Symbolic play development in toddlers with expressive specific language impairment (SLI-E).

Journal of Speech and Hearing Research, Volume 35, 1290-1302, December 1992

Symbolic Play Development in Toddlers With Expressive Specific Language Impairment (SLI.E) Leslie Rescorla Marijke Goossens Bryn Mawr College, Bryn Mawr, PA

Twenty toddlers with expressive specific language impairment (SU-E) and 20 toddlers with normal language development were compared intheir symbolic play development. The groups did not differ inamount of engagement with the toys or infunctional conventional play behaviors. However, the children with SLI-E displayed less decentered play (use of play schemes with a doll or another person), less well-developed sequential play, and fewer occurrences of symbolic play transformations (use of a neutral object or an absent object to carry out pretending). The provision of structure inthe form of thematically related toy sets, instructions, and modeling did not reduce the discrepancy between demonstrated play behaviors of toddlers with SLI-E and their normally developing peers. Three possible explanations for this discrepancy are considered: a "stylistic" difference in play, a developmental lag insymbol use, or a deficit in retrieval of stored symbolic representation. KEY WORDS: expressive language delay, symbolic play, toddlers

Language delay, a very common developmental disability, is a major health problem in the preschool years (Tallal, 1988). Children with a history of language delay are very likely to develop learning disabilities (Silva, McGee, & Williams, 1983), and they have a much higher rate of identifiable psychiatric disorders than children with normal language development (Cantwell, Baker, & Mattison, 1979). The preschool language-delayed population is heterogenous, consisting of mentally retarded children, autistic children, and youngsters with "specific language impairment" (SLI). Children with SLI have normal nonverbal IQs and no obvious sensory, motor, or social-emotional problems, but they have serious language impairment (Bishop & Edmundson, 1987; Tallal, 1988). The SLI subgroup of particular interest in this study is toddlers with expressive language delay only (SLI-E). These children have normal nonverbal cognitive ability (e.g., visual discrimination, form perception, visual-motor coordination, etc.) and age-adequate receptive language. However, they manifest significant delay in expressive speech (Rescorla & Schwartz, 1990). Toddlers with expressive language delay only have not been widely studied until recently. However, several reports in the last few years (Fischel, Whitehurst, Caulfield, & DeBaryshe, 1989; Paul, 1991; Rescorla & Schwartz, 1990) suggest that up to half of such 2-year-olds may be at risk for continuing language delay at 3. Children with SLI-E are particularly interesting because of the sharp contrast they display between two aspects of the same symbolic function, namely receptive and expressive language. This raises the question of whether toddlers with SLI-E only have normal development of another symbolic function, namely symbolic play. Does the toddler with SLI-E have symbolic play development commensurate with his or her normal receptive language, or is symbolic play development delayed in parallel with his or her expressive speech? © 1992, American Speech-Language-Hearing Association

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Rescorla & Goossens: Symbolic Play Development

Symbolic Play Development Developmental psychologists have demonstrated that symbolic play develops in an orderly and predictable sequence (Bretherton, 1984; McCune-Nicolich, 1977; Piaget, 1962; Watson & Fischer, 1977). As children move from about 12 months to roughly 36 months of age, play becomes more complex and flexible, as well as more generalized and symbolic. Children become able to represent increasingly diverse roles in play, and they become capable of sustaining thematic play in the absence of concrete play materials or props. Building on Piaget's seminal work (1962), McCuneNicolich (1977, 1981) postulated a developmental sequence starting with Presymbolic Schemes (meaningful use of sensorimotor actions demonstrating knowledge of the functions of real objects), moving through Autosymbolic Schemes (meaningful actions used "playfully") to Decentered Symbolic Games (using play schemes with reference to others), and culminating in Combinatorial Symbolic Games and Internally Directed Symbolic Games. At around the same time as McCune-Nicolich's (1977) work, Watson and Fischer (1977) postulated a four-stage sequence of agent use in play between 14 and 24 months of age: (a)self as agent, (b) use of an object as a passive agent, (c) use of a passive substitute agent, and (d) use of an object as active agent. Thus, the infant develops from understanding only his or her own actions to finally understanding that objects are independent and active agents of action. A similar developmental progression was proposed by Bretherton (1984), who studied developing "role representations." The child begins with representations of self, next projects his or her gestural play schemes onto a passive person or doll, and then progresses to using an object as an active recipient or as an active partner in a reciprocal role. Consistent with McCune's taxonomy, Bretherton also observed that single-schema play develops into hierarchically structured multischema combinations set into entire "episodes." In addition, Bretherton demonstrated that the child will move from using a toy that is a scaled-down version of a real object to using increasingly unrealistic and/or abstract versions of that object, finally resulting in the ability to "mime." Symbolic play provides a window on the child's developing knowledge of scripts, or event representations. Scripts specify the actors, actions, and props needed to enact ordered, sequential scenarios. According to Nelson (1986), children as young as 3 have generalized, sequentially correct scriptlike representations of familiar routine situations. These scripts can be enacted in thematic play. If event knowledge is uncertain, external support may be needed to sustain thematic play. This may take the form of objects as cues to call up a particular script structure, or social mediation to trigger enactment of a familiar but not fully accessible script. It is known that manipulations of physical materials or social context can enhance or dampen the quality and quantity of play scripts exhibited by a child. For example, McCune-Nicolich and Fenson (1984) demonstrated that the presentation of organized toy sets that suggest a particular script appears to facilitate the production of symbolic play

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sequences. In addition, prototypical objects are preferred by infants presented with a modeled play scheme; they are less willing and/or able to imitate schemes modeled with less realistic objects (Bretherton, 1984; Bretherton, O'Connell, Shore, & Bates, 1984; Jackowitz & Watson, 1980; Largo & Howard, 1979). Finally, modeling consistently leads to an increase in maturity of play levels demonstrated when compared with premodeling performance (Fenson & Ramsay, 1981; Largo & Howard, 1979; Watson & Fischer, 1977). Using Feuerstein's (1980) terminology, modeling might be considered a form of social mediation by which the child attains a higher level of performance than he or she can attain independently, allowing him or her to function in what Vygotsky (1986) labeled the zone of proximal development.

