Child-Initiated Pretend Play Assessment Research Articles

Qualitative and quantitative pretend play and their predictors in children with autism spectrum disorder: A path-analysis study

Children with autistic spectrum disorder (ASD) often have difficulties in both qualitive and quantitative pretend play. Theory of mind (ToM), symptom severity, and verbal comprehension appear to be potential correlates of pretend play. However, the underlying relationships of these correlates to pretend play remain unclear. Therefore, we applied path analysis to explore the relationships among these variables in children with ASD. A total of 151 children with ASD aged 3 to 12 years and their caregivers participated in this study. Children’s pretend play, ToM, verbal comprehension, and symptom severity were respectively assessed with Child Initiated Pretend Play Assessment, Theory of Mind Task Battery, The verbal comprehension index of Wechsler Intelligence Scale for children–Fourth Edition or Wechsler Preschool and Primary Scale of Intelligence–Fourth Edition, and Childhood Autism Rating Scale. The results showed that the SEM model fit well. The quality and quantity of pretend play were correlated to each other. ToM was positively related to qualitive and quantitative pretend play. Moreover, symptom severity was directly related to quality of pretend play; verbal comprehension was indirectly linked to quantity and quality of pretend play through ToM and symptom severity. In conclusion, our study reveals the underlying relationships of ToM, symptom severity, and verbal comprehension to quantitative and qualitative pretend play in children with ASD. This study both clarifies the important factors of qualitative and quantitative pretend play and provides suggestions to improve pretend play in children with ASD.

Correlation Between the Theory of Mind and Pretend Play in 5 to 7-Year-Old Children with Autism and Their Typically Developed Peers

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with 2 main symptoms of social and communication deficits and stereotyped behaviors. Pretend play and theory of mind (ToM) have an essential role in a child’s cognitive and social development. Objectives: In this study, different variables of pretend play with levels of ToM were examined in 2 groups of typical children and children with autism. Methods: In this case-control observational study, 45 typical children and 18 children with autism aged 5 to 7 years participated. For both groups, the ToM test was performed to measure the levels of ToM, and the child-initiated pretend play assessment (ChIPPA) was performed to analyze the pretend plays in both groups. Both tests were performed directly on children, and the scores were recorded by the examiner. Results: The results showed a significant positive relationship between the total score of ToM and pretend play. In children with autism, there was no difference between the ToM scores regarding age (P > 0.05). There was also a significant relationship between the levels of ToM, percentage of elaborate pretend actions (PEPA), and the number of object substitutions (NOS; P < 0.001). The scores of the ToM and pretend play levels of children with autism and typical children were significantly different (P < 0.001). Conclusions: Based on the findings, the ToM and pretend play levels were lower in ASD children than in typical children. In addition, children who had higher PEPA scores and better NOS had higher ToM scores.

The use of the Child Initiated Pretend Play Assessment - ChIPPA: a scoping review

Resumo Introdução O brincar é uma importante ocupação infantil e sua avaliação deve fazer parte do processo terapêutico para analisar o desempenho ocupacional da criança e planejar intervenções embasadas nessa ocupação. A Avaliação do Brincar de Faz de Conta Iniciado pela Criança (ChIPPA) já foi traduzida, adaptada transculturalmente e validada para a população brasileira. Objetivo Realizar uma revisão do escopo sobre a ChIPPA e identificar como tem sido descrita e abordada na literatura nacional e internacional. Método Entre janeiro e junho de 2021, foi realizada a busca dos artigos nas bases de dados PubMed, Scopus, BVS, ERIC, CINAHL, Web of Science e PsycInfo, usando estratégias de busca com diferentes sintaxes de acordo com o método de cada base: Chippa OR “Child-Initiated Pretend Play Assessment”, ChIPPA OR “Child-Initiated Pretend Play Assessment” OR “Avaliação do faz de conta iniciado pela criança”, Chippa OR “Child-Initiated Pretend Play Assessment” AND Publication Type: Journal. Resultados Foram localizados 25 artigos, entre 2000 e 2021, envolvendo 971 crianças entre 3 e 12 anos de idade, com desenvolvimento típico e atípico, desenvolvidos em estudos analíticos observacionais (transversais e de coorte) e experimentais; metodológicos (validação do instrumento e de adaptação cultural de instrumento); e descritivos. Conclusão A ChiPPA tem sido descrita na literatura como uma avaliação que permite correlacionar o faz de conta e as habilidades verbais, sociais, acadêmicas e de processamento sensorial de pré-escolares. É uma medida de desfecho eficaz, válida e confiável, permitindo avaliar crianças típicas e atípicas em diferentes contextos e países, inclusive no Brasil.

