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spacer features > > > pervasive developmental delay

Computer Play as a Clinical Intervention for Children with PDD

Danielle M. Thorp, MSW

Educational software for young children is in no short supply. Programs abound that teach basic concepts such as colors and shapes as well as more advanced academics like math and reading. But what if the concepts that are challenging to your child are not academic in nature but social or language related? Such are the challenges faced by children with Pervasive Developmental Delay (PDD). Many children with PDD love to play with the computer. And its no wonder- the computer is predictable, (a plus for children who love routine and have difficulty with social skills), visual (a strength for many of these children), and provides sensory stimulation. As a therapist for this population I am often approached by parents and educators who want to know how to make the most of computer time with their child. Traditional educational software is not always effective with the idiosyncratic learning style of this population, so how does one use the computer to address social and language deficits?

Pivotal Response Training (PRT) is a research-based, state of the art treatment used with children with PDD that can be easily implemented during computer play. PRT is so named because this intervention targets pivotal behaviors, or behaviors that are central to wide areas of functioning. In other words, changes in pivotal behaviors result in concomitant positive changes in other behaviors. Motivation is one such pivotal behavior. By targeting motivation, we can increase a child's interest in learning a variety of different skills, such as language, social skills, and play skills. The computer serves as a strong motivator for many of these children who are so notoriously difficult to engage. Implementing the following PRT techniques can greatly enhance computer time with a child, helping them to climb the developmental ladder by improving their language and social skills.

  1. First, in order to create a teaching environment during computer play it is essential to have your child's attention. Attention is the foundation for the teaching experience and is central to the majority of good communication. Getting your child's attention during computer time can be easier than in other environments; the child is likely seated and you have at your disposal an item that is of high interest. Avoid prompting your child while they are engrossed in the computer screen- instead try and get them to look at you when you are prompting or asking a question. One helpful technique is to bring the computer mouse (presumably a high-desired object) in front of your face- a child will look at what he wants and you can gain incidental eye contact.

  2. After you get the child's attention you want to be sure to use clear and appropriate prompting in order to elicit language. There are several levels of prompting: (a) open ended questions, such as "What do you want?" (b) multiple choice questions, such as "Do you want to click on the blue triangle or the red circle?" (c) yes/no questions, (d) imitation prompts, where the child is expected to imitate a sound or word you say, and (e) nonverbal prompts, such as holding your hand over a desired object and waiting for the child to initiate a request. Use appropriate prompts according to the child's developmental level.

  3. A very important point of Computer PRT is shared control, which we divide into two subcomponents: child's choice and turn taking. Allowing a child to have a role in choosing the task or materials to be used in the teaching interaction can greatly enhance the child's motivation to participate in learning. Thus whenever possible allow the child to choose the computer game he wants to play with as well as how long he wishes to play with it. Of course do not allow the child to engage in behavior that is self-stimulatory or destructive in nature. You can also limit the programs you make available to the child in order to meet your teaching goals (i.e., if you want to work on letters only make letter games available).

    The second component of shared control is turn taking. Turn taking is extremely important to teach, as reciprocity is central to all human interactions. Children must learn the give and take interaction necessary for the play and language situations he will encounter at school. Turn taking is also important because it provides the therapist with an opportunity to model appropriate language and play. For example, when taking a turn with an object use language that is a level above that used by the child.

    Turn taking also provides a wonderful opportunity to practice pronouns, a notoriously difficult concept to teach. When playing with the child restrict access to the mouse and ask the child "whose turn is it?" The child will learn to say "My turn" when he wants to play, and to say "Your turn" when he is playing a game with which he need help. In addition, respect what the child wishes to do with the computer during his turn, providing that it is appropriate play. In other words you want to avoid directing the child's turn, such as "Click on the red triangle". If the child instead prefers to click on the circle, allow him to do so.

  4. In PRT we classify tasks into two categories, maintenance tasks and acquisition tasks. When organizing the child's learning environment it is important to intersperse maintenance tasks, or tasks the child can do with 90% accuracy, with new and more challenging tasks. By doing this the child's motivation and self-confidence should be increased and maintained, enabling him to tackle novel tasks while still being highly successful overall. For example, ask a child to say "mouse" and "my turn", presumably both easy tasks, to get access to the computer. Then require him to try and say "want mouse" or "My turn to play" in order to get access to the computer. Because you have already asked the child some questions that have been easy for him, he is likely feeling successful and will make an attempt to say the harder phrases. This is in contrast to an intervention that drills a child on new and more difficult tasks that lead to frustration and a loss of motivation. It is more important to keep the child feeling successful than to push him to do tasks that result in frustration. You can practice the more difficult questions again at a later time.

  5. Be sure to reinforce the child's attempts. Any goal-directed attempt to respond to questions, instructions, or opportunities should be reinforced. This means that we want to be certain to encourage the child to try his best by reinforcing attempts rather than run the risk of discouraging the child by requiring only correct responses.

  6. Besides the timing and the nature of the response, the type of reinforcer is also extremely important. Always use a direct response reinforcer relationship. In other words, all reinforcers should have a direct relationship to the child's speech. For example, you might prompt a child to say "Car" to click on a car icon. An indirect response-reinforcer relationship would be to ask a child their name and then reinforce by allowing them to click on the car icon. Here there is no relationship between what the child said and his reward; he is not taught the communicative power of language.

    The main advantage of a direct reinforcer relationship is that it is the type of consequence the child will normally receive in the natural environment and thus we may expect the speech to generalize to new situations. A child learns to use language to communicate and this language is strengthened and maintained because it is successful for that purpose. Above all, remember to use high affect when playing computer games with your child- big smiles, laughter, exaggerated gestures. If your child sees that you are having fun he is more likely to enjoy playing with you. Bring siblings and peers into the playtime. By doing so you can expand the child's social world while building language and play skills. Chances are it will be an enjoyable teaching experience for all involved.

About the author

Danielle Thorp is a clinician and researcher specializing in the field of autism. She received a Bachelor's degree in Psychology from UC San Diego and a Master's degree in Social Work from UC Berkeley. Currently Danielle lives in San Diego where she conducts research on PRT at the UC San Diego Autism Laboratory. She also has a clinical practice and works with children throughout California as well as in Canada and Europe.

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