Synchrony in Play and Language Development According to Piaget (1962), play and language development are parallel phenomena. Semiotic functioning is what makes it possible for a child to evoke mental images, defer imitations, represent nonpresent realities in pretend play, and use words symbolically. According to Vygotsky (1986), the ability to substitute one object for another in play is a prelude for the transition from "things as objects of action" to "things as objects of thought." Several researchers have carried out empirical study of the temporal relationship between play and expressive language. Bates (1976) demonstrated that children begin to produce their first words at the same time that they begin to produce nonlinguistic symbols such as play gestures. Likewise, Bates and her colleagues (Bates, Benigni, Bretherton, Camaioni, & Volterra, 1979; Bates, Bretherton, & Snyder, 1988) showed that at 20 and 28 months of age, the longest number of different play schemes a child could produce correlated significantly with measures of syntactic development, thus suggesting that the link between language and symbolic play remains through the second year. Play and language in special populations have also been investigated. Casby and Ruder (1983) found that the severity of language delay in children with mental retardation was associated with the severity of their symbolic play deficits. Casby and McCormack (1985), studying children with hearing impairments, found that those with more developed communicative skills displayed more symbolic play than those with minimal abilities to communicate. Beeghly, WeissPerry, and Cicchetti (1990) found that children with Down syndrome made the transition from single-word utterances to word combinations at the same time that they began to produce sequential play schemes. A number of studies have examined the relationship between play and language in children with SLI, a literature that was recently summarized by Leonard (1987). In one of the first such studies, Lovell, Hoyle, and Siddell (1968) found that older children with SLI (4-year-olds) spent less time on symbolic play than their normal language peers, although this difference was not significant for younger children with SLI (3-year-olds). Brown (Brown, Redmond, Bass, Liebergott, &Swope, 1975) found that 3- to 5-year-old children with SLI were less adept at utilizing a collection of non-toy objects


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(sticks, straws, etc.) to enact a scenario (e.g., a birthday party) than their normal-language peers. In a study by Udwin and Yule (1983), 3- to 5-year-olds with SLI had lower scores on the Lowe Symbolic Play Test and less sophisticated spontaneous play than children with normally expressive language. Terrell, Schwartz, Prelock, and Messick (1984), who also used the Lowe Symbolic Play Test, found that, when compared to younger language-matched toddlers, children with language impairments performed more advanced symbolic play, but that their play was deficient when compared to norms for their age. In contrast, Roth and Clark (1987) found that play abilities of children with languageimpairments (5- to 7-year-olds) were less well developed than those of younger language-matched controls (3-yearolds). Although the studies reviewed above demonstrate that children with SLI tend to have less well-developed pretend play skills than their peers with normal language, few such studies have examined toddlers. However, it is in the period from 18 to 30 months of age that symbolic play development really flourishes. One of the few play and language studies focused on toddlers is that by Thal and Bates (1988), who studied gestural imitation in a group of 9 late-talking toddlers. They reported that the language-delayed children performed like language-matched younger controls on single-scheme imitation, but like the normal age-matched controls on multischeme imitation. A limitation of the Thal and Bates study is that their "late-talking" toddlers manifested a range of receptive language skills. Although some were receptively normal, others had delayed language comprehension. The only play study of toddlers with expressive delay only (SLI-E) is that by Skarakis-Doyle and Prutting (1988), who followed 2 toddlers with SLI-E at monthly intervals from about 24 to 30 months of age. Results indicated that these toddlers with SLI followed Nicolich's developmental play sequence, but at a slower rate than found in normally developing toddlers. Additionally, play sequences tended to be short and lacking in variety; virtually no improvement in these dimensions occurred over the 6-month period, which is quite different from the development of play in normal children. Thus, these toddlers with SLI-E tended to be delayed, restricted, and repetitive in their play, when compared with toddlers who are developing language normally.

Goals of the Study In conclusion, previous research indicates that language development and symbolic play tend to proceed in parallel. Additionally, existing studies with language-delayed children suggest that symbolic play is delayed relative to play of age-mates, but may be more advanced than the play of younger children matched on expressive language, at least in some respects. However, only the Skarakis-Doyle and Prutting (1988) research, a case study of 2 children, has examined symbolic play development in toddlers with expressive SLI only, that is, children who have age-adequate receptive language but delayed expressive speech. Thus, the study reported here was designed to examine whether toddlers with SLI-E would have symbolic play commensurate

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with their receptive language and thus comparable to the play of their normal age-mates, or conversely, whether their symbolic play would be delayed, in parallel with their expressive language development. We manipulated both physical context (contrasting free play vs. structured play contexts, and varying the level of "realism" of the toys provided for play) as well as social context (examining spontaneous pretending vs. pretend play following social mediation in the form of instruction and modeling) to determine whether toddlers with SLI-E might have play skills less developed than those of their peers under neutral or less supportive conditions, but be more comparable in their play under physical and social conditions known to maximize pretend behavior in young children.

Method .__ .,._..

Subjects Forty children between the ages of 24 and 26 months were assessed: 20 children with expressive specific language impairment (SLI-E) and 20 youngsters matched for sex, age, and SES with normal receptive and expressive language. Children with SLI-E were recruited by means of ads in local newspapers and notices sent to pediatricians requesting 2-year-old children with little or no expressive language but "normal" development in other areas. Because approximately 95% of the referrals were boys, both samples consisted of 19 boys and 1 girl. Each child was seen for administration of the Bayley Scales of Mental Ability (Bayley, 1969) and the Reynell Receptive and Expressive Language Scales (Reynell, 1977). In addition, both groups were referred for audiological screening and were evaluated for social-emotional status by a clinical psychologist. Medical histories were employed to determine neurological status. The criteria used to identify expressive SLI were: (a) a Bayley Mental Development Index (MDI) above 85, (b) Reynell Receptive Age within 3 months of chronological age (CA), and (c) Reynell Expressive Age 6 months or more below CA, (d) no evident emotional or behavioral disturbance, (e) medical history negative for neurological impairment, and (f) no permanent hearing loss. Criteria for inclusion in the normal-language comparison group were identical, except that their Reynell Expressive language age had to be within 3 months of CA. Demographic and psychometric data for the two groups appear in Table 1. As can be seen in Table 1, t test comparisons revealed that toddlers with SLI-E and their normal-language peers did not differ significantly in age or social class. Furthermore, they did not differ significantly on the Reynell Receptive Language Scale. This scale assesses the child's comprehension of object labels, two-part commands, and action/function statements. Both groups' Receptive language z-scores derived from the Reynell norms fell within one SD of the mean for 2-year-olds, or within normal limits. Receptive age scores in both groups fell slightly above CA (SLI-E = 26.85 months vs. normal-language = 28.75 months).



TABLE 1. Demographic and psychometric data for SLI-E and normal-language toddlers. Variables

