Better when I’m playing developing the playfulness and social play of learners with autism spectrum disorders through play-based occupational therapy
Date
2024-03
Authors
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Background: Play is essential to a child’s optimal development; therefore, occupational therapists use it to achieve play-related or functional goals. Without the foundational motivators of playfulness and social play, play engagement and consequently, play skills may be limited. Elements of playfulness, and social play skills may be difficult for children with autism spectrum disorders (ASD) to demonstrate during play engagement. These aspects could perhaps be even more limited in children with ASD who require high levels of support and those living in Low- and middle-income countries (LMIC) such as South Africa. Play-based occupational therapy interventions could improve playfulness and social play of learners with ASD, resulting in more opportunities for practicing play and social skills, therefore influencing overall occupational performance and satisfaction.
Objectives: This study aimed to determine the effectiveness of play-based interventions through two phases. Phase one involved a systematic review of literature investigating the effect of play-based occupational therapy interventions on the playfulness, social play, and occupational performance of learners with ASD. Phase two outlines a study protocol which aims to evaluate the effect of a play-based intervention on the playfulness, social play, and occupational performance of learners with ASD in Gauteng, South Africa.
Methods: Phase one used a systematic review of 12 quantitative studies, following PRISMA guidelines, to explore the effect of play-based interventions on playfulness and social play and strategies contributing to successful interventions. It was registered with PROSPERO (CRD42022349695). The databases PubMed, EBSCOhost, OT seeker, Scopus, Sabinet, Cochrane, and ProQuest were searched, and 12 eligible studies were assessed for methodological quality and intervention reporting quality using the JBI and TIDieR checklists, respectively. Phase two was informed by the results of phase one. The study will use a within-subject-repeated-measures design to implement the Playbox Africa Intervention with learners (aged 3-8 years) who have ASD, in a school in Johannesburg, Gauteng. The Test of Playfulness (ToP) and modified version of the Canadian Occupational Performance Measure (M-COPM) will be outcome measures for playfulness, social play, and occupational performance. The protocol follows the SPIRIT (2013) guidelines for interventions.
Results: The systematic review found moderate to strong evidence for 11 of the 12 studies, that play-based interventions improve the playfulness and social play of learners with ASD. Six key principles to developing successful interventions were highlighted, as well as the Playboxes Joint Play Approach which demonstrated high feasibility. It was found that only one study was conducted in an LMIC (Anu et al., 2019) and only two studies involved learners with high support needs (Dionne & Martini, 2011; Fabrizi, 2015). These aspects informed the intervention protocol which was developed by incorporating the most recent evidence regarding play-based interventions, and culturally adapting an existing intervention to the study context, according to the TIDieR checklist requirements. A product of Phase 2 is the development of Playbox Africa, a culturally adapted and evidence-informed elaboration of the Playboxes Joint Play Approach (Marwick et al., 2021).
Conclusion and Recommendations: Play-based interventions can improve playfulness and social play if certain principles are followed. These include combining social, free, and structured play, using caregivers to model the play, toys of interest and video-modelling, and considering the level of support of the learners, as well as the duration of the intervention. There remains a significant gap between theoretical knowledge regarding play interventions and implementation in practice and research. It is imperative that play-based interventions targeting playfulness and social play are further researched and implemented, especially for children with ASD who have high support needs, in LMIC.