Современные зарубежные подходы к оценке игровой деятельности дошкольников: обзор избранных методик

<p>In contemporary foreign literature the concept of children's play is described through the prism of various theories (psychoanalysis, theory of motivational modulation, metacommunicative theory, cognitive theories, etc.). On the basis of these theories a number of diagnostic tools have been developed to assess the play of preschoolers. The article presents an overview of the most famous of them: Revised Knox Preschool Play Scale (RKPPS), The Child-Initiated Pretend Play Assessment (ChIPPA), Test of Playfulness (ToP). Each of these methods assesses specific components of children's play according to the age norms. The practical application of the methods considered in the article is largely based on the ideas of occupational therapy and focuses primarily on the rehabilitation of preschoolers with disabilities as well as on solving other therapeutic challenges.</p>

Pretend play ability in preschool-aged children with an acquired brain injury.

This study compares the self-initiated pretend play abilities of preschool-aged children with an acquired brain injury, with the self-initiated pretend play ability of their neurotypical peers. A non-experimental group comparison was conducted between 22 preschool-aged neurotypical children (M = 52.8months, SD = 7.1months) and 21 children with an acquired brain injury (ABI, M = 50.5months, SD = 11.9months), who had been discharged from inpatient rehabilitation and who were able to engage in a play session. The children were assessed individually using the Child-Initiated Pretend Play Assessment (ChIPPA). The children with an ABI had significantly lower scores in pretend play ability than their neurotypical peers as measured by the percentage of elaborate play actions in both the conventional (P <.000) and symbolic (P <.000) sections of the ChIPPA, as well as the number of object substitutions (P < .000). The children with an ABI completed significantly less of the play time required compared with their neurotypical peers (P = .001); 66% could not play for the required time. There was no significant difference in the ChIPPA scores of the children with an ABI injured before and after the age of 18 months, nor between children with a severe or moderate injury. The quality and the quantity of pretend play of preschool-aged children with an ABI are significantly below that of their neurotypical peers. Assessment of pretend play ability and direct intervention in ABI rehabilitation by occupational therapists is essential to enable children with an ABI to participate in pretend play and garner the developmental benefit this affords.

The Comparative Study of Pretend Plays Between 5 - 7 Years Old High-functioning Autistic Children and Their Normal Peers with Child-initiated Pretend Play Assessment

Background: Autism is one of the prevalent disorders in childhood. Children with autism have difficulties in different life skills and their daily activities. Pretend plays are essential in improving these skills, but the patterns of playing are impaired in this group. Objectives: The present study was designed to compare pretend plays between high-functioning autistic children and typical peers. Methods: The research is the result of a cross-sectional study. Two groups of children with high-functioning autism and typical peers in the age range of 5 - 7 years were studied. Each group consisted of 87 participants who were selected by convenience sampling. Each participant was assessed by the Child-Initiated Pretend Play assessment (ChIPPA) test. The results were analyzed using descriptive statistics and an independent t-test. Results: Data analysis and comparison of scores between the two groups of children showed a significant difference in the mean scores. The average percentage score of the number of object substitutions (NOS) and the elaborate pretend play actions (PEPA) in children with autism were lower than typical peers (P &lt; 0.001). In other words, children with autism were less able to organize play and pretend. But the number of imitated actions (NIA) scores in children with autism was higher than their counterparts (P &lt; 0.001). That is, children with autism relied more on examiner-playing patterns. Conclusions: The significant difference in scores between children with autism and typical peers showed significantly lower pretend skills in children with autism. According to pretend play basics on academic skills, language, and having a flexible mind, and with the attention to the same problems in children with autism, pretend play can be in greater attention to be improved among these groups.

