Learning to Mean: The Cognitive/Language Connection.

The Play Assessment Question can monitor a child’s ability to use symbols to think. Symbolic Gesture can be measured through the MacArthur-Bates Words and Gestures.

Symbolic Play and Symbolic Gesture

Symbolic play and symbolic gesture provide a window into the cognitive problem-solving of children who have not yet begun to communicate through language or are in the beginning stages of language development. Observing how children interact with the objects in the environment and people can tell us a great deal about the cognitive readiness of the child for mastering language targets. An excellent way to establish targets for intervention is to observe the symbolic play and symbolic gesture of the child.

Symbolic Play is highly related to symbolic gesture.

Cognitive development, as measured by Play Assessment Questionnaire (PAQ), was found to be highly related to gesture age on the MacArthur Communicative Development Inventory. The PAQ has been shown to have a strong relationship with the development of prelinguistic gestures (Carey, 1995), a measure of self-help (Coulter, 1995), comprehension-conceptualization (Coulter, 1995) and situation-comprehension (Coulter, 1995) on the Minnesota Child Development Inventory and a criterion reference teacher checklist of symbolic play in preschool (Coulter, 1995) and the Westby Play Scale (Coulter, 1995).

Symbolic Play has significant and strong relationships with Gestures Produced, Words Produced, Phrases Understood and Words Understood on the MacArthur Communicative Development Inventory: Words and Gestures. Additionally, this measure has a strong relationship with gestures produced, words understood, phrases understood and words produced on the MacArthur CDI (Day, 1995). Both Minnesota Child Development Inventory (MCDI) and the MacArthur Communicative Development Inventory (CDI) have very strong relationships with the Sequenced Inventory of Communicative Development (SICD) and the Mean Length of Utterance (MLU). Parent questionnaires, such as the MacArthur Communicative Development (CDI) have been used to investigate the interrelationship of symbolic gesture and language through a connectionist perspective.

What is the benefit/contribution of knowledge about symbolic play development for the parent and provider?

Symbolic Play relationships with language development with typically developing children. Several of these relationships have been demonstrated in the development of typically developing children (Bates, Camaioni and Volterra, 1975; Snyder, 1978; Harding and Golinkoff, 1979; Miller, Chapman, Branston and Reichle, 1980; Smolak, 1982; Gopnik and Melzoff, 1986; Tomasello and Farrar, 1984; McCune-Nicolich, 1981; Shore, 1986; Shore, O’Connell, and Bates, 1984).

The Play Assessment Quotient (PAQ) is not intended to be an intelligence quotient nor does the author make any claims that the quotient is a predictor of later language skills. However, during the birth through three year period, there is, however, an extremely high relationship between symbolic play skills and language skills. There is evidence for a very strong parallel relationship so that observation of symbolic play can be a mirror into the child’s understanding of concepts important to language development especially when the child is deaf or hard of hearing.

Symbolic play development could be a crucial element at this stage level because it allows an investigation of non-verbal variables which are not as affected by hearing levels but have a strong relationship with language targets. Regardless of the intelligence level of the child, a lack of synchrony between language skills and symbolic play skills may later impede the child’s ability to reach his/her intellectual potential.

Symbolic Play Inventory and strong relationships with vocabulary development among infants and toddlers who are deaf or hard of hearing:

Those children who were identified at birth and had quotients above 80 on the Play Assessment Questionnaire (PAQ) were the most likely to be close to their hearing peers in language skills, regardless of whether a child is deaf or hard of hearing (Carey, 1995). This same relationship between age of identification, cognitive and language skills was found in a study of 150 children were deaf or hard of hearing (Yoshinaga-Itano, Sedey, Coulter & Mehl, 1998).

Normative data on developmental levels of symbolic play can help the intervention provider/parent determine whether language and symbolic play development are similar.

The provider/parent can determine how similar the child who is deaf or hard of hearing is to children with typical development and normal hearing.
The intervention provider/parent can examine the individual skills of the child and determine what language aspects are most likely to be learned quickly.
The developmental scores represent the range of scores obtained from the Colorado population of over 350 children. Using these graphs, the intervention provider is able to determine how any individual child compares with a normative sample of children with mild through profound hearing loss.
Delays in the development of symbolic play and symbolic gesture have been found to be highly significant characteristics of children who have later been diagnosed with Autism Spectrum Disorder. If the Play Assessment Quotient decreases significantly with age, this decrease should be a red flag for further investigation and referral.
The development of symbolic play and symbolic gesture can help provide valuable information for children who may have auditory perceptual disorders in addition to being deaf or hard of hearing.
Deaf Plus: Children who are deaf or hard of hearing and have additional neurological/cognitive disorders can provide challenges for assessment and intervention planning. Information about symbolic play and symbolic gesture development can provide the parent and early intervention provider with information about the child’s ability to symbolically represent objects and actions in his/her environment prior to the development of verbal symbols.
Deaf Plus: Even when children are not demonstrating observable gains in receptive and expressive language development, children with additional disabilities can demonstrate through their play behavior significant gains in cognitive understanding.
Children with later-identified hearing loss whose language development is significantly delayed can help to determine the relationship of the language delay to the cognitive symbolic understanding of the child.

