Edited by: Vera Coelho, University of Maia, Portugal
Reviewed by: Helena Azevedo, Instituto Universitário da Maia (ISMAI), Portugal; Manuela Sanches-Ferreira, Escola Superior de Saúde, Instituto Politécnico do Porto, Portugal
This article was submitted to Special Educational Needs, a section of the journal Frontiers in Education
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This multiple case study investigated a peer-based intervention and instruction (PBII) for social play, Play Time/Social Time (PT/ST), in four inclusive Swedish preschools. PT/ST contains 28 learning activities where children playfully practice six social skills with significance for social play and friendships. One teacher in each preschool was trained and instructed to implement PT/ST, two with coaching early in the implementation, and two without. At each preschool, one child with special educational needs (SEN) in social play (
For preschool children, playing with peers is crucial. Both because play in its own right gives children joy and wellbeing (
The complexity of social play emerges in the sociodramatic, cooperative pretend play for which children use negotiations to interact and experience togetherness (
Regarding inclusion, international education policy has shifted to emphasize a welcoming, creative and supportive learning community where every child is valued (
For some children, disability, and/or, a non-adapted learning environment, can counteract participation in social play with peers. For example, some children with a disability may be less likely to engage in social play and to express their experiences while playing. They may thus also miss opportunities to learn and use more complex social play behaviors that lead to mutual exchange and communication with peers with typical development (TD) (
Furthermore, a Swedish review of research and reports on play for children with disabilities also shows the importance of the physical environment to enable play (
Peer-Based Intervention and Instructions (PBIIs) are complementary teaching methods supported in systematic research reviews for inclusive ECE (
Initially, researchers developed PT/ST based on extensive observations of activities in preschools that supported interactions between children (
Swedish preschools enroll about 95% of all children aged 3–5 years (
In this multiple case study, four teachers at four inclusive preschools implemented PT/ST with a two-model design. Two of the teachers received training in the program, implementation instructions, and a manual for lessons and play activities. The other two teachers received the same training, instructions, and manual, with additional coaching. The study had two aims. First, it aimed to explore if there were differences in how the teachers in the two models perceived the influences of PT/ST on social engagement and social play skills in the children with SEN and if PT/ST supported social play between the participating children. Second, it aimed to examine the implementation feasibility of PT/ST and the influences on inclusion quality in the preschools, with and without coaching. These were the research questions:
Were there differences in how the teachers that received and did not receive coaching perceived social play skills and social engagement in children with SEN?
Did PT/ST support social play among children with SEN and their TD peers? What were the facilitators and barriers to social play?
Were there differences in the fidelity and completion of the PT/ST implementation in preschools that received and did not receive coaching?
How was the inclusion quality in the preschools that did and did not receive coaching?
For this multiple case study (
To participate in the study, the preschools needed consent from the guardians (a) for one child, the staff considered to have SEN in social play with peers, with or without disabilities, and (b) for one or more children, the staff considered as socially skilled (hereafter, peers), aged between three to five. We allowed all settings that signed up for the study meeting these criteria to participate. However, we had set a limit of 10 participating preschool units/classes to enable the coaching and observations that the first author would make during the study.
We recruited the participants via a research-practice network that included principals, teachers, childcare workers, and special educators from different preschools and municipalities in Sweden. Since childcare workers often have similar responsibilities as teachers to plan and perform activities in Swedish preschools, they could also sign up for the study. Based on our previous knowledge of Swedish preschools, most settings enroll more than one child with a disability or other SEN, making it possible for several preschools within the network to participate. By this convenience and snowball sample, we also assumed some variation of the preschool settings (
We divided the five preschools into two groups, one where the teachers should get basic training and instructions for PT/ST (Alpha 1–3) and one where the teachers should get additional coaching (Beta 1–2). In January 2018, the three teachers (from Alpha 2, Alpha 3, and Beta 1) participated in a 4-h training and instruction session. This session included a video-recorded role-play of the learning activities performed by the first and second author and question time and instructions for the teacher-observations of the children with SEN; pre-and post-PT/ST (see section “Measures”). Since the teachers at Alpha 1 and Beta 2 could not participate in the first session, they received the corresponding basic training and instruction by the first author in February 2018, including the video-recorded role-play and question time at their preschools. These lasted about 2 h, respectively. After completing the basic training from February and ahead, the teachers should perform three learning activities per week, including their pre-and post-observations. The teacher in Alpha 3 dropped out of the study due to staff changes after completing the initial observations (for the recruitment and training procedures see
Description of the participating preschools.
Alpha 1 | Alpha 2 | Beta 1 | Beta 2 | |
Municipality population | 39,000 | 78,000 | 960,000 | 78,000 |
Type of municipality | Industrial/rural | Suburban | City | Suburban |
Type of preschool | Municipal | Independent | Independent | Municipal |
Additional pedagogical orientation to the compulsory Swedish preschool curriculum | No | Reggio Emilia | Reggio Emilia | No |
Teacher/children ratio | 6.3 | 6.3 | 5.2 | 5.6 |
Number of children, setting | 95 | 95 | 115 | 60 |
Number of children, intervention unit/class | 19 | 19 | 21 | 17 |
Age of children, intervention unit/class (years) | 3–4 | 4–5 | 3–5 | 1–4 |
Opening hours (a.m. to p.m.) | 6.30–5.30 | 6.30–5.30 | 6.30–6.30 | 6.30–5.30 |
Access to a contracted special educator | Yes | Yes | Yes | Yes |
Data on municipality population and teacher/children ratio are approximate.
The first author conducted the coaching for the teachers in Beta 1 and Beta 2, in direct connection with the fidelity observations of learning activities (see section “Measures”) three times at each preschool, early in the implementation. The coaching addressed the goal of the last and the preceding learning activity with guiding questions such as “What did you do?,” “How did it feel?,” “What do you think about what happened?,” and “What would you like to do differently?” (
Three teachers and one experienced childcare worker (hereafter, teachers) participated in the study (
Participating children and teachers with pseudonyms for the case studies.
Preschools | Intervention children with SEN | Age (in years) | Type of SEN | Intervention peers, age (in years) | The teachers, work experience (in years) |
Alpha 1 | Alex ♂ | 4 | ASD | Sara |
Anita |
Alpha 2 | Bill ♂ | 4 | Unspecified | Sam ♀, Sofie |
Beatrice |
Beta 1 | Carl ♂ | 5 ½ | Unspecified | Simon ♂ (5 ½) | Celia |
Beta 2 | Dean ♂ | 5 | ASD, limited verbal speech, using PECS | Sigge ♂, Sebastian ♂ (5) | Danielle |
SEND, SEN, Special Educational Needs with or without a Disability; ASD, Autism Spectrum Disorder; PECS, Picture Exchange Communication System (
aExperienced child care worker that during the study underwent preschool teacher education.
Ten children participated in the study, four of the children had SEN, and six of the children participated as peers (
The PT/ST manual suggests that the preschools ask for consent for more than one peer to compensate for any absences that may prevent their participation during the implementation. However, the same child with SEN is expected to participate. Alpha 1 and Beta 1 had consent for more than one peer in case of dropouts and planned the PT/ST activities for one peer at a time. Alpha 2 and Beta 2 had consent for two peers and planned the PT/ST activities for two peers at a time. According to the teachers’ logbooks, another peer than Sara in Alpha 1 discontinued participation after three lessons/play activities, and one peer in addition to Sara participated in lesson/play activity 12; in Beta 1 the peer Simon discontinued participation after 11 lessons/play activities, and another peer participated in five lessons/play activities. Since we have no further data about these children they are not included in the study. In Alpha 2 and Beta 2, the two peers participated throughout the implementation.
Play time/social time (PT/ST) addresses 3–5-year-old children and focuses on six observable social skills that children use to begin or maintain social play interactions with peers, with potential for friendships; sharing with others, requesting to share, persistence, initiating/organizing play, agreeing to play, providing help, and helping others (
An authorized translator translated PT/ST to Swedish. For the implementation instructions, we used “learning activity” as the overall concept for the lessons and play activities. Further, we used “mini-circle time” for the first part of the lesson, and “playgroup” for the following play activity. “Lesson” is not used in Swedish preschools even though the concept of
Before and after implementing the PT/ST program, the teachers conducted three to four approximately 5-min play observations using the teacher impression scale (TIS) (
Complementing the information from the TIS observations of the children with SEN, the teachers used CEQ (
To evaluate the inclusion of preschool quality for children with SEN in preschools, the first author conducted inclusive classroom profile (ICP) observations (
During the study, we had mini-circle times and playgroups video-recorded, comprising 209 min of material: Alpha 1; 37 min, Alpha 2; 1.23 min, Beta 1; 54 min, and Beta 2; 35 min. From this material, we selected three playgroups for each of the four children with SEN. These were from the beginning and the middle of the PT/ST implementation. We analyzed a 5-min sequence for each of the 12 playgroups, yielding 60 min of video recordings (
The sample of analyzed playgroups (PG) with PT/ST learning goalsa for children with SEND (Alex, Dean) and SEN (Bill, Carl) and their peers (Sara, Sam, Sofie, Simon, Sigge, Sebastian).
Alex |
Bill |
Carl |
Dean |
|
PG # 3: Sharing and persistence | Sigge, |
|||
PG # 4: Sharing and persistence—review and practice | ● Sam, |
● Sigge, |
||
PG # 5: Sharing and persistence—review and practice | ● Sara | ● Simon | ||
PG # 7: Requesting to share—target children | ● Sara | ● Simon | ||
PG # 9: Sharing, persistence, requesting to share—review and practice | ● Sara | ● Sigge | ||
PG # 10: Sharing, persistence, requesting to share—review and practice |
● Sam, |
● Simon | ||
Minutes | 15 | 15 | 15 | 15 |
PT/ST, play time/social time (
aThe preschool teachers were instructed to perform three learning activities per week, including mini-circle time and playgroup, from February to June 2018.
To evaluate the fidelity of the implementation, the first author performed observations of 14 learning activities with a revised version of an implementation checklist for social interaction interventions, corresponding to PT/ST (
To examine how the teachers perceived social skills in free play situations and the engagement in social interactions and preschool activities for children with SEN, we calculated their pre, and post-intervention mean scores and SD for the TIS (
Distribution of prosocial behaviors (%) for children with SEN during 12 video-recorded PT/ST playgroups with peers (15 min/child), observed with OSPIP. For Alex playgroup 5, 7, 9; for Bill playgroup 4, 10, 11; for Carl playgroup 5, 7, 11; and for Dean playgroup 3, 4, 9; PT/ST = play/time social/time (
Distribution of play behaviors (%) for children with SEN during 12 video-recorded PT/ST playgroups with peers (15 min/child), observed with OSPiP. For Alex playgroup 5, 7, 9; for Bill playgroup 4, 10, 11; for Carl playgroup 5, 7, 11; and for Dean playgroup 3, 4, 9; PT/ST = play/time social/time (
The Regional Ethical Review Board in Stockholm approved the study (Diary Number 2016/5:8), and it follows the regulations for research data (
At Alpha 1, the teacher Anita implemented PT/ST with training and manual and without coaching. She fulfilled fidelity of PT/ST to a relatively high degree, 70% (
Frequencies of fidelity and completion of PT/ST implementation in Swedish preschools (
Preschool | Coaching | Peers in playgroups | Fidelity |
Completion |
||
% | % | |||||
Alpha 1 | No | 1 | 70 | 39/56 | 82 | 23/28 |
Alpha 2 | No | 2 | 87 | 49/56 | 89 | 25/28 |
Beta 1 | Yes (3 times) | 1 | 91 | 51/56 | 57 | 16/28 |
Beta 2 | Yes (3 times) | 1 or 2 | 88 | 37/42 | 46 | 13/28 |
PT/ST, play time/social time (
Pre-test observation with ICP regarding preschool inclusion quality took place indoors and post-test observation outdoors. For Alpha 1 it was noted an increase in inclusion quality in the ICP observations regarding the teachers’ involvement in peer interactions (from score 3 to 4), and guidance of children’s free-choice activities and play (from score 2 to 6), before and after PT/ST (
Inclusion quality in observations with ICP, items 2, 3, 6, before and after the PT/ST implementation, for the preschool units.
Ratings | Alpha 1 |
Alpha 2 |
Beta 1 |
Beta 2 |
||||
Pre | Post | Pre | Post | Pre | Post | Pre | Post | |
Adults’ involvement in peer interactions | 3 | 4 | 6 | 6 | 5 | 6 | 6 | 2 |
Adults’ guidance of children’s free choice activities and play | 2 | 6 | 5 | 6 | 5 | 6 | 4 | 2 |
Relationships between adults and children | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
ICP, Inclusive Classroom Profile, min = 1, max = 7 (
According to the teacher’s observations with TIS (
Teachers’ ratings of social skills, engagement, and involvement in interactions with other children and preschool staff at pre and post PT/ST-intervention for children with SEND (Alex, Dean) and SEN (Bill, Carl) observed with the teacher impression scale (TIS) and three children engagement questionnaires (CEQ).
Ratings | Alex |
Bill |
Carl |
Dean |
||||
Pre | Post | Pre | Post | Pre | Post | Pre | Post | |
T |
||||||||
Item mean | 2.7 | 3.4 | 2.5 | 3.8 | 3.3 | 2.8 | 2.7 | 3.8 |
1.54 | 0.90 | 0.63 | 0.54 | 0.81 | 0.83 | 1.34 | 1.11 | |
Total score | 43 | 55 | 40 | 61 | 54 | 45 | 44 | 61 |
C |
||||||||
Item mean | 2.7 | 3.3 | 2.1 | 2.8 | 1.7 | 1.8 | 1.8 | 2.3 |
1.09 | 0.87 | 0.46 | 0.74 | 0.60 | 0.66 | 0.99 | 0.86 | |
Total score | 81 | 96 | 63 | 82 | 52 | 53 | 55 | 69 |
C |
||||||||
Item mean | 2.1 | 3.1 | 2.6 | 3.5 | 2.9 | 2.6 | 2.1 | 3.3 |
1.13 | 1.05 | 0.69 | 0.70 | 0.96 | 0.68 | 1.11 | 0.78 | |
Total score | 35 | 50 | 42 | 57 | 47 | 43 | 34 | 54 |
C |
||||||||
Item mean | 4.3 |
4.4 | 3.5 | 4.6 | 3 | 3.6 | 3.3 | 4 |
SD | 0.72 | 0.86 | 1.24 | 0.65 | 1.14 | 0.91 | 1.5 | 0.94 |
Total score | 87 |
88 | 70 | 93 | 60 | 72 | 70 | 80 |
PT/ST, play/time social/time (
aMissing value, item 1 The child begins the interaction, replaced with 3.
In the sample of video-recorded playgroups at the beginning and middle of the implementation of PT/ST, Alex used prosocial behaviors 34% of the time. For Alex, these behaviors were primarily about sharing and other prosocial behaviors like seeking the peer Sara’s attention or giving her attention and temporarily proposing a play idea (
For Playgroup 9 (
For Playgroup 5 (
Beatrice at Alpha 2 implemented PT/ST with training and manual, without coaching. She fulfilled fidelity of PT/ST for the participating children to a high degree (87%), see
Regarding preschool inclusion quality, pre-test observation with ICP took place indoors, and post-test observation indoors and outdoors. For Alpha 2 it was noted an increase in inclusion quality in the ICP observations regarding teachers’ guidance of children’s free-choice activities and play (from score 5 to 6), before and after PT/ST (
According to the teacher’s observations with TIS, Bill had increased levels of social skills in play situations, from 2.5 in pre-observation to 3.8 in post-observation, in the total mean scores (
For Bill, the analysis of the video-recorded playgroups shows that he often used prosocial behaviors with his peers, Sam and Sofie, to 61%, and with variation by sharing toys and persisting, for example (
Before Playgroup 11 (
In Playgroup 4 (
The preschool teacher Celia at Beta 1 implemented PT/ST with training and manual, and coaching. She fulfilled fidelity of instruction of PT/ST for the participating children to a high degree (91%), see
The pre-test ICP observation regarding preschool inclusion quality took place indoors and the post-test observation both outdoors and indoors. For Beta 1, it was noted an increase in inclusion in the ICP observations quality regarding the teachers’ involvement in peer interactions, from score 5 to 6, and guidance of children’s free-choice activities and play, from score 5 to 6 (
According to the teacher’s estimations, Carl showed decreased levels of social skills in non-staged play situations in pre-and-post observations with TIS, from a total mean score of 3.3 to 2.8 (
In the sample of PT/ST playgroups from the beginning and middle of the implementation, Carl used prosocial behaviors to 98%. For Carl, these behaviors were primarily about sharing and other prosocial behaviors like waiting for his turn or agreeing with Simon but also about proposing play ideas, persisting in interaction, and asking Simon for help (
For Playgroup 5 (
Ahead of playgroup 11 (
The teacher Danielle implemented PT/ST with training, manual, and coaching. She fulfilled fidelity of PT/ST for the participating children to a high degree (88%), see
The pre-observation with ICP regarding preschool inclusion quality took place indoors and the post-observation outdoors. For these occasions, there was a decrease in the teachers’ involvement in peer interactions (from score 6 to 2), and guidance of children’s free-choice activities and play, from score 4 to 2 (
According to the teacher’s estimations, there was a major change for Dean in using social skills in play situations before and after the implementation of PT/ST, from 2.7 to 3.8 in total mean scores for pre-and-post observations with TIS (
In the video-recorded playgroups at the beginning and middle of the PT/ST-implementation of PT/ST, Dean used prosocial behaviors 48% of the time. For Dean, he did so primarily by sharing toys, with 34%. He also asked his peers for help, to 7%, and persisted, to 5% (
For playgroup 4 (
For playgroup 9 (
The first aim of this study was to explore how the teachers, who received/did not receive coaching, perceived the influences of PT/ST on social play skills and the social engagement in children with SEN, and if PT/ST supported social play between children with SEN and their peers.
The results of the teachers’ observations with TIS and CEQ showed increased scores for social skills in free play and engagement in interactions with other children, after the application of PT/ST for three of the children with SEN in the study; Alex, Bill, and Dean. For the fourth child with SEN, Carl, the teacher did not observe the same increase in social skills in free play after PT/ST. Possibly this outcome could reflect that his peer Simon, due to circumstances outside the preschool, became less socially motivated during the PT/ST implementation and interrupted his participation. Thereby it was not the same continuity in the playgroups as intended. However, in the CEQ estimations, the teachers perceived Carl to be more engaged in other preschool activities and interactions with them after PT/ST. Besides, he demonstrated exclusively cooperative play behaviors in the random sample of video-recorded PT/ST playgroups. This may indicate that adult-guided activities were favorable for his social participation.
Illustrated by the vignettes from the playgroups, all the children with SEN used social play and prosocial behaviors in the PT/ST playgroups, with some differences in the type and occurrence of social play behaviors. While, as noted, Carl only showed cooperative play behaviors, Alex and Dean mostly showed parallel play. Bill, in turn, engaged in as much parallel as cooperative play. In addition, the video-recorded observations showed that the extent of prosocial behaviors corresponded to the social play behaviors of children with SEN. The more complex or varying prosocial skills we observed, the higher the prevalence of more complex social play behaviors.
Through the video recordings, we could also identify possible facilitators and barriers to the children’s social play in the playgroups. In our study, social play between the children seemed to occur when the toys and play materials similarly attracted the children and when the play situation and play goals, tasks, and roles engaged and fitted all the children. In addition, how the teachers instructed and encouraged the children in their interactions may have contributed to social play, although it is difficult to conclude from this study. Conversely, barriers to social play seemingly arose when the children were not attracted in the same way by the toys and play materials or when the play situation did not allow for a division of tasks or roles that resulted in shared play. The vignettes from the video-recorded playgroups also showed that communicative exchanges between the children seemed to be an integral part of children’s social play interactions. These could include verbal and non-verbal communication, and alternative and complementary means of communication, such as PECS for Dean. When his teacher, Beatrice, prompted him and his peers to use PECS, social play interactions both seemed to arise and be a bit delayed. Regarding this, our results exemplify the understanding of social play that
Further, the vignettes in this study illustrated that Bill and Dean, at some points, were seemingly outside social play with their two peers, in a similar way as the peer Sara sometimes was outside when Alex was playing with the teacher (although all in safe and secure situations). Previous studies on friendship for children with ASD (
The second aim of this study was to examine the feasibility of implementing PT/ST with and without coaching, and the influences of the program on preschool inclusion quality. First, the coaching was positively associated with implementation fidelity, with lower levels of fidelity in the basic condition (Alpha 1 and Alpha 2) and higher levels of fidelity in the add-on model (Beta 1 and Beta 2). We expected these results, as previous studies have shown that coaching is important to achieve intervention fidelity (
Finally, higher levels of preschool inclusion quality regarding the teachers’ involvement in peer interactions after the PT/ST implementation were observed for two of the four preschools (Alpha 1, Beta 1). For Alpha 2 the scorings for this item remained at the second-highest level (between
In summary, the results of this study suggest that the PT/ST activities made it possible for the children with SEN to engage in social play with peers and practice social skills, with and without coaching for their teachers. The results also indicate that coaching strengthened the intervention fidelity but did not seem associated with preschool inclusion quality; the two preschools that implemented PT/ST without coaching also received higher preschool inclusion quality scores at post-observation regarding adults’ involvement in peer interactions and guidance of children’s free choice activities and play.
Due to the broad inclusion criteria for the participating children with SEN, and the lack of a control group, this study cannot generalize the results of the influences of PT/ST on their social play with peers and learning of social skills. Instead, the study may provide
The result from our study indicates that children’s engagement and participation in social peer play seem to be associated with their common play goals, and a division of roles and tasks that they find meaningful and manageable. To enable this, preschool staff in inclusive settings may need to offer both children with and without SEN, targeted support, which the PT/ST program offers. Assigning peers for parts of the free playtime would extend PT/ST to an even more naturalistic form of instruction. In a continued implementation, the professional teacher training and coaching could also address the relational aspects of preschool inclusion quality. This could include resources to support children’s social-emotional development and communication, and strategies for playgroups with two or more children included. From the results of this study, we also conclude that it would be necessary to involve more preschool staff in the implementation in each setting; both to ensure they all use similar approaches and to enable a more complete program fulfillment, as staff shortages may affect the continuity of implementations.
The original contributions presented in this study are included in the article/
The studies involving human participants were reviewed and approved by the Regional Ethical Review Board in Stockholm. Written informed consent to participate in this study was provided by the participants’ legal guardians.
MG planned the study, recruited the participants, collected the data, performed the quantitative and qualitative analyses, and wrote the article. ES planned the study, supported the qualitative analyses, and contributed to the revision of the article. MWA planned the study, supported the quantitative analyses, and contributed to the revision of the article. SO wrote a section of the article and contributed to the revision of the article. All authors approved the submitted version.
We thank all preschools, children, parents, headmasters, preschool teachers, childcare workers, and special educators who made this study possible.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
The Supplementary Material for this article can be found online at: