Rajiv Gandhi University of Health Sciences, Karnataka s42

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON CREATIVE COMMUNICATION TECHNIQUES WITH CHILDREN AMONG THE MOTHERS OF PRESCHOOLERS AT SELECTED COMMUNITY IN BANGALORE”

SUBMITTED BY, Ms JENNI GRACEN JOHNY 1ST YEAR M.Sc. NURSING ROYAL COLLEGE OF NURSING UTTARAHALLI BANGALORE-61

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. PROFORMA SYNOSPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. Name of the Candidate and Address MS. JENNI GRACEN JOHNY 1ST YEAR M.Sc. NURSING, ROYAL COLLEGE OF NURSING, 7THMAIN,1STBLOCK, UTTARAHALLI, BANGALORE-560061.

2. Name of the Institution Royal College Of Nursing, Bangalore 3. Course of study 1st Year MSc. Nursing, Child Health Nursing. 4. Date of admission to course 01-06-2011 5. Title of the Topic: “A Study to Assess the Effectiveness of Structured Teaching Programme on Creative Communication Techniques with Children among the Mothers of Preschoolers at selected Community in Bangalore”

1 6. Brief resume of the intended work: 6.1 Need for the study Enclosed 6.2 Review of literature Enclosed 6.3 Objectives of the study Enclosed 6.4 Operational definitions Enclosed 6.5 Hypothesis of the study Enclosed 6.6 Assumptions Enclosed 6.7 Delimitations of the study Enclosed 6.8 Pilot study Enclosed 6.9 Variables Enclosed

7. Materials and methods 7.1 sources of data- Data will be collected from mothers of preschool children who are residing in a selected community, Bangalore. 7.2 Methods of data collection- structured interview schedule. 7.3 Does the study require any interventions or investigation to the patients or other human being or animals? Yes. 7.4 Has ethical clearance been obtained from your institution? Yes ethical committee’s report is here with enclosed.

8. List of references Enclosed

2 Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. PROFORMA SYNOSPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. Name of the Candidate and MS.JENNI GRACEN JOHNY Address 1ST YEAR M.Sc. NURSING, ROYAL COLLEGE OF NURSING, 7TH MAIN, 1ST BLOCK, UTTARAHALLI, BANGALORE-560061.

2. Name of the Institution Royal College Of Nursing,

3. Course of study and subject 1st Year MSc. Nursing Child Health Nursing.

4. Date of admission to course 01-06-2011.

5. Title of the topic

“ Effectiveness of Structured Teaching Programme on Creative Communication

Techniques with Children among the Mothers of Preschoolers ”

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

3 "Great speakers are not born, they are trained."

[Dale Carnegie]

Communicating with a child is one of the most pleasurable and rewarding experiences for both parent and child. Children learn by absorbing information through daily interactions and experiences with other kids, adults, and the world. And between the ages of 4 and 5, many kids enter preschool or kindergarten programs, making language competency necessary for learning in the classroom.1

The more interactive conversation and play kids are involved in, the more they learn. Reading books, singing, playing word games, and simply talking to kids will increase their vocabulary while providing increased opportunities to develop listening skills.1

As kids gain mastery over language skills, they become more sophisticated in their conversational abilities. Kids ages 4 to 5 years can follow complex directions and enthusiastically talk about things they do. They can make up stories, listen attentively to stories, and retell stories. At this age, kids usually are able to understand that letters and numbers are symbols of real things and ideas, and that they can be used to tell stories and offer information.1

Sentence structures now incorporate up to eight words, and vocabulary is between 1,000 and 2,000 words. Most kids this age should have intelligible speech, although there may be some developmental sound errors and stuttering, particularly among boys. Preschoolers generally are able to make comments and requests and give directions. They should know the names and gender of

4 family members and other personal information. They often play with words and make up silly words and stories.1

Communication is much more than words going from one person's mouth to another's ear. In addition to the words, messages are transferred by the tone and quality of voice, eye contact, physical closeness, visual cues, and overall body language.2