Normal-language

SLI-E

M age (mos.) 24.90 25.26 M SES rating 1.70 1.80 Reynell + .18 + .82 Receptive z-score Expressive z-score + .30* -1.64* Bayley MDI 112.00* 95.00* Adjusted MDI 106.00* 95.00* Notes. SES level was determined using a Hollingshead Four Factor Index of Social Status in which 1.00 represents the highest socioeconomic group. Adjusted Bayley MDIs were obtained to correct for items requiring expressive language skills. *p < .001 A significant group difference was evident on the Reynell Expressive Language Scale. On this test, the child is asked to label objects and pictures, and lexical and grammatical levels are scored on a developmental scale. The z-score for the group with SLI-E was greater than -1.5 SD from the mean (and thus met the common diagnostic criterion for determining a language problem), whereas the normal-language children's group score fell within one SD of the mean. The toddlers with SLI-E were not only significantly different in expressive language skills from the controls, but they demonstrated a marked asynchrony in development between expressive and receptive language skills, unlike the normally developing toddlers. Normal-language children had extensive vocabularies of object and person names and could combine these into at least two-word phrases (Rescorla, 1989). The speech of the children with SLI-E consisted of very few, if any, intelligible words and virtually no word combinations. The children with SLI-E relied on physical gestures such as pointing and on nonword vocalizations such as "eh eh" to convey meanings. Additional group comparisons revealed that toddlers with SLI-E achieved significantly lower Bayley MDI scores than their demographically matched, normally developing peers, even when expressive language differences were controlled; this was done by adjusting the Bayley raw score through elimination of the top five expressive language items, failed by virtually all the children with SLI-E. It is possible that nonverbal ability differences between the two groups would have been even greater had a Piagetian measure depending less on visual-spatial skills than the Bayley been used to assess nonverbal ability. Upon examination of the data, it was apparent that 3 children in the normal-language sample had extremely high Bayley MDI scores (e.g., 130 or higher). These 3 normallanguage subjects were therefore temporarily eliminated from the sample, along with 3 children with expressive SLI matched on age, SES, and receptive language, resulting in a Reduced sample of 17 in each group. No significant difference in MDI was found between these two groups in the Reduced sample [t(32) = 1.96]. Normal toddlers and children with SLI-E in the Reduced sample did not differ on any of the demographic or psychometric measures. Because of the possibility that differences in play might be attributable to differences in the children's cognitive ability as reflected by

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Bayley score, all major play analyses that follow were carried out for the Complete sample and for the Reduced sample. There were no changes in significance on the play variables when the Complete sample and Reduced sample results were compared. Hence, all analyses reported in this paper are for the Complete sample. Both children with SLI-E and the normal-language children were referred to a private audiologist for a free hearing screening as part of the intake procedure for the study. Information from the pure-tone and immittance screening was obtained for 17 of the children with SLI-E, but only about one quarter of the mothers of the normal-language children took advantage of the complimentary audiological screening. Thirteen of the 17 children with SLI-E were within normal limits, 2 had normal pure-tone thresholds but some negative middle ear pressure, 1 had significant wax accumulation, and 1 had a possible 20-db hearing loss but was fitted with PE tubes. Of the normal-language children screened, 2 had some unilateral hearing loss, 1 had questionable results, and 2 had normal audiological functioning. Two of the children with SLI-E had a history of chronic otitis media and wore tubes, but the other 18 toddlers with SLI-E had minimal histories of middle ear infection. Two of the normal-language children had a history of chronic ear infections, but had not been treated surgically. Thus, it appeared that the children with SLI-E had otitis media histories and audiological status comparable to those of the normal-language children. All children's social-emotional status was assessed clinically by the first author, a clinical child psychologist. No child in either group demonstrated a conspicuous degree of emotional or behavioral disturbance over a 4-hour intake session. This was confirmed by maternal report. Medical histories obtained from subjects' mothers were negative for neurological impairment. A final comparison examined the child care history of the two groups. In the children with expressive SLI, 12 of the 20 children were cared for full time at home by their mothers; 3 attended preschools or were cared for by a babysitter less than 10 hours per week, 2 others were cared for 10-15 hours per week by babysitters, and 3 received full-time child care. In the normal-language group, 2 toddlers were in full-time child care, 3 received child care 10-15 hours per week, 1 attended nursery school fewer than 10 hours per week, and the rest (14) were cared for full time by their mothers. Thus, differences between the groups were slight in terms of child care history, with only 5 children in each group spending more than 10 hours per week with an alternate caregiver. Although mothers varied in the amount of time they reported spending playing with their children, these differences did not seem to be related to group status.

Procedure Children participated in play with a basket of toys Each type of play situation and again in Session 2. below.


two types of play situation-free and structured play with toy sets. occurred twice, once in Session 1 These procedures are outlined

1294 Journalof Speech and Hearing Research Session 1: Structuredplay with toy sets. The structured play situation using toy sets was modeled after Lowe's Symbolic Play Test (Lowe & Costello, 1976). Immediately after the Bayley assessment, the child was presented with four sets of toys, one set at a time, and was allowed to interact with them for approximately 3 min each. The sets included several standard toys and either a stick or a block as an item to be transformed. Set 1: doll, baby bottle, quilt, stick. Set 2: stuffed bear, brush, blanket, stick. Set 3: two small human figures, horse, soap, block. Set 4: truck, doll, screwdriver, two blocks, stick. Session 1: Free play alone with Basket A. The free play procedure was modeled after that of McCune-Nicolich (1981). Each child was presented with a basket, which contained a variety of toys (a large plastic dump truck, a small metal truck, two small robots, one baby doll, a brush and comb, a fork, a spoon, a knife, a cup and saucer, and small plastic animals) as well as several less representational items that might facilitate play transformations (blocks and popsicle sticks). The child was invited to play with the toys as the basket was placed in the center of the floor in clear view of the video cameras. Mother remained in the room but was requested to fill out a form and not intercede in her child's play until the 10-min free play period was over. While the 2-year-old played with toys, the examiner was seated on the floor nearby but did not actively engage in the ongoing activities, except to gently redirect the child's focus to the toys if his or her attention wandered before the end of the 10-min period. Session 2: Free play alone with Basket B. In the second session, which usually occurred 1 week after the initial visit, the child was first seen by a speech-language pathologist for receptive and expressive language testing and then participated in the second free play assessment. The child was once again presented with a basket containing similar yet different toys, as well as some items open to transformations (two trucks, two baby dolls, a stuffed bear and a stuffed rabbit, a baby bottle, a spoon, a plate, a brush, a pillow, a quilt, two small blankets, two little doll house figures, small plastic farm animals, blocks, a jar lid, and popsicle sticks). The procedure was identical to that followed in Session 1. session 2: Structured play with toy sets: Instruction and modeling conditions. After playing with Basket B, the toddler was redirected to the table for the social mediation manipulation. The child was presented with the same four sets of toys as listed for Session 1. This time, however, a variety of codable pretend behaviors at differing levels of sophistication were requested by specific instructions. For those behaviors that did not occur in response to instructions alone, the toys were presented once again and the remaining desired actions were demonstrated by the examiner accompanied by verbal instructions. For example, the examiner would present the child with a doll and a bottle and say: "Can you give the dolly a bottle?" If the child did not perform the action requested, a second instruction was given in the form of a command: "Give her some juice." In this manner, all instructions within that set were given. The examiner then returned to those codable behaviors not yet performed and attempted to elicit them by demonstration. In the case of this

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example, the examiner picked up the necessary toys, pretended to feed the doll with the bottle, and handed both items to the toddler with the instruction: "Can you give the dolly a bottle like that? Now you do it." If the child still did not imitate the desired behavior, the examiner merely touched the relevant toys and said: "Give her some juice." Thus, instructions and modeling were used as techniques of social mediation, designed to enable the child to attain higher levels of play behavior than he or she had demonstrated independently.

Data Coding Coding procedures for free play. The manipulative, social, functional, and pretend behaviors exhibited during free play with Basket A and Basket B were coded for frequency from the videotape with the sound turned off using a grid that listed behavior codes across the top and minutes down the side. A check was made in the relevant box for each time a codable behavior occurred; duration coding was not carried out. The coding categories are listed and described in Appendix A. They include three basic categories of functional and/or pretend play ("Functional Conventional," "Functional to Self," and "Functional to Other"), two types of more elaborate or advanced play ("Sequences," which were subclassified into four types, and "Symbolism," subclassified into three types), as well as a variety of other nonpretend behaviors such as "grouping," "manipulation," "wandering," and "social interaction." Following frequency coding of the basic behavior categories, the tape was reviewed with the sound tumed on with specific focus on the occurrence of sequences of play and/or symbol use in play. These behaviors were written out as well as tallied, in order to provide descriptive information on the quality of play. Play behaviors were considered to constitute a sequence if the child performed the same action with multiple recipients, multiple actions with the same object or recipient, or multiple and related actions with multiple recipients. If the child shifted to a new toy without combining itwith ongoing play, then the sequence was considered to be terminated (e.g., started pushing the truck after brushing the doll's hair and covering it with a blanket). Interrater reliability for the free play coding procedure was consistently at the 90-95% level of agreement, with the second rater blind to the language status of the children. Coding procedure for play with toy sets. The target behaviors and their respective codes for each of the four toy sets are listed in Appendix B. If a desired behavior was displayed spontaneously in Session 1, it received the maximum score of 3. If it did not occur in Session 1, it was scored as zero. If the target play scheme occurred in Session 2 in response to instruction, the child was given a score of 2. If the child performed the behavior only following modeling, he or she received a score of 1. Finally, failure to perform the response in Session 2 even after modeling was scored as zero. Inthis way, the most capable "player" could earn a total score of 5 for each target behavior with the toy sets (3 for spontaneous performance in the first session plus 2 for performance with instruction in the second session). Inter-



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TABLE 2. Total number of free play behaviors overall and by basket for normal-language and SLI-E children. Normal-language

SLI-E

A +B A B A+ B A B A +B A B A +B A B

88 48 40 553 299 254 296 153 143 225 115 110

147' 71 76* 681' 387* 294 321 193 128 128** 57** 71'

A +B A B A+ B A B A+ B A B

294 127 167 43 27 16 189 112 77

376 192' 184 7' 7 0* 71 ** 35** 36

A +B A B A +B A B A +B A B

174 87 87 133 66 67 117 63 54

Behaviors Non-pretend Grouping Manipulation Social Unoccupied

Functional/pretend Functional/ Conventional Functional to Self Functional to Other Advanced Pretend Sequence ABCD Symbol ABC Verbal Symbol ABC

77*** 38** 39** 51** 20*** 31* 6** 1*** 5**

*p < .01 **p < .01 **p< .001

rater reliability was calculated at 95% for this coding scheme, with the second rater blind to SLI-E versus normal-language status.

Results Free Play Analysis Free Play data consisted of frequency tallies of coded functional/pretend behaviors, play sequences, symbolic behaviors, and nonpretend activities for both Basket A and Basket B. The two-basket design was conceived in order to examine test-retest reliability of play behavior in the free play situation. Pearson product-moment correlation coefficients were calculated between Basket A and Basket B play behaviors in each coding category. These correlations were significant at the p < .01 level for 12 of the 16 play codes, with the significant correlations ranging from .41 to .80. The four code categories that were not significant across the two baskets were all subtypes of "Symbols," most of which occurred very infrequently. The high degree of comparability found in the

children's play behavior across these two different sessions and toy baskets allowed us to aggregate free play scores across baskets, thus obtaining larger samples of behaviors with enhanced reliability. The total frequencies for each play code by group, reported both aggregated across the two baskets and for each basket separately, appear in Table 2. Examination of the non-pretend play codes reveals that the 2-year-olds with expressive SLI engaged in a significantly higher frequency of manipulation and handling of the toys and objects across the two baskets and for Basket A than did the normal-language subjects [t (38) = -2.55, p < .05]. The children with SLI-E also displayed significantly more grouping behaviors overall and for Basket B (e.g., towering blocks, lining up sticks, etc.) than did their normal peers [t (38) = -2.65, p < .05]. The two groups of toddlers engaged in similar frequencies of social interactive play acts, both overall and for the two baskets. When the child did not interact with the toys, this was coded as "unoccupied." The normal-language children displayed significantly greater frequency of such behavior than did the delayed youngsters. This was seen overall [t (38) =


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3.36, p < .01], as well as in both baskets separately. Although duration recording was not done formally in this study, it appeared that when the normal-language group children were unoccupied they tended to jump up and down frequently, taking a quick spin around the room or checking with mother, but were soon back with the baskets and redirected to the play. Toddlers in the SLI-E group, on the other hand, tended to have fewer occurrences of off-play behavior, but these appeared to be interludes during which the child would sit but not be engaged with the toys. As can be seen in Table 2, the children with expressive SLI tended to engage in more Functional Conventional play than their normal-language peers. The normal-language toddlers exhibited a greater frequency of more complex play than did their language-delayed peers, as seen in the overall significant difference between the groups on Functional to Self play [t (38) = 2.53, p < .05]. The higher frequency of decentered play in the Normal subjects was seen in the overall total of Functional to Other play [t(38) = 3.09, p < .01]. This difference was especially marked in Basket A. The data in Table 2 indicate that the children with expressive SLI and their normally developing peers were most different inthe play categories of Sequences and Symbolism, with the normal-language children demonstrating a significantly greater number of sequences and symbols in their play than did the 2-year-olds with SLI-E. The group difference on Sequences was attributable entirely to the subcategories Sequence B, C, and D, all of which required a recipient of one or more actions (either self or other) [t (38) = 3.25, p < .01]. The average sequence produced by a child in the normallanguage group was longer (M = 4.5 play gestures) than the average sequence produced by the children with SLI-E (M = 2.2 play gestures), and also involved a wider range and variety of toys and objects. For example, a child with expressive SLI might engage in a total of three sequences, each involving play with trucks, while a normally developing child would engage in several different sequences, with each sequence involving a new and different play scenario (trucks, dolls, animals, etc.). At the level of symbol production, the normal-language children produced a significantly greater number of transfor-

mations than did their delayed counterparts [t (38) = 3.32]. Just as these normal children used "placeholders" more (e.g., using a stick as a knife), they also engaged in pantomime or pretended with absent objects more than did the expressive SLI children [t (38) = 3.28, p < .01], both overall and for each basket. No significant differences were noted between groups for symbolic play involving animation of objects (Symbol C), because very few children in either group engaged in this higher-level symbolic behavior. When Verbal symbols were analyzed, the children with good expressive language naturally were at a distinct advantage and exhibited consistently greater frequencies of such verbal-symbolic play across both baskets and in total: verbal transformations [t (38) = 4.61, p < .001]; verbal creation of absent objects [t (38) = 3.51, p < .001]; and verbal animation of objects [t (38) = 5.09, p < .001].