Can children's play themes be assessed to inform play therapy practice?

In play therapy with children, identifying play themes is key to understanding the meaning within sessions, and allows therapists to systematically track therapeutic change. This study investigated if play themes could be identified using a time limited, standardized assessment, for children aged 5–7 years. A descriptive, observational mixed methods, non-experimental study with 30 typically developing children was conducted, with participants assessed individually on one occasion using the Child-Initiated Pretend Play Assessment (ChIPPA). Play themes were able to be identified for 26 of the 30 participants. Of these 26 children, a range of primary and subthemes were observed. These findings indicate that a baseline measure of both play ability and play themes can be integrated to prescribe and align the model of play therapy with the needs of the child. Play themes were not identified for four participants which may be due to limited pretend play ability, indicating that deficits in play ability may need to be addressed in the first instance.

Construct validity of the Child-Initiated Pretend Play Assessment-For 3-year-old Brazilian children.

Play is an indication of children's development and how they function. In occupational therapy it is regarded as an important occupation of childhood. Assessment of a child's play should be included in the test batteries of occupational therapists, who understand the construct validity of the assessment they have chosen. Our aim was to provide evidence of reliability, internal consistency and hypotheses testing of the construct validity of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment. Two hundred typically developing Brazilian children aged 3years were evaluated individually using the Child-Initiated Pretend Play Assessment. The internal consistency showed a Cronbach's alpha coefficient to Percentage of Pretend Play Actions (PEPA) of 0.86 and NOS of 0.81. There were significant differences between the younger children (aged 36-41months) and the older children (aged 42-47months) for elaborate play across both conventional-imaginative play (p=.002), symbolic play (p=.012), and the combined score (p=.005). There were significant differences between younger and older girls for elaborate play with symbolic play materials (p=.009) and elaborate play overall (p=.039). There were significant differences between young and older boys for elaborate play with conventional toys (p=.006) and elaborate play overall (p=.025). There were no significant differences for object substitution or imitated actions. The measurement properties of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment for 3-year-old Brazilian children identified evidence for response processes, internal structure, with discussion of consequences of testing for 3-year-old Brazilian children.

Prediction Of Playfulness By Pretend Play, Severity Of Autism Behaviors, And Verbal Comprehension In Children With Autism Spectrum Disorder.

BackgroundChildren with autism spectrum disorder (ASD) often exhibit deficits in pretend play and have less playfulness. The purpose of this study was to evaluate the relationship between pretend play and playfulness in children with autism spectrum disorder, while controlling for severity of autism behaviors, verbal comprehension, and age.MethodsA sample of 72 children with ASD aged between 3 and 12 years were assessed with the Child-Initiated Pretend Play Assessment, Test of Playfulness, and Childhood Autism Rating Scale, respectively, for their pretend play, playfulness, and severity of autism behaviors. Correlation and multiple regression analyses were conducted.ResultsThe results of Pearson correlation coefficients revealed that the pretend play variables had mild to moderate associations with the playfulness variables (r = −0.25 to 0.68). The multiple regression analyses showed that, overall, the internal locus of control was the significant predictor of the pretend play variables (accounting for 5–47% of the variance, p < 0.001). The six pretend play variables were all important predictors of all playfulness variables (explaining 41–76% of the variance, p < 0.001–0.047). Particularly, the elaborate pretend play action was a significant predictor of all four playfulness variables. Our findings indicated that the more children with ASD engaged in pretend play, the more they experienced playfulness.ConclusionClinicians could help children with ASD improve their feeling of being in charge of their play in order to develop better performance in pretend play. Assisting children with ASD to engage in pretend play is important to promote their internal experience of playfulness.