Language employs symbols—words, gestures, or spoken sounds—to represent objects and ideas. Communication of language begins with spoken sounds combined with gestures, relying on two different types of skills. Children first learn to receive communications by listening to and understanding what they hear (supported by accompanying gestures); next, they experiment with expressing themselves through speaking and gesturing. Speech begins as repetitive syllables, followed by words, phrases, and sentences. Later, children learn to read and write. Many children begin speaking significantly earlier or later than the milestone dates.2

Preschool children from three to five years of age develop further. They expand their word combinations and are able to speak in sentences, use correct grammatical patterns, use pronouns, articulate sounds clearly, and rapidly increase their working vocabulary. Preschool children may also understand words they do not use themselves.2

5 Preschoolers are like chameleons. All day long they verbalize and act out scenes from their imaginations but when you ask them: "How was your day at preschool?" or "How was your play date?" they turn quiet and run off. Between the ages of 3 and 5 years, children take a huge leap in their social skills. They will experience their first close friendships, their first jealousies and first hurt feelings. These feelings can be extremely overwhelming, and although they don't necessarily talk about things that are bothering them, they are able to express themselves in other ways.3

Reading to your child serves several basic functions: to build vocabulary, to recognize the relationship between written and spoken language (phonics, or the sounds of letters), to recognize groups of letters as words (associated with sounds and images) and to understand or comprehend the aspects of a story. Some parents start as soon as their child is born.4

Parents should begin talking to their children as soon as they are born, and continue this practice as the child learns to communicate. By the time your child is in preschool, she should have enough vocabulary to hold short conversations. Take turns speaking and then listening to what the other person has to say.4

6.1 NEED FOR THE STUDY

"Listening looks easy, but it's not that simple. Every head is a world." -- Cuban proverb

6 Preschool-aged children acquire language skills constantly, and helping them to focus on effective, positive communication will provide them with useful life skills. Parents and educators can help direct this learning in a way that will help children acquire language skills that will prepare them for a lifetime of learning and growing.4

Expose your child to language in print and spoken forms. Read to your child from an early age, and let your child's questions and natural curiosity determine the topic of discussions at times. As you read and share discussions with your child, talk about language, such as what new words mean, how words sound, how to sound out letters and so on. This repetition will help your child learn and retain more.4

To improve your child's communication skills, help your child relate to books by selecting stories that mirror families like yours or people from your cultural or ethnic group, keep books, magazines, and other reading material where kids can reach them without help, help kids create their own "This Is Me" or "This Is Our Family" album with photographs or mementos, talk with your child about books or TV programs and videos that you watch together, let your child see you reading and enjoying books.1

Creative thinking skills are essential for success in learning and success in life. Creative thinking involves a range of skills that can be promoted across the curriculum. There is potential for creative thinking in all fields of human activity, and in all lessons. This article offers strategies that can be adapted to enrich teaching in a range of subject areas. It aims show ways to develop children’s capacity for original ideas and creative achievement.5

A study was conducted on development of Communication skills in Finnish pre-school children examined by the children's communication checklist (CCC). The children between three and six years of age were taken for samples examined using the Children's Communication Checklist. The children's communication checklist was effective in evaluating typical 7 communication skills in pre-school children, and it can be used to investigate pragmatic skills in children as young as three years of age. 6

A study was conducted on family story play: reading with young children (and Elmo) over a distance, a system that supports grandparents to read books together with their grandchildren over the Internet. Family Story Play is designed to improve communication across generations and over a distance, and to support parents and grandparents in fostering the literacy development of young children. Results indicate that Family Story Play improves child engagement in long-distance communication and increases the quality of interaction between young children and distant grandparents. Additionally, Family Story Play encourages dialogic reading styles that are linked with literacy development. Ultimately, reading with Family Story Play becomes a creative shared activity that suggests a new kind of collaborative story telling.7

During the clinical posting in pediatric ward, investigator found that preschool children were less communicating with the parents, family members and health team members. Investigator applied creative communication technique such as storytelling, drawing and found that children more interacting. So the investigator likes to create awareness on creative communication techniques among mothers of preschool children.

