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A close look at the cognitive play of preschoolers with visual impairments in the home.

Traditionally the field of Early Childhood has valued young children's play as a primary way to promote learning and developmental competence (Bredekamp, 1986; Skellenger & Hill, 1994; Vondra & Belsky, 1991). Support for this position comes, in part, from the Piagetian theory (1952) which views learning as developing from the interaction of accommodation (as seen in imitation) and assimilation (as seen in its purest form of play). A similar perspective has also been adopted in the field of Early Childhood Special Education, whereby play has become a valued approach for assessment and intervention in programs serving young children with disabilities and those at risk (Bricker & Cripe, 1992; Division for Early Childhood, 1993; Linder, 1993).

Even though researchers have utilized different designs (e.g., control groups) and methodologies (e.g., developmental scales or coding systems) to examine the play behaviors of young children, there appears to be a general consensus that children's play occurs in a predictable developmental and sequential manner, and involves active engagement with the environment (Belsky & Most, 1981; Bruner, 1973; Piaget, 1976). Belsky and Most's study validated the developmental progression of cognitive play behaviors at from undifferentiated explorative play of infants (i.e., mouthing, simple manipulation) to decontextualized play of 2-year-olds (i.e., pretend self, pretend external, substitution, sequence pretend, and sequence substitution). They and others found that during the first year of life, children's object play progressed from repetitive and undifferentiated activity to more organized and sequenced action patterns (Johnson, Christie, & Yawkey, 1987). By 12 months of age, children understood the relationship between actions and resulting consequences (e.g., pushing buttons, opening and closing lids). Play shifted from simple exploration and application of the same schemes, to all objects, to different schemes according to the type of toy being used (Linder, 1993). Belsky and Most specifically found that the frequency of undifferentiated exploration (i.e., mouthing and simple manipulation) declined linearly across age groups. Not seen before 12 months of age, all types of decontextualized pretense play revealed a linear increase across age groups. Infants as young as 12 months have been observed in the simplest type of pretend play in which the action is directed towards himself/herself (e.g., pretending to be asleep, pretending to drink from a cup). By 2 years of age, children are able to think of one set of objects as standing in for another set of objects (e.g., using a wooden stick as an ice cream cone). As children get older, the representational objects get increasingly abstract, and children at 3 years of age begin to use imaginary objects, and are engaged in some form of abstract representational play (Anselmo & Franz, 1995; Belsky & Most; Johnson et al., 1987; Linder, 1993; Lowe, 1975).

In preschool age children with visual impairments, a limited body of empirically-based literature has found that these children often showed more significant delays in their play skills compared to other children with disabilities and sighted peers, especially in the areas of sensorimotor development and symbolic play (Preisler & Palmer, 1989; Tait, 1972; Troster & Brambring, 1994). Troster and Brambring investigated the influence of vision on the play activities and toy selection of infants and preschoolers who were blind. Ninety-one children with visual impairments who ranged in ages from 4 to 72 months were compared with 73 sighted children between 4 to 48 months of age. Based on parents' responses to questionnaires, Troster and Brambring developed three category schemes of preferred toys, activities, and types of social play (i.e., solitary, with siblings or other children, and with adults). Significant group differences were found between the blind and sighted children on all levels of play; undifferentiated object manipulations, relational object manipulations, functional object manipulations, and role play. As the levels of play became more difficult, the age differences widened between the blind and sighted children. Significant differences were found regarding play with siblings or other children; that is, 39.7% of the parents of blind children versus 78.1% of the parents of sighted children reported that their children played with siblings or other children. In addition, blind children engaged in noise-making activities more often than sighted children who engaged in more complex construction play. With regard to solitary play between the older (25-48 months) and younger (under 25 months) age groups, chi-square analyses revealed that blind children in the older age group explored objects and engaged in simple construction play more frequently than the sighted children. In contrast, sighted children in the older group, engaged in significantly more simple and complex symbolic play than the blind children.

Tait (1972) investigated the play behavior of 29 young blind children and a group of sighted peers matched on gender and chronological age (4 through 9 years of age) in a structured play situation using a portable enclosure and adult facilitation. The researcher gave each child the same set of visually unstimulating toys to play with for 15 min. Data collection consisted of audio-taped records of the play sessions and brief notations made immediately after each session. Chi-square analyses were utilized to determine whether or not blindness was independent of certain types of play behaviors (i.e., manipulative, dramatic, or play forms other than dramatic and manipulative). The results revealed that blind children engaged in manipulative play more frequently than the sighted children. Other results showed no significant difference between groups in frequency of dramatic play and in other types of play forms (e.g., hide and seek).