Structured Play Analysis It will be recalled that, in the Structured Play situation, a desired play scheme exhibited during free play was scored as 3, the same scheme exhibited with instruction alone was weighted as 2, and play exhibited after modeling was weighted as 1. No response was scored as 0. As already noted, four different toy sets were presented and the desired play behaviors ranged in sophistication from Functional Conventional use of the toys to more mature and/or complex Functional to Other play, Sequences, and Symbolism. As hypothesized, there was a significant increase in performance of most target play behaviors under conditions of social mediation, that is, when instructed and/or modeled behaviors were compared to what the child had displayed initially under spontaneous play conditions. Normally developing toddlers were more likely to perform the desired play behavior spontaneously or with instruction only, while the 2-year-olds with SLI-E tended to need the final modeling phase to produce the play behavior in question. As can be seen in Table 3, both groups showed an improvement when given the social mediation of instructions or modeling.

TABLE 3. Mean number of targeted responses in free play versus nstructlon/modellng by group. Toy set

Maximum

SET 1 (doll, bottle, quilt) 4 Free Play Inst./Mod 4 SET 2 (bear, brush, pillow, blanket) 4 Free Play 4 Inst./Mod SET 3 (men, horse, soap, block) 6 Free Play 6 Inst./Mod SET 4 (truck, man, screwdriver, blocks) 6 Free Play 6 Inst./Mod

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Normal-language

SLI-E

t (38)

2.30 3.55

1.75 2.55

1.96* 2.82**

1.35 3.55

0.80 3.00

3.13** 1.72

1.80 4.95

0.85 3.55

4.40*** 2.85**

2.20 5.80

2.00 4.35

0.58 3.38**

*p < .05 **p < .01 **D < .001



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TABLE 4. Mean weighted scores during structured play with toy sets for normal-language and SLI-E children. Weighted score by toy set Toy set SET SET SET SET

1 2 3 4

Maximum

Normal-language

20 20 30 30

13.10 10.35 13.70 16.95

SLI-E 9.70 7.45** 7.90*** 12.75**

Weighted score by play code Play code FC FO SqA SqC SqD SymbA SymbB SymbC Note. n = 20 per group. *p< .05

Maximum

Normal-language

5 30 5 5 5 20 20 10

4.50 21.90 2.15 1.85 0.65 10.75 4.35 3.90

SLI-E 4.60 16.20** 0.75** 1.50 0.25* 5.45*** 2.40*** 2.55

**p < .01 ***p < .001

As seen inTable 3, normal-language subjects exhibited more of the desired behaviors for the doll set (containing a doll, a bottle, a stick, and a quilt) in their free play than did the SLI-E children. When Instruction/Modeling was introduced, both groups improved, yet the language-normal subjects scored significantly higher than the children with SLI-E [t (38) = 2.82, p < .01]. For the second toy set, containing a bear, a brush, a pillow, and a blanket, more normal-language toddlers brushed the bear and put it to bed while engaged in free play than did their language-delayed peers [t (38) = 3.13, p < .01]. However, when instructions and modeling were provided, the two groups did not differ significantly. Toy Set 3, which contained a horse, some people, and a bar of soap, generated relatively little spontaneous play. However, the normal-language subjects performed more pretend play behaviors both during free play and after instructions and/or modeling than did the children with SLI-E [Free Play: t (38) = 4.40, p < .001; Instruction/modeling: t(38) = 2.85, p < .01]. Finally, neither sample exhibited many of the target play behaviors during free play with the truck, blocks, and people. However, they both improved with instruction and modeling, with the normal subjects scoring significantly higher [t (38) = 3.38, p < .01]. To further explore group differences in play behavior with the toy sets, the child's weighted play score for each toy set was computed, using the 3-2-1 system outlined above (see Table 4). The maximum possible score for each toy set was calculated, based on a score of 5 for each target behavior for that toy set. The data in Table 4 indicate that the normal-language group obtained significantly higher scores for three of the four toy sets. For the next analysis, play behaviors were aggregated by play code across all four toy sets. As can be seen in Table 4, the children with expressive SLI did not differ from the languagenormal subjects in performing Functional Conventional play, as was also seen during free play with the toy baskets. However,

the groups differed significantly in Functional to Other play with the toy sets [t(38) = 3.64, p < .001], with the normally developing children obtaining higher weighted scores for the six opportunities to display play schemes directed toward a doll or toy animal. Likewise, the normal group scored higher than the children with SLI-E on using a neutral object in a play scheme (Symbol A) (e.g., using a stick as a screwdriver) and on performing a play gesture with an absent object (Symbol B) (e.g., feeding the doll with the hand as a bottle). As during the free play in the basket situation, few children engaged in animation of the toy figures (Symbol C) (e.g., making the toy man wash the horse). An area of play in which there appeared to be a difference between the structured toy set situation and the unstructured basket play situation was sequencing. Whereas the children with SLI-E and their language-normal peers performed a similar number of Sequence A's (e.g., loading truck with block and pushing truck-FC + FC) when playing with the wide array of toys available in the baskets, there was a marked difference in such sequence production with the toy sets. Thus, the language-normal children scored significantly higher [t(38) = 3.25, p < .01] on Sequence A with the toy sets. Children with SLI-E and the normal-language children did not differ in their score on the Sequence C target behavior with the toy sets (putting animal and doll to bed). However, the children with expressive SLI did obtain a significantly lower score on the most complex type of sequence, Sequence D-which involved two different play schemes to two different recipients (i.e., making the man pat the horse and giving the lady a ride on the horse) [t(38) = 2.22, p < .05].

Discussion Despite having nonverbal cognitive abilities and receptive language skills within the normal range for their age, 2-year-


1298 Journalof Speech and Hearing Research

olds with expressive SLI-E have significant delays in their productive use of language. Our data from 20 toddlers with SLI-E support the case study of Skarakis-Doyle and Prutting (1988) in demonstrating that these children also have concomitant delay in the development of representational play, relative to other 2-year-olds of similar age and SES background who are acquiring expressive speech at a normal rate. The pretend play of the children with expressive SLI in our study was less advanced developmentally and less rich and varied in content than the play of demographically matched comparison toddlers. The manipulation of physical and social context in this study made it possible to examine pretend play behavior under various kinds of enhancing environmental conditions. Providing small sets of thematically related toys and giving the children social mediation in the form of instructions and modeling can be seen as attempts to move the child's action into the zone of proximal development, as conceptualized from a Vygotskian (1986) perspective. That is, such enhancing conditions allow the child to perform at a higher level of functioning than he or she is able to manage when playing independently with an unstructured set of materials or without an adult play partner. As anticipated, the use of scenariotriggering toy sets and the addition of Instruction and Modeling conditions served to increase pretend play behavior and raise the developmental level of play in both toddlers with expressive SLI and in normal-language toddlers. However, even with the social mediation provided by Instructions and Modeling, the children with SLI-E tended to lag behind their language-normal peers in play, especially in the higher levels of the taxonomy, notably Functional to Other, Sequence D (multiple actions and recipients), and Symbol A and B (use of substitute object or absent object to carry out a play scheme). According to Feuerstein (1979), a particularly important facilitating condition for young children is mediated leading, which involves an experienced adult who "mediates" between the child and the world by "framing, selecting, focusing, and feeding back environmental experiences" so as to create "appropriate learning sets and habits." It was our qualitative impression that the children with SLI-E in this study often seemed at a loss as to how to proceed to use the toys provided when playing alone. For example, they would pick up a baby doll and shake it; although sitting within arm's length of a quilt, pillow, brush, bottle, spoon, and cup, they would not use these objects in conjunction with the doll. That they had knowledge of the function of these objects became obvious when their mothers joined in with the play and would say, "Let's put the baby to bed," at which point the child might then immediately arrange the pillow and quilt. This suggests that the children with expressive SLI were capable of drawing on stored representations of daily life scenarios (e.g., bedtime), but that often they tended not to do so spontaneously. Although it is not clear why pretend play would be delayed in toddlers with SLI-E, or whether a single cause is likely to explain the link between expressive language and pretend play delays in all toddlers with expressive SLI, three possible explanations will be considered. Although the design of this study did not permit testing of these three hypothetical explanations, they may prove fruitful for future research.

