Effectiveness of leisure and play activities for socialization skills of a child with intellectual disability - A case study.
Objective: To investigate effectiveness of leisure and play social group activities for enhancing socialisation skills in a child with intellectual disability.
Method: The experimental study was done at a special education school for disadvantaged children Lahore from 28th November, 2016 to 3rd February, 2017. The subject was a boy aged 17 years who was part of a leisure and play group comprising peers. Pre-rating of socialisation domain of the subject was carried out through Portage Guide to Early Education (PGEE). Atotal of 20 groups were conducted in which two sessions per week were carried out. One session of group activity lasted 25-30 minutes. Postrating was carried out after the completion of group activities.
Results: There were 6 children in the play group, but the focus remained on 1(17%) subject. From pre and post rating it was evident that significant reduction in symptoms occurred in the subject, indicating effectiveness of leisure and play social groups approach.
Conclusion: Leisure and play social group activities were found to be effective in enhancing overall social skills of a child having intellectual disability.
Keywords: Intellectual disability, Leisure and play social group activities.
As per the criteria charted by the American Association on Intellectual and Developmental Disabilities (AAIDD), the limitations in the intellectual as well as adaptive functioning are observable in limited conceptual and practical skills as well as ineffective social skills. Since it is neuro-developmental in nature, the onset of this disorder is before the age of 18 years.1 Among the deficits found associated with intellectual disability, social deficits are quite critical. Social skills is a set of behaviours that enables a person to effectively interact with others, as well as helps in recognising and responding to social cues, in applying situation-specific appropriate responses, in avoiding interpersonal conflicts as well as in adjusting response to a simple or comp lex situation acc ordingly.2 Individuals suffering from intellectual disability find it difficult to make and sustain friendships.
Their relationships are usually less warm and lack reciprocal positivity and closeness compared to the relationships of peers.3 For the improvement of the social skills of individuals with intellectual disability, programmes that include leisure time and various play activities were found to be effective. Leisure time was found to be associated with several health benefits since it provided a relief from responsibilities and pressures; and also reduced stress.4 Play, in particular, was the primary activity through which children developed vital childhood roles. The children did not feel obligated to engage in it but it was free from the realistic constraints and usually reflected creativity, fun, pleasure and spontaneity. It was an interaction carried out with the environment that involved exploring, moving and manipulating accordingly.5
With respect to activities included in leisure time, it ranged from being engaged in recreation to obtaining entertainment, improving knowledge and skills, and getting involved voluntarily in social activities after familial and social responsibilities have been fulfilled. It also led to better behaviour control, stable performance and better coping abilities.6 On the basis of the literature cited above, the current study was planned to examine the effectiveness of leisure and play-time activities when applied as a group activity on a child with intellectual disability.
Subject and Method
The case study was conducted at special education school for disadvantaged children Lahore from 28th November, 2016 to 3rd February 2017 and comprised a boy aged 17 having two siblings where his birth order was 2nd. He was selected based on behavioural observation of the therapist and reporting of his teachers regarding his social skills that were significantly poor. Leisure and play group activities had other children who also had intellectual disability; and were the same age as that of the subject. They were selected through purposive sampling technique. The sample size was selected based on previous studies that suggested that if the sample size was too large, the participants having intellectual disability would face difficulty in engaging with group activities because of having intellectual issues or difficulty understanding other group members.7 Further, groups having 5 participants were found to be adequate for gaining a variety of observation.7
All the participants belonged to lower economic class and none of them was previously admitted to government or private school. Total 20 groups were conducted in which two sessions per week were carried out based on time that was provided for conducting the study that was two months and two weeks. On the basis of behavioural observations done by the subject's teacher and mother, subjective ratings for various identified social issues were done before and after the group activities. One session of a group activity lasted 2530minutes. The participants included were diagnosed with intellectual disability but had social skills slightly better than that of the subject so as to encourage and motivate the subject for learning social skills. Individuals having social skills worse than that of the subject, and those who had disability other than intellectual disability were excluded. The assessment tool used for assessing the skills of the subject was Portage Guide to Early Education (PGEE).8
This was basically developed for assessing functioning in socialisation domain, self-help domain, cognitive domain, language domain, and motor domain of children ranging from birth to six years of age who had various disabilities. The ability of the subject was assessed on each domain mentioned in PGEE. Of all the domains in which the subject had problems, the socialisation domain was specifically targeted. Counselling plan focussed on group activities and was devised according to the needs of the subject along with forming goals for each group activity. The activities were carried out in order of increasing difficulty. In case the subject faced difficulty then through verbal, physical and gestural prompts he was provided help. After fulfilling a group activity, the subject was reinforced by giving stickers, stars, and candies. Before starting another group activity, skills learned at a previous activity was revised.
Finally, in the last session, a summary of how to interact with others was given to the subject. At the beginning, all the group members were greeted and the therapist introduced herself. Then each member was asked to tell his/her names for breaking the ice between them. Children were seated comfortably on chairs and seemed enthusiastic for starting group activities. The therapist was also seated at an equal level as that of group members so as to maintain eye contact. Further, the therapist observed behaviour of the subject as group activities were conducted. And the therapist maintained a loving and accepting environment where the subject was reinforced by praise every time he tried to carry out activities. The goals of conducting various social group activities were to increase greeting behaviour, group participation, turn taking, recognition of emotions (smile and sadness), expression of 'sorry' and 'thank you' and sharing behaviour.
In the first social group activity, greeting behaviour was taught in which the subject along with other group members were shown different pictures. All the group members were required to see three pictures, in which a boy was shaking/waving his hand to another boy so that the subject could get an idea regarding how to greet another person. The goal of the second group activity was to further increase greeting behaviour in the subject and it was done through role playing. First of all, the group members were required to sit in a circle and then the therapist role-modelled how to greet one another by waving her hands to all group members. Then the subject was asked to stand in the centre of the circle and to wave his hand to all. Social group activity three also targeted increasing greeting behaviour as well increasing participation of the subject through a game called 'treasure hunt'.
In this activity all group members were required to greet one another by waving hands to each other and then they were told to play the game. First, green and yellow colour pencils were shown to the subject along with other group members and then these colour pencils were hidden in a specified area (playground). After this, the subject was asked to find colour pencils for enabling the subject to work with his peers and for increasing his participation behaviour in the game. The goal of group activity four was to further increase the degree of participation behaviour in the subject. A diamond-shaped figure was made on a chart. Then the group members, including the subject, were asked to paste small-cut random-shaped pieces of green colour paper on area outside the boundary of the diamond shaped figure and to paste small-cut random-shaped pieces of yellow colour paper inside the boundary of the diamond shaped figure with verbal prompting.
Social group activity five was also aimed at enhancing group participation behaviour in the subject through painting. First, different shapes of fish, banana and grapes were pasted on a hard chart. Then the group members were given that hard chart and were asked to paint yellow, green and blue colours in the pasted objects. Also, the subject had to introduce himself, greet others by nodding his head and then he was supposed to paint along with the group members. Group six was conducted with the goal of increasing group participation as well as turn taking behaviour in subject. Activity carried out was pasting parts of a tree on a chart. A tree was made by asking the subject to paste leaves on a tree made from hard chart for increasing his participation in the activity. Also, the subject was allowed to paste one leaf and was required to wait for his turn after all other members had pasted a leaf on the tree.
Further, numbers (1, 2) and body parts (eye, nose) were cut from colour papers so that they could be pasted on leaves of the tree upon request from the subject for further strengthening turn taking behaviour in subject. Group activity seven was also conducted for increasing turn taking behaviour in the subject by sorting and pasting activity. Beads of yellow and green colours were put in front of the group members and they were instructed to put each colour separately in a separate box assigned to each colour respectively. Also, the subject was allowed to put a bead after all group members had their turn for putting beads in the respective boxes. After that, square shapes were cut from a colour paper. Two columns (one for pasting square shapes and other for pasting ribbons) were made on a chart. Then the subject was requested to paste squares and ribbons in their respective column when his turn came.
Group activity eight had the goal of increasing turn taking behaviour along with increasing recognition of emotions (smile and sad faces) in subject. In activity, cards showing emotions of smile and sad face were shown to the subject along with other group members. They were shown a sad and a smile card separately so that they could recognise what emotion the card was representing; and were also told why a person smiled or showed a sad face in different situations. For further enhancing turn taking and recognition of emotions, group activity nine was conducted in which many cards having smiles and sad faces were put in front of the participants and they were asked to sort out cards having smiles and sad faces separately when their turn came. In group activity 10, the focus was again on increasing recognition of emotions (smile and sad faces) in the subject through showing a short video that included faces showing emotions (smile and sadness).
Group activity 11 was conducted for teaching subject how to express 'sorry' and 'thankyou' to others by sign language. This was taught through role playing. First of all a scenario was created in which one group member was instructed to snatch a balloon from another member. Then the subject was told that this wasn't a socially right behaviour and in case anything like this was to happen, then he should express 'sorry' to the other person nonverbally by holding both his ears. Also, another scenario was created in which one group member helped the subject. The subject was told that whenever a person helped him then he was supposed to express 'thankyou' nonverbally by bending his head a little. This activity was carried out in another session too in which the scenario was changed. The goal of group activity 12 was conducted for increasing sharing behaviour in the subject. This activity included sorting cards, and balloon game.
Cards on which numbers (1, 2) were written by Chinese clay, and balloons were put in front of the subject and other group members. The subject was instructed to pick up cards with verbal prompts and was instructed to put them in separate boxes for 1 and 2. Then the subject was allowed to play balloon game and was asked to share his balloons with other group members too.
Table-1: Demographic detail of the subject.
No of siblings###2
Table-2: Subjective rating of the problems by teacher.
Recognition of Emotions###3###5
Expression of Sorry and Thank You###3###5
Table-3: Subjective rating of the problems by mother.
Recognition of Emotions###2###5
Expression of Sorry and Thank You###2###5
Of the 6 individuals in the study group, 2(33%) were girls and 4(67%) were boys among whom the focus of attention remained the subject (Table-1). It was evident from results of PGEE that the functional age of the subject in socialisation domain was 3 years, 9 months, and 11 days; in self-help domain the functional age was 2 years, 11 months, and 5 days; in cognitive domain the functional age was 1 years, 8 months, 14 days; in language domain it was 7 months, and 6 days; and in the motor domain it was 3 years, 6 months, and 12 days. Pre and post-intervention subjective ratings were obtained from the teacher and the mother in order to compare the =ratings with respect to the problems of the subject. The problems were rated on a scale of 1 (minimum) to 10 (maximum) (Tables 2-3), which indicated significant improvements as reported by his teacher and parents.
The results of the current study revealed that leisure and play-group activities brought significant improvement in social skills of the subject as evident from pre and post ratings taken from the subject's teacher and mother. Similar results were also found by previous researches, such as by a study that investigated the efficacy of leisure activities in a sample of intellectually disabled children and adults that were within the age range of 15-39 years. Results indicated that implementation of leisure activities brought significant improvements in social abilities as well a reduction in issues regarding affective and behavioural domain.9 Furthermore, another study explored the effectiveness of play therapy in improving social abilities in a sample of 10 children having intellectual disability within an age range of 5-15 years.
It was evident from results that play therapy was effective in increasing social abilities in intellectually disabled children 10 which was also evident from findings of current study. Similarly, findings of another study indicated effectiveness of groupplay activities/therapy in improving social skills of individuals having intellectual disability.11 Hence, results of the current study are consistent with findings of previously conducted studies. Individuals having disability are reluctant to engage with others due to which they feel excluded from their social circle and they also prefer playing by themselves even if they are in a group of their peers which may hinder their social development. Encouraging them to participate in a group activity would increase their cooperation with their peers and this interactive setting would also educate these individuals with regard to how to interact with others.12
Leisure and play-group activities were found to be effective in enhancing overall social skills of children having intellectual disability. Hence, such activities ought to be incorporated in academic schedules followed at special education centres for further improving skills - specifically social skills - of such children.
Conflict of Interest: None.
Source of Funding: None.
1. Schalock RL, Borthwick-Duffy SA, Bradley VJ, Buntinx WH, Coulter DL, Craig E et al. Intellectual disability: definition, classification, and systems of supports. American Association on Intellectual and Developmental Disabilities. 444 North Capitol Street NW Suite 846, Washington, DC 20001.
2. Matson JL, Leblanc LA, Weinheimer B. Reliability of the Matson evaluation of social skills in individuals with severe retardation (MESSIER). Behav Modif. 1999; 23:647-61.
3. Tipton LA, Christensen L, Blacher J. Friendship quality in adolescents with and without an intellectual disability. J Appl Res Intellect Disabil. 2013; 26: 522-32.
4. Neumayer B, Wilding C. Leisure as commodity. In G Whiteford, V Wright-St Clair (Eds.), Occupation and practice in context. Marrickville: Elsevier; 2004.
5. Bundy AC. Children at play. In: SJ Lane, AC Bundy (Eds.), Kids can be kids: A childhood occupations approach. Philadelphia: F.A Davis company; 2012.
6. McConkey R, Collins S. The role of support staff in promoting the social inclusion of persons with an intellectual disability. J Intellect Disabil Res 2010;54:691-700.
7. Fraser M. Fraser, A. Are people with learning disabilities able to contribute to focus groups on health promotion. J Advanced Nursing 2001; 33: 225-33.
8. Doan MA, Wollenburg K, Wilson E. Portage guide to early education (2nd ed.) Portage Wisconsin: Cooperative Educational Service Agency 12; 1994.
9. Eratay E. Effectiveness of leisure time activities program on social skills and behavioural problems in individuals with intellectual disabilities. Educational Research and Reviews 2013; 8: 1437.
10. Asjad AT, Iqbal N, Masroor U. Effectiveness of play therapy in enhancing social skills in intellectually disabled children. Rawal Med J 2017, 42.
11. Mirahmadi Z, Alamdarloo GH. The Effectiveness of Group Play Therapy on Social Skills of Female Students With Intellectual Disability. Physical Treatments-Specific Physical Therapy Journal 2016; 6: 115-23.
12. Lane SD1, Cherek DR, Lieving LM, Tcheremissine OV. Marijuana effects on human forgetting functions. J Exp Anal Behav 2017; 93: 369-83.
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|Publication:||Journal of Pakistan Medical Association|
|Date:||Feb 28, 2019|
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