Pretend play as a therapeutic modality to enhance social competence in children with autism spectrum disorder:A quasi-experimental study

Background: Social development for a child is the child's ability to approach others, get along with other children and their ability to manage a relationship with other peers. Play as an occupation allows the child to express who they are as a player and to socially interact with others. Such a recognized play for a child to develop important skills is pretend play. Children who do not imitate or initiate play are likely to have difficulty in some area of childhood performance that limits their ability to respond. Objectives: To explore the pretend play behaviors and to improve social competence through pretend play for children with autism spectrum disorder (ASD). Study Design: A prospective, comparative, interventional, quasi-experimental study design was chosen for this research. Methods: The study included 42 children, aged 3–7 years of both genders, diagnosed with ASD, verbalizing a word or two productively for interacting. All the children were assessed using Child-Initiated Pretend Play Assessment and Communication DEALL Developmental Checklist for social skills, who were then grouped into experimental group with Learn to Play program and into control group who were under general play-based social skill training for 80–100 sessions within 6 months of the study period. Results: Nineteen children out of 21 in the experimental group showed the presence of typical indicators of pretend play. There was a significant improvement (P

An investigation of the quality of pretend play ability in children with cerebral palsy.

Cerebral palsy (CP) describes a group of permanent disorders in the development of movement and posture due to non-progressive disturbances during foetal or infant brain development that can result in activity limitations, including engagement in pretend play. Twenty children aged four to seven years with spastic CP participated in this descriptive qualitative study. The Child-Initiated Pretend Play Assessment (ChIPPA) clinical observations were analysed from five categories: Time, Interaction with the examiner, Imitation, Theme and Story. Seventy per cent (70%) of the children completed the assessment (Time), and 90% of children interacted socially with the examiner during the play (Interaction with the examiner). All children initiated their pretend play without requiring examiner demonstration (Imitation). Sixty per cent (60%) of the children were appropriate to their stage of development for Theme. Finally, 60% of the children set up a scenario, but did not develop a narrative (Story). Qualitative aspects of the children's pretend play performance were satisfactory, showing typical play indicators in all the categories, except for 'Story'. 'Story' represents more complexity in a child's pretend play ability. Therefore, a play intervention is suggested to stimulate and expand the pretend play ability of preschool children with CP.

Relationship Between Sensory Processing and Pretend Play in Typically Developing Children.

We sought to investigate the relationship between sensory processing and pretend play in typically developing children. Forty-two typically developing children ages 5-7 yr were assessed with the Child Initiated Pretend Play Assessment and the Home and Main Classroom forms of the Sensory Processing Measure (SPM). There were significant relationships between elaborate pretend play and body awareness (r = .62, p < .01), balance (r = .42, p < .01), and touch (r = .47, p < .01). Object substitution was associated with social participation (r = .42, p < .05). The sensory processing factors (from the SPM)-namely, Body Awareness, Balance, Touch, and Social Participation-were predictive of the quality of children's engagement in pretend play in the home environment. The results indicated that, to engage and participate in play, children are involving sensory processing abilities, especially body awareness, balance, and touch.

Theory of mind predominantly associated with the quality, not quantity, of pretend play in children with autism spectrum disorder.

This study aimed to clarify the relationships between theory of mind and pretend play in children with autism spectrum disorder, using refined assessments of theory of mind and pretend play while controlling for autistic behaviors and verbal comprehension. A total of 92 children with autism spectrum disorder aged 4-10years were enrolled. In two visits, the children were assessed with the Theory of Mind Task Battery, the Child-Initiated Pretend Play Assessment, the Childhood Autism Rating Scale, and the Verbal Comprehension Index of the Wechsler Intelligence Scales, respectively, for their theory of mind, pretend play performance, autistic behaviors, and verbal comprehension. The hierarchical regression models showed that in addition to the contributions of the autistic behaviors and verbal comprehension scores, the theory of mind scores positively predicted (p<0.001) the elaborateness scores of pretend play in the conventional imaginative and symbolic play contexts, respectively, accounting for an additional 8.1 and 18.5% of the variance, but did not predict the scores for number of object substitutions or imitated actions. The findings demonstrate that theory of mind has a predominant role in the quality, not the quantity, of pretend play of children with autism spectrum disorder, when the children's autistic behaviors and verbal comprehension are considered. This study fills a gap in the previous literature and provides information useful for clinicians and researchers on the relationships between theory of mind and pretend play in children with autism spectrum disorder.

