মুখ্য AAESPH Review Improving the Leisure-Time Behaviors of Severely/Profoundly Mentally Retarded Children through Toy...
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Improving the leisure-time behaviors of severely/profoundly mentally retarded children through toy play Clark Wambold Roberta Bailey The present paper describes procedures that were designed to promote the toy play of a group of severely/profoundly mentally retarded children in a classroom setting. Time sampling procedures were used to assess the students' play behavior during a 30-minute play period. Group and individual interventions were established based on the pretests and probe tests. Changes were made according to student needs, based on the data collected. The results that are presented and discussed suggest improvements in the students' toy play. The 1970s will be recorded in educational history as the decade when the right to education was extended to all children regardless of the severity of their hand icapping condition. This includes a number of severely/profoundly mentally retarded (S/P MR) children who live in large state residential facilities where before only their most basic needs had been cared for. As these children begin to enter classrooms, educators are being charged with providing them with experiences that will promote socially appropriate behaviors. Many of the maladaptive behaviors that the children have learned on the ward will need to be extinguished and replaced with more appropriate school and community behaviors. One area for concern is to develop activities that will aid in the acquisition of leisure-time behaviors. Included within this domain is play. Since many of these AABSPH Review, 1979,4(3), 237-250 238 AAESPH Review, Fall, 1979 children have had little opportunity to acquire play behaviors, they spend much of their leisure time being idle or engaging in socially inappropriate activities. The present paper describes procedures designed to promote the toy play of a group of S/P MR children in a classroom setting. METHOD Students The six children who participated in this study live in a state residential facility for the severely and profoundly mentally retarded; located in Madison, Wisconsin. The children attend a full day educational program at the Harry A. Waisman Center on Mental Retardation and Human Development. All of the children had attended school for one year before this study. Table 1 presents a descriptive summary of the children. Setting and Materials The area of the classroom in which the children played was 12' x 20'. A low book shelf divided the room into equal toy and home-living sections. The home-living area was furnished with two beanbag chairs, a storage chest, a child's rocking chair, a child's table and chair set, a television set, a large chair, and an end table. The toys in this area were: books puzzles stacking rings dial telephone shape box round mirror In addition to the carpeted floor, two gym mats were placed in the center of the toy area. Three sides of the area had open bookshelves housing the toys. The toys were: airplane plastic blocks cloth blocks bowling pins and ball bozo clown doll baby doll busy box wind-up clock coffee can with lid tericloth chicken drowsy doll dressy bessy doll graduated cans stuffed monkey pounding peg board popcorn popper piano stuffed rabbit rocking boat rocking horse school bus xylophone zoo cage and wooden animals Procedures The study was part of a classroom curriculum and took place over 1 academic year. A 30-minute group toy play was scheduled 4 of the 5 weekly school days. The 5th day was set aside for community field trips. Assessment The children's play skills were assessed during the daily 30-minute group toy play. Pre- and posttest measures were done on each child 15 minutes a day for 5 days. Rater reliability checks were taken on 3 of 5 days for each child. Additionally, 10-1 Down's syn drome M Dana Motor skills Verbal skills Ambulatory; nonimitative Ambulatory; nonimitative Bladder-regulated but not bowel-regulated; self-feeder; requires a high degree of assistance in toileting, handwashing, toothbrushing, and dressing. Self-help skills Responds to name; babbles Frequent accidents between but has no expressive Ian- 2-hour bathroom schedule; selfguage. feeder; requires a high degree of assistance in toileting, handwashing, toothbrushing, and dressing. Frequent accidents between Does not attend to a speaker and does not follow 2-hour bathroom