6.2 REVIEW OF LITERATURE “Literature review to the activities involved in identifying and searching for information or a topic and developing a comprehensive picture of the state of knowledge on that topic”

A study was conducted on a pediatric digital storytelling system for third year medical students: the virtual pediatric patients. Online survey respondents (N = 393) described the overall quality as excellent or very good (88.4%). the digital storytelling system, has been developed and evaluated which and appears to be successful in overcoming some of the limitations of earlier computer-based patient simulations by featuring patient's stories in their own words, by focusing on problems rather than diseases, and by having stories that are quick for students to work through.8

8 A study was conducted on storytelling as a communication tool for health consumers: development of an intervention for parents of children with croup. The objective of this paper is to describe the development of a story-based intervention for delivery of health evidence to parents of children with croup. The study allowed shape products to ensure accuracy, credibility, and relevance. It helps for further work in the area of stories and narratives, as well as more broadly for identifying and developing communication strategies for healthcare consumers.9

A study was conducted on occurrence of child abuse: knowledge and possibility of action of speech-language pathologists to understand the occurrence of child abuse and neglect of children and adolescents treated by speech-language pathologists. The study shows that to give voice to children who are victims of violence, understanding that behind a speech-language complaint there might be a cry for help.10

A study was conducted on storytelling techniques and approaches with preschool children. One hundred twelve stories were chosen by parents and told to their preschool children in one-to- one settings in their homes. The result shows that reading stories motivated more verbal exchanges than narrating stories and storytelling is a child-centered activity that meets the entertainment needs of the child.11

A study was conducted on electrophysiological correlates of semantic processing in Williams syndrome. Samples were a group of 12 individuals diagnosed with Williams syndrome, with age range between 9 and 31 years. Participants were presented with sentences that ended with words incongruent (50%) with the previous sentence context or with words judged to be its best completion (50%). Results represent a physiological signature of underlying impaired on-line language processing in this disorder.12

A study was conducted on the sense of growth and Loevinger's ego developmental level. Samples were 799 children between 5th and 12th grades responded to a Sentence Completion Test of ego development and sense of growth. The results confirmed the higher the age, the higher the ego developmental level, and the level affected what children thought about their growth.13

A study was conducted on psychogenic thoracic pain attacks. Over a five-month period a 10-year-old girl presented repeatedly with attacks of chest pain and eventually diagnosed as a

9 conversion disorder. An interview and projective sentence completion test was used. Result shows that over a follow-up period of two years the patient remained symptom-free and her further development was unproblematic. Aspects of this case that are typical of conversion disorder and factors indicating a good prognosis are discussed.14

A video analyzed study was conducted among thirty children with cochlear implants regarding the development of preverbal communication skills in Chinese deaf children with cochlear implants. All statistical analyses were performed using the SPSS 13.0 statistical software package with a criterion of statistical significance set at P < 0.05. Children established a vocal/auditory mode of early communicative behavior following cochlear implantation. They preferred to communicate with others in a more vocal style.15

A study was conducted on the effect of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder. Sixty-two children were the samples of the study. The study suggests that internet video game playing might be a means of self-medication for children with attention-deficit/hyperactivity disorder.16

A study was conducted on the use of verbal communicative abilities to increase the mean length of utterance in high-functioning autism and Asperger Syndrome. Samples were three 12- year-old males with high-functioning autism and Asperger Syndrome. Result shows the application of the proposed strategies for verbal communicative abilities achieved the purpose of increasing the mean length of utterance.17

A study was conducted on social communication and interaction skills training for children and adolescents with autism spectrum disorders. Results indicate distinct improvement of verbalization and contact abilities. Participants benefited particularly from role play.18

A longitudinal study of three-year-old children with delayed development of language was conducted. Samples were 113 three-year-old children. The study shows that poor mental outcome could be predicted by delayed development of both expressive and comprehensive language, particularly associated with dysfunction of communication skills at the age of three. ABR is a useful method for detecting of hearing loss in non-cooperative young children with delayed development of language.19

