Overview - PLAY Project Autism Intervention

Available through the Bowen Center

For information contact:Barbara Terry, MA Ed

574-267-7169Ext. 3147

What is PLAY Project?

Autism early intervention characterized by joyful interactions

Infrastructure

• Elly Barrow, BS – Allen County• Katie Alexander, BA – Allen County• Kelly Strong, BS– DeKalb, Steuben, LaGrange, Noble• Jennifer Gomez, BA – Huntington, Wabash• Vonnie Netzly, BA – Kosciusko, Marshall• Barbara Terry, MA – Kosciusko, Whitley

About our staff

• Using the 7 Circles of PLAY as a guide, PLAY Consultant trains and supports parent to effectively engage child

• 7 Circles is the actual experience of the family• Can be provided in a home or clinic setting• Key elements of the program:

– Parent support and guidance: coaching, modeling, and feedback

– Video footage: capture parent-child interaction – PLAY Plan: provides clear techniques and activities for

parents to engage child

Autism Early Intervention

Intro to the PLAY Project

Need: Intensive Intervention

National Research Council (2001)– Begin early: 18 month-5 years– 25 hours/week– 1:1 or 1:2– Engaging– Strategic Direction– Comprehensive programs address ASD

Need: Intensive Intervention

– PLAY Begins early: 18 month-5 years– Parent-mediated model results in 25

hours/week– Always working with child 1 on 1 – Engaging: Main focus of PLAY Project– Strategic Direction: Use of 7 circles of PLAY– Comprehensive program: designed to address

the main deficits of autism

PLAY Project ABA/EIBIFocus on interactions Teach skillsUnstructured: naturalistic Highly structuredFollow child’s lead/intent Train child in small stepsInternal reinforcement: fun External reinforcementIntensive 20+ hrs/wk Intensive 30-40 hrs/wkOne-on-one to begin One-on-one to beginHarder to measure: capture the butterfly

Measurable, strong research

More generalization Less generalizationLess expensive More expensive

Comparison: Both are Intensive Approaches

• Family and child centered • Empowering for parents• Relationship-based• Playful & fun: Significantly positively impacts a

core deficit of autism: Social impairment

“When you do what the child loves, the child will love to be with you.”

PLAY Project Early Intervention is . . .

• Read the child's cues and intent• Slow the pace of play, observing and waiting • Follow the child's lead, responding to what child wants• Open and close circles of communication (back and forth

interactions)• Make it intensive! 2 hours per day broken up into 15-20 minute

sessions• Accurately profile the child • Based on the child’s profile, play at the right level

Circle 1 :Principles & Methods

Circle 2: Creating a Child’s Unique Profile

• Functional Developmental Levels (FDLs)

• Sensory Motor Profile (SMP)

• Comfort Zone (CZ)

– Developed by Stanley Greenspan– Used by PLAY Project to help measure

child’s developmental progress.

6 Functional Developmental Levels

– Self regulation and shared attention (FDL 1)– Engagement (FDL 2)– Two-way Communication (FDL 3)– Complex two-way Communication (FDL 4)– Shared Meanings & Symbolic Play (FDL 5)– Emotional Thinking (FDL 6)

6 Functional Developmental Levels

The unique way a child experiences the world through the various sensory modalities and movement:• Visual Processing• Tactile• Auditory • Oral• Olfactory• Motor Planning• Vestibular• Proprioceptive

Circle 2: Sensory Motor Profile

• Self regulation: The ability (or inability!) to stay calm and attentive (i.e. regulated) during social interactions.

• Closely related to SMP• Avoidance on one end of the SR continuum• Over-excitement on the other end• Types of dysregulation:

– Sensory seekers– Over-reactive– Under-reactive

SMP: Self Regulation

Circle 2: Comfort Zone

• What the child does when you let them do whatever they want to do

• Focused on repetitive interests• In their own world, not ‘with us’ • Examples:

– Lining up trains– Visually self stimming on wheels, lines,

objects– Watching TV, videos– Stuck on the same topic: planets, trains,

dinosaurs

– Family Intake and assessment– Baseline parent-child interaction– Example assessment tools:

• Childhood Autism Rating Scale (CARS) • Greenspan Social-Emotional Growth Chart• Functional Emotional Assessment Scale (FEAS)• REEL-3 (Language)

Circle 2: Understanding the Child

Circle 3: PLAY Plan Techniques

The Purpose of the Techniques:• Provide parents and professionals with ideas

for engagement• Increase alertness and awareness• Improve initiative & flexibility• Increase numbers & complexity of circles of

communication• Improve ability to solve problems

Seven Circles of the PLAY Project7 Circles of the PLAY Project

• PLAY Consultant – Models PLAY Techniques– Observes and Coaches

PLAY Partners (Parents)– Provides written

Feedback on PLAY Session plus video

• Empowers parents!

Circle 4: Family Guidance

Seven Circles of the PLAY Project7 Circles of the PLAY Project

Circle 5: PLAY Time Engagement Between Parent and Child

• Playful & fun: “When you do what the child loves, the child will love to be with you.”

• 2 hours per day, broken up into 10-20 minute PLAY sessions

• Daily routines such as meal time, bath time, and bed time

• Research study showed families could meet this goal without increased stress.

Seven Circles of the PLAY Project7 Circles of the PLAY Project

• Use 7 Circles of PLAY Project as guide • Video shows caregivers and Consultant playing

with child • Parent/Video Report Form:

– Gives parents feedback about interaction– Gives parents feedback about child progress

Circle 6: Visit ReviewVideo & Written Feedback

Seven Circles of the PLAY Project7 Circles of the PLAY Project

• Joyful relating• Simple and complex nonverbal gestures• Long interactive sequences (e.g. 50+)• “Circles” of spontaneous verbal communication”• Shared social attention (FDL 1-3)• Symbolic language related to feelings (FDL 4-6)• ‘With us’ continuously, not fragmented/stuck in CZ. • Socially functional & interested in others.

Circle 7: PLAY Clinical Goals

• Pilot: University of Michigan 2000-2009• Pre-Post, uncontrolled study published in Autism

11, no. 3 (2007) 205-224.

• “Feasibility” Study 2005• Randomized Controlled Design 2009

– Results final 2013– October 2014: published in Journal of

Developmental & Behavioral Pediatrics

PLAY Project Research

• Richard Solomon, MD, principle investigator

• Michigan State University co-investigators

• Randomized controlled, multi-site, blinded study

• 5 sites, 60 children per year x 2 years = 120

• Largest study of its kind in US.

• Funded by National Institutes of Health (NIH) mental health division (NIMH)

Randomized control trial

• Aim 1: Improve Parent Interaction– Maternal Behavioral Rating Scale (Mahoney)

• Aim 2: Improve Child Development– MacArthur CD Inventories– Mullen Scales of Early Development– Pivotal Behavior Rating Scale (Mahoney)– Funtional Emotional Rating Scale (DiGangi,

Greenspan)– Vineland II– Autism Diagnostic Observation Scale (Lord)

Measures By Aim

• Aim 3: PLAY is feasible for parents to implement – Peabody Picture Vocabulary Test-4 (Adult IQ

Screen)– Parenting Stress Index– CES-D (Depression)– Parent Perception of Training and Intervention

(Satisfaction)• Aim 4: Home Consultants have fidelity to the model

– Home Consultant Rating Scale (Fidelity)

Measures By Aim

• Significant improvements in: caregiver/parent and child interaction social interaction of children with autism social-emotional development of children

with autism autism symptomatology

Research: Primary Findings

Additional outcomes:

•Improved parent stress and depression•PLAY Project consultant fidelity – they were true to the model

Research: Secondary Findings

1. PLAY parents interact with more skill2. PLAY children improve in their development

– Better interaction– Better language– Less autism severity

3. Effectiveness of parent-mediated model

More Evidence for PLAY

• PLAY Project offers a replicable method • Using an efficient training and certification

model• At relatively low cost to parents and society• That can be broadly and quickly disseminated• To serve a growing need• Get children off of waiting lists and into

services

Research: Implications

Together we can change the course of life for children

with autism.

Impact