Lastly, Preisler and Palmer (1989) conducted a longitudinal study of a younger group of children with visual impairments who were enrolled in integrated nursery school programs with sighted children. The sample consisted of six blind children, 2 to 7 years of age, who were videotaped regularly in their schools and homes. Findings from the school observations revealed that when the children with visual impairments were offered toys, they mouthed them and explored them with their hands and feet, as well as other parts of their bodies. The children also banged toys on the floor and threw them about the room. This pattern of manipulation of toys was repeated continuously by the children, and was seen more often during unstructured play periods than structured ones. They often rejected most of the toys at the schools and displayed more interest in "natural" objects that opened and closed (e.g., doors) or light switches. Lastly, the children mostly remained in one area on the floor and paid little attention to their sighted peers in the classroom.

In light of this research suggesting apparent delays in play of young children with visual impairments in settings such as preschool classrooms or structured play environments, and the importance of play in relation to children's overall development, there remains a need to examine the spontaneous nature of blind children's play in early and more natural learning environments such as the home. Furthermore, given the heavy reliance on play as an assessment and intervention strategy in special education and inclusive preschools, a comparison of the play levels of a homogeneous group of young children with visual impairments was made to the sample group of young sighted children in the Belsky and Most study ( 1981).



Thirteen subjects were originally recruited from private agencies and public schools that served children with visual impairments located in Southern California. All the subjects were from Anglo backgrounds with English as the primary language in the home. Due to the low-incidence rate of children with visual impairments, and to other exclusionary criteria, social economic status (SES) was not controlled during subject selection. All the children were from intact families with the exception of one family. The mothers' educational levels were high school graduate (n = 4), partial college (n = 2), and college or university graduate (n = 7). Seven of the mothers did not work outside of the home; however, the remaining six mothers' occupations were clerical worker (n = 1), technicians or semiprofessionals (n = 2), and managers (n = 3). The fathers' educational levels were partial high school (n = 1), high school graduate (n = 2), partial college (n = 4), college or university graduate (n = 4), and graduate training (n = 1). The occupations of the fathers were menial worker (n = 1), semiskilled or skilled manual workers (n = 2), technicians or semiprofessionals (n = 1), managers (n = 3), and professionals (n = 5). The mean social status score was 45.40 (ranged 17.00 to 66.00, SD, 16.80) as measured by the Four Factor Index of Social Status (Hollingshead, 1975).

The sample of children consisted of five boys and eight girls. Children's ages were adjusted for those not full term at birth. The mean adjusted chronological age of the children was 39.40 months with a range from 32 to 52 months. The mean developmental age for the children based on the Social Maturity Scale for Blind Preschool Children (Maxfield & Buchholz, 1957) was 45 months (3.76 years) with a standard deviation of 11 months (.93 years). All children were legally blind according to the definition of the American Medical Association (Koestler, 1976), with their visual acuity ranging from no light perception to 20/200. The children's visual impairments were due to a variety of etiologies. They were all blind from birth except for one child, who was adventitiously blinded at 4 months of age. There were no other disabilities diagnosed during the data collection phase of the study (see Table 1 for subject characteristics).
Description of Subjects

Adjusted Age Sex Etiology Visual Acuity
(in months)

44.0 F Peter's anomaly 20/200

51.50 F Septo-optic No light

31.75 M ROP(b) Light

43.00 F Retinopathy No light

41.25 M Brain hemorrhage left eye only

35.25 F ROP 20/200

34.75 F ROP 20/400

33.25 F Bilateral colobomas 20/560

38.00 F Albinism 20/400

33.00 M ROP Light

47.50 M Leber's amaurosis Light

39.25 M ROP 20/400

39.75 F Albinism 20/200

Adjusted Age Age(a)
(in months) Gestation (in months)

44.0 full-term 63.48

51.50 full-term 49.20

31.75 25 weeks 26.40

43.00 full-term 41.16

41.25 full-term 34.44

35.25 25 weeks 39.00

34.75 25 weeks 39.96

33.25 full-term 52.20

38.00 full-term 53.88

33.00 26 weeks 40.20

47.50 full-term 33.60

39.25 24 weeks 49.56

39.75 full-term 60.48

Note: Visual acuity based on eye examination report; if no acuity was given, then acuity was determined from the University of California, Berkeley, Preferential Looking Test.

(a) Developmental Age based on Social Maturity Scale for Blind Preschool Children (Maxfield & Buchholz, 1957).(b) ROP = Retinopathy of Prematurity.


First, the children's developmental levels were derived from an interview with the mothers and a standardized developmental assessment of the children in their own homes. While one researcher interviewed the mother using the Maxfield, the other researcher administered the Reynell-Zinkin Developmental Scales for Young Visually Handicapped Children--Part 1: Mental Development (Reynell, 1979) developmental scale to the child. As a final procedure each child was videotaped playing alone with toys, provided by the researchers, that were both developmentally appropriate and appealing to young children with visual impairments (e.g., auditorily responsive and tactilely stimulating). An average of 7 min was recorded for each play session. Each of the mothers was asked to remain in the room with their child and not to initiate any play with them. However, if a child initiated any type of interaction, the mothers were asked to acknowledge but not encourage or elaborate on their child's bids. The set of toys included simple manipulatives, such as tactilely stimulating blocks, various plastic and wooden shapes; and higher level toys, such as a toy telephone; a small baby doll with a blanket, bed, and baby bottle; a cup and saucer, wooden preformed 3- and 4-piece puzzles; and a 8- piece shape sorter.


The Reynell was used to assess the developmental levels of the children. This measure assessed the following five areas of development: (a) social adaptation (self-help skills), (b) sensorimotor understanding (use of objects), (c) exploration of the environment (regarding orientation and awareness), (d) response to sound and verbal comprehension, and (e) vocalization and pragmatic expressive language. The Reynell provided individual age level equivalents, but no overall total score to compare the children being assessed in this study with the larger norming sample of children with visual impairments.

The larger norming group consisted of 109 children with visual impairments, which included 17 children with mild cerebral palsy and 8 with hearing impairments. The children with hearing impairments were partially sighted and were excluded from the language subscale with the exception of one child who had minimal hearing loss. Information was not provided on the etiology or age of the onset of blindness, or the gender of the subjects. Based on the presence or absence of visually directed reaching, the subjects were divided into partially sighted and blind groups. There has been no attempt to standardize the Reynell. The age equivalencies were obtained by comparing the raw scores on the Reynell to age scores on scales already standardized for blind children without other significant disabilities. Using these ages in place of chronological ages, and plotting them against raw scores for each child in each of the subscales, scattergrams were obtained which showed developmental progressions. From the scattergrams, a mean age level equivalent to each score on each subscale was obtained.

Interviewing the mothers using the Maxfield was also used to assess the overall developmental levels of the children. This scale consists of 95 items in the areas of self-help, communication, socialization, locomotion, and occupation. The validity of the Reynell to the Social Maturity Scale for Blind Preschool Children (DoteKwan, 1995) has been established with a very strong correlation (r = .949, p [is less than] .001) between the two instruments total scores. In addition, the correlations between the Maxfield and the subscales in Reynell were all highly significant at the alpha level of .01. The internal consistency as measured by Cronbach's alpha for the total scale and subscales ranged from .853 to .969 for the Reynell.


Each tape was coded independently by two research assistants blind to the study for frequency and duration of the three play categories and one nonplay category which were adapted from Belsky and Most's (1981) hypothesized sequence of development of exploration and play for children ages 7 1/2 months to 21 months. The three types of play categories coded were exploration and sensorimotor play, functional-relational play, and symbolic play. Duration of play for each category was coded as the total amount of seconds for each type of play. Total play was calculated as the total number of seconds for any combination of the three types of play (e.g., functional-relational + symbolic). Each play category score was then converted into a percentage score by dividing the category score by the total amount of seconds of the videotaped session. The duration of each nonplay instance was also coded as the total number of seconds a child was not engaged with play materials. (For a more detailed description of each of these categories see Figure 1.)

FIGURE 1 Categories of Play and Nonplay Behaviors

Exploration and Sensorimotor Play

Indiscriminate mouthing and manipulation of toys, such as banging, throwing, shaking; simple manipulation (excluding former descriptions) such as picking up and turning over toy.

Functional-Relational Play

Involves intentional and appropriate manipulation of toys, such as turns dial on telephone; bringing two objects together, such as placing a puzzle piece in the formboard; play directed towards self, such as raising phone to ear and talking.

Symbolic Play

Uses object in a way that differs from the original intended use, such as pretending a block is a car and driving it home or a bottle is a baby and putting it to bed.


Involves any behavior where the child is not engaged with the toys, such as crawling away, walking away, sitting with no action, or talking or singing about something unrelated to the toys.

Total Play

Is the total amount of play in seconds that the child exhibits involving either exploration and sensorimotor play, functional- relational play, or symbolic play.

Note: Play categories were adapted from the 14-step developmental sequence of cognitive play as proposed in the work of Belsky and Most (1981).

Interrater Reliability

Two research assistants blind to the nature of the study were trained by the principal investigator to code the play behaviors of four children who matched the subject selection criteria, but who were not a part of the sample. Research assistants were trained until interrater agreement of 80% or greater was obtained between the raters. Once reliability was established on the pilot tapes, they independently recorded both the frequency and duration (in seconds) of each category of play and nonplay for the entire play session. When discrepancies of more than 30% existed on the frequency or duration of play categories, the raters met with the principal investigator and reviewed and discussed the subjects' taped play sessions. The raters then independently recoded the same play sessions. The percentage of interrater agreement for all dependent variables was calculated by the number of agreements over the total number of agreements plus disagreements times 100. The mean percentage agreement for the play and nonplay categories ranged from 69% to 89%. Interrater reliability was calculated using Pearson product moment correlations for all observed categories. The interrater reliability for exploration and sensorimotor play was r = .71, p [is less than] .01, functional-relational play was r = .86, p [is less than] .001,symbolic play was r = .95, p [is less than] .001, nonplay was r = .80, p [is less than] .01, and total play was r = .80, p [is less than] .01.


Preliminary analyses were conducted using a series of Pearson product moment correlations to examine the relations between SES, developmental outcome, and play categories. The results indicated no significant associations between these variables. In addition, other preliminary examinations also found that the levels of visual acuity (i.e., low vision and functionally blind) were not related to SES.

Descriptive analyses were performed to determine the means and standard deviations for each Reynell subscale score and each category of play and nonplay (see Table 2 and Table 3 for mean, standard deviation, and percentage scores). Over half of the play behaviors exhibited by the total group was in the category of exploration and sensorimotor play where banging, shaking, and mouthing of toys were the primary behaviors. Twenty-four percent of the other behaviors were functional-relational play where children engaged in such play behaviors as bringing the telephone to ear or drinking from a toy baby bottle. Nonplay accounted for over 15% of the behaviors displayed, and symbolic play was observed even less, approximately 4%.
Means and Standard Deviation for Reynell Subscale Scores

Subscale M SD

Social Adaptation 4.09 0.85

Sensorimotor Understanding 3.97 0.61

Exploration of the Environment 3.73 0.63

Receptive Language--Response to sound and
verbal comprehension 3.87 0.85

Expressive Language--Vocalization 3.48 0.71

Expressive Language--Pragmatic Functioning 3.09 1.07
Individual Percentage Scores for Play and Nonplay Categories and
Group and Total Means and Standard Deviations

 Exploration/ Functional
Groups Sensorimotor Relational Symbol

 Low Vision Group

Low Vision 1 34 27 25
Low Vision 2 28 67 0
Low Vision 3 76 7 5
Low Vision 4 41 59 0
Low Vision 5 27 73 0
Low Vision 6 61 7 0
Low Vision 7 39 57 0
M 43.70 42.43 4.27
SD 18.20 28.21 9.32

 Functionally Blind Group

Functionally Blind 1 89 0 0
Functionally Blind 2 65 3 0
Functionally Blind 3 68 8 0
Functionally Blind 4 75 0 0
Functionally Blind 5 58 0 0
Functionally Blind 6 93 0 0
M 74.67 1.83 0
SD 13.84 3.25

 Total Group

M 58.00 23.69 4.27
SD 22.44 29.08 6.96
Groups Nonplay Total Play

 Low Vision Group

Low Vision 1 12 86
Low Vision 2 5 95
Low Vision 3 11 88
Low Vision 4 0 100
Low Vision 5 0 100
Low Vision 6 33 67
Low Vision 7 4 96
M 9.29 90.40
SD 11.49 11.62

 Functionally Blind Group

Functionally Blind 1 11 89
Functionally Blind 2 33 68
Functionally Blind 3 23 76
Functionally Blind 4 25 75
Functionally Blind 5 42 58
Functionally Blind 6 7 93
M 23.50 76.50
SD 13.14 13.00

 Total Group

M 14.04 86.96
SD 13.87 13.75

A series of Pearson product moment correlations were conducted to examine the relations between play categories, visual acuity and developmental outcomes. There were two significant associations regarding the level of visual acuity. The first was a negative relation between vision and the category of exploration and sensorimotor play, r = - .72, p [is less than] .01, and the second was a positive relation between functional-relational play, r = .70, p [is less than] .01, and visual acuity. There were also two significant associations between play behaviors and children's level of receptive language development. The first indicated a negative relation between receptive language and nonplay, r = -.64, p [is less than] .05, and the second found a positive relation between receptive language and total play, r = .61, p [is less than] .05. Further data analyses were conducted to examine within group differences. The children were divided into two groups based on level of visual acuity. There were seven children who exhibited visually directed reaching and six who did not, and they were identified as low vision and functionally blind, respectively. Significant differences revealed that the children who were functionally blind engaged in more exploration and sensorimotor play than the children who had low vision, t = 3.57, p = .02. In contrast, the low vision group engaged in more functional-relational play than the functionally blind group, t = - 2.97, p = .03. The remaining categories (i.e., symbolic, nonplay, and total play) did not reveal any difference between the two groups. A closer examination of individual scores revealed only two of the children who were functionally blind displayed any functional-relational play and these were at very low levels (i.e., 3% and 8% of the time), and none of these children displayed any symbolic play. As for the children in the low vision group, only two displayed any symbolic play behaviors. In terms of development, t-tests were significant for the Maxfield (p [is less than] .001) and the Reynell subscale for social adaptation (p [is less than] .001) which indicated that the children with low vision functioned at higher play levels than children in the functionally blind group.

Between group and within group comparisons were made with Belsky and Most's (1981) sample regarding the developmental progression of cognitive play behaviors (see Figure 2). Overall, the comparison of the entire sample of children with visual impairments with the developing sample indicated that the play levels of the children with visual impairments were equivalent to 12- to 14-month-old sighted children's play levels. The group of young children with visual impairments exhibited more exploratory and sensorimotor types of play (more than 50%) than what had been reported for sighted children in Belsky and Most's sample. Although the children in Belsky and Most's study were considerably younger than the children in this study, less than one third of the nature of their play behaviors were exploratory and sensorimotor. Additionally, less than 4% of the play behaviors exhibited by the group of children with visual impairments were symbolic play. In comparison, sighted children have been reported to perform symbolic play acts by 2 years of age (Anselmo & Franz, 1995) and at a rate of 35% in Belsky and Most's sample.


In terms of the within group comparisons, the findings indicated that children who were functionally blind engaged in the same level of exploration and sensorimotor play as 12-month-old sighted children in Belsky and Most's sample. In addition, their functional-relational play was equivalent to the play of 9-month-old sighted children, and their early symbolic play behaviors were equivalent to the play of 7-month-old sighted children. As for the low vision group, their play behavior levels were equivalent to the play levels of the 15-month-old sighted children across all three categories of play.


The results of this study further confirm Troster and Brambring's (1994) findings that children with visual impairments continue to show significant delays in their play skills in the areas of exploratory-sensorimotor, functional-relational, and symbolic play. These delays are nearly 30 months, with respect to symbolic play in functionally blind children. Although the children with low vision tended to engage in levels of play behavior that were more advanced than children who were functionally blind, all the children in this study were performing at least 2 years behind in cognitive play as compared to sighted children. This is a critical concern as these children were functioning at expected developmental levels in other domains (i.e., receptive language and cognition) for children with visual impairments. (See Table 1 for subject characteristics.)

Skellenger and Hill (1994) postulated that the development of play behaviors may necessitate vision to facilitate the acquisition of new behaviors modeled by adults and peers. As revealed in the study, the data confirmed a relationship between the level of visual acuity and the type of play. As the amount of usable vision increased, the children engaged in more functional-relational play and less exploratory and sensorimotor play. That is, almost 75% of play behaviors exhibited by the functionally blind group were exploration and sensorimotor as compared to more than 40% for the children with low vision. Furthermore, less than 2% of the play behaviors for the functionally blind group were functional-relational, while children with low vision engaged in this type of play over 40% of the time.

In contrast, visually impaired infants between the ages of 20 and 30 months have been reported to engage in symbolic play with their parents (Chen, 1996). When provided with play situations that were either action-based or reference-based routines, these infants engaged in symbolic play behaviors at a level comparable to Belsky and Most's sighted infants. Chen speculated that the structure of the routines provided the necessary scaffolding in terms of a predictable sequence and parental prompts tO engage the infants in this higher level of play. The necessity for adult or peer facilitation of play also seemed to have some impact on the solitary play skills of one child in the study. That is, a female child with low vision displayed developmentally appropriate play behaviors across the categories of play expected for sighted children. This child had two older sisters and a mother who often engaged her in the same type of symbolic play (i.e., doll play) she exhibited in the taped solitary play session.

It has also been suggested that delays in symbolic play may not be an indication of delays in cognitive or social development in young children with visual impairments (Troster & Brambring, 1994). If traditional symbolic toys do not represent realistic versions of real objects or persons, then perhaps emerging symbolic play may be demonstrated by children with visual impairments in other ways such as in their use of language rather than object or toy manipulation.


As with all research on children with visual impairments, the nature of the subject pool presented a methodological problem. Less than. 1% of the school age population is classified by the federal government as "visually impaired" (Hallahan & Kauffman, 1997). Therefore, it is difficult to identify subjects that are within an obtainable geographic area. Another challenge is the fact that children who are visually impaired often have other disabilities. This presents a problem when selecting subjects whose only impairment is visual. These particular issues limited the size of the potential sample pool. In addition, the small sample size and similar Anglo backgrounds in which English was the primary language might present problems with the interpretation of the results. In order to generalize these results, it would be necessary to replicate this study with a larger number of subjects across different ethnic groups. Another limitation is the lack of a control group, whereby comparisons were made to secondary data of a group of younger sighted children. A final limitation of this study was that it only measured solo play for an average length of 7 min. However, this might be due to the fact that this study measured solo play and not play facilitated by an adult in some type of interaction. Finally, due to the high degree of variance between children across the categories of play, caution should be taken regarding the interpretation of the play behaviors of this group of young children with visual impairments.


The implications of these findings are immense considering these children for the most part were developing normally for children with severe visual impairments. First, one needs to question the value of different types of play with children who are blind. Perhaps, symbolic play as traditionally measured with sighted children is not a valid indication of advanced play skills in this population. Secondly, solitary or solo play may not adequately represent a child's true play repertoire, which, if further validated by future research, might stress the importance of developing a responsive caregiver-child relationship in play routines. Thirdly, one also needs to question the heavy reliance on play-based activities in preschool programs, particularly in inclusive settings. That is, given the tremendous delays as reported in the literature, play-based activities, although an appropriate avenue for the development of numerous cognitive, linguistic, and social skills may not be meaningful to children with severe visual impairment without some type of facilitation. Inclusion of an adult in play activities may be essential to facilitate the acquisition of play skills (Skellenger & Hill, 1994) by initiating and modeling play, participating in play activities, and extending the play repertoire of these children. In light of the findings of this study and the need for developmentally appropriate practices in Early Childhood Special Education programs, play-based activities for children who are severely visually impaired may need to be further examined in terms of its effectiveness as an early intervention.


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MARGARET HUGHES (CEC #0029), Assistant Professor, Department of Special Education, California State University, Fullerton. JAMIE DOTE-KWAN (CEC #0188), Professor, Division of Special Education, California State University, Los Angeles. JANET DOLENDO (CEC #0188), Master's Student, California State University, Fullerton.

Please send correspondence to Margaret Hughes, Department of Special Education, Box 6868, California State University, Fullerton, CA 92834-6868.

Manuscript received April 1997; revision accepted November 1997.
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Author:Hughes, Margaret; Dote-Kwan, Jamie; Dolendo, Janet
Publication:Exceptional Children
Date:Jun 22, 1998
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