10 A study was conducted on The Role of Pretend Play in Children's Cognitive Development. The study shows that there is a growing body of evidence supporting the many connections between cognitive competence and high-quality pretend play. If children lack opportunities to experience such play, their long-term capacities may be diminished. These complex and multidimensional skills involving many areas of the brain are most likely to thrive in an atmosphere rich in high- quality pretend play.20

A study was conducted on reading versus story telling with preschoolers. 33 preschool children were the samples taken. Results shows that mothers used positive emotion talk during shared reading but negative emotion talks during oral storytelling.21

A study was conducted on creative expression workshops in school: prevention programs for immigrant and refugee children to help the children bridge the gap between past and present, culture of origin and host society. The result shows that workshops provide a safe space for expression.22

A study was conducted on teaching autistic children to use sign language. Three questions are raised with respect to the use of sign language as an alternative system of communication for nonverbal autistic children. Result shows that some children shows increase in spontaneous communication, decrease in self-stimulatory behavior, and improvement in social skills.23

A study was conducted on children's knowledge of cancer diagnosis and treatment and Jordanian mothers' perceptions and satisfaction with the process. 51 mothers attending pediatric oncology clinics in Jordan were interviewed. Mothers who found it difficult to tell the news of the diagnosis to their children finally withheld the diagnoses from them. Those same mothers were unhappy and uncomfortable with the communication method they had used with children . Conclusion of this study emphasized the role of nurses' interaction with their child patients diagnosed with cancer and preferably should take an active role in the process of communication between mothers and their children. 24

11 A randomized controlled study was conducted among preschool children regarding joint attention intervention for children with autism. Results showed significant difference between the intervention and the control group, with the intervention group yielding more joint attention initiation during interaction with the preschool teachers.25

A study was conducted on pediatricians and mothers talk about in the well-child program visits regarding children’s development and education. Result shows that a balance in the communication between pediatricians and mothers in the emission of words and in the introduction of topics. Mother's educational level was not considered as communication barrier.26

6.3 OBJECTIVES OF THE STUDY

1. To assess the knowledge on creative communication techniques among mothers of preschoolers by pre-test knowledge scores.

2. To assess the effectiveness of STP on creative communication techniques by comparing pre and post test knowledge scores of mothers of preschoolers.

3. To find out the association between knowledge scores of mothers of preschoolers on creative communication techniques with selected demographic variables.

6.4 OPERATIONAL DEFINITIONS

12 1. Assess - Assess refers to process of the critical analysis and valuation and judgement of the status or quality or a particular condition or situation.

2. Effectiveness - A desirable change which is a result or consequence of an action or other cause.

3. Structured Teaching Programme - In this study structured teaching programme refers to, structured systematic information, instruction, or training given to mothers regarding creative communication techniques

4. Creative communication techniques - In this study it is a modified method of giving and taking the message to improve the interaction with the children, such as storytelling, play, drawing etc

5. Mothers of preschoolers - A mother is a woman who has child between the age group of 4 - 6 years. 6.5 HYPOTHESIS OF THE STUDY

1. H1:- There will be a statistically significant difference between pre and post test knowledge scores of the mothers of preschoolers regarding creative communication techniques with children

2. H2:-There will be a statistically significant association between knowledge scores of mothers of preschoolers with their selected demographic variables.

6.6 ASSUMPTIONS

1. Mothers of preschoolers may have some knowledge on creative communication technique with children.

13 2. Mothers of preschoolers knowledge on creative communication technique with children can be measured by using structured interview schedule.

3. Mothers of preschoolers knowledge on creative communication technique with children can be improved by administrating structured teaching programme.

4. Effectiveness of structured teaching programme can be assessed by comparing pre and post- test knowledge scores of mothers of preschoolers.