Theory of Mind Deficit Is Associated with Pretend Play Performance, but Not Playfulness, in Children with Autism Spectrum Disorder

Objective/BackgroundThis study aimed to examine the relationships of theory of mind (ToM) to both pretend play and playfulness in children with autism spectrum disorder (ASD).MethodsTwenty children with ASD aged between 3 years and 7.11 years were assessed with the ToM test, and then placed in a free play condition and a pretend play condition to assess pretend play and playfulness with the Child-Initiated Pretend Play Assessment and Test of Playfulness, respectively. In addition, the children's symptom severities of ASD and verbal abilities were also assessed with the Childhood Autism Rating Scale (CARS) and Receptive and Expressive Vocabulary Test—second edition, respectively.ResultsThe results of the regression analysis confirmed that ToM significantly predicted pretend play variables, namely, Number of Object Substitutions (R2 = .158, p = .002) and Number of Imitated Actions (R2 = .175, p = .001), but not playfulness. The CARS score was a significant predictor of the Percentage of Elaborate Pretend Play Actions of pretend play (R2 = .075, p = .034), as well as the internal control (R2 = .125, p = .006) and framing (R2 = .071, p = .039) variables of playfulness.ConclusionThe findings support the idea that children with ASD who have better ToM might be able to develop better pretend play, but not better playfulness, which might be more strongly related to their autistic severity.

Psychometric Properties of Persian Version of “Child-Initiated Pretend Play Assessment” For Iranian Children

Background: Play, particularly pretend play, has a cognitive basis and has been linked to the language and social ability. Objectives: The goal of this study was to examine face and content validity, inter-rater, intra-rater and test-retest reliability of the Persian translation of the child-initiated pretend play assessment Methods: Ten occupational therapists consented to be in the content validity study. Face validity was examined by five occupational therapy specialists. For reliability, 31 typically developing children aged 4 - 6 years were chosen from kindergartens of four regions of Tehran, Iran. Two weeks after the initial assessment the children were re-tested for test-retest reliability. Intra-rater and inter-rater reliability was scored from videos of the children’s play assessment. Results: To be culturally appropriate for Iran, some phrases were changed and the pigs were replaced by dogs. Content validity index (CVI) and content validity ratio (CVR) were acceptable for all items. The Intra-class correlation coefficient was ICC = 0.99 for intra-rater reliability and ICC = 0.98 for inter-rater reliability. For test-retest reliability, the intra-class correlation coefficient for symbolic and combined object substitution scores and all elaborate play scores ranged from ICC = 0.69 to - 0.99. For imitated actions, the majority of children scored 0 on both test and re-test. Conclusions: The Persian version of child initiated pretend play assessment has appropriate face and content validity. Inter-rater and intra-rater reliability were excellent. PEPA, combined and symbolic NOS showed good to excellent test-retest reliability. Test retest reliability for conventional NOS was moderate and NIA was not stable with more children imitating the examiner in the first test but not the re-test.

Quality of pre-school children’s pretend play and subsequent development of semantic organization and narrative re-telling skills

Purpose: This study investigated if the quality of pre-school children's pretend play predicted their semantic organization and narrative re-telling ability when they were in early primary school. It was hypothesized that the elaborateness of a child's play and the child's use of symbols in play were predictors of their semantic organization and narrative re-tell scores of the School Age Oral Language Assessment.Method: Forty-eight children were assessed using the Child-Initiated Pretend Play Assessment when they were aged 4–5 years. Three-to-five years after this assessment their semantic organization and narrative re-telling skills were assessed.Result: Results indicate that the elaborateness of a child's play and their ability to use symbols was predictive of semantic organization skills. Use of symbols in play was the strongest play predictor of narrative re-telling skills. The quality of a pre-school child's ability to elaborate complex sequences in pretend play and use symbols predicted up to 20% of a child's semantic organization and narrative re-telling skills up to 5 years later.Conclusion: The study provides evidence that the quality of pretend play in 4–5 year olds is important for semantic organization and narrative re-telling abilities in the school-aged child.

