Examining reliability and validity of the Preschool Play Scale with handicapped children

Early Play Behaviors of Infants at Elevated Likelihood for Autism Spectrum Disorder

IMPORTANCE

Although research has examined early identification of autism spectrum disorder (ASD), few studies have found behavioral markers during midinfancy associated with later ASD diagnosis.

OBJECTIVE

To examine infants' play behaviors and atypical positions at age 6 mo and later outcome classification among infants at elevated likelihood (EL) and typical likelihood (TL) for ASD. Atypical positions refer to movement patterns indicative of motor delays or deviations, including atypical extension and flexion, poor weight shift and rotation, hypertonicity or hypotonicity, and the presence of primitive reflex patterns.

DESIGN

Observational cohort longitudinal design using blinded video analysis.

PARTICIPANTS

Fifty-eight infants (41 EL infants and 17 TL infants) 6 mo of age.

RESULTS

Infants later diagnosed with ASD needed more support to engage in play at age 6 mo compared with infants who did not receive an ASD diagnosis (U = 130, z = -2.29, p < .05, r = .31). Atypical positions at 6 mo of age were not associated with a later diagnosis of ASD.

CONCLUSIONS AND RELEVANCE

Play behaviors may be early indicators of developmental differences for infants later diagnosed with ASD. The results of this pilot study suggest the need to observe the quality of interaction with a caregiver and objects during early play, which may serve as potential early indicators of ASD. Plain-Language Summary: Few studies have found behavioral markers during midinfancy that are associated with a later diagnosis of autism spectrum disorder (ASD). The results of this study showed that infants who were later diagnosed with ASD were found to have differences in play behaviors compared to infants who were not later diagnosed with ASD. Thus, early play behaviors may be an early indicator of developmental differences for infants who are later diagnosed with ASD.

Application of remodeled glove puppetry for children with developmental disabilities: a randomized controlled trial

This study aimed to improve hand performance and play behavior in children with developmental disabilities (DD) using a remodeled glove puppetry approach. Overall, 62 children with DD were randomly assigned to experimental and control groups (n = 31 each). The experimental group underwent a 12-week rehabilitation program by playing with the remodeled glove puppetry, while the children in the control group played with non-remodeled glove puppetry. The Chinese puppet was remodeled using a Lego EV3® robot. Hand kinematics were analyzed through the Siliconcoach® Pro 7 software, which measured the force produced by the baseline ® hydraulic pinch gauge. Play behavior was measured using the Knox Preschool Play Scale-revised (KPPS-r). The experimental group exhibited significant improvements compared to the control group in hand kinematics (wrist range of motion [ROM], p < .05; metacarpophalangeal ROM, p < .05; proximal interphalangeal ROM, p < .05) and KPPS-r scores (space management, p < .05; material management, p < .05; pretense-symbolic, p < .05; participation, p < .05). After the 12-week rehabilitation with the remodeled glove puppetry, the experimental group exhibited significant improvement in kinematics and KPPS-r scores.

Systematic review: Need for high-quality research on occupational therapy for children with intellectual disability

BACKGROUND

Enabling participation in everyday life and supporting development are essential goals in occupational therapy of children and young people with intellectual disabilities (ID).

OBJECTIVE

To gather and evaluate evidence of the effectiveness of occupational therapy interventions for children with ID in terms of participation in everyday life.

MATERIAL AND METHODS

A literature search conducted using electronic databases (CINAHL, Cochrane Library, PubMed and EMBASE) from January 2000 to May 2020. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Quality of evidence was critically appraised with the GRADE.

RESULTS

The search yielded 4741 records, of which 15 studies met the inclusion criteria: 3 randomized controlled trials, 3 case-control studies, 2 case series and 7 case reports. The studies were diverse in quality. The evidence is inconclusive because of the limited amount of methodologically robust studies.

CONCLUSIONS AND SIGNIFICANCE

Results support the notion that occupational therapy in daily environments for children with ID may enhances participation in everyday activities. Further research with appropriate study designs and outcome measurements is needed. Although the research evidence was limited, the results encourage focussing on occupational therapy for children with ID to enhance participation in school and home environments.