schedule, selfdirections; babbles but has feeder; requires a high degree of assistance in toileting, handno expressive language. washing, toothbrushing, and dressing. Semi-ambulatory; imitates Responds to name; follows gross motor actions already simple one-component diin her repertoire. rections; imitates sounds and few words; in frustration has used 3-word sentences; hums tunes. *Ages were computed in September, 1975. Down's syn drome 6-6 M Postnatal infection; cerebral palsy; microcephaly. Diagnosis Cory Age* 8-0 Sex Tootie Name Table 1 F M Jennifer Richard Down's syn drome Diagnosis 13-6 Down's syn drome 11-1 Cornelia de Lange syn drome 6-2 Age* *Ages were computed in September, 1975. M Sex Todd Name Table 1 (Continued) Toilet-regulated; self-feeder; requires minimal assistance in toileting, handwashing, tooth brushing, and dressing. Ambulatory; imitates novel gross and fine motor ac tions. Responds to name; follows simple two-component directions; babbles and im itates beginning sounds of words; uses 7 functional manual communication signs. Frequent accidents between 2-hour bathroom schedule; selffeeder; requires moderate assis tance in toileting, handwashing, toothbrushing, and dressing. Ambulatory; imitates gross Responds to name; follows motor actions already in her simple one-component di rections; low or growl repertoire. pitched voice but has no expressive language. Self-help skills Toilet-regulated; self-feeder; requires a moderate degree of assistance in toileting, handwashing, toothbrushing, and dressing. Verbal skills Ambulatory; imitates gross Responds to name; follows motor actions already in his simple one-component direpertoire. rections; babbles but has no expressive language. Motor skills Wambold & Bailey 241 four probe assessments were done on each child between the pre- and posttests. The probes were done for 15 minutes a day for 2 days. A rater reliability check was done on 1 of the 2 days. A time-sampling procedure was used to assess the children's play skills. Data were recorded when a tape recorder signaled every 15 seconds. After receiving the signal, the observer(s) looked at one of the two children being assessed and recorded on the data sheet (a) what area the child was in, (b) what toy, if any, the child was interacting with, and (c) a brief description of the child's behavior. During the next 15-second interval, a second child was observed and his or her activity recorded. Each of the two children being observed had his or her activity recorded every 30 seconds for 15 minutes, for a total of 30 observations per session. Following the data collection, the data were translated to percentages and placed on a Summary Data Sheet (Figure 1 ). This allowed the investigators to more closely examine each child's play skills and aided in the development of intervention approaches. The variables recorded are described below. Total number of different toys. The number of different toys was added and recorded. Percent (%) of time with toys. The number of observations the child had a toy were added and then divided by the total number of observations. Percent (%) of time without toys. The number of observations the child did not have a toy were added and then divided by the total number of observations. Percent (%) of types of toy interaction. Each individual toy interaction was added, and then divided by the total number of observations. This was repeated for each action listed. Total percent (%) of appropriate play. A positive (+) or negative ( - ) sign was placed beside the description of the child's behavior, following data collection. A negative ( - ) was recorded if the child was dangling or flapping a toy, throwing a toy, climbing or standing on the furniture, mouthing a toy, body rocking, hand flapping, self-abusing, destroying a toy, or bothering another child. All other toy interactions were recorded as positive. In some instances judgments had to be made as to the "appropriateness" or "inappropriateness" of an activity. For example, sitting would normally be recorded as a positive ( +); however, if a child sat for extended periods without interacting with toys, it would be considered negative ( - ) . The percentage of appropriate play was calculated by adding the number of appropriate behaviors (+) and then dividing by the total number of observations. Percent (%) of inappropriate behavior. Each instance of inappropriate behavior (-) was added and then divided by the total number of observations. Total