AFRIKAANSE OPSOMMING: Agtergrond: Spel is noodsaaklik vir 'n kind se optimale ontwikkeling; daarom gebruik arbeidsterapeute dit om spelverwante of funksionele doelwitte te bereik. Sonder die intrinsieke en ekstrinsieke motiveerders van speelsheid en sosiale spel, kan speel- en speelvaardighede nie beperk word nie. Speelsheid, of die gewilligheid om betrokke te raak, en sosiale spel, om met maats te speel, ontbreek dikwels by kinders met outismespektrumafwykings (OSV). Hierdie aspekte kan dalk selfs meer beperk word by kinders met OSV wat hoe vlakke van ondersteuning benodig en diegene wat in Lae tot Middel-inkomstelande (LMIC) soos Suid-Afrika woon. Spelgebaseerde arbeidsterapie-intervensies kan speelsheid en sosiale spel van leerders met OSV verbeter, wat kan tot meer geleenthede vir die inoefening van spel en sosiale vaardighede lei. Doelwitte: Hierdie studie het ten doel om die effektiwiteit van spelgebaseerde intervensies deur twee fases te bepaal gehad. Fase een het 'n sistematiese oorsig van literatuur behels wat die effek van spelgebaseerde arbeidsterapie-intervensies op die speelsheid en sosiale spel van leerders met OSV ondersoek. Fase twee skets 'n spelgebaseerde intervensieprotokol wat daarop gemik is om die speelsheid en sosiale spel van leerders met OSV in Gauteng, Suid-Afrika, te verbeter. Metodes: Fase een het 'n sistematiese oorsig van 12 kwantitatiewe studies, volgens PRISMA-riglyne, gebruik om die effek van spelgebaseerde intervensies op speelsheid en sosiale spel en strategiee wat tot suksesvolle intervensies bydra, te ondersoek. Dit was geregistreer by PROSPERO (CRD42022349695). Die databasisse PubMed, EBSCOhost, OT seeker, Scopus, Sabinet, Cochrane en ProQuest is deursoek, en 12 kwalifiserende studies is geassesseer vir metodologiese kwaliteit en intervensieverslaggewingkwaliteit met behulp van die JBI en TIDier kontrolelyste. Fase twee het ingelig geword deur die resultate van fase een. Die studie sal 'n binne-vak-herhaalde-maatreels-ontwerp gebruik om 'n spelgebaseerde intervensie met leerders (ouderdom 3-8 jaar) wat OSV het, in 'n skool in Johannesburg, Gauteng, te implementeer. Die toets van speelsheid (ToP) en Kanadese beroepsprestasiemaatstaf (M-COPM) sal uitkomsmaatstawwe vir speelsheid en sosiale spel wees. Die protokol volg die SPIRIT-riglyne vir intervensies.
AFRIKAANSE OPSOMMING: Agtergrond: Spel is noodsaaklik vir 'n kind se optimale ontwikkeling; daarom gebruik arbeidsterapeute dit om spelverwante of funksionele doelwitte te bereik. Sonder die intrinsieke en ekstrinsieke motiveerders van speelsheid en sosiale spel, kan speel- en speelvaardighede nie beperk word nie. Speelsheid, of die gewilligheid om betrokke te raak, en sosiale spel, om met maats te speel, ontbreek dikwels by kinders met outismespektrumafwykings (OSV). Hierdie aspekte kan dalk selfs meer beperk word by kinders met OSV wat hoe vlakke van ondersteuning benodig en diegene wat in Lae tot Middel-inkomstelande (LMIC) soos Suid-Afrika woon. Spelgebaseerde arbeidsterapie-intervensies kan speelsheid en sosiale spel van leerders met OSV verbeter, wat kan tot meer geleenthede vir die inoefening van spel en sosiale vaardighede lei. Doelwitte: Hierdie studie het ten doel om die effektiwiteit van spelgebaseerde intervensies deur twee fases te bepaal gehad. Fase een het 'n sistematiese oorsig van literatuur behels wat die effek van spelgebaseerde arbeidsterapie-intervensies op die speelsheid en sosiale spel van leerders met OSV ondersoek. Fase twee skets 'n spelgebaseerde intervensieprotokol wat daarop gemik is om die speelsheid en sosiale spel van leerders met OSV in Gauteng, Suid-Afrika, te verbeter. Metodes: Fase een het 'n sistematiese oorsig van 12 kwantitatiewe studies, volgens PRISMA-riglyne, gebruik om die effek van spelgebaseerde intervensies op speelsheid en sosiale spel en strategiee wat tot suksesvolle intervensies bydra, te ondersoek. Dit was geregistreer by PROSPERO (CRD42022349695). Die databasisse PubMed, EBSCOhost, OT seeker, Scopus, Sabinet, Cochrane en ProQuest is deursoek, en 12 kwalifiserende studies is geassesseer vir metodologiese kwaliteit en intervensieverslaggewingkwaliteit met behulp van die JBI en TIDier kontrolelyste. Fase twee het ingelig geword deur die resultate van fase een. Die studie sal 'n binne-vak-herhaalde-maatreels-ontwerp gebruik om 'n spelgebaseerde intervensie met leerders (ouderdom 3-8 jaar) wat OSV het, in 'n skool in Johannesburg, Gauteng, te implementeer. Die toets van speelsheid (ToP) en Kanadese beroepsprestasiemaatstaf (M-COPM) sal uitkomsmaatstawwe vir speelsheid en sosiale spel wees. Die protokol volg die SPIRIT-riglyne vir intervensies.
Description
Thesis (MOccTher)--Stellenbosch University, 2024.