Early peer play interactions of resilient children living in disadvantaged communities

Resilience for children is positive adaptation and a capacity to thrive despite challenging circumstances. Children demonstrating resilience are seen to have strong cognitive skills and have developed positive peer relationships. The ‘Supporting Resilience’ project is exploring the conditions and characteristics of resilience of young children and their families who live in rural, regional and metropolitan communities that are economically and socially disadvantaged. The aim of this paper was to report on pretend play and social competence within the early years’ cohort of the ‘Supporting Resilience’ project. Twenty-six children aged 4–6 years who were identified as resilient by their preschool teacher were involved in the study. Results obtained from the Child Initiated Pretend Play Assessment and the Penn Interactive Peer Play Scale when the children were at pre-school found significant relationships between object substitution and social interaction (r = .414, p < .05). Children who could elaborate play with unstructured objects were less likely to be socially disconnected (r = –.49, p < .05). There was no significant difference between geographical locations for play ability. Significant difference for social competence was found between geographical locations. By situating play as individual development within a socio-cultural environment the relationship between children's pretend play ability and social peer play interactions are considered within early childhood development and resilience literature.

Impact of the Learn to Play program on play, social competence and language for children aged 5–8 years who attend a specialist school

The aim of this study was to investigate the change in the relationship between play, language and social skills of children aged 5-8 years pre and post participation in the 'Learn to Play' program. The Learn to Play program is a child led play based intervention aimed at developing self-initiated pretend play skills in children. All 19 participants attended a specialist school, with 10 of the 19 children having a diagnosis of autism. The play, language and social skills of the children were assessed at baseline and at follow up. Children were assessed using the Child-Initiated Pretend Play Assessment, the Preschool Language Scale and the Penn Interactive Peer Play Scale. Follow up data collection occurred after the children had been participating in the Learn to Play program for 1 hour twice a week for 6 months. After 6 months in the program, typical indicators of play accounted for an increase of 47.3% in shared variance with social interaction and an increase of 36% in shared variance for social connection. For language, object substitution ability accounted for 50% of the shared variance, which was an increase of 27% from baseline. The 'Learn to Play' program was associated with increases in children's language and social skills over a 6-month period within a special school setting, indicating the Learn to Play program is an effective intervention for children with developmental disabilities. This paper presents an example of how the Learn to Play program can be adapted into a classroom setting.

Cross-Cultural Adaptation and Reliability of Child-Initiated Pretend Play Assessment (ChIPPA)

Play is an indication of a children's development. Purpose. Organize a culturally adapt the Child-Initiated Pretend Play Assessment to Brazilian population. Translation and cultural adaptation procedures consisted of translation, synthesis, back translation, author's approval, and pretest of the assessment. For the pretest, 14 typically developing children were assessed. Was evaluated the use of play materials, duration of the assessment, and reliability. Play materials and duration of the assessment were appropriate for Brazilian children. Analysis of intra-rater reliability showed good agreement ranging from 0.90 to 1.00. Inter-rater reliability showed good to moderate agreement for five items ranging from 0.76 to 0.59. Four items showed chance to poor agreement (rho = -0.13 to 0.50). Results of the pretest indicate the Brazilian version of the ChlPPA is potentially useful for Brazilian children. ChlPPA training in Portuguese in Brazil with play observation feedback is recommended to improve inter-rater reliability.

Pretend Play of Children with Cerebral Palsy

ABSTRACTBackground and Purpose: Evaluate self-initiated pretend play of children with cerebral palsy. Method: Twenty preschool children participated in the study. Pretend play ability was measured by using the child-initiated pretend play assessment culturally adapted to Brazil. Results: There were significant negative correlations between the children's motor severity level and their elaborateness of play with conventional-imaginative and symbolic play materials and a number of object substitutions in symbolic play. This indicated that children with greater motor limitations had diminished play ability. In this sample, 35% of the children showed typical play styles, identified by good scores in elaborate pretend play actions, number of object substitutions, and ability to self-initiate play, whereas 65% showed delay in their play. Implications: The type of pretend play deficits that might be expected in children with cerebral palsy were described. Furthermore, suggested directions for therapeutic intervention to enhance pretend play performance in cerebral palsy children were proposed.