Knox Preschool Play Scale: a scoping review

Abstract Introduction Playing is intrinsically related to child development. Through play assessment, health professionals, including occupational therapists, can obtain information about child development. The Knox Preschool Play Scale - revised (KPPS-r) is a standardized instrument that enables the effective assessment of the skills existing in preschoolers’ play behavior. Objective To examine the national and international scientific production on the KPPS-r. Method This is a scoping review of the literature utilizing the following research databases: Scopus, Lilacs, BDENF, Embase, Cochrane, Medline, PubMed, CINAHL, Web of Science, PsycINFO, Dedalus, BDTD, and PROQUEST; also Scielo, Google Scholar, and Capes Articles Website. The search strategy included the descriptors “Escala Lúdica Pré-escolar de Knox” OR “Knox Preschool Play Scale”. Results 51 studies published between 1983 and 2019 involving 1816 children were identified. The associated use of over 36 assessment instruments was identified, enabling knowledge about the strengths and weaknesses of the scale. The KPPSr is a valuable and reliable instrument both in clinical practice and in research. However, the lack of a manual or guidelines for its application is a weakness of this instrument. Conclusion This scoping review qualitatively analyzed the national and international literature addressing the KPPS, identifying gaps in scientific production and generating a broad panorama of data on the use, dissemination, and availability of this instrument, in addition to presenting an outline of the studies, their methodologies, and objectives.

Escala Lúdica Pré-Escolar de Knox: uma revisão de escopo

Resumo Introdução O brincar é intrinsecamente relacionado ao desenvolvimento infantil. Através da avaliação do brincar, profissionais de saúde, incluindo terapeutas ocupacionais, podem obter informações sobre o desenvolvimento global da criança. A Escala Lúdica Pré-escolar de Knox – revisada (ELPKr) é um instrumento padronizado capaz de avaliar eficazmente as habilidades presentes no brincar de pré-escolares. Objetivo Examinar a produção científica nacional e internacional sobre a utilização da ELPKr. Método Trata-se de uma revisão de escopo da literatura, utilizando as seguintes bases de dados para busca: Scopus, Lilacs, BDENF, Embase, Cochrane, Medline, PubMed, CINAHL, Web of Science, PsycINFO, Dedalus, BDTD, PROQUEST, além de Scielo, Google Scholar e Portal Capes de Periódicos. A estratégia de busca incluiu os descritores “Escala Lúdica Pré-escolar de Knox” OR “Knox Preschool Play Scale”. Resultados Foram identificados 51 estudos publicados entre 1983 e 2019, envolvendo 1.816 crianças. Além disso, foi constatado uso associado de mais 36 instrumentos de avaliação, sendo possível indicar potencialidades e fragilidades da escala. A ELPKr é um instrumento útil e confiável tanto na prática clínica como na pesquisa. No entanto, a não existência de um manual ou orientações sobre sua forma de aplicação foi indicada como uma fragilidade do instrumento. Conclusão Esta revisão de escopo analisou qualitativamente a literatura nacional e estrangeira a respeito da ELPK, identificando lacunas nas produções científicas e gerando um amplo panorama de dados sobre a utilização, difusão e disponibilidade desse instrumento, além de apresentar um delineamento dos estudos, suas metodologias e objetivos.

A Systematic Review on Clinimetric Properties of Play Instruments for Occupational Therapy Practice

Play is considered the main occupation for children. Pediatric occupational therapists utilize play either for evaluation or intervention purpose. However, play is not properly measured by occupational therapists, and the use of play instrument is limited. This systematic review was aimed at identifying play instruments relevant to occupational therapy practice and its clinimetric properties. A systematic search was conducted on six databases (Academic Search Complete, CINAHL, MEDLINE, Psychology and Behavioral Science Collection, Scopus, and ASEAN Citation Index) in January 2020. The quality of the included studies was evaluated using Law and MacDermid's Appraisal for Clinical Measurement Research Reports, and psychometric properties of play instruments were evaluated using Terwee's checklist while the clinical utility is extracted from each instrument. Initial search identifies 1,098 articles, and only 30 articles were included in the final analysis, extracting 8 play instruments. These instruments were predominantly practiced in the Western culture, which consists of several psychometric evidences. The Revised Knox Preschool Play Scale is considered the most extensive and comprehensive play instrument for extrinsic aspect, whereas the Test of Playfulness + Test of Environmental Supportiveness Unifying Measure is a promising play instrument for intrinsic aspect on play, where both instruments utilize observation. My Child's Play is a potential questionnaire-based play instrument. However, the current development of play instruments in the occupational therapy field is immature and constantly evolving, and occupational therapists should exercise good clinical reasoning when selecting a play instrument to use in practice.

Validation of the Revised Knox Preschool Play Scale for the Brazilian Population

Background

Play is essential to child development, and its evaluation is considered valid to indicate the stage of development of the child and indicate possible lagging. The Revised Knox Preschool Play Scale (RKPPS) provides an evolving description of the typical play behavior of preschool children, in six-month periods from zero to three years of age and then in annual periods up to six years of age. The RKPPS has already undergone the process of cultural adaptation for use in the Brazilian population, and it is necessary to analyze its applicability.