percent (%) of inappropriate behavior. All the inappropriate behaviors were added and then divided by the total number of observations. Interventions Since the major goal of the play was to improve the childrens'/ndependenf use of leisure-time in a group setting, teacher intervention was minimized. Generally, if a child was playing appropriately, he was left alone. Occasionally, in an effort to teach new types of play or maintain a particular play activity, individual children were interacted with or praised. A general procedure that was followed when a child was playing inappropriately with a toy (i.e., throwing, Stereotypie dangling, destroying) ■n io' II C/1 ι- 3 H er S É -5 p Q. e ai m 8 » in CD ►e ut S w M O es n 3 H TOTAL NUMBER DIFFERENT TOYS % TIME WITH TOYS % TIME WITH OUT TOYS a rr -* s TOUCH GRASP HOLD h3 CARRY o SHAKE SS POUND 32 SQUEEZE PUSH PULL TURN OTHER o. TOTAL % APPROPRIATE PLAY H 8 THROW TOY* TOY IN MOUTH M H BODY ROCK SS TOTAL % IN APPROPRIATE BEHAVIOR Wambold & Bailey 243 was that the teacher would intervene and model a more appropriate way to play with the toy. If the child continued the inappropriate behavior, the teacher would model the appropriate action again and wait a few seconds for the child to initiate a similar action. If the child persisted in the inappropriate activity, the teacher would physically prompt the child in an appropriate use of the toy. Continued inappropriate activity resulted in the loss of the toy, and another toy was substituted. Variations in this procedure were at the discretion of the teachers or in instances where interventions were more specifically designed, as in the individual guidelines that follow. More specific procedures were developed following each assessment. If the child did not interact with toys or limited his or her play to using the same toy for an extended period ottime, the teacher offered the child a toy to play with. If no interaction continued, the teacher modeled a use and physically prompted the child as in the forementioned sequence. During intervention it was important that the adults did not become more reinforcing to the child than toys. Therefore, the teachers tried to maintain a balance between child-toy interactions and teacher intervention. This was done in proportion to the child's level of appropriate/inappropriate play. Intervention I. Following the pretest, area size changes were made, new toys were added, and individual interventions were incorporated. Since the children used the toy area more often than the home-living area, the bookcase which divided the two areas was moved toward the home-living area. Thus two-thirds of the play area was now the toy area and one-third the home-living area. The following toys were added: Toy area hour glass toy grand piano marble cylinder Home-living Area full length mirror dress-up clothes shoe board snap board clothes pins beads to string books play dough The individual guidelines were: Name Tootie Behavior 1. No toy interaction Leaving toy/home-living area Approaches 1. Allowable for short periods (1 to 2 minutes), then present a toy. No interaction, try another toy. No interaction, model an appropriate use. Wait. No interaction, physically prompt. Repeat model-prompt. Fade teacher assistance. Return to an area, not too close proximity to others. Wait. If no toy interaction, proceed as in # 1 . 244 AAESPH Review, Fall, 1979 3. Hitting self and head banging 4. Throwing toys 5. Laying on table Tell her matter of factly "No, don't do that" or "No, don't hit yourself." Catch hand in midair if possible. Wait. Present a toy. No interaction, proceed as in # 1 . Tell her in a firm manner not to throw the toys. Wait. Present a toy. No interaction, proceed as in # 1 . Tell her to "get off the table." No response, physically remove her from the table. Wait. Present a toy. No interaction, proceed as in # 1 . Cory 1. Head banging Tell him matter of factly "No, don't do that." Banging head on wall-move him away from wall. Banging head on toy-remove toy and give him another toy to play with. Dana 1. Dangling toy/toys in mouth Tell him "No" and move his arm down. Model an appropriate use of the toy. Wait. No interaction, physically prompt. Repeat model-prompt. Fade teacher assistance. Tell him" No, get down." Wait. No response, physically prompt. Watch to see where he goes next. No toy interaction, present a toy and model an appropriate use. No interaction, physically prompt. Repeat model-prompt. Fade teacher assistance. Tell him "No" and remove the string. Present a toy. Wait. No interaction, model an appropriate use. Wait. No interaction, physically prompt. Repeat model-prompt. Fade teacher assistance. 2. Standing or lying on tables or furniture 3. Twisting string Todd 1. Flapping or dangling toys 2. Throwing toys Model an appropriate use of the toy. Wait. No response, physically prompt. Repeat model-prompt. Fade teacher assistance. Repeated misuse of toy resulted in toy substitution. Model-prompt. Say "No, don't throw the toys." Wait. If he engages in play, praise and leave Wambold & Bailey 245 alone. If no toy interaction, present a toy and model an appropriate use. Wait. No interaction, physically prompt. Repeat model-prompt. Fade teacher assistance. Jennifer 1. Toys in mouth 1. Tell her to "take the toy out of your mouth." Wait. If necessary, take the toy from her mouth. Model an appropriate use of the toy. Wait. No interaction, physically prompt. Repeat model-prompt. Fade teacher assistance. Richard 1. Dangling toys 1. Tell him "find some other way to play with the toy." If he is lying down tell him to "sit up." Follow through with the direction if necessary. If he continues to misuse the toy, model an appropriate use. Continued misuse, tell him to find another toy to play with. If necessary, trade toys with him. Intervention II. The intervention procedures following the analysis of probe 1 data remained essentially the same as those in Intervention I. Because Dana required a good deal of direction, a teacher was assigned to him for the 30-minute playtime. The procedures for Dana remained the same as in Intervention I, and the teacher faded out gradually over a 30-day period. The following toys were added to the play area: Toy area chime telephone squeek nose telephone doll rabbit 2 puppets Home-living area purse Intervention III. Intervention III begun after probe 2 data were reduced and analyzed. The same general and individual procedures were continued. The follow ing toys were added to the play area: Toy area Home-living area moo cow dress-up clothes peek-a-boo block 3 piece puzzle musical merry go round pop-up Jack-in-box wind-up guitar turtle on wheels sing-a-long record player wind-up choo choo train 246 AAESPH Review, Fall, 1979 farmer says TV music box casper punch a bag jumping jack scooter wind-up jack-in-box busy bubble Intervention IV. Intervention IV began following probe 3 and continued through probe 4. For the most part, the approaches that were established during Intervention I were continued. However, greater emphasis was given in an area where each child encountered the most difficulty. The adjusted guidelines were: Name Behavior Tootie 1. Throwing toys Cory 1. No special problems Dana 1. Twisting string Todd 1. Throwing toys Jennifer 1. Toys in mouth Approaches In a firm manner tell her not to throw the toys. Have her pick up the thrown toy. Wait. Present a toy, model an appropriate use. Physically prompt if necessary. Reinforce appropriate behavior. 1. Same as Intervention I. Tell him in a firm manner not to throw the toys. Have him pick up the thrown toy. Wait. If he engages in play, praise and leave alone. No toy interaction, present a toy. Wait. Model-prompt if necessary. If throwing continues, reprimand and have him pick up the toy. Then direct him to the gross motor toys such as scooter and rocking horse. 1. Remove the wind-up guitar and wind-up jack-in-the-box from the toy area during play time. Work with her during skill-building time on the appropriate use of these toys. Bring these toys back into the toy area after she has learned the appropriate usage. Wambold & Bailey Richard 1. Dangling toys 247 1. Remove bozo clown doll from the toy area for one week. Exchange toys with him if he is dangling. 2. Reinforce appropriate behavior. The following toys were added to the play area: Toy area Mr. Music says inchworm small piano butterfly squeeze ball musical typewriter drowsy doll Home-living area refrigerator stove sink ironing board and iron small table and 2 chairs dishes, silverware, pots and pans empty cereal boxes doll carriage Removed or broken toys: Toy area squeek nose telephone 2 puppets musical merry-go-round wind-up guitar wind-up jack-in-box bozo doll Home-living area play dough RESULTS AND DISCUSSION Rater Reliability The rater reliabilities for the pretest, 4 probes, and posttest were computed by dividing the instances of agreement by the total number of observations (agreements + disagreements) and multiplying by 100. The reliabilities ranged from 96% to 100% for the objects while the actions reliability ranged from 89% to 99%. The average of rater reliability for objects on the pretest was 98% and 99% on the posttest. For the action on the pretest, the reliability was 94% and the posttest was 96%. Appropriate Play The results of the group and individual pretests and posttests for the percentage of appropriate play are presented in Figure 2. The group gain was 24%. On an individual basis, considerable improvement was observed in Richard, Tootie, Dana, and Todd with an increase of appropriate play at 37%, 60%, 33%, and 21 % respec tively. Cory's level of appropriate toy play remained unchanged since he was en gaging in a high level of appropriate toy play (98%) during the pretest. Jennifer's level of appropriate play dropped 11%. This was due primarily to her inactivity du ring the posttest. During the various probe tests, Jennifer demonstrated high levels of appropriate play during some probes (93%) and somewhat lower levels during other 248 AAESPH Review, Fall, 1979 100 75 UJ o < z SO (J a£ uj o. 25 PRE —i 1 PRE —i — POST PRE POST PRE POST PRE 1 — POST J E N N I FER —\ PRE POST PRE I POST Figure 2 Percentage of appropriate play for pre- and posttests for the group (TOP) and for each student (BOTTOM) probes (52%). This pattern of ups and downs is also noted in her behavior during other curricular activities. Level of Interactions The type of toy interaction was examined to determine the children's level of play. The interaction was separated into two levels: level 1 —touch, grasp, hold, and carry toys; level 2—squeeze, pound, shake, push, pull, turn, other. The pretest and Wambold & Bailey 249 100 Level 2 squeeze pound shake push pull turn other ( s t a c k , climb, rock) 75 Level 1 touch grasp hold carry PRE LEVEL POST I I POSI LEVEL 1 POST LEVEL TODD PIE PRE 1 2 RICHARD I PRE I POS T LEVEL 2 —i PRE 1 POST LEVEL 1 ' —i r 1 PRE POST LEVEL 2 1 PRE POST LEVEL 1 1 PRE 1 POST LEVEL 2 CORY I ME L f V I l I POST 1 1 Γ PRE POST LEVEL 7 PRE POST LEVEL I PRE LEVEL POST 3 PRE POST LEVEL 1 PRE POST LEVEL 2 Figure 3 Percentage of types of play for pre- and posttests for the group (TOP) and for each student (BOTTOM) posttest group and individual results are shown in Figure 3. The group increased on level 2 by 24% and decreased on level 1 by 5%. This represents a significant change because their interaction with the toys progressed from touching and holding to manipulating and exploring, which is more in line with what is considered "play." As level 2 increased for Todd 42%, Richard 75%, and Cory 17%, level 1 decreased by 19%, 25%, and 18% respectively. Tootie increased on both levels: level 1,40%; 250 AAESPH Review, Fall, 1979 level 2, .03%. Dana improved on level 1, 17%, and stayed the same on level 2. Jennifer decreased on level 1 by 26% and increased on level 2 by 8%. Other results of the study indicated that the children's play behavior improved in several other ways: 1. The children remained in the play areas a greater percentage of the time on the posttest than on the pretest. 2. The children required fewer prompts to initiate and sustain play as the year progressed. 3. The children played with a wider variety of toys. 4. Play with a single toy was sustained for a longer period of time. Toy play is an important activity for children. In addition to being a source for occupying leisure time, it is beneficial in child's growth and development. Children can develop numerous skills while interacting with toys; they practice motor move ments, they learn how objects work and how to function in a group. It is through play that children acquire what are generally thought of as "intelligent" behaviors. The research described in the present paper demonstrates that S/P MR chil dren can learn to play independently. The main ingredients seem to be a comforta ble play area, appropriate toys, prompting, and encouragement from the teacher, balanced with self-directed action on the part of the children. Received November 16, 1978 Final acceptance December 1, 1978 Clark Wambold, Ph.D., is Associate Professor, Department of Studies in Behavioral Disabilities, School of Education, University of Wisconsin, 1500 Highland Avenue, Madison, Wisconsin 53706; Roberta Bailey is a graduate student in the Department of Studies in Behavioral Disabilities, School of Education, University of Wisconsin, 1500 Highland Avenue, Madison, Wisconsin 53706.