6.7 DELIMITATIONS OF THE STUDY

1. The study is limited to mothers having children aged 4-6 years of age at selected community, Bangalore.

2. The study is limited to mothers residing at selected community, Bangalore

3. The study is limited to mothers who are between the age group of 25-45 years.

6.8 .PILOT STUDY

The study will be conducted with 12 samples. The purpose to conduct the pilot study is to find out the feasibility for conducting the study and design on plan of statistical analysis.

6.9 VARIABLES A quantity that can assume any of a set of values is called variables.

Dependent variable: knowledge level of mothers of preschoolers on creative communication techniques with children.

Independent variable: structured teaching programme on creative communication techniques with children.

14 7.0 MATERIAL AND METHODS

7.1 SOURCE OF DATA The data will be collected from mothers of preschoolers who are residing at selected community, Bangalore 7.1.1 RESEARCH DESIGN

Pre experimental design The design adopted for this study is pre experimental in nature. One group pre-test and post- test design.

7.1.2 RESEARCH APPROACH Evaluative research approach.

7.1.3 SETTING OF THE STUDY The study will be conducted at selected community, Bangalore

7.1.4 POPULATION Mothers of preschoolers who meet the inclusion criteria and are residing at selected community, Bangalore

7.1.5 SAMPLE Mothers of preschoolers who are in the age group of 25-45 years and are residing at selected community, Bangalore

7.1.6 SAMPLE SIZE

The sample consists of 60 mothers of preschoolers who are in the age group of 25-45 years and are residing at selected community, Bangalore

15 7.1.7 SAMPLING TECHNIQUE Sampling technique adopted for the selection of sample is non-probability convenience sampling.

SAMPLING CRITERIA

7.1.8 INCLUSION CRITERIA 1. Mothers who are residing at selected community, Bangalore 2. Mothers who are between the age group of 25-45 years. 3. Mothers who are having children between the age group of 4-6 years 4. Mothers who are available at the time of study. 5. Mothers who know to read and write Kannada or English.

7.1.9 EXCLUSION CRITERIA

1. Mothers who are selected for pilot study. 2. Mothers who are in age below 25 years and above 45 years 3. Mothers who are not willing to participate in the study. 4. Mothers who are not mentally sound.

7.2 METHOD OF COLLECTION OF DATA

The data collection procedure will be carried out for a period of one month. The study will be conducted after obtaining permission from concerned authorities. The investigator will collect data from mothers of preschoolers by using structured interview schedule to assess knowledge before and after structured teaching programme regarding the creative communication techniques with children.

Data collection instruments consist of the following sections Section ‘A’: Demographic data of mothers of preschoolers.

16 Section ‘B’: Structured knowledge questionnaire on creative communication techniques with children

7.2.1 TOOL FOR DATA COLLECTION

Structured interview schedule will be used to collect the data from the mothers of preschoolers who are residing at selected community, Bangalore.

7.2.2 DATA ANALYSIS METHOD

The data collected will be analyzed by using descriptive and inferential statistics.  Descriptive statistics- Frequency and Percentage for analysis of demographic data and mean, mean percentage and standard deviation will be used for assessing the level of knowledge of the mothers.  Inferential statistics - Chi-square test will be used to find the association between knowledge and selected demographic variables. And paired t’ test will be used for assessing the effectiveness of structured teaching program.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

Since the study design is pre-experimental in nature, no investigation is required but interventions are required.

7.4 ETHICAL CLEARENCE

Yes, ethical committee’s report is here with enclosed. The main study will be conducted after the approval of research committee of the college. Permission will be obtained from the head of the institution. The purpose and details of the study will be explained to the study subjects and assurance will be given regarding the confidentiality of the data given. 17 8. LIST OF REFERENCES: [VANCOUVER’S STYLE FOLLOWED]

1. Dowshen S. Communication and Your 4- to 5-Year-Old. 2008 [cited 2011 Oct 10]. Available from: http://kidshealth.org/parent/growth/communication/comm_4_to_5.html#

2. Communication Skills. 2009 [cited 2011 Oct 10]. Available from: http://www.answers.com/topic/communication-skills#ixzz1fQ2FIA6r