Aims

To verify the reliability and internal consistency of the RKPPS for Brazilian children.

Method

135 children participated in the study, divided into different age groups with 15 in each group, and were filmed during free play in school or home contexts. Two independent raters evaluated the footage from two different times. Based on these evaluations, a statistical analysis was carried out in order to ascertain the reliability and the internal consistency of the Brazilian version of the RKPPS.

Results

Intra- and interrater reliability showed a predominance of near-perfect to moderate agreement; however, some dimensions of certain age groups presented reasonable to poor agreement. The internal consistency was found to be satisfactory for most of the items evaluated; however, there were items with poor results in some dimensions of certain age groups.

Conclusions

There is a need for further analysis of these items by a committee of experts to ensure the reproducibility of the instrument.

Reliability of ‘The Motor Observations with regards to Sensory Integration’: A Pilot Study

The Motor Observations (MO) with regards to Sensory Integration’ (Horowitz 1994) is based on the original Clinical Observations of Ayres (1972a). The test aims to identify children aged 5 to 12 years with a learning disorder, described in this study as a developmental coordination disorder (DCD), hypothesised by Ayres to be due to sensory integration dysfunction. This study initiated the measurement of the reliability (internal consistency and intrarater and interrater reliability) of the MO, not included in its Dutch standardisation.

An observational correlational design was employed. The subjects were 28 children aged 6 to 10 years from the Sussex Weald. The MO was administered to a random sample of 21 children without DCD and a convenience sample of 7 children with DCD. Reliability coefficienss (Cronbach's alpha and intraclass correlation [ICC] random observers) were obtained via statistical analysis of score sets generated from live testing and its video recording.

The results indicate marginal reliability of the MO. Internal consistency (N=28) at 0.62 fell below the a priori level of 0.70. Intrarater and interrater reliability for the total samples (N=28, n=15) and the DCD samples (n=7, n=5) was high, ranging from 0.98 to 0.91, above the 0.75 a priori level. However, interrater reliability for the normal sample (n=10) fell below at 0.57, which suggests a deficiency in the test to identify normal development of sensory integration reliably. As the findings are not generalisable due to small samples, further studies are recommended.

Current Trends in Assessing Children's Play

Occupational therapists often assess children's play both formally and informally. A critical review of play assessments from occupational therapy and other disciplines is presented. Many of the assessments available were found to be limited by incomplete psychometric development in regard to validity and reliability and by factors relating to clinical usefulness, such as the artificial context of many play observations.

The need for a range of types of play assessment to choose from is argued and a checklist for helping to select a suitable play assessment is presented. Finally, the suggestion is made that occupational therapists continue to develop more play assessments.

Play Preference and Play Performance in Normal Boys and Boys with Sensory Integrative Dysfunction

The Preschool Play Scale and Preschool Play Materials Preference Inventory were administered to 66 pre-school-age boys (35 normal, 31 with sensory integrative [SI] dysfunction). Data were analyzed descriptively. The results demonstrated that (a) normal pre-school-age boys and pre-school-age boys with SI dysfunction did not differ with regard to play preference; (b) preschool-age boys with SI dysfunction scored significantly lower than did their normal peers on three of the four dimensions of the play scale; and (c) there was no relationship between play preference and performance for the boys with SI dysfunction and only a moderate relationship for the normal boys. Furthermore, none of the scores of the normal preschoolers fell into the category of high preference, low performance in any area of play, whereas 9% of the scores of the boys with SI dysfunction were associated with this type of play deficit. A greater percentage of scores (22%) of the boys with SI dysfunction fell into the category of low preference, low performance in given play categories; only 4% of the scores of the normal boys fell into this category. Clinical implications and recommendations for further study of play deficits are discussed.

A Comparison of the Play Skills of Normal Boys and Boys with Sensory Integrative Dysfunction

Occupational therapists often assume that children with sensory integrative (SI) dysfunction also have play deficits. However, occupational therapy literature suggests that some children with SI dysfunction may compensate for their deficits and be able to play in an age-appropriate fashion. The purpose of this investigation was to determine whether the mean scores on the Preschool Play Scale (PPS) of a group of young boys with SI dysfunction were significantly lower than those of a group of their normal peers. Sixty-one boys between the ages of 54 and 82 months (normal group, n = 30; group with SI dysfunction, n = 31) were the subjects for this study. The group with SI dysfunction scored significantly lower than the normal boys on four of five PPS scores. However, many of the boys with SI dysfunction obtained normal PPS scores. This suggests that therapists should routinely assess the play skills of young children referred to them for SI evaluation.