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A first possible explanation is that children with expressive SLI are delayed in representational play for reasons that might be considered "stylistic." It will be recalled that the children with expressive SLI in our study spent as much time in hands-on engagement with the toys as the languagenormal subjects, but that the quality and type of play they manifested was different from that displayed by the language-normal sample. The children with expressive SLI more frequently engaged in manipulations and handling of the toys and in grouping similar objects together than did the other toddlers. They appeared to be inclined toward repetitive, kinesthetic, patterned types of play, rather than toward dramatic play. Thus, the youngsters with SLI-E appeared to be more intrigued with the physical affordances of the items and less responsive to the social, thematic, or representational qualities of the toys than the other children. Their "scripts" tended to lack a social component, whereas the normal-language children were very likely to enact a highly social scenario, such as putting the doll to bed or feeding the examiner. This meant that the children with SLI-E had more functional Conventional play and less functional to Other and Symbolic play than the other children. This possible stylistic difference between toddlers with SLI-E and the languagenormal toddlers is reminiscent of Wolf and Gardner's (1978) distinction between "patterner" and "dramatist" styles of play in somewhat older children. Although this stylistic hypothesis seems to capture some of the play differences between the toddlers with SLI-E and the children without SLI-E, it does not readily explain why toddlers with SLI-E might be more likely to have this "pattemer" play style. That is, it is not clear whether this play style is a result of slow expressive language development, a factor contributing to expressive language delay, or whether both slower language development and a "patterner" play orientation are the result of some third factor. A second possible explanation is that play differences between the toddlers with SLI-E and the normal-language children are not so much stylistic as they are "developmental." The play taxonomy used in this study was based on McCune-Nicolich's (1981) system, which has a very wellvalidated developmental ordering wherein decentered play, sequential play, and symbolic substitutions are the more mature forms. It will be recalled that the primary codes of play displayed by the children with expressive SLI in this study were Functional Conventional (FC) schemes and simple, linear sequences of these FC gestures (Sequence A). Relative to the normal-language group, the children with expressive SLI evidenced significantly less play at the higher levels of the developmental taxonomy, namely play focused on a recipient (Functional to Self or Other), and fewer complex hierarchical sequences involving several recipients and varying actions (Sequence B, C, and D). In addition, the children with SLI-E appeared to be less successful than the other toddlers in sustaining a script with alternative or absent props. That is, children with SLI-E demonstrated less sophisticated symbolic play involving transformations, animation, or creation of absent objects. Furthermore, the play sequences produced by the language-normal children tended to be longer and involved a wider range of play behaviors than those of the children with SLI-E. The fact that the normal



children could use expressive language to aid in pretending made their play appear even more sophisticated and symbolic in nature, but the groups were significantly different in the more sophisticated types of symbolic play even when verbally encoded use was not included in the analysis. Thus, one might argue that the parallel deficits found in this study between expressive language and higher levels of symbolic play reflect slower maturation of a complex developmental system of symbol use. This slower maturation would result in a smaller "lexicon" of play schemes and less richness, complexity, and flexibility in that play lexicon. This explanation is compatible with Leonard's (1987) suggestion that children with SLI-E simply fall at the lower end of the normal distribution of abilities in the language/symbolism faculty, rather than manifesting some pathological process or disorder. In addition to the "stylistic" hypothesis and the "developmental lag" hypothesis, a third possible explanation for the apparent link between expressive language delay and pretend play delay in children with expressive SLI is that a problem in access or retrieval exists for these children. According to this hypothesis, children with expressive SLI might have some deficiency in the fluent, rapid, and spontaneous retrieval and encoding of two forms of stored symbolic representations, namely lexical entries for semantic referents in the case of language and event representations, scripts, or schemes in the case of play. According to this retrieval hypothesis, the child with SLI-E might have lexical and play script information stored in memory, as seen in language comprehension and in the ability to carry out action schemes when prompted by object or verbal cues, but a retrieval problem might make it difficult to spontaneously and readily access such words or action scripts. Thus, according to the "retrieval" hypothesis, children with expressive SLI find deliberate accessing and verbal encoding of stored language representations effortful. Because retrieval is difficult, some children with expressive SLI may also develop a secondary "motivational" deficit, resulting in their making relatively little effort to talk. This hypothesis is consistent with our clinical impression that many children with expressive SLI have conspicuous word retrieval and verbal formulation problems and that they often appear to choose not to talk rather than bothering to put their ideas into speech. Similarly, we might argue that children with expressive SLI have some stored information about thematic scenarios, but that this might be less easily triggered than would be the case for toddlers developing language normally. Thus, perhaps because it is less effortful, the child's prepotent response to toys would be to deal with them as physical objects of manipulation, rather than drawing on stored representations about how these objects can be used in narrative or thematic scenarios. In conclusion, this study suggests that toddlers with expressive SLI may have concomitant delays in symbolic play development. Because our sample was relatively small and demographically quite selective, generalization from this study should be made cautiously. However, we would suggest that the parallel we observed between delayed expressive language and delayed symbolic play in the context of good language comprehension and adequate world knowl-

1299

edge warrants further exploration. A fruitful avenue of research would be to try to examine the degree to which the three possible explanations proposed above for the apparent link between expressive language and spontaneous pretend play deficits might apply for specific toddlers with SLI-E. For example, there may be some toddlers with SLI-E who have a stylistic preference toward "patterner" types of play that may go along with a low rate and diversity of spontaneous communicative acts and a relative disinterest in joint attention and verbal interaction. In contrast, other toddlers with SLI-E may be highly communicative and very oriented toward thematic play, but they may have difficulty in accessing or retrieving the words or play schemes appropriate to the situation. Investigation of such individual differences seems to warrant future research. There are several clinical implications of the research summarized here. First, it seems to be quite likely that many toddlers with expressive SLI have parallel developmental lags in their pretend play. This suggests that a productive remediation strategy for such children would be to provide language stimulation within a pretend play context. Goals of such intervention would be to help the toddler with expressive SLI to develop more elaborated, flexible, and varied thematic scenarios while learning the vocabulary that pertains to those scripts. A second implication of the study is that toddlers with expressive SLI may be more likely to manifest pretend play when given realistic toys that are grouped thematically, rather than highly abstract objects with a less obvious thematic connection. Finally, children with expressive SLI may benefit greatly from the kind of socially mediated learning experience described by Feuerstein (1980) and implemented here in the form of instruction and modeling. Children with expressive SLI may need more focused adult scaffolding and modeling than children with normally developing language, if they are to readily demonstrate their stored representations of thematic scenarios in pretend play behavior.

Acknowledgments This research was supported by grants to the first author from the Bryn Mawr College Faculty Research fund and from the National Institutes of Health (NICHD AREA grant 1-R15-HD22355-01). Portions of these data were presented at the 19th Annual Symposium of the Jean Piaget Society, Philadelphia, PA, June 1989. The authors wish to thank Ellen Schwartz for assistance in collection of these data, Elisabeth Davis for serving as the second coder, and Bob Milrod for technical and personal support. Finally, thanks are due to the children and mothers who made this research possible.

References Bates, E. (1976). Language and context: The acquisition of pragmatics. New York: Academic Press. Bates, E., Benignl, L., Bretherton, I., Camalonl, L., & Volterra, V. (1979). The emergence of symbols: Cognition and communication in infancy. New York: Academic Press. Bates, E., Bretherton, I., & Snyder, L. (1988). From first words to grammar: Individual differences and dissociable mechanisms. New York: Cambridge University Press. Bayley, N.(1969). Bayley Scales of Infant Development. New York:


1300 Joumrnal of Speech and Hearing Research The Psychological Corporation. Beeghly, M., Weiss-Perry, B., & Cicchetti, D. (1990). Beyond sensorimotor functioning: Early communicative and play development of children with Down syndrome. In D. Cicchetti & M. Beeghly (Eds.), Children with Down syndrome: A developmental perspective. New York: Cambridge University Press. Bishop, D. V. & Edmundson, A. (1987). Specific language impairment as a maturational lag: Evidence from longitudinal data on language and motor development. Developmental Medicine and Child Neurology, 29, 442-459. Bretherton, I. (1984). Representing the social world in symbolic play: Reality and fantasy. In I. Bretherton (Ed.), Symbolic play: The development of social understanding. Orlando, FL: Academic Press. Bretherton, I., O'Connell, B., Shore, C., & Bates, E. (1984). The effect of contextual variation on symbolic play: Development from 20 to 28 months. In I. Bretherton (Ed.), Symbolic play: The development of social understanding. Orlando, FL: Academic Press. Brown, J. B., Redmond, A., Bass, K., Llebergott, J., & Swope, S. (1975). Symbolic play in normal and language-impaired children. Paper presented at the Annual Convention of the American Speech and Hearing Association, Washington, D.C. Cantwell, D. P., Baker, L., & Mattison, R. E. (1979). The prevalence of psychiatric disorder in children with speech and language disorder: An epidemiological study. Journal of the American Academy of Child Psychiatry, 18, 450-461. Casby, M. W. & McCormack, S. M.(1985). Symbolic play and early communication development in hearing-impaired children. Journal of Communication Disorders, 18, 67-78. Casby, M.W. & Ruder, K.F. (1983). Symbolic play and early language development in normal and MR children. Journal of Speech &Hearing Research, 26, 404-411. Fenson, L., & Ramsay, D. (1981). Effects of modeling action sequences on the play of twelve-, fifteen-, and nineteen-month-old children. Child Development, 32, 1028-1036. Feuersteln, R. (1979). The dynamic assessment of retarded performers: The learning potential assessment device, theory, instruments, and techniques. Baltimore: University Park Press. Feuersteln, R. (1980). Instrumental enrichment: An intervention program for cognitive modifiability. Baltimore: University Park Press. Flschel, J., Whitehurst, G., Caulfield, M., & DeBaryshe (1989). Language growth in children with expressive language delay. Pediatrics, 82(2), 218-2227. Jackowltz, E., & Watson, M. (1980). Development of object transformations in early pretend play. Developmental Psychology, 16, 543-549. Largo, R. H., & Howard, J. A. (1979). Developmental progression in play behavior of children between 9 & 30 months. Developmental Medicine and Child Neurology, 21, 299-310. Leonard, L. B. (1987). Is specific language impairment a useful construct. In S. Rosenberg (Ed.), Advances in appliedpsycholinguistics. Cambridge, England: Cambridge University Press. Lovell, K., Hoyle, H., & Siddell, M. Q. (1968). A study of some aspects of the play and language of young children with delayed speech. Journal of Child Psychology and Psychiatry, 9, 41-50. Lowe, M., & Costello, A.J. (1976). The Symbolic Play Test. Windsor, England: NFER-Nelson Publishing.

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McCune-Nicollch, L. (1977). Beyond sensorimotor intelligence: Assessment of symbolic maturity through analysis of pretend play. Merrill Palmer Quarterly, 23(2), 89-101. McCune-Nlcolich, L. (1981). Toward symbolic functioning: structure of early pretend games and potential parallels with language. Child Development, 52, 785-797. McCune-Nlcolich, L., & Fenson, L. (1984). Methodological issues in studying early pretend play. In T. D. Yawkey & A. D. Pellegrini, (Eds.), Child's play: Developmental and applied (pp. 81-103). Hillsdale, NJ: Lawrence Erlbaum. Nelson, K. (1986). Event knowledge: Structure and function in development. Hillsdale, NJ: Lawrence Erlbaum. Paul, R. (1991). Profiles of toddlers with slow expressive language. Topics in Language Disorders, 11(4), 1-13. Plaget, J. (1962). Play, dreams, and imitation in childhood. New York: Norton and Company. Rescoria, L. (1989). The Language Development survey: A screening tool for delayed language in toddlers. Journal of Speech and Hearing Disorders, 54, 587-599. Rescorla, L., & Schwartz, E. (1990). Outcome of toddlers with specific expressive language delay. Applied Psycholinguistics, 11, 393-407. Reynell, J. (1977) Reynell Developmental Language Scales. Windsor, England: NFER. Roth, F.P., & Clark, D.M. (1987). Symbolic play and social participation abilities of language-impaired and normally developing children. Journal of Speech and Hearing Disorders, 52, 17-29. Silva, P. A., McGee, R., & Williams, S. M. (1983). Developmental language delay from three to seven and its significance for low intelligence and reading difficulties at seven. Developmental Medicine and Child Neurology, 25, 783-793. Skarakls-Doyle, E., & Pruttlng, C. (1988). Characteristics of symbolic play in language disordered children. Human Communication Canada, 12(1), 7-17. Tallal, P. (1988). Developmental language disorders. In J. F. Kavanaugh & T. J. Truss, Jr. (Eds.), Learning disabilities: Proceedings of the national conference. Parkton, MD: York Press. Terrell, B. Y., Schwartz, R. G., Prelock, P. A., & Messlck, C. K. (1984). Symbolic play in normal and language-impaired children. Journal of Speech and Hearing Research, 27, 424-329. Thai, D., & Bates, E. (1988). Language and gesture in late talkers. Journal of Speech and Hearing Research, 31, 115-123. Udwin, O., & Yule, W. (1983). Imaginative play in language disordered children. British Joumrnal of Communication, 18, 197-205. Vygotsky, L. (1986). Thought and language. Cambridge, MA: MIT Press. Watson, M.W., & Flascher, K. W. (1977). A developmental sequence of agent use in late infancy. Child Development, 48, 828-836. Wolf, D., & Gardner, H. (1978). Style and sequence in early symbolic play. In M. Franklin &N. Smith (Eds.), Early symbolization. Hillsdale, N.J.: Lawrence Erlbaum. Received March 13, 1991 Accepted March 3, 1992 Contact author: Leslie Rescorla, PhD, Department of Human Development, Bryn Mawr College, Bryn Mawr, PA 19010.



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Appendix A Play Codes Wandering/Unoccupied Behaviors not involving any active interaction with objects or individuals in the room. Includes sitting quietly, staring out the window, pacing back and forth, rocking while standing or sitting.

Sequence Type A (SqA) Two or more consecutive but different actions, one or more of which is FC (e.g., pouring in cup and stirring with spoon (FC x FC); stirring in pot and feeding baby with that spoon (FC x FO).

Manipulatlon/Handllng Behaviors that do not involve pretending or functionally appropriate use of objects, but which involve the child's visual and kinesthetic exploration and manipulation of a toy. Includes mouthing, waving, banging, squeezing, shaking.

Sequence Type B (SqB) Same recipient/ (two or more consecutive but) different actions (e.g., brush doll's hair and feed doll [FO x FO]).

Grouping Placing of two or more like objects together ina group, line, or stack. Includes play in which like objects are placed in a container, for example, blocks in box, sticks in basket. Functional Conventional (FC) Not pretend play but behavior indicating the child knows the functionally appropriate use of an object, or can associate two or more objects in a conventional manner (e.g., putting cup on saucer, brushing floor with brush, loading truck). Functional to Self (FS) Functionally appropriate use of an object on oneself (e.g., brushing own hair, drinking from bottle). Functional to Other (FO) Involves performance of a pretend action upon a recipient other than self (doll, animal, person) that involves conventional use of an object or a gesture of emotion towards "other" (e.g., brushing doll's hair, kissing bear) Symbolism Type A (SA) Substitution of one object for another; using object in a manner different from its intended functional use (e.g., using stick as spoon, using block as cup). Symbolism Type B (SB) Pretending to use an absent object, creating an absent person, or referring to an absent substance (e.g., using an absent spoon to eat with, referring to "coffee" incup). Symbolism Type C (SC) Animating the doll or animal as an independent and active agent (e.g., having doll prepare dinner).

Sequence Type C (SqC) Two or more recipients/ (two or more consecutive and) same actions (e.g., brush doll's hair then own hair [FO x FS]). Sequence Type 0 (SqD) Two or more recipients/ (two or more consecutive but) different actions (e.g., brush doll's hair, brush bear, and put both to bed). Verbal Transformation (VSA) Verbal substitution of one object for another; referring to an object in a manner different from its intended functional use (e.g., putting a block down and calling it "cake"). Verbal Creation of Object (VSB) Verbally creating an absent person or object by referring to it (e.g., saying "milk" while pouring into a cup, "here come Daddy" hen pushing truck around). Verbal Animation (VSC) Verbally creating action, animating an object or toy with no ensuing or accompanying action (e.g., "man eating" or "Daddy go to work" when the doll is simply placed on the floor). Child-Initiated Social Games Play behavior involving an adult in the room without functional or symbolic use of an object. Includes "patty-cake," "peek-a-boo," hiding games, teasing, tickling. Child-initiated Social Interaction Active or verbal non-play behavior initiated by the child and directed at an adult. Includes showing items, purposefully directing verbal or gestural requests to the adult, posing questions, giving social greetings.


1302 Journal of Speech and Hearitg Research

35 1290-1302

Appendix B Coded Behaviors in Structured Play With Modeling Set 1 (doll, bottle, quilt, stick): SymbB-Symbolism B feeding doll with pretend (nonexistent) bottle SymbA-Symbolism A feeding doll with stick-as-bottle FO-Functional to Other feeding doll with baby bottle FO-Functional to Other covering doll with blanket Set 2 (stuffed animal, brush, pillow, blanket, stick): SymbB-Symbolism B brushing the animal with pretend brush SymbA-Symbolism A brushing the animal with stick-as-brush FO-Functional to Other brushing bear with hair brush SqC-Sequence C putting animal and doll to bed Set 3 (2 human figures, small horse, soap, block): SymbB-Symbolism B washing horse with pretend soap SymbA-Symbolism A washing the horse with block-as-soap

FO-Functional to Other washing the horse with bar of soap FO-Functional to Other giving little man a ride on the horse SymbC-Symbolism C making little man wash the horse SqD-Sequence D making little man pat horse and giving little lady a ride on the horse Set 4 (truck, little figure, plastic tool, blocks, stick): SymbB-Symbolism B fixing truck with pretend tool SymbA-Symbolism A fixing truck with stick-as-tool FO-Functional to Other fixing truck with plastic screwdriver FO-Functional to Other giving little man a ride in the truck SymbC--Symbolism C making little man drive truck SqA-Sequence A loading truck with blocks and making little man drive the truck


December 992

Examining the Language Phenotype in Children With Typical Development, Specific Language Impairment, and Fragile X Syndrome.

A comparison of receptive-expressive language profiles between toddlers with autism spectrum disorder and developmental language delay.

Characteristics of children with specific language impairment attending language units.

The receptive-expressive gap in bilingual children with and without primary language impairment.

Specific Language Impairment Across Languages.

Word Detection in Sung and Spoken Sentences in Children With Typical Language Development or With Specific Language Impairment.

Phonological and morphophonological effects on grammatical development in children with specific language impairment.

Processing Binding Relations in Specific Language Impairment.

Executive functioning in preschoolers with specific language impairment.

The continuity of babble and speech in children with specific expressive language delay.

Profiling relative clause constructions in children with specific language impairment.

Relative clause constructions in children with specific language impairment.

Gesture-speech integration in children with specific language impairment.

Case Marking in Hungarian Children with Specific Language Impairment.

Clumsiness and perceptual problems in children with specific language impairment.

value-expressive function of outgroup attitudes among homosexuals.

Older Sibling Influences on the Language Environment and Language Development of Toddlers in Bilingual Homes.

Family history in developmental expressive language delay.

Sleep Disturbance and Expressive Language Development in Preschool-Age Children With Down Syndrome.

Associations of HLA alleles with specific language impairment.

Deficits in narrative abilities in child British Sign Language users with specific language impairment.

[Children with specific language impairment: electrophysiological and pedaudiological findings].

Sensorimotor function in preschool-aged children with expressive language disorder.

Cognitive development in children with language impairment, and correlation between language and intelligence development in kindergarten children with developmental delay.