3. Hoff H. Communication Techniques That Work. 2009 [cited 2011 Oct 10]. Available from: http://www.thebabycorner.com/page/252/

4. Communication Techniques with Preschool Children. 2009 [cited 2011 Oct 10]. Available from: http://www.ehow.co.uk/way_5863756_communication-techniques- preschool-children.html

5. Fisher R. Expanding Minds: Developing Creative Thinking in Young Learners, The IATEFL Young Learners SIG journal2006 [cited 2011 Oct 10]. Available from: http://www.ehow.co.uk/way_5863756_communication-techniques-preschool-children.html

6. Yliherva A, Loukusa S, Väisänen R, Pyper A, Moilanen I. Development of communication skills in Finnish pre-school children examined by the Children's Communication Checklist (CCC), SAGE journals online [homepage on the Internet]. 2009 [cited 2011 Oct 10].;25(2) Available from: http://clt.sagepub.com/content/25/2/235

7. Raffle H, et al. Family Story Play: Reading with Young Children (and Elmo) Over a Distance, [home page on the Internet]. 2010 [cited 2011 Oct 10]. Available from: http://research.nokia.com/files/FamilyStoryPlayCHI10.pdf 18 8. D'alessandro DM, Lewis TE. A pediatric digital storytelling system for third year medical students: the virtual pediatric patients. BMC Med Educ. [Homepage on the Internet]. 2004 [cited 2011 Oct 10].;19(4) Available from: University of Iowa Hospitals and Clinics, Department of Pediatrics Website: http://research.nokia.com/files/FamilyStoryPlayCHI10.pdf

9. Hartling L, Scott S, Pandya R, Johnson D, Bishop T, Klassen TP. Storytelling as a communication tool for health consumers: development of an intervention for parents of children with croup. Stories to communicate health information. BMC Pediatr [homepage on the Internet]. 2010 [cited 2011 Oct 10].;2(10) Available from: University of Alberta, Department of Pediatrics Web site: http://www.ncbi.nlm.nih.gov/pubmed/20813044

10. Noguchi MS, De Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono [Homepage on the Internet]. 2006 [cited 2011 Oct 10].;18(1 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16625870

11. Souliotis M, Kyridis AG. Narrating and Reading Folktales and Picture Books: Storytelling Techniques and Approaches with Preschool Children, Early Childhood Research & Practice (ECRP) [Homepage on the Internet]. 2006 [cited 2011 Oct 10].;8(1) Available from: University of Western Macedonia, Web site: http://ecrp.uiuc.edu/v8n1/natsiopoulou.html

12. Pinheiro AP, Galdo-Álvarez S, Sampaio A, Niznikiewicz M, Gonçalves OF. Electrophysiological correlates of semantic processing in Williams syndrome. [Homepage on the Internet]. 2010 [cited 2011 Oct 10]. Available from: University of Minho, Web site: http://www.ncbi.nlm.nih.gov/pubmed/20674263

13. Ohno K. What children think about their growth: the sense of growth and Loevinger's ego developmental level? Shinrigaku Kenkyu [homepage on the Internet]. 1997 [cited 2011 Oct 10].;68(2) Available from: Tokyo Metropolitan University, Department of Psychology Website: http://www.ncbi.nlm.nih.gov/pubmed/9278961

19 14. Dittmann RW. Psychogenic thoracic pain attacks. Pathogenesis, follow-up, therapy]. Z Kinder Jugendpsychiatr [home page on the Internet]. 1994 [cited 2011 Oct 10].;22(2) Web site: http://www.ncbi.nlm.nih.gov/pubmed/805326

15. Chen X, Chen D, Jiang W, Zheng Y, Gong S. The development of preverbal communication skills in Chinese deaf children with cochlear implants. [Home page on the Internet]. 2011 [cited 2011 Oct 10]. Available from: Capital Medical University, Website: http://www.ncbi.nlm.nih.gov/pubmed/21949987

