I thought I’d write a little bit today about the importance of play in the speech & language therapist’s arsenal of assessment tools. You’ll probably find this post useful if you are a speech and language therapy student, a newly qualified SLT or a parent wanting to know more about how SLTs work.
It’s very easy to watch a speech therapist(or, for that matter, occupational therapist, psychologist or teacher) at work and to say ‘But they’re just playing! What’s so special about that?’. Simply playing with a child is not something that most people immediately think of as an assessment tool. In fact you can learn a HUGE amount about a young person’s communication and interaction skills if you know what to look for! This is where the professional training and skills come in.
Play is an essential part of development and it is where we learn thousands of fundamental skills that relate to language development, motor skills, social interaction, physical skills, imagination and understanding of the world. It is so natural and ‘everyday’ that it’s very easy to dismiss as ‘just playing’ without understanding that engaging play offers endless opportunities to observe the development of a massive range of skills. Play starts to develop within weeks of being born and almost all children engage in play at some level. This means that play based assessment is accessible to almost every child unlike more formal assessments which require well developed joint attention, listening skills, understanding of the basic test instructions (eg ‘point to…’), co-operation, auditory memory and indeed the desire to please.
As well as being a useful way to assess a child who cannot engage in formal assessment, play can also give you access to the ‘bigger picture’ of a child’s use of communication in a real life, functional context. So, what is a speech and language therapist assessing while a child plays?
- The play itself! – Play itself has a developmental order and can be broken down into several different social categories (that’s a separate post in itself!). A speech and language therapist will look to see what level the child’s play is at because play skills underlie communication development. The broad stages are Exploratory Play (touching, feeling, mouthing), Relational Play (banging things together, dropping them, stacking etc), Pretend Play (simple pretending like feeding teddy) and Imaginative Play (truly imaginative play using objects to represent other things or involving imagined objects or characters). Pretend play is an important stage in communication development as the abstract thinking processes involved are also necessary for increasingly abstract and creative use of language. Play development is also divided into levels of social development, the broadest divisions being; Solitary play (completely alone), Parallel play (plays alongside but not with others), Co-operative play (plays jointly and interactively with others). Observing the social stage of a child’s play gives a good insight into their social communication – eg a child who prefers solitary play is less likely to engage in communication with others.
- Expressive language – most children talk or vocalise while they play. They are usually quite relaxed as they do this so you get a representative view of their abilities. An SLT will be looking first to see if the child does talk or vocalise while playing. If they do, the SLT will look to see what vocabulary is used, whether the child combines words, what sort of sentences are used and what language functions they express (eg, greetings, requests, refusal, comments…).
- Understanding – while a child is playing, it is possible to get an idea of their level of understanding. Speech and language therapists are highly trained to do this as it is not as easy as it sounds! To ensure that the child truly understands the language used, you must ensure that there is a choice for every key word in the sentence. For example, if you give a child a dolly and a hairbrush only, they don’t need to understand any words to follow the instruction ‘Brush dolly’s hair’ because the situation gives it away. However, if you had a dolly, a teddy, a brush and a sponge and you said ‘Brush Teddy’s feet’, the child would have to understand 3 key words: ‘brush’ (not wash), ‘Teddy’ (not dolly) and ‘feet’ (not hair, tummy or other body part).
- Social skills – Play gives away a lot of information about social interaction. In addition to the social level of play (solitary, parallel or co-operative), play also allows the therapist to observe eye contact, turn taking and non verbal communication like use of gesture and facial expression. The skill of the SLT here is to break each of these areas down and ‘put a finger on’ the problem area. For example, most people will be able to tell you if a child’s eye contact is unusual or not but in most cases won’t be able to pinpoint why they think that. It is not enough to say that a child makes more or less eye contact than usual, after all, natural eye contact isn’t measured in minutes and seconds! A more important consideration is what functions eye contact is used for. A speech and language therapist is trained to recognise and specify the subtle functions of eye contact such as reference to another person, specific communicative functions (eg, your turn, help me, more), and direction of communication.
There are many advantages to assessing a child through play. First and foremost is that it is fun for the child! Secondy, the child usually does not realise they’re being assessed and this creates a relaxed atmosphere which builds trust and rapport with the therapist. Finally a comfortable and relaxed atmosphere is more conducive to communication and often allows you to see things you may not get in a more formal setting. An added advantage is that building that trust and rapport early on means that you have a better chance of getting the child to constructively engage in formal assessment at a later date if you need to.
So there you go! Play, it’s not rocket science, but it is!