer initiations, positive responses (e.g., complying with request) are scored as maintaining interaction. 2. Initiates conversation: verbalizations that are not in direct response to a preceding question or that occurred at least 5 s after a preceding verbalization. For example, ‘‘the car has wheels’’ or ‘‘ I like dogs’’ are scored as conversation initiations. 3. Initiates play: any verbal or nonverbal initiation of novel play or game. For example, handing the peer trainer a ball or saying “play cars’’ (while engaged with a different toy) are scored as play initiations. Synchronous Reciprocal Social Interaction (SRSI)

Target Peer Same Initiating and Same Initiating and Activity/Same Responding to Duration > 1 Synch. Recip. Activity/Same Responding to Duration > 1 Synch. Recip. Minute Time One Another Minute Social Interaction Time One Another Minute Social Interaction

9:48

9:49

9:50

9:51

9:52

0% 0% 0% 0% 0% 0% 0% 0% Same Initiating and Synch. Recip. Activity/Same Responding to Duration > 1 Social Child Activity Time One Another Minute Interaction

Target PE

Peer PE

Thank you for your participation!

Survey & Certificate

You will receive email with survey from LUCY GIMBLE ([email protected])

Must complete unique survey to get certificate

Certificate will be emailed after survey completion (within 24 hours)

Issues with survey or certificate, please contact us at [email protected]

Thank you for supporting the children and families of Illinois! Let’s Keep in Touch! Visit our Website EITP.education.illinois.edu

Follow us on Twitter @EITPIllinois The Early Intervention Training Program at the University of Illinois Join Our Facebook Group Early Intervention Training Program at The University The Children’s Research Center of Illinois 51 Gerty Drive, Room 105

Champaign, IL 61820