16. Han DH, et al. The effects of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder. [Home page on the Internet]. 2009 [cited 2011 Oct 10]. Available from: Chung Ang University Medical School, Department of Psychiatry Website: http://www.ncbi.nlm.nih.gov/pubmed/19374970

17. Lopes-Herrera SA, Almeida MA. The use of verbal communicative abilities to increase the mean length of utterance in high-functioning autism and Asperger Syndrome. [Home page on the Internet]. 2008 [cited 2011 Oct 10]. Available from:, Web site: http://www.ncbi.nlm.nih.gov/pubmed/18408862

18. Herbrecht E, Poustka F. Frankfurt group social communication and interaction skills training for children and adolescents with autism spectrum disorders. [Home page on the Internet]. 2007 [cited 2011 Oct 10]. Available from: Klinikum der Johann Wolfgang Goethe-Universität, Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters Website: http://www.ncbi.nlm.nih.gov/pubmed/17230427

19. Oki J, Cho K. A longitudinal study of three-year-old children with delayed development of language. [Home page on the Internet]. 1996 [cited 2011 Oct 10]. Available from:, Department of Pediatrics website : http://www.ncbi.nlm.nih.gov/pubmed/8934207

20. Bergen D. The Role of Pretend Play in Children's Cognitive Development, a peer-reviewed multilingual journal on the development, care, and education of young children [homepage

20 on the Internet]. 2002 [cited 2011 Oct 10].;4(1) Available from: Miami University, Web site: http://ecrp.uiuc.edu/v4n1/bergen.html

21. Stephanie C, Jones CM. The Role of Pretend Play in Children's Cognitive Development, [homepage on the Internet]. 2002 [cited 2011 Oct 10]. Available from:, Website: http://www.ingentaconnect.com/content/routledg/gecd/2011/00000181/00000001/art00010

22. Rousseau C. Creative Expression Workshops in School: Prevention Programs for Immigrant and Refugee Children. [Homepage on the Internet]. 2005 [cited 2011 Oct 10]. Available from:, Canadian Academy of Child and Adolescent Psychiatry Web site: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542909/

23. Carr EG. Teaching autistic children to use sign language: some research issues. J Autism Dev Disord [Homepage on the Internet]. 1979 [cited 2011 Oct 10].;9(4) Available from:, Web site: http://www.ncbi.nlm.nih.gov/pubmed/521429

24. Arabiat DH, Alqaissi NM, Hamdan-mansour AM. Children's knowledge of cancer diagnosis and treatment: Jordanian mothers' perceptions and satisfaction with the process. Int Nurs Rev. [Homepage on the Internet]. 2011 [cited 2011 Oct 10].;58(4) Available from: The State University of New York, Web site: http://www.ncbi.nlm.nih.gov/pubmed/521429

25. Kaale A, Smith L, Sponheim E. A randomized controlled trial of preschool-based joint attention intervention for children with autism. J Child Psychol Psychiatry [Homepage on the Internet]. 2011 [cited 2011 Oct 10].;10(1111) Available from:, Web site: http://www.ncbi.nlm.nih.gov/pubmed/21883204

26. Nunes C, Ayala M. What do pediatricians and mothers talk about in the well-child program visits? An Pediatr (Barc). [Homepage on the Internet]. 2011 [cited 2011 Oct 10].;75(4)

21 Available from: Universidad del Algarve, DepartamentodePsicología Web site: http://www.ncbi.nlm.nih.gov/pubmed/21550325

27. Piramal R, Law J. Evaluating a programme to enhance vocabulary development in preschoolers. Int J Lang Commun Disord. [Homepage on the Internet]. 2001 [cited 2011 Oct 10].; Available from:, Web site: http://www.ncbi.nlm.nih.gov/pubmed/11340786

9. Signature of the candidate.

10. Remarks of the guide.

22 11. Name and designation. 11.1 Guide

11.2 Signature

11.3 Co-guide

11.4 Signature

11.5 Head of the department

11.6 Signature

12. 12.1 Remarks of the chairman and principal.

12.2 Signature.