An infants’ ability to interact symbolically with objects in his/her environment has been studied by investigating: Imitation, Causal Understanding, Means End, Object Permanence and Recognitory Gesture.

IMITATION:

Vocal Imitation and Imitation of Symbolic Gesture have been found to have strong relationships with language development at 9 and 10 months of age (Bates, Benigni, Bretherton, Camaioni & Volterra , 1979).
A child’s ability to imitate more than one action occurs at about the same time as the emergence of two-word utterances (McCall, Parke & Kavanaugh, 1977).

MEANS-END:

“Means end” is observed when an infant figures out how to achieve a goal by using a tool or object to help accomplish the task. An example of means-end can be observed when the infant pulls a cord to get an attached toy, or pulls a tablecloth to get a toy.
“Means end” is observed at about the same time as the infant demonstrates the intent to communicate at about 9 months of age.

OBJECT PERMANENCE:

An infant’s understanding of “existence” or “non-existence”, “disappearance” has been found to be a strong pre-requisite to symbolic representation, learning the first verbal symbol.
Stages of Object Permanence
- Stage 1 – does not look for object when it disappears
- Stage 2 – follow movement of object until it disappears
- Stage 3 – able to find a partially hidden object
- Stage 4 – able to find a fully hidden object from the position they last saw the object
- Stage 5- can find an object that has been hidden, exposed, hidden, exposed several times
- Stage 6 – invisible displacements – i.e. when an item is hidden in a one of two visible containers and moved from one to the other, and object is found (18-24 months)
- Stage 6 in object permanence is significantly related to rapid increases in vocabulary at the same age.

The Play Assessment Questionnaire PAQ:

The Play Assessment Questionnaire (PAQ) (Calhoun, 1987) was derived from the Fewall Play Assessment Scale (PAS) (1984). Both the PAQ and PAS assess the development of play in young children. There is evidence that the PAS correlates highly with measures of cognitive functioning in handicapped and non-handicapped populations (Eisert & Lamorey, 1996; Fewell & Glick, 1994; Fewell & Kaminski, 1988; Fewell & Rich, 1987) such as the Bayley Mental Scales (personal communication, Calhoun, 1987), Developmental Activities Screening Inventory II (Fewell & Langley, 1984), Gesell Developmental Schedules (Knobloch, Stevens & Malone, 1987), Mullen Scale of Early Learning Play, Early Intervention Profile (Schaefer & Moersch, 1981), the Gestural Approach to Thought and Expression, (Langley, 1976), the Callier-Azusa (Stillman, 1978) and the Wisconsin Behavior Rating Scale (Song, Jones, Lippert, Metzgen, Miller & Borreca, 1980). The PAQ is arranged in a developmental sequence that reflects the development of play in children with normal hearing.

The PAQ adapts the PAS 45 items in a parent-questionnaire format to assess children’s symbolic play but has a simplified scoring procedure and allows parents rather than professionals to observe and check the items.

In an preliminary report, Day (1995) conducted a concurrent validity study of the Play Assessment Questionnaire used with CHIP families who had deaf and hard-of-hearing infants and toddlers. Comparisons between the MacArthur CDI, the MCDI Receptive Language (Comprehension/Conceptual subtest), MCDI Expressive Language and CDI Gesture Total correlated between .52 and .86 with the highest correlations for Gesture and PAQ scores.

Validity of the PAQ

The validity of the PAQ in this study, was tested by examining the correlations of the PAQ and subtests of the Minnesota Child Development Inventory, in a sample of deaf and hard-of-hearing children between the ages of 8 and 36 months of age

There was a strong significant correlation between the PAQ play total score and Situation-Comprehension subtest of the MCDI (r=.893,p<.001), the Self-Help subtest of the MCDI (r=.742, p.001), General Development (r=.911,p<.001), Gross Motor (r=.853, p<.001), and the Fine Motor subtest of the MCDI (r=.849, p<.001)

SUBSCALES OF THE PLAY ASSESSMENT QUESTIONNAIRE:

The PAQ, in its original form, gives a unitary total score. Snyder et al (1994) divided the item scores into subscale clusters in addition to using total PAQ scores. This was accomplished by grouping items by the type of play that they typified. The play subscale items in the Autosymbolic category included 6 items. Both the Symbolic Substitution subscale and the Sequenced Symbolic subscale were each comprised of 8 items. The Combinatorial subscale category also included 8 items. See the Appendix for the actual items for each subscale. Parents circled Y (Yes), N (No) or H (with Help) to indicate whether their child was observed producing the play behavior described. Only responses for which parents had indicated Yes received a score, which were then summed by subscale and later added for a total score on the measure.

