An Evaluation of Play Development in Children and Adolescents with Angelman Syndrome
Presentations at the 1st World Conference IASO - Tampere, Finland, 4-8 July, 2000
Presented by: Angela Reason, B.A. (Hons), MSc.
Background to the Study
Whilst working with a lady with Angelman Syndrome (AS), I became interested in a 'play' behaviour she displayed which entailed poking a small stick through a button hole which she would maintain for long periods of time. I wondered if such a behaviour was characteristic of other individuals with Angelman Syndrome. I was also interested to see if AS individuals preferred certain materials, e.g. wood, plastic, etc.
Theory Relating to the Study
According to Jean Piaget, a highly influential figure in the field of child development, a child passes through four stages:
(i) The Sensorimotor Stage (age 0 to 2 years) where the infant is learning about the environment around him;
(ii) Pre-Operational Thought Stage (age 2 to 7) where thought processes are developing but are not logical;
(iii) Concrete Operational Thought Stage (age 7 to 11) where thoughts are more rational and adult-like;
(iv) Formal Operational Thought Stage (age 11 to 16) where the child starts to think like an adult.
Play is considered to progress through three stages (according to Piaget)
Stage 1: 'Practice' - develops during the sensorimotor stage. Infant repeats different actions for functional pleasure. (N.B. 'practice' is not deemed as 'play' per se).
Stage 2: Symbolic Play - develops during pre-operational stage. The child is now in a world of pretence and make believe and fantasy play develops (e.g. pretending a stone is a dog).
Stage 3: Sociodramatic Play - imitation of adult activities (e.g. dolls' tea parties).
Aim of the Study
The first stage of this investigation was to see if individuals with AS do actually 'play' or if they carry out repetitive behaviours. To do this I needed to establish a developmental level to see if they reach the stage where 'play' is seen.
Method
Part 1: I conducted various assessments of development, focusing on the sensorimotor stage. These were as follows:
(i) Object permanence - (the concept of objects still existing when they are out of sight).
(ii) Imitation skills - (e.g. clapping, waving, banging).
(iii) Span of attention.
Each measure is made up of several tasks which increase in difficulty. Therefore when the individual could no longer do the tasks, this was the cut off point (i.e. the stage in their development that they had reached).
I conducted these measures on 2 groups - the 'AS Group' (4 children with Angelman Syndrome, ranging in age from 6 to 15) and the 'Comparison Group' (4 children with Global Developmental Delay, ranging in age from 2 to 8). The 2 groups were used so that I could see if the results were specifically due to Angelman Syndrome or extended to other individuals with severe learning disability.
Part 2: Each child's 'free play' behaviour was also observed to see if there were any common characteristics in choices of activity, or object.
Part 3: A semi-structured interview was carried out with the parent(s) of each child, focusing on interactions and behaviours commonly demonstrated by their child.
Results
Statistical analysis of the results from the 3 measures (object permanence, imitation skills and span of attention) showed that the differences in performance between the 2 groups was not significant (i.e. the differences were not great enough so that chance could be excluded). However, although not significant, the greatest difference between the groups was on the object permanence task where the AS group did better. The AS group also performed marginally better at imitation. The two groups were similar in their attention span.
Assessment of developmental level showed that individuals in the AS group appeared to have a level of approximately one year. This indicates that they do not reach a level where traditional 'play' is seen, but that they use 'practice' play (repetition of different actions for functional pleasure), e.g. the slotting of the stick through buttonholes with the lady I worked with.
It was hoped that the comparison group would be matched for developmental level so that more effective comparisons could be drawn, but results showed that two in this group were slightly different (one above the one year level, and one below). This should be noted when interpreting results as higher and lower cognitive levels will influence responses to some of the tasks.
Results from Clinical Observations of 'Free Play' Behaviour
Activity - children in both groups displayed behaviours involving banging objects and throwing (casting) objects. This is a common feature of their developmental level. It is therefore not possible to say banging and casting are directly associated with a diagnosis of Angelman Syndrome.
Choice of object - all individuals in the AS group tended to show a preference to tactile materials, like rubber, plastic and paper. They also loved water. These preferences did not appear to be the case with the comparison group.
Conclusion
This small study offers some information into these children's level of functioning, and aspects of their sensorimotor milestones. It also indicates that individuals with Angelman Syndrome, in this study, appeared to prefer certain materials. It would be unwise to generalise these findings to all AS individuals as the sample size was small but it poses further research questions for a future larger scale study.
Note: The author is presently conducting a further study into cognitive functioning in Angelman Syndrome.
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