The Impact of Occupational Therapy on a Child's Playfulness

The constant changing health care system has made it imperative for occupational therapists (OTs) to examine the effectiveness of treatment interventions with children. Few studies exist examining play as the desired outcome of the intervention. Previous studies in occupational therapy (OT) have focused on the motor aspects of play in children (Anderson, Hinojosa & Strauch, 1987; Florey, 1981; Morrison, Bundy, & Fisher, 1991). In these studies, the researchers hypothesize that improving motor skills will improve play skills in children. OTs frequently evaluate play using the Preschool Play Scale (PPS) (Bledsoe & Shephard, 1982; Knox, 1997) which provides a developmental age for play skills. Therapists also use developmental assessments designed to examine the skills used during play (Bundy, 1991). Skills used in play are important but fail to look at a child's approach or attitude during play. A child's approach to activities of play is termed "playfulness" (Bundy, 1997). The Test of Playfulness (TOP) (Bundy, 1997) was developed to measure this construct. The TOP provides information that can assist therapists working with children in designing measurable playfulness goals. This study examined the playfulness of four children who received OT intervention specifically designed to improve play behaviors in comparison to four children who did not receive this intervention. The results provide therapists with information and insight for treating children with play deficits. This information will help therapists design effective treatment to increase playfulness in children.

Physical and Social Play of Preschool Children with and without Coordination Difficulties: Preliminary Findings

Introduction:

This preliminary study investigated the play skills and frequency of engagement in play of young children with and without motor coordination difficulties.

Method:

Using a quasi-experimental design with two independent groups, the play of 21 children aged 4–6 years with (n = 11) and without coordination difficulties (n = 10) was assessed using the Revised Knox Preschool Play Scale and the Play Observation Scale, based on 30 minutes of videotape of play at preschool. Motor skills were assessed using the Developmental Coordination Disorder Questionnaire — German and the Movement Assessment Battery for Children — Second Edition.

Results:

Significant differences were found in developmental play skills between the two groups, specifically in the children's overall play age and in gross and fine motor play, with lower play ages found for children with coordination difficulties. Frequency of engagement and social interaction in play was significantly different: children with coordination difficulties spent more time as onlookers, or in transition, than their typically developing peers. They were more frequently involved in an aggressive incident and had higher frequency of negative affect than the control children during play.

Conclusion:

Children with coordination difficulties engaged in less mature gross and fine motor play than the control group. Difficulties in social interaction seem to be evident at a younger age than has previously been described. Early identification of these difficulties may provide directions for intervention; however, this needs to be more fully explored with a larger sample.

Play assessment for group settings: A pilot study to construct an assessment tool

The Play Assessment for Group Setting (PAGS) was constructed to measure children's play performance. The study was undertaken with 93 children aged from 2 to 8 years to examine whether the items of the PAGS construct a unidimensional scale that can be used to measure children's play ability. The internal scale validity and the person response validity of the PAGS were investigated by examining the goodness-of-fit of the play items and children's play performance to the many-faceted Rasch model for the PAGS. In total, 46 of the 51 play items demonstrated acceptable goodness-of-fit. Of the 93 children, 90.3% demonstrated acceptable goodness-of-fit on the scale of play items. Overall, the results support both the scale and person response validity for the PAGS, as well as providing preliminary evidence that the PAGS can be used for a more detailed evaluation of children's abilities in play performance within natural day-care contexts. Further research is needed to examine other aspects of the validity and reliability of the PAGS measures.

Analyse descriptive du comportement ludique d'enfants ayant une déficience physique et fréquentant la garderie

Depuis toujours, les ergothérapeutes qui travaillent auprès des enfants ont recours à des activités de jeu comme ressources thérapeutiques. Afin de décrire le comportement ludique de l'enfant avec une déficience physique et de préciser certaines caractéristiques de son jeu, une recherche exploratoire a été menée au domicile et à la garderie auprès de 20 enfants, âgés de 3 à 5 ans, présentant une déficience physique. Pour ce faire, la Grille d'observation du jeu chez l'enfant d'âge préscolaire (Preschool Play Scale) et une adaptation de l'Historique du jeu (Play History) ont été utilisées. Les résultats obtenus permettent de retracer la séquence de développement du jeu de l'enfant présentant une déficience physique et d'analyser l'écart entre son âge chronologique et son âge de jeu.