Autosymbolic Play

Actions in which the use of realistic objects is gestured directly to the child.

EXAMPLE: Taking a closed tube of lipstick and gesturing as if applying it

Symbolic Substitution

Action in which a realistic object is used in a non realistic way.

EXAMPLE: Pretending that a block is a cup and bringing it to the mouth as if to drink.

Sequenced Symbolic Play

Two script related play actions.

EXAMPLE: Feeding a baby doll and then burping it.

Combinatorial Play

Actions in which two objects are brought into spatial relationships with one another.

EXAMPLE: Nesting two cups or putting blocks into a box.

PLAY ASSESSMENT QUESTIONNAIRE

Subscale Items

AUTOSYMBOLIC SUBSCALE:

Has she ever clearly used a particular sound with a specific toy during a play time? For example: saying “un-un” everytime she moved her truck, or “boom” as she knocked down her blocks, or other _______________ Y H N
Have you ever seen her direct actions toward herself on at least three occasions? For example: “drink” from an empty cup, “eat” from an empty spoon, brush hair in play time, put on jewelry as a playful act, try on glasses for fun, try on hats for fun, or other actions _________ Y H N
Have you ever seen her use two related play actions, with herself as the actor? For example: 1) stir in an empty cup then “drink” from it. 2) or put on hats, glasses or jewelry then try to see her/himself, 3) or brush her/his hair then look into a mirror, 4) or any other two related play actions:________________ Y H N
Have you ever seen him/her do two or more different appropriate actions in the same play period using the same toy? For example: 1) loading blocks on a truck and pushing the truck or emptying it. 2) using a spoon to first stir in a cup then to “feed the baby 3) other examples: ______________ Y H N
During the same play period, has she ever used the same action with two different toys or tools? Perhaps: 1)”drinking” from a toy bottle then from an empty cup, 2) or pushing a truck down a road to a spot, 3) then pushing a car to the same place, 4) or combing her own hair then brushing it, 5) or other: _____________________________________ Y H N
Does your child use sound effects while playing and then name what he/she was playing with? For example: 1) pushing around a toy car while making car noises then saying “car”?; 2) or “drinking” from an empty cup with gulping noises then saying “juice” or “milk”? 3) or holding a doll and making crying sounds then saying “baby”?; 4) or ? _____ Y H N

COMBINATORIAL SUBSCALE:

Has your child ever banged together any two objects? (Not banging on the table or floor but hitting the two objects together.) Which objects has she used? __________________________________________Y H N
Does your baby ever seem to put two objects near each other on purpose? This does not mean dropping an object so that it happens to land near another but would include: purposely putting a cup next to a toy or a ring, or a block on top of a doll, or other similiar action________________________ Y H N
Has she ever put one or more object(s) inside another even though it may not have belonged there? For example: a block into a bucket, or a toy truck into a box, or a peg into a cup, or other________________ Y H N
Does your child ever put an object near something to show that she knows what the object should be used for? For example: putting a toy cup or spoon near her mouth, holding a brush near her head, placing pegs near the pegboard, or rings near the ringbase, or other ____________ Y H N
Does she ever put the same kinds of toys together and apart from her other toys? For example: putting several blocks in a pile, getting many of her cars and trucks into the same area, getting all of her dolls and doll accessories together, or other ___________________________ Y H N
Has she/he ever brought out all of the parts to one type of game even though he/she may not have arranged them in an organized fashion, such as: 1) putting the play dishes on a table but not arranging them in table settings? 2) or getting the toy people and people furniture out but not organized as a “house”? 3) or other toys _________________ Y H N
Has your child ever shown that she is aware that four or more related objects can be put in order from smallest to largest by 1) putting together four or more nesting cups in the right order?; 2) stacking four or more rings of increasing size in the right order on a ring stack?; 3) or stacking up four or more blocks to make a tower?; 4) or other? ____________________ Y H N
Have you noticed her being careful to use big props for bigger dolls and small objects for smaller dolls? For example: 1) larger play dishes with a larger doll 2) and a smaller plate, spoon or bottle for a smaller doll 3) other examples: ____________________________________ Y H N

SYMBOLIC SUBSTITUTION SUBSCALE:

During the same play period, has she ever used two different actions with the same toy or object? For example: 1) using a piece of cloth first to wipe a doll, 2) then to cover it, 3) or “eating” from and then “drinking” from a toy cup, 4) or other ___________ Y H N
Has your child ever used one object to be something else in play, such as: 1) a box for a house, 2) or a peg for a doll bottle, 3) or a chair as a car, 4) or a paper as a doll blanket, 5)- or other ______________ Y H N
Has your child organized props for pretend play before playing, such as: 1) “setting” a table with play dishes, 2) or arranging doll furniture into “rooms”, 3) or other? ______________________________ Y H N
If you ask your child to pretend that she is doing something and she doesn’t have the correct tool, will she choose a toy or an object that has some similar characteristics? For example, use: 1) a toy screwdriver if you ask her to brush her teeth, 2) or a toy block if you ask her to play cars, 3) or a nesting toy if you ask her to “drink”, 4) or other:_______________________ Y H N
During the same game has she ever pretended that at least two different objects were something else? For example: 1) using a shoe for a doll’s bath tub or bed; 2) and a piece of paper as a doll’s towel or blanket; 3) or a chair for a car, and the couch or a box for the house in the same game; 4) or other: ___________________ Y H N
If you ask your child to pretend that she is doing something like brushing her teeth or eating her cereal when she has no toys or props, will she then use a body part in place of the missing tool or prop? For example: 1) use his/her fingers for a toothbrush; 2) or her hand for a spoon?; 3) other example: _________________________________ Y H N
Has she ever called any object as something else to fit her game? For example: 1) naming a box as a house; 2) or a table as a stove, 3) or a chair as a car, 4) or a cup as a pan; 5) or other? ___________Y H N
If you give your child a familiar toy or object and ask her/him to pretend it is something else, will she/he? For example: 1) Give him/her a piece of paper and ask her/him to brush her hair 2) give him/her a toy toool from her/his tool set and ask her/him to “drink juice”, 3) give her/him a block of wood and tell her to “feed the doll” 4) or other _______________ Y H N

SEQUENCED SYMBOLIC SUBSCALE:

Have you ever seen her use two related play actions, with herself as the actor? For example: 1) stir in an empty cup then “drink” from it. 2) or put on hats, glasses or jewelry then try to see her/himself, 3) or brush her/his hair then look into a mirror, 4) or any other two related play actions:________________ Y H N
Have you ever seen him/her do two or more different appropriate actions in the same play period using the same toy? For example: 1) loading blocks on a truck and pushing the truck or emptying it. 2) using a spoon to first stir in a cup then to “feed the baby 3) other examples: ______________ Y H N
During the same play period, has she ever used the same action with two different toys or tools? Perhaps: 1)”drinking” from a toy bottle then from an empty cup, 2) or pushing a truck down a road to a spot, 3) then pushing a car to the same place, 4) or combing her own hair then brushing it, 5) or other: _____________________________________ Y H N
During the same play period, has she ever used two different actions with the same toy or object? For example: 1) using a piece of cloth first to wipe a doll, 2) then to cover it, 3) or “eating” from and then “drinking” from a toy cup, 4) or other ___________ Y H N
During the same play period, have you ever noticed him/her using the same action on two different people or objects with different tools or objects, such as: 1) using a big spoon to “feed” him/herself then a small spoon to “feed” a doll; 2) or covering a doll with one blanket then herself with another while playing; 3) or putting one lid on one pot and then a different lid on another pot; 4) or other similar activity? _____________________ Y H N
During the same play period has your child ever used two different actions or props, in correct sequence, on a doll? For example 1) put a doll on the bed and then covered it with a doll blanket; 2) or sat a doll on a toy chair and put the chair up to the table; 3) or other: ______________________ Y H N
Does your child ever put two or more objects together then play with them, such as: 1) putting blocks or “logs” on the back of a truck then pushing it; – or putting a toy person into a car then pushing it around, 2) or putting a doll into a doll cradle then rocking it; 3) or putting a doll in a stroller and pushing it, 4) or other ________ Y H N
Has your child ever done a sequence of three or more related actions? For example: 1) bathing, dressing, then feeding a doll; 2) pouring, stirring in then giving a “tea” cup to someone; 3) loading blocks on a toy truck, emptying the truck, then building with the blocks; 4) other: __________ Y H